Experts propose novel classification for COVID-19 vaccination skin reactions

Spongiotic dermatitis was the most commonly reported cutaneous reaction to COVID-19 vaccination among patients who also had biopsy results available for review, according to a registry-based study.

“Cutaneous reactions after COVID-19 vaccination have been commonly reported,” Devon E. McMahon, MD, of the department of dermatology at Massachusetts General Hospital and Harvard Medical School, and colleagues wrote. “However, histopathologic features and clinical correlations have not been well characterized.”

The researchers reviewed an international registry and found 803 cases reporting COVID-19 vaccine skin reactions, of which 7% (n = 58; mean age, 61 years; 62% female; 75% white) also included skin biopsy reports. Vaccine manufacturers were Moderna (46%), Pfizer-BioNTech (42%), Johnson and Johnson (1.7%), Oxford-AstraZeneca (1.7%) and unspecified (8.6%).

Results showed that spongiotic dermatitis was the most commonly occurring histopathologic reaction pattern. This outcome ranged in pattern and severity from robust papules with overlying crust to pityriasis-rosea like eruptions. In addition, pink papules with fine scale also were observed in this group.

With those findings in mind, the group proposed the acronym V-REPP (vaccine-related eruption of papules and plaques) for this spectrum of comorbid events.

Further investigation revealed that bullous pemphigoid-like reactions occurred in 12 patients. Four patients each experienced dermal hypersensitivity, herpes zoster and lichen planus-like reaction.

Three patients reported pernio, while two each reported urticarial reactions, neutrophilic dermatosis, leukocytoclastic vasculitis, morbilliform or delayed large local reactions. One patient reported erythromelalgia, while five patients experienced other reactions.

The researchers noted that the study was limited due to a minority of patients having histopathological data available. Also, incidence rates are unable to be measured using registry data.

“Clinical and histopathologic correlation allowed for categorization of cutaneous COVID-19 vaccine reactions,” the researchers wrote.

Beyond the proposed novel acronym, the researchers suggested that 12 other patterns should be on the radar for clinicians managing patients who have received COVID-19 vaccination.