Cutaneous reactions after SARS‐COV‐2 vaccination: A cross‐sectional Spanish nationwide study of 405 cases

Català , A.; Muñoz‐Santos, C.; Galván‐Casas, C.; Roncero Riesco, M.; Revilla Nebreda, D.; Solá‐Truyols, A.; Giavedoni, P.; Llamas‐Velasco, M.; González‐Cruz, C.; Cubiró, X.; Ruíz‐Villaverde, R.; Gómez‐Armayones, S.; Gil Mateo, M.P.; Pesqué, D.; Marcantonio, O.; Fernández‐Nieto, D.; Romaní, J.; Iglesias Pena, N.; Carnero Gonzalez, L.; Tercedor‐Sanchez, J.; Carretero, G.; Masat‐Ticó, T.; Rodríguez‐Jiménez, P.; Gimenez‐Arnau, A.M.; Utrera‐Busquets, M.; Vargas Laguna, E.; Angulo Menéndez, A.G.; San Juan Lasser, E.; Iglesias‐Sancho, M.; Alonso Naranjo, L.; Hiltun, I.; Cutillas Marco, E.; Polimon Olabarrieta, I.; Marinero Escobedo, S.; García‐Navarro, X.; Calderón Gutiérrez, M.J.; Baeza‐Hernández, G.; Bou Camps, L.; Toledo‐Pastrana, T.; Guilabert, A.

BACKGROUND: Cutaneous reactions after SARS‐CoV‐2 vaccines are poorly characterized. Objectives: The primary objective was to describe and classify cutaneous reactions after SARS‐CoV‐2 vaccination. METHODS: A nationwide Spanish cross‐sectional study was conducted. We included patients with cutaneous reactions within 21 days after any dose of the approved vaccines at the time of the study. After a face‐to‐face visit with a dermatologist, information on cutaneous reactions was collected through an online professional survey and clinical photographs were sent by email. Investigators searched for consensus on clinical patterns and classification. RESULTS: From February 16 to May 15, 2021, we collected 405 reactions after vaccination with the BNT162b2 (Pfizer‐BioNTech, 40.2%), mRNA‐1273 (Moderna, 36.3%) and AZD1222 (AstraZeneca, 23.5%) vaccines. The mean patient age was 50.7 years and 80.2% were female. Cutaneous reactions were classified as: injection‐site (COVID‐ARM, 32.1%), urticaria (14.6%), morbilliform (8.9%), papulovesicular (6.4%), pityriasis rosea‐like (4.9%) and purpuric (4%) reactions. Varicella zoster and herpes simplex virus reactivations accounted for 13.8% of reactions. The COVID‐ARM was almost exclusive to women (95.4%). The most reported reaction in each vaccine group were COVID‐ARM (mRNA‐1273, Moderna, 61.9%), varicella zoster virus reactivation (BNT162b2, Pfizer‐BioNTech, 17.2%), and urticaria (AZD1222, AstraZeneca, 21.1%). Most reactions to the mRNA‐1273 (Moderna) vaccine were described in women (90.5%). Eighty reactions (21%) were classified as severe/very severe and 81% required treatment. CONCLUSIONS: Cutaneous reactions after SARS‐CoV‐2 vaccination are heterogeneous. Most are mild‐to‐moderate and self‐limiting, although severe/very severe reactions are reported. Knowledge of these reactions during mass vaccination may help healthcare professionals and reassure patients.