Case of Erythema annulare centrifugum reported after COVID-19 vaccination

SARS-CoV-2 infection has caused an international pandemic with significant health, and economic consequences. To prevent the severity of this infection vaccination has been done rampantly and rapidly leading to unexpected skin reactions. Recently a case of erythema annulare centrifugum (EAC) after AZD1222 (Oxford-AstraZeneca COVID-19) vaccine administration was reported in the Clinical and Experimental Dermatology journal.

A 74 year old woman presented with multiple annular scaly erythematous patches with a central pale zone on the arms and shoulders which she had developed 5 days after AZD1222 vaccination. Histopathology of lesions showed spongiosis, parakeratosis and tight perivascular lymphocytic infiltration (coat-sleeve pattern) without any fungal elements on Periodic Acid-Schiff stain. Finally a diagnosis of EAC induced by SARS-CoV-2 vaccination was mad. She was treated with levocetirizine, rupatadine, methylprednisolone, roxithromycin, and topical methylprednisolone aceponate lotion (1 mg/g). After 3 weeks of treatment, the skin lesions and pruritus were resolved without any complications. In the follow up period, she did not develop any recurrence after second AZD 1222 vaccination.

EAC is a rare cutaneous hypersensitivity disorder showing annular erythematous plaques with central clearing and peripheral scales which is often asymptomatic or may have pruritus. It has been linked to cutaneous or systemic infections, malignancy, drugs and pregnancy. The dense perivascular infiltration composed of lymphocytes and histiocytes is the most representative findings in histology.

This case could be a result of a delayed type hypersensitivity or T-cell–mediated immune reaction to the vaccine. It widens the horizon of dermatologists regarding the possibility of EAC from AZD1222 vaccination which can lead to prompt diagnosis and treatment of the disease.

Source- Kim JC, Lee SY, Kang SY, Kim HO, Park CW, Chung BY. Erythema annulare centrifugum induced by SARS-CoV-2 vaccination. Clin Exp Dermatol. 2021 Nov 3. doi: 10.1111/ced.15002. Epub ahead of print. PMID: 34731529.