Department of Dermatology and Allergy, University Hospital Bonn, Bonn, Germany.
J Dermatol. 2022 Jan;49(1):151-156. doi: 10.1111/1346-8138.16210. Epub 2021 Oct 24.
Effective vaccines for prevention of severe course and lethal outcome of coronavirus disease 2019 have been developed and approved in regulatory rolling and fast-track procedures; they are now widely distributed worldwide. Data about cutaneous side-effects of the new mRNA-type vaccines is scant, however. We herein report two similar cases of cutaneous adverse drug reactions (ADR) mimicking Rowell's syndrome that occurred after the first dose of BNT162b2 and mRNA-1273, respectively. Both patients achieved prompt clinical improvement with a short pulse of oral prednisolone and non-steroidal inflammatory drugs. We suspect this phenomenon to occur in a timeframe of 7-14 days after vaccination due to an interferon-γ-driven shift towards type I immunity in susceptible individuals. As rheumatic patients were excluded from phase III clinical trials and as most countries prioritized the elderly population to receive the vaccinations first, cutaneous ADR might become more frequent once the younger part of the population is vaccinated over the course of 2021. Atypical cutaneous ADR might be misinterpreted or overlooked by non-dermatologists. Further studies are required to determine the best suitable vaccine types for individual groups of patients.
已开发出并经监管滚动和快速通道程序批准了可有效预防 2019 年冠状病毒病严重病程和致死结局的疫苗；目前它们已在全球范围内广泛分发。然而，关于新型 mRNA 疫苗的皮肤副作用数据很少。在此，我们报告了两例分别在接种 BNT162b2 和 mRNA-1273 后第一针后出现类似罗厄尔综合征的皮肤药物不良反应（ADR）的相似病例。两例患者均经短疗程口服泼尼松龙和非甾体类抗炎药治疗后迅速临床改善。我们推测这种现象发生在接种后 7-14 天内，这是由于易感个体中干扰素-γ驱动的向 I 型免疫的转变。由于风湿性疾病患者被排除在 III 期临床试验之外，并且大多数国家首先将老年人群列为接种疫苗的优先人群，因此一旦 2021 年轻人群体开始接种疫苗，皮肤 ADR 可能会变得更加频繁。非皮肤科医生可能会错误地解释或忽视非典型皮肤 ADR。需要进一步的研究来确定适合个体患者群体的最佳疫苗类型。
