Original article
Cutaneous reactions reported after Moderna and Pfizer COVID-19 vaccination: A registry-based study of 414 cases

https://doi.org/10.1016/j.jaad.2021.03.092Get rights and content

Background

Cutaneous reactions after messenger RNA (mRNA)-based COVID-19 vaccines have been reported but are not well characterized.

Objective

To evaluate the morphology and timing of cutaneous reactions after mRNA COVID-19 vaccines.

Methods

A provider-facing registry-based study collected cases of cutaneous manifestations after COVID-19 vaccination.

Results

From December 2020 to February 2021, we recorded 414 cutaneous reactions to mRNA COVID-19 vaccines from Moderna (83%) and Pfizer (17%). Delayed large local reactions were most common, followed by local injection site reactions, urticarial eruptions, and morbilliform eruptions. Forty-three percent of patients with first-dose reactions experienced second-dose recurrence. Additional less common reactions included pernio/chilblains, cosmetic filler reactions, zoster, herpes simplex flares, and pityriasis rosea-like reactions.

Limitations

Registry analysis does not measure incidence. Morphologic misclassification is possible.

Conclusions

We report a spectrum of cutaneous reactions after mRNA COVID-19 vaccines. We observed some dermatologic reactions to Moderna and Pfizer vaccines that mimicked SARS-CoV-2 infection itself, such as pernio/chilblains. Most patients with first-dose reactions did not have a second-dose reaction and serious adverse events did not develop in any of the patients in the registry after the first or second dose. Our data support that cutaneous reactions to COVID-19 vaccination are generally minor and self-limited, and should not discourage vaccination.

Key words

COVID-19
dermatology
Moderna
mRNA
Pfizer
public health
registry
SARS-CoV-2
vaccine
vaccine reaction
delayed hypersensitivity
delayed inflammatory reaction
zoster
shingles
delayed large local reaction
pityriasis rosea
local injection site reaction
erythromelalgia
urticaria
morbilliform
pernio
chilblains
vesicular
erythema multiforme
filler
vasculitis

Abbreviations used

IQR
interquartile range
mRNA
messenger RNA

Cited by (0)

Funding sources: COVID-19 registry support provided to Massachusetts General Hospital by the International League of Dermatological Societies for administration and maintenance and by the American Academy of Dermatology for in-kind administrative support.

IRB approval status: Exempt. The registry was reviewed by the Partners Healthcare (Massachusetts General Hospital) Institutional Review Board and was determined to not meet the definition of human subject research.

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