A case of pityriasis rubra pilaris following COVID-19 vaccination and a review of literature.

Abstract

Aim: To present a case of pityriasis rubra pilaris (PRP) following the first AstraZeneca (AZ) vaccine and to summarise the data from published cases of PRP triggered by COVID-19 vaccination. Method(s): We present the case of a 65-year-old Caucasian man with erythroderma characterised by erythematous to orange scaly plaques with islands of sparing, follicular keratotic red-brown papules and waxy red-orange keratoderma on palmoplantar surfaces that progressively developed over an 8-week period following the first dose of AZ COVID-19 vaccination. The clinical features and histopathology were consistent with a diagnosis of PRP. Given the temporal relationship and lack of preceding infection or medication changes, the proposed trigger for this eruption was the first dose of the AZ vaccine. We have reviewed 6 cases of COVID19 vaccination induced PRP, including our case, and summarised the findings. Result(s): The age range of patients presenting with post- COVID-19 vaccination PRP is from 51 to 82-years-old, with three males and three females affected. Three cases occurred following AZ vaccination, two following Pfizer- BioNTech vaccination and one following Moderna vaccination. All cases occurred following the first dose and the time of PRP onset following vaccination ranged from two days to three weeks. Two cases received a second COVID- 19 vaccination, with one case leading to significant worsening of PRP and the other with no recurrence. Conclusion(s): The COVID-19 vaccines currently in use worldwide have demonstrated to be extremely safe, however rare side-effects continue to be reported. More data needs to be collected to determine causality of COVID-19 vaccination and PRP. It is unknown whether the second dose of AZ will cause worsening or recurrence of PRP. As more people are vaccinated around the globe, it is vital that dermatologists and other health care practitioners are cognisant that COVID-19 vaccination may be a potential trigger for PRP to ensure early diagnosis and appropriate management ensue.