Cazzato Gerardo, Ambrogio Francesca, Pisani Maria Carla, Colagrande Anna, Arezzo Francesca, Cascardi Eliano, Dellino Miriam, Macorano Enrica, Trilli Irma, Parente Paola, Lettini Teresa, Romita Paolo, Marzullo Andrea, Ingravallo Giuseppe, Foti Caterina
Section of Molecular Pathology, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari "Aldo Moro", 70124 Bari, Italy.
Section of Dermatology and Venereology, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari "Aldo Moro", 70124 Bari, Italy.
Vaccines (Basel). 2023 Feb 9;11(2):397. doi: 10.3390/vaccines11020397.
The advent of vaccines represented a milestone to allow the slowing down and then containing of the exponential increase in ongoing infections and deaths of COVID-19. Since the first months of the vaccination campaign in various continents, there has been a certain number of reports of adverse events, including skin reactions. We conducted a systematic review, searching on PubMed, Web of Science, Scopus, and Cochrane Library for the words: COVID vaccine, dermatopathology, skin, eruptions, rash, cutaneous, BNT162b2 (Pfizer-BioNTech), ChAdOX1 (AstraZeneca), and mRNA-1273 (Moderna). A total of 28 records were initially identified in the literature search of which two were duplicates. After screening for eligibility and inclusion criteria, 18 publications were ultimately included. Various clinical cutaneous manifestations and histopathological patterns following vaccination have been described in literature. The most frequent clinical-pathological presentations were erythematous maculo-papular eruptions in different way of distribution with histopathological pictures mostly represented by interface changes and mixed peri-vascular and peri-adnexal cell infiltrate. Other presentations included new onset of pemphigoid bullous disease (n = 15), delayed T-cell-mediated hypersensitivity reaction (injection site reactions) (n = 10), purpuric skin rash (n = 13), mostly localized on the legs bilaterally and symmetrically with histological pictures characterized by extravasation of erythrocytes in the superficial and middle dermis, and other types of reactions. New studies with large case series and further literature reviews are needed to improve the clinical management of patients and optimize the timeline for carrying out histological biopsy for confirmatory, supportive, and differential diagnosis purposes.
疫苗的出现是一个里程碑，使得新冠病毒持续感染和死亡人数的指数增长得以放缓并随后得到控制。自各大洲开展疫苗接种运动的头几个月以来，已有一定数量关于不良事件的报告，包括皮肤反应。我们进行了一项系统综述，在PubMed、科学网、Scopus和考克兰图书馆中搜索了以下词汇：新冠疫苗、皮肤病理学、皮肤、皮疹、疹、皮肤的、BNT162b2（辉瑞-生物科技公司）、ChAdOX1（阿斯利康）和mRNA-1273（莫德纳）。在文献检索中最初共识别出28条记录，其中两条为重复记录。在根据入选标准和纳入标准进行筛选后，最终纳入了18篇出版物。文献中描述了接种疫苗后出现的各种临床皮肤表现和组织病理学模式。最常见的临床病理表现是以不同分布方式出现的红斑丘疹，组织病理学图片大多表现为界面改变以及血管周围和附属器周围混合性细胞浸润。其他表现包括新发类天疱疮大疱性疾病（n = 15）、迟发性T细胞介导的超敏反应（注射部位反应）（n = 10）、紫癜性皮疹（n = 13），大多双侧对称地局限于腿部，组织学图片特征为红细胞在真皮浅层和中层外渗，以及其他类型的反应。需要开展更多有大病例系列的新研究并进行进一步的文献综述，以改善对患者的临床管理，并优化为进行确诊、支持和鉴别诊断而进行组织活检的时间安排。
