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CASE REPORT
Year : 2022 | Volume
: 26
| Issue : 2 | Page : 82-85
Vaccine-induced pityriasis rosea and pityriasis rosea-like Eruptions: A review of literature and a case report of COVID-19 vaccine-induced pityriasis rosea
Eman Almukhadeb1, Faisal A Alghubaywi2, Yousef Alharthi3, Amer Alharbi4
1 College of Medicine, King Saud University; Division of Dermatology, King Khaled University Hospital, Riyadh, Saudi Arabia
2 College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
3 College of Medicine, University of Tabuk, Tabuk, Saudi Arabia
4 College of Medicine, Jouf University, Sakaka, Saudi Arabia
Correspondence Address:
Dr. Faisal A Alghubaywi
8408 Ad Dayha, Al Khaleej, Riyadh 13224 4407
Saudi Arabia
Source of Support: None, Conflict of Interest: None
DOI: 10.4103/jdds.jdds_7_22
Pityriasis rosea (PR) is frequently proposed to result from a viral etiology. In line with the current pandemic, COVID-19 vaccines are noticed to trigger PR development. Our patient is a 23-year-old female who developed an itchy skin rash following the Pfizer–BioNTech COVID-19 vaccine. Examination showed one erythematous plaque on the left shoulder and multiple small scaly plaques of similar appearance distributed over the trunk and proximal extremities. The patient was clinically diagnosed, educated, reassured, prescribed topical mometasone ointment and oral chlorpheniramine, and was given a follow-up appointment. We report this case to increase awareness on COVID-19 vaccines as potential triggers of PR.
Keywords: Adverse effects, case report, COVID-19, pityriasis rosea, vaccine
Pityriasis rosea (PR) is an acute and self-limited papulosquamous eruption that classically presents with a large solitary pink-colored patch or plaque, known as herald patch, lasting 1–2 weeks followed by secondary eruptions of smaller erythematous patches or plaques with associated peripheral collarette scaling distributed along the cleavage lines of the trunk, forming a Christmas tree pattern. However, in cases of atypical PR, it may present with erythema multiforme-like lesions and purpura.[1]
We report a patient with COVID-19 vaccine-induced PR. To the best of our knowledge, this is the first reported case in Saudi Arabia.
Case ReportA 23-year-old middle eastern female, not known to have any medical diseases, presented to our outpatient clinic with a 1-week history of a slightly itchy skin rash that started as a single lesion over the left shoulder for 3 days and then spread to her trunk and proximal extremities. No other symptoms are reported before, during, or after this presentation. She denied a history of COVID-19 infection nor any relevant medical, drug, surgical, family, or social history. The patient was never investigated nor treated for her current complaint. She received the second dose of Pfizer–BioNTech COVID-19 vaccine 10 days prior to the onset of the current presentation. On examination, there were multiple oval-to-round, variable in size, erythematous scaly plaques with a characteristic trailing of collarette scales at the borders, distributed over the trunk and proximal extremities, following Langer's cleavage lines [Figure 1]a, [Figure 1]b, [Figure 1]c. A typical herald patch was seen over her left shoulder [Figure 1]d. PR was diagnosed with this classical picture with no laboratory tests or biopsy needed. Due to the significant correlation between vaccination and onset of rash, COVID-19 vaccination was the most likely etiology. The patient was educated, reassured, prescribed topical mometasone ointment and oral chlorpheniramine as needed for 2 weeks, and was given a follow-up appointment.
Figure 1: (a-c) Showing numerous ovoid reddish scaly plaques on the trunk. (d) A typical herald patch over her left shoulder Discussion PR clinically appears as an eruption that usually persists for 6–8 weeks and then spontaneously resolves; however, some patients have lesions that may last for 5 months or longer.[1] With the current COVID-19 pandemic, several vaccines have been approved to alleviate morbidity and mortality associated with the disease. Unfortunately, several cutaneous adverse reactions were reported as erythema, edema, pain, induration at the injection site, as well as some rare cutaneous manifestations that were later identified as PR.[2]
In the literature, cases of PR/PR-LE had been reported following vaccination for smallpox, tuberculosis, influenza A, diphtheria, tetanus, diphtheria–pertussis–tetanus, papillomaviruses, yellow fever, and hepatitis B. The exact pathogenetic process that causes PR following vaccination is unknown. Observation of PR following vaccination was first reported in 1947.[3] PR is seldom reported with other vaccines compared to the COVID-19 vaccines.
All 16 COVID-19-related PR case reports found in the literature are reviewed and compared to ours [Table 1].[4],[5],[6],[7],[8],[9],[10],[11],[12],[13],[14] Noticeably, there are more PR cases after Pfizer–BioNTech COVID-19 vaccination than the other COVID-19 vaccines. The time-lapse between COVID-19 vaccination and PR presentation might range from 2 h to 21 days, with most cases averaging 7 days. In our case, the patient developed PR 10 days after receiving the Pfizer–BioNTech COVID-19 vaccine. The age varies among reported cases of such presentation, with the youngest being a 19-year-old male while the eldest being a 54-year-old female. In our case, the patient was 23 years old, which is within the range of typical presenting age for PR.[1] Furthermore, there is a nearly equal incidence between males (8 reported cases) and females (7 reported cases). Moreover, most of the patients who got the Pfizer–BioNTech COVID-19 vaccine got PR after the second dose, as did our patient. The majority of the case reports show racial predilection toward people of Caucasian ethnicity in contrast to our patient, who is of Arab ethnicity. Most cases reported as well as ours are of previously healthy individuals. Nonetheless, 3 cases had significant comorbidities, including glioblastoma, alopecia areata, and Hashimoto's thyroiditis.
Table 1: Summary of reported cases of pityriasis rosea and pityriasis rosea-like eruptions following COVID-19 vaccinationIn conclusion, the data obtained from the literature and our case suggest a causal relationship between COVID-19 vaccines and PR development after that. Most of the reported cases were related to Pfizer–BioNTech COVID-19, remarkably after the second dose. Both age and gender do not seem to impact the incidence of COVID-19 vaccine-induced PR. Physicians should be aware of COVID-19 vaccines as potential triggers of PR. Unfortunately, limited data and reports were available, and more studies are needed before this link can be fully understood. We suggest further research to correlate the relation between COVID-19 vaccines and PR.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that her name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
References
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