Study Finds Patient-Reported Link Between COVID-19 and its vaccination with Allergic Contact Dermatitis

The review revealed that a small percentage of patients may experience the onset of allergic contact dermatitis following COVID-19 infection or vaccination.

Several case series have reported dermatoses occurrence following COVID-19 infection or vaccination, which is associated with a variety of cutaneous symptoms. No study to date has investigated whether COVID-19 is associated with an increased prevalence of ACD. However, there have been several registry-based case series of associated dermatoses after COVID-19 infection or vaccination. Therefore, Nicholas Battis From the Department of Dermatology, Park Nicollet Health Services, Minneapolis, Minnesota, USA, and colleagues aimed to describe patient-reported associations between COVID-19 infection or vaccination and the onset of ACD.

For this purpose, the researchers performed a single-center retrospective noncomparative chart review of 1073 patients patch-tested at the Park Nicollet Contact Dermatitis Clinic (Minneapolis, MN) from 2020 to 2022.

The following were the key findings of the study:

· A total of 5 patients (100% women) reported ACD after a test-confirmed COVID-19 infection. These women were aged 22 to 63 years and presented with face rash (n=3), eyelid rash (n=1), and generalized rash (n=1).

· Four of the five patients had no history of dermatitis before COVID-19 infection; 3 developed rash 1 day or more after COVID-19 symptom onset, and 3 experienced rash for 6 or 7 days straight.

· Rash improved in 2 patients with allergen avoidance and 1 patient with systemic treatment. Clinical relevance (CR) scores were definite or probable in 3 patients and possible or not relevant in 2 patients.

· Only 12 patients (1.11%; 10 women; aged 36 to 80 years) associated ACD with COVID-19 vaccination. These patients presented with generalized rash (n=5), rash on the scalp (n=1), face (n=1), eyelid (n=1), oral area (n=1), neck (n=1), arm (n=1), and leg (n=1). Nine had received the Pfizer vaccine, 2 the Moderna vaccine, and 1 the Johnson & Johnson vaccine.

· Three patients had received three vaccine doses, 5 had received 2 doses, and 4 had received 1 dose. Most patients (n=10) had no history of dermatitis before vaccination.

· The onset of most rash cases (n=10) occurred between 1- and 14 days postvaccination. In 6 patients, ACD improved with allergen avoidance, and in 5, it improved with systemic treatment. CR scores were definite or probable in 8 patients and possible or not relevant in 4 patients.

· In those with COVID-19 infection-related ACD, none of the patients reported a second positive COVID-19 test or recurrence of symptoms with reinfection. In contrast, in patients with ACD associated with COVID-19 vaccination, 25% experienced recurrence with revaccination.

· Among the 17 patients who suspected that COVID-19 vaccination or infection had contributed to their development of chronic dermatitis, 11 (64.7%) had probable or definite ACD, a rate consistent with previously reported CR rates for the general patch test population.

• Among patients with ACD in both groups, the prevalence of facial dermatitis (45.5%) was nearly three times higher than that usually reported for patch-tested patients (16.0%).

"To our knowledge, the study is the first in the literature investigating the potential association between COVID-19 vaccination or infection and ACD development through extensive retrospective chart review," the researchers wrote.

Reference:

Battis N, Ekstein SF, Cosky EEP, Neeley AB. Patient-Reported Association Between COVID-19 Infection or Vaccination and Onset of Allergic Contact Dermatitis. Dermatitis. 2024 Mar 27. doi: 10.1089/derm.2023.0379. Epub ahead of print. PMID: 38535725.