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1. Shard Calculation

Query:

Response:

Calculated Shard: 143 (from laksa025)

2. Crawled Status Check

Query:

curl -X POST \
  'http://laksa143.int.ahrefs:8124/' \
  -H 'Content-Type: text/plain' \
  -H 'X-ClickHouse-Database: crawler3' \
  -H 'Authorization: Basic YXBpOg==' \
  -d 'SELECT getAhrefsURLFromUnparsed(src_unparsed) AS found_url, ifNull(toUnixTimestamp(download_stamp), 0) AS crawl_time, ifNull(toUnixTimestamp(props_url_first_seen), 0) AS first_indexed_time, download_http_code AS http_code, src_unparsed AS src_unparsed, src_root_hash AS src_root_hash, history_drop_reason AS history_drop_reason, meta_title AS meta_title, meta_descriptions AS meta_descriptions, attrs_boilerpipe_text AS attrs_boilerpipe_text, attrs_markdown AS attrs_markdown, attrs_readable_markdown AS attrs_readable_markdown, meta_canonical AS meta_canonical FROM crawler3.page_info_local FINAL PREWHERE (src_root_hash, src_unparsed) IN ((getAhrefsRootHashFromUnparsed(getAhrefsUnparsedNoserviceFromURL(\'https://dermnetnz.org/topics/skin-reactions-to-covid-19-vaccines\')), getAhrefsUnparsedNoserviceFromURL(\'https://dermnetnz.org/topics/skin-reactions-to-covid-19-vaccines\'))) FORMAT JSONEachRow'

Response:

{"found_url":"https:\/\/dermnetnz.org\/topics\/skin-reactions-to-covid-19-vaccines","crawl_time":1775949930,"first_indexed_time":1639644713,"http_code":200,"src_unparsed":"org,dermnetnz!\/topics\/skin-reactions-to-covid-19-vaccines s443","src_root_hash":"6258778422224653543","history_drop_reason":null,"meta_title":"COVID-19: Skin Reactions to COVID-19 Vaccines - DermNet","meta_descriptions":["There are a spectrum of skin reactions following COVID-19 vaccination including local site reactions, urticaria, a delayed large local reaction \"COVID arm\", and morbilliform eruptions. For images, click on the following link."],"attrs_boilerpipe_text":"Skin reactions to COVID-19 vaccines — extra information\nSynonyms:\ncoronavirus vaccine skin reactions, SARS-CoV-2 vaccination, Coronavirus vaccine reactions\nCategories:\nReactions\nICD-10:\nT50.B95A\nICD-11:\nXM68M6\nSNOMED CT:\n1156256003, 1142181004, 1145003007\nReactions\nAuthors: Dr Sarah Elyoussfi (Dermatology Registrar) and Dr Ian Coulson (Consultant Dermatologist), Department of Dermatology, East Lancashire NHS Trust, United Kingdom. Copy edited by Gus Mitchell. December 2021. Further updated May 2023\nIntroduction\nVaccine differences\nCommon skin reactions\nIncidence of skin reactions\nUncommon mild skin reactions\nUncommon serious skin reactions\nSkin reaction treatment\nWhat are the COVID-19 vaccines?\nThe\ncoronavirus disease 2019 (COVID-19)\npandemic has led to the\ndevelopment\nand approval of vaccines against the responsible virus — severe\nacute\nrespiratory\nsyndrome\ncoronavirus 2 (SARS-CoV-2). More than 100 companies and institutions worldwide have developed vaccine candidates.\nHow do the COVID-19 vaccines differ?\nCurrent approved\nvaccines\nrely on a nucleic-acid-based vaccine platform\nMessenger\nribonucleic acid\n(\nmRNA\n) eg, Pfizer\/BioNTech + Fosun Pharma, Moderna + National Institute of\nAllergy\nand Infectious Diseases\nViral\nvector\nplatforms eg, AstraZeneca + University of Oxford, Janssen Pharmaceutical\nInactivated virus eg, Sinopharm + China National Biotec Group Co\nProtein\nsubunit vaccines eg, Novavax (not yet approved in any country)\nWhat are the common types of skin reaction to COVID-19 vaccines?\nThe majority of current literature regarding\ncutaneous\nreactions relate specifically to mRNA COVID-19 vaccinations.\nThe spectrum of reported cutaneous reactions after mRNA vaccination include:\nLocal site reaction\nSwelling,\nerythema\n, and pain in the vaccinated arm.\nMedian\nonset of 1 day after vaccination.\nUrticaria\nMedian onset reported on day 2–3 after vaccination.\nCommon sites include arms (68%), trunk (57%), and legs (46%).\nMorbilliform\neruptions\nMedian onset reported on day 2–3 after vaccination.\nCommon sites include the arm (62%), legs (27%), and trunk (42%).\nDelayed large local reaction (“COVID arm\")\nThe COVID-19 vaccines may cause a delayed localized\nhypersensitivity\nreaction presenting as a\npruritic\nand painful\nerythematous\nreaction near the injection site.\nMedian development of 7 days after vaccine administration with a median duration of 5 days, but can\npersist\nfor up to 21 days.\nPink\nplaques\nare variably\noedematous\nand typically\nhomogenous\nor less commonly\nannular.\nSweet syndrome\n-like local reactions have been reported.\nTreatments include\ntopical steroids\n,\noral antihistamines\n, and\ncool compresses\n, but\nlesions\nare usually\nself-limiting.\nEosinophilic pustular folliculitis\nmay be triggered by Covid vaccines.\nHow common are cutaneous reactions after COVID-19 vaccination?\nIn one study, cutaneous reactions within 3 days after receiving the vaccine were reported in 1.9% of individuals after receiving their first dose of the mRNA COVID vaccine (Pfizer-BioNtech and Moderna).\nThe majority of cutaneous reactions after COVID-19 vaccination occur in women (around 90%). Erythema and itching (other than at the injection site) was the most common cutaneous reaction, which was reported by 1%.\nIn a study (May, 2021) of those with a self-reported cutaneous reaction to the first dose, 95% received their second dose. Among those who completed a\nsymptom\nsurvey after the second dose, 83% reported no\nrecurrent\ncutaneous reactions.\nHowever, a different study (July, 2021) reported that 43% of patients receiving an mRNA COVID-19 vaccine who reported first-dose reactions, experienced a second-dose\nrecurrence.\nWhat are the uncommon mild skin reactions to COVID-19 vaccines?\nFiller reactions\nSwelling at the site of cosmetic fillers has been reported after COVID-19 vaccination. Reports have identified patients with facial swelling after both Moderna and Pfizer vaccines associated with prior use of injectable cosmetic filler.\nMay indicate delayed hypersensitivity to filler following introduction of an immunologic trigger. Similar reactions have been previously noted after other viral illnesses and influenza vaccines.\nErythromelalgia\nErythromelalgia has also been reported in response to other vaccines such as those for influenza and\nhepatitis\nB.\nPernio\/chilblains\nMimics dermatologic\nmanifestations\nof COVID-19 (COVID toes)\nPotentially suggests that the\nhost\nimmune response to the virus is being replicated by the vaccine\nPityriasis rosea\nReported with both COVID-19\ninfection\nand COVID-19 vaccines.\nVaricella zoster\nand\nherpes simplex\nflares\nCase reports have documented flares following COVID-19 vaccination.\nRaynaud phenomenon\nA case has been reported occurring 2 weeks after the COVID-19 vaccine.\nWhat are the uncommon serious skin reactions to COVID-19 vaccines?\nBullous pemphigoid\nRelapses\nof\nautoimmune\nbullous\ndisease have been reported\nOnset within 3 days – 2 weeks following vaccination.\nSubacute cutaneous lupus erythematosus\nInduction\nand flares have been reported.\nOnset days to weeks following vaccination.\nExacerbation\nof underlying skin condition\nCOVID-19 vaccination may trigger exacerbation of a pre-existing\ninflammatory\nskin condition such as\npsoriasis\nand\natopic dermatitis\n.\nHowever, a recent study involving over 2000 individuals did not show that vaccination statistically significantly exacerbated either\natopic\neczema\nor psoriasis.\nLichen planus\nThe vaccine leads to increased levels of IL-2,\nTNF\n-α, and IFN-γ — the exact\ncytokines\ninvolved in the development of lichen planus. Reports of this condition following vaccination have been made.\nErythema multiforme\nLinked to the first dose of Moderna COVID-19 vaccine.\nIt should be noted that major-type EM is considered to be a continuous spectrum with life-threatening\ntoxic\nanti-\nepithelial\nreactions (e.g., Stevens–Johnson syndrome, toxic\nepidermal\nnecrolysis).\nNeutrophilic\nand\nPustular\nDrug Reactions\nBoth\nacute generalised exanthematous pustulosis (AGEP)\nand a\npustular flare of psoriasis\nassociated with an inactivated viral vector COVID-19 vaccine have been published.\nA further case report was classified as an overlap between AGEP and\ndrug reaction with eosinophilia and systemic symptoms (DRESS)\nassociated with COVID-19 vaccination.\nAnaphylaxis\nRare even with rates of 4.7 cases\/million doses of the Pfizer-BioNTech and 2.5 cases\/million doses of the Moderna vaccine\nAnaphylaxis\nto vaccines generally is usually due to individual vaccine components, such as egg protein, gelatin, and other additives. However, the cause of vaccine anaphylaxis with the COVID-19 vaccine cases is unclear, but polyethylene glycol (PEG 2000) is a candidate\nallergen.\nCommon signs and symptoms include\ngeneralised\nurticaria\n,\nangioedema\n, and respiratory and airway obstruction symptoms.\nOnset is typically within minutes to hours of administration.\nAlthough the Pfizer\/BioNTech vaccine contains a number of\nexcipients\n, PEG 2000 is the only one reported to cause anaphylaxis. The Oxford-AstraZeneca vaccine does not contain PEG 2000 so is an alternative for people with a history of allergy to PEG 2000. However, there is occasional\ncross-reactivity\nbetween PEG and polysorbate 80, an ingredient in the Oxford-AstraZeneca vaccine. Evaluation by an allergy specialist may be advisable before vaccination in anyone with a suspected PEG allergy.\nContraindications\nfor receipt of the mRNA COVID-19 vaccines include:\nKnown history of a severe\nallergic reaction\nto any vaccine component, including the\nexcipient\nPEG 2000\nAn allergic reaction to a previous dose of an mRNA vaccine.\nIdentification of risk factors for allergy symptoms after COVID-19 vaccination will guide safe vaccination practices for individuals at the highest risk.\nHow are the COVID-19 skin reactions treated?\nSevere cutaneous\nadverse reactions\nare very rare. The established vaccines have a satisfactory safety profile. Management should be directed at the presenting skin condition, however most of the encountered skin reactions are self-limiting.\nAnaphylaxis\nrequires prompt treatment with\nintramuscular\nadrenaline\nand oxygen.\nUnlike anaphylaxis, cutaneous adverse reactions alone are not a\ncontraindication\nto re-vaccination. The available evidence supports that cutaneous reactions to COVID-19 vaccination are generally minor, self-limiting, and should not discourage vaccination.\nBibliography\nAl-Jighefee HT, Najjar H, Ahmed MN, Qush A, Awwad S, Kamareddine L. COVID-19 Vaccine Platforms: Challenges and Safety Contemplations. Vaccines (Basel). 2021;9(10):1196. doi: 10.3390\/vaccines9101196.\nPubMed Central\nBusto-Leis JM, Servera-Negre G, Mayor-Ibarguren A, et al. Pityriasis rosea, COVID-19 and vaccination: new keys to understand an old acquaintance. J Eur Acad Dermatol Venereol. 2021;35(8):e489–e491. doi:10.1111\/jdv.17301.\nPubMed Central\nHiltun I, Sarriugarte J, Martínez-de-Espronceda I, et al. Lichen planus arising after COVID-19 vaccination. J Eur Acad Dermatol Venereol. 2021;35(7):e414–e415. doi:10.1111\/jdv.17221.\nPubMed Central\nJohnston MS, Galan A, Watsky KL, Little AJ. Delayed Localized Hypersensitivity Reactions to the Moderna COVID-19 Vaccine: A Case Series. JAMA Dermatol. 2021;157(6):716–20.\nJournal\nJoseph AK, Chong BF. Subacute cutaneous lupus erythematosus flare triggered by COVID-19 vaccine. Dermatol Ther. doi: 10.1111\/dth.15114.\nJournal\nLospinoso K, Nichols CS, Malachowski SJ, Mochel MC, Nutan F. A case of severe cutaneous adverse reaction following administration of the Janssen Ad26.COV2.S COVID-19 vaccine. JAAD Case Rep. 2021;13:134–7. doi:10.1016\/j.jdcr.2021.05.010.\nPubMed Central\nMcMahon DE, Amerson E, Rosenbach M, et al. Cutaneous reactions reported after Moderna and Pfizer COVID-19 vaccination: A registry-based study of 414 cases. J Am Acad Dermatol. 2021;85(1):46–55. doi:10.1016\/j.jaad.2021.03.092.\nPubMed Central\nNiebel D, Novak N, Wilhelmi J, et al. Cutaneous Adverse Reactions to COVID-19 Vaccines: Insights from an Immuno-Dermatological Perspective. Vaccines (Basel). 2021;9(9):944. doi:10.3390\/vaccines9090944.\nPubMed Central\nRobinson LB, Fu X, Hashimoto D, et al. Incidence of Cutaneous Reactions After Messenger RNA COVID-19 Vaccines. JAMA Dermatol. May 2021;157(8):1000–2. doi:10.1001\/jamadermatol.2021.2114.\nJournal\nSellaturay P, Nasser S, Islam S, Gurugama P, Ewan PW. Polyethylene glycol (PEG) is a cause of anaphylaxis to the Pfizer\/BioNTech mRNA COVID-19 vaccine. Clin Exp Allergy. 2021;51(6):861–3. doi: 10.1111\/cea.13874.\nJournal\nShimabukuro TT, Cole M, Su JR. Reports of Anaphylaxis After Receipt of mRNA COVID-19 Vaccines in the US-December 14, 2020-January 18, 2021. JAMA. 2021;325(11):1101–2. doi:10.1001\/jama.2021.1967.\nJournal\nOn DermNet\nCOVID-19\nCOVID-19 immunisation and immunomodulators\/biologic agents\nDermatology patients and COVID-19\nAdverse cutaneous reactions to vaccines\nOther websites\nCOVID-19 vaccines\n— The World Health Organization (WHO)\nCOVID-19 vaccine safety\n— Centre for Disease Control and Prevention (CDC)\nBooks about skin diseases\nBooks about the skin\nDermatology Made Easy\n - second edition\nOther recommended articles","attrs_markdown":"[![DermNet](https:\/\/dermnetnz.org\/topics\/_resources\/themes\/mercury\/dist\/images\/svg\/logo-white-tm.svg)](https:\/\/dermnetnz.org\/ \"DermNet\")\n\nAre you a healthcare professional\n\n[GO TO DERMNET PRO](https:\/\/pro.dermnetnz.org\/)\n\n[Home](https:\/\/dermnetnz.org\/)\n\n[Topics A-Z](https:\/\/dermnetnz.org\/topics)\n\n[Images](https:\/\/dermnetnz.org\/images)\n\n[Cases](https:\/\/dermnetnz.org\/cases)\n\n[Skin checker](https:\/\/dermnetnz.org\/dermdiag)\n\n[Give feedback](https:\/\/dermnetnz.org\/contact-us\/website-feedback)\n\nMain menu\n***\n\n[Home](https:\/\/dermnetnz.org\/)\n\n[Topics A-Z](https:\/\/dermnetnz.org\/topics)\n\n[Images](https:\/\/dermnetnz.org\/images)\n\n[Cases](https:\/\/dermnetnz.org\/cases)\n\n[Skin checker](https:\/\/dermnetnz.org\/dermdiag)\n\n[Give feedback](https:\/\/dermnetnz.org\/contact-us\/website-feedback)\n\nCommon skin conditions\n***\n\n[Acne](https:\/\/dermnetnz.org\/topics\/acne) [Athlete's foot](https:\/\/dermnetnz.org\/topics\/athletes-foot) [Cellulitis](https:\/\/dermnetnz.org\/topics\/cellulitis) [Cold sores](https:\/\/dermnetnz.org\/topics\/herpes-simplex) [Dermatitis\/Eczema](https:\/\/dermnetnz.org\/topics\/dermatitis) [Heat rash](https:\/\/dermnetnz.org\/topics\/miliaria) [Hives](https:\/\/dermnetnz.org\/topics\/urticaria-an-overview)  [Impetigo](https:\/\/dermnetnz.org\/topics\/impetigo) [Psoriasis](https:\/\/dermnetnz.org\/topics\/psoriasis) [Ringworm](https:\/\/dermnetnz.org\/topics\/tinea-corporis) [Rosacea](https:\/\/dermnetnz.org\/topics\/rosacea) [Seborrhoeic dermatitis](https:\/\/dermnetnz.org\/topics\/seborrhoeic-dermatitis) [Shingles](https:\/\/dermnetnz.org\/topics\/herpes-zoster) [Vitiligo](https:\/\/dermnetnz.org\/topics\/topics\/vitiligo)\n\n[![](https:\/\/dermnetnz.org\/assets\/images\/home-page-pro-waitlist.webp) **NEWS** **Join DermNet PRO** Read more](https:\/\/pro.dermnetnz.org\/)\n\nQuick links\n***\n\n[![](https:\/\/dermnetnz.org\/assets\/svg\/white-magnifying-glass.svg) Skin checker Try our skin symptom checker](https:\/\/dermnetnz.org\/dermdiag)\n\n[Home](https:\/\/dermnetnz.org\/ \"Home\")\n\n![divider](https:\/\/dermnetnz.org\/topics\/_resources\/themes\/mercury\/dist\/images\/svg\/divider.svg)\n\n[Topics A-Z](https:\/\/dermnetnz.org\/topics)\n\n![divider](https:\/\/dermnetnz.org\/topics\/_resources\/themes\/mercury\/dist\/images\/svg\/divider.svg)\n\n[Skin reactions to COVID-19 vaccines](https:\/\/dermnetnz.org\/topics\/skin-reactions-to-covid-19-vaccines)\n\n[![toggle glossary](https:\/\/dermnetnz.org\/topics\/_resources\/themes\/mercury\/dist\/images\/svg\/glossary.svg)](https:\/\/dermnetnz.org\/topics\/skin-reactions-to-covid-19-vaccines \"Toggle glossary items\")   [![topic information](https:\/\/dermnetnz.org\/topics\/_resources\/themes\/mercury\/dist\/images\/svg\/information.svg)](https:\/\/dermnetnz.org\/topics\/skin-reactions-to-covid-19-vaccines \"View topic information\")   [![print](https:\/\/dermnetnz.org\/topics\/_resources\/themes\/mercury\/dist\/images\/svg\/print.svg)](https:\/\/dermnetnz.org\/topics\/skin-reactions-to-covid-19-vaccines \"Print this page\")\n\n##### Skin reactions to COVID-19 vaccines — extra information\nSynonyms:\n\ncoronavirus vaccine skin reactions, SARS-CoV-2 vaccination, Coronavirus vaccine reactions\n\nCategories:\n\nReactions\n\nICD-10:\n\nT50.B95A\n\nICD-11:\n\nXM68M6\n\nSNOMED CT:\n\n1156256003, 1142181004, 1145003007\n\nADVERTISEMENT\n\n**[Reactions](https:\/\/dermnetnz.org\/topics\/topics?category=Reactions)**\n\n# **Skin reactions to COVID-19 vaccines**\nAuthors: Dr Sarah Elyoussfi (Dermatology Registrar) and Dr Ian Coulson (Consultant Dermatologist), Department of Dermatology, East Lancashire NHS Trust, United Kingdom. Copy edited by Gus Mitchell. December 2021. Further updated May 2023\n\n[Introduction](https:\/\/dermnetnz.org\/topics\/skin-reactions-to-covid-19-vaccines#Introduction<br%20\/>%0A)  [Vaccine differences](https:\/\/dermnetnz.org\/topics\/skin-reactions-to-covid-19-vaccines#Vaccine%20differences<br%20\/>%0A)  [Common skin reactions](https:\/\/dermnetnz.org\/topics\/skin-reactions-to-covid-19-vaccines#Common%20skin%20reactions<br%20\/>%0A)  [Incidence of skin reactions](https:\/\/dermnetnz.org\/topics\/skin-reactions-to-covid-19-vaccines#Incidence%20of%20skin%20reactions<br%20\/>%0A)  [Uncommon mild skin reactions](https:\/\/dermnetnz.org\/topics\/skin-reactions-to-covid-19-vaccines#Uncommon%20mild%20skin%20reactions<br%20\/>%0A)  [Uncommon serious skin reactions](https:\/\/dermnetnz.org\/topics\/skin-reactions-to-covid-19-vaccines#Uncommon%20serious%20skin%20reactions<br%20\/>%0A)  [Skin reaction treatment](https:\/\/dermnetnz.org\/topics\/skin-reactions-to-covid-19-vaccines#Skin%20reaction%20treatment)\n\n## What are the COVID-19 vaccines?\nThe [coronavirus disease 2019 (COVID-19)](https:\/\/dermnetnz.org\/topics\/covid-19) pandemic has led to the development and approval of vaccines against the responsible virus — severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). More than 100 companies and institutions worldwide have developed vaccine candidates.\n\n## How do the COVID-19 vaccines differ?\nCurrent approved [vaccines](https:\/\/dermnetnz.org\/topics\/covid-19-immunisation-and-immunomodulatorsbiologic-agents) rely on a nucleic-acid-based vaccine platform\n\n- Messenger ribonucleic acid (mRNA) eg, Pfizer\/BioNTech + Fosun Pharma, Moderna + National Institute of Allergy and Infectious Diseases\n- Viral vector platforms eg, AstraZeneca + University of Oxford, Janssen Pharmaceutical\n- Inactivated virus eg, Sinopharm + China National Biotec Group Co\n- Protein subunit vaccines eg, Novavax (not yet approved in any country)\n## What are the common types of skin reaction to COVID-19 vaccines?\nThe majority of current literature regarding cutaneous reactions relate specifically to mRNA COVID-19 vaccinations.\n\nThe spectrum of reported cutaneous reactions after mRNA vaccination include:\n\n- [Local site reaction](https:\/\/dermnetnz.org\/topics\/adverse-cutaneous-reactions-to-vaccines)\n  - Swelling, erythema, and pain in the vaccinated arm.\n  - Median onset of 1 day after vaccination.\n- [Urticaria](https:\/\/dermnetnz.org\/topics\/urticaria-an-overview)\n  - Median onset reported on day 2–3 after vaccination.\n  - Common sites include arms (68%), trunk (57%), and legs (46%).\n- Morbilliform eruptions\n  - Median onset reported on day 2–3 after vaccination.\n  - Common sites include the arm (62%), legs (27%), and trunk (42%).\n- Delayed large local reaction (“COVID arm\")\n  - The COVID-19 vaccines may cause a delayed localized hypersensitivity reaction presenting as a pruritic and painful erythematous reaction near the injection site.\n  - Median development of 7 days after vaccine administration with a median duration of 5 days, but can persist for up to 21 days.\n  - Pink plaques are variably oedematous and typically homogenous or less commonly annular.\n  - [Sweet syndrome](https:\/\/dermnetnz.org\/topics\/acute-febrile-neutrophilic-dermatosis)\\-like local reactions have been reported.\n  - Treatments include [topical steroids](https:\/\/dermnetnz.org\/topics\/topical-steroid), [oral antihistamines](https:\/\/dermnetnz.org\/topics\/antihistamines), and [cool compresses](https:\/\/dermnetnz.org\/topics\/compression-therapy), but lesions are usually self-limiting.\n  - [Eosinophilic pustular folliculitis](https:\/\/dermnetnz.org\/topics\/eosinophilic-pustular-folliculitis) may be triggered by Covid vaccines.\n## How common are cutaneous reactions after COVID-19 vaccination?\nIn one study, cutaneous reactions within 3 days after receiving the vaccine were reported in 1.9% of individuals after receiving their first dose of the mRNA COVID vaccine (Pfizer-BioNtech and Moderna).\n\nThe majority of cutaneous reactions after COVID-19 vaccination occur in women (around 90%). Erythema and itching (other than at the injection site) was the most common cutaneous reaction, which was reported by 1%.\n\nIn a study (May, 2021) of those with a self-reported cutaneous reaction to the first dose, 95% received their second dose. Among those who completed a symptom survey after the second dose, 83% reported no recurrent cutaneous reactions.\n\nHowever, a different study (July, 2021) reported that 43% of patients receiving an mRNA COVID-19 vaccine who reported first-dose reactions, experienced a second-dose recurrence.\n\n## What are the uncommon mild skin reactions to COVID-19 vaccines?\n- Filler reactions\n  - Swelling at the site of cosmetic fillers has been reported after COVID-19 vaccination. Reports have identified patients with facial swelling after both Moderna and Pfizer vaccines associated with prior use of injectable cosmetic filler.\n  - May indicate delayed hypersensitivity to filler following introduction of an immunologic trigger. Similar reactions have been previously noted after other viral illnesses and influenza vaccines.\n- [Erythromelalgia](https:\/\/dermnetnz.org\/topics\/erythromelalgia)\n  - Erythromelalgia has also been reported in response to other vaccines such as those for influenza and hepatitis B.\n- [Pernio\/chilblains](https:\/\/dermnetnz.org\/topics\/chilblains)\n  - Mimics dermatologic manifestations of COVID-19 (COVID toes)\n  - Potentially suggests that the host immune response to the virus is being replicated by the vaccine\n- [Pityriasis rosea](https:\/\/dermnetnz.org\/topics\/pityriasis-rosea)\n  - Reported with both COVID-19 infection and COVID-19 vaccines.\n- [Varicella zoster](https:\/\/dermnetnz.org\/topics\/chickenpox) and [herpes simplex](https:\/\/dermnetnz.org\/topics\/herpes-simplex) flares\n  - Case reports have documented flares following COVID-19 vaccination.\n- [Raynaud phenomenon](https:\/\/dermnetnz.org\/topics\/raynaud-phenomenon)\n  - A case has been reported occurring 2 weeks after the COVID-19 vaccine.\n## What are the uncommon serious skin reactions to COVID-19 vaccines?\n- [Bullous pemphigoid](https:\/\/dermnetnz.org\/topics\/bullous-pemphigoid)\n  - Relapses of autoimmune bullous disease have been reported\n  - Onset within 3 days – 2 weeks following vaccination.\n- [Subacute cutaneous lupus erythematosus](https:\/\/dermnetnz.org\/topics\/subacute-cutaneous-lupus-erythematosus)\n  - Induction and flares have been reported.\n  - Onset days to weeks following vaccination.\n- Exacerbation of underlying skin condition\n  - COVID-19 vaccination may trigger exacerbation of a pre-existing inflammatory skin condition such as [psoriasis](https:\/\/dermnetnz.org\/topics\/psoriasis) and [atopic dermatitis](https:\/\/dermnetnz.org\/topics\/atopic-dermatitis). However, a recent study involving over 2000 individuals did not show that vaccination statistically significantly exacerbated either atopic eczema or psoriasis.\n- [Lichen planus](https:\/\/dermnetnz.org\/topics\/lichen-planus)\n  - The vaccine leads to increased levels of IL-2, TNF\\-α, and IFN-γ — the exact cytokines involved in the development of lichen planus. Reports of this condition following vaccination have been made.\n- [Erythema multiforme](https:\/\/dermnetnz.org\/topics\/erythema-multiforme)\n  - Linked to the first dose of Moderna COVID-19 vaccine.\n  - It should be noted that major-type EM is considered to be a continuous spectrum with life-threatening toxic anti-epithelial reactions (e.g., Stevens–Johnson syndrome, toxic epidermal necrolysis).\n- Neutrophilic and Pustular Drug Reactions\n  - Both [acute generalised exanthematous pustulosis (AGEP)](https:\/\/dermnetnz.org\/topics\/acute-generalised-exanthematous-pustulosis) and a [pustular flare of psoriasis](https:\/\/dermnetnz.org\/topics\/generalised-pustular-psoriasis) associated with an inactivated viral vector COVID-19 vaccine have been published.\n  - A further case report was classified as an overlap between AGEP and [drug reaction with eosinophilia and systemic symptoms (DRESS)](https:\/\/dermnetnz.org\/topics\/drug-hypersensitivity-syndrome) associated with COVID-19 vaccination.\n- [Anaphylaxis](https:\/\/dermnetnz.org\/topics\/anaphylaxis)\n  - Rare even with rates of 4.7 cases\/million doses of the Pfizer-BioNTech and 2.5 cases\/million doses of the Moderna vaccine\n  - Anaphylaxis to vaccines generally is usually due to individual vaccine components, such as egg protein, gelatin, and other additives. However, the cause of vaccine anaphylaxis with the COVID-19 vaccine cases is unclear, but polyethylene glycol (PEG 2000) is a candidate allergen.\n  - Common signs and symptoms include generalised [urticaria](https:\/\/dermnetnz.org\/topics\/urticaria-an-overview), [angioedema](https:\/\/dermnetnz.org\/topics\/angioedema), and respiratory and airway obstruction symptoms.\n  - Onset is typically within minutes to hours of administration.\n\nAlthough the Pfizer\/BioNTech vaccine contains a number of excipients, PEG 2000 is the only one reported to cause anaphylaxis. The Oxford-AstraZeneca vaccine does not contain PEG 2000 so is an alternative for people with a history of allergy to PEG 2000. However, there is occasional cross-reactivity between PEG and polysorbate 80, an ingredient in the Oxford-AstraZeneca vaccine. Evaluation by an allergy specialist may be advisable before vaccination in anyone with a suspected PEG allergy.\n\nContraindications for receipt of the mRNA COVID-19 vaccines include:\n\n- Known history of a severe allergic reaction to any vaccine component, including the excipient PEG 2000\n- An allergic reaction to a previous dose of an mRNA vaccine.\n\nIdentification of risk factors for allergy symptoms after COVID-19 vaccination will guide safe vaccination practices for individuals at the highest risk.\n\n## How are the COVID-19 skin reactions treated?\nSevere cutaneous adverse reactions are very rare. The established vaccines have a satisfactory safety profile. Management should be directed at the presenting skin condition, however most of the encountered skin reactions are self-limiting.\n\n[Anaphylaxis](https:\/\/dermnetnz.org\/topics\/anaphylaxis) requires prompt treatment with intramuscular adrenaline and oxygen.\n\nUnlike anaphylaxis, cutaneous adverse reactions alone are not a contraindication to re-vaccination. The available evidence supports that cutaneous reactions to COVID-19 vaccination are generally minor, self-limiting, and should not discourage vaccination.\n\nADVERTISEMENT\n\n### Bibliography\n- Al-Jighefee HT, Najjar H, Ahmed MN, Qush A, Awwad S, Kamareddine L. COVID-19 Vaccine Platforms: Challenges and Safety Contemplations. Vaccines (Basel). 2021;9(10):1196. doi: 10.3390\/vaccines9101196. [PubMed Central](https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC8537163\/)\n- Busto-Leis JM, Servera-Negre G, Mayor-Ibarguren A, et al. Pityriasis rosea, COVID-19 and vaccination: new keys to understand an old acquaintance. J Eur Acad Dermatol Venereol. 2021;35(8):e489–e491. doi:10.1111\/jdv.17301. [PubMed Central](https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC8242646\/)\n- Hiltun I, Sarriugarte J, Martínez-de-Espronceda I, et al. Lichen planus arising after COVID-19 vaccination. J Eur Acad Dermatol Venereol. 2021;35(7):e414–e415. doi:10.1111\/jdv.17221. [PubMed Central](https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC8250777\/)\n- Johnston MS, Galan A, Watsky KL, Little AJ. Delayed Localized Hypersensitivity Reactions to the Moderna COVID-19 Vaccine: A Case Series. JAMA Dermatol. 2021;157(6):716–20. [Journal](https:\/\/jamanetwork.com\/journals\/jamadermatology\/fullarticle\/2779643)\n- Joseph AK, Chong BF. Subacute cutaneous lupus erythematosus flare triggered by COVID-19 vaccine. Dermatol Ther. doi: 10.1111\/dth.15114. [Journal](https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/dth.15114)\n- Lospinoso K, Nichols CS, Malachowski SJ, Mochel MC, Nutan F. A case of severe cutaneous adverse reaction following administration of the Janssen Ad26.COV2.S COVID-19 vaccine. JAAD Case Rep. 2021;13:134–7. doi:10.1016\/j.jdcr.2021.05.010. [PubMed Central](https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC8149168\/)\n- McMahon DE, Amerson E, Rosenbach M, et al. Cutaneous reactions reported after Moderna and Pfizer COVID-19 vaccination: A registry-based study of 414 cases. J Am Acad Dermatol. 2021;85(1):46–55. doi:10.1016\/j.jaad.2021.03.092. [PubMed Central](https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC8024548\/)\n- Niebel D, Novak N, Wilhelmi J, et al. Cutaneous Adverse Reactions to COVID-19 Vaccines: Insights from an Immuno-Dermatological Perspective. Vaccines (Basel). 2021;9(9):944. doi:10.3390\/vaccines9090944. [PubMed Central](https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC8470727\/)\n- Robinson LB, Fu X, Hashimoto D, et al. Incidence of Cutaneous Reactions After Messenger RNA COVID-19 Vaccines. JAMA Dermatol. May 2021;157(8):1000–2. doi:10.1001\/jamadermatol.2021.2114. [Journal](https:\/\/jamanetwork.com\/journals\/jamadermatology\/fullarticle\/2781364)\n- Sellaturay P, Nasser S, Islam S, Gurugama P, Ewan PW. Polyethylene glycol (PEG) is a cause of anaphylaxis to the Pfizer\/BioNTech mRNA COVID-19 vaccine. Clin Exp Allergy. 2021;51(6):861–3. doi: 10.1111\/cea.13874. [Journal](https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/cea.13874)\n- Shimabukuro TT, Cole M, Su JR. Reports of Anaphylaxis After Receipt of mRNA COVID-19 Vaccines in the US-December 14, 2020-January 18, 2021. JAMA. 2021;325(11):1101–2. doi:10.1001\/jama.2021.1967. [Journal](https:\/\/jamanetwork.com\/journals\/jama\/fullarticle\/2776557)\n### On DermNet\n- [COVID-19](https:\/\/dermnetnz.org\/topics\/covid-19)\n- [COVID-19 immunisation and immunomodulators\/biologic agents](https:\/\/dermnetnz.org\/topics\/covid-19-immunisation-and-immunomodulatorsbiologic-agents)\n- [Dermatology patients and COVID-19](https:\/\/dermnetnz.org\/topics\/dermatology-patients-and-covid-19)\n- [Adverse cutaneous reactions to vaccines](https:\/\/dermnetnz.org\/topics\/adverse-cutaneous-reactions-to-vaccines)\n### Other websites\n- [COVID-19 vaccines](https:\/\/www.who.int\/emergencies\/diseases\/novel-coronavirus-2019\/covid-19-vaccines) — The World Health Organization (WHO)\n- [COVID-19 vaccine safety](https:\/\/www.cdc.gov\/coronavirus\/2019-ncov\/vaccines\/safety\/safety-of-vaccines.html) — Centre for Disease Control and Prevention (CDC)\n### Books about skin diseases\n- [Books about the skin](https:\/\/dermnetnz.org\/topics\/books-about-the-skin\/)\n- [*Dermatology Made Easy* - second edition](https:\/\/www.amazon.com\/Dermatology-Made-second-Amanda-Oakley-dp-1914961161\/dp\/1914961161\/ref=dp_ob_title_bk?&_encoding=UTF8&tag=nzdermnet-20&linkCode=ur2&linkId=2addc7901a76f7726fa42eeeea7a28ea&camp=1789&creative=9325)\n\nADVERTISEMENT\n\n### Other recommended articles\n![close](https:\/\/dermnetnz.org\/topics\/_resources\/themes\/mercury\/dist\/images\/svg\/close.svg)\n\nADVERTISEMENT\n\nADVERTISEMENT\n\nADVERTISEMENT\n\nADVERTISEMENT\n\nDo Not Sell or Share My Personal Information\n\nDo Not Sell or Share My Personal Information\n\n## Join our newsletter\n**RESOURCES**\n\n[Skin checker](https:\/\/dermnetnz.org\/dermdiag)  \n [PO-PASI scoring](https:\/\/dermnetnz.org\/resources\/psoriasis-po-pasi)  \n [AI image dataset](https:\/\/dermnetnz.org\/dermatology-image-dataset)  \n [Quizzes](https:\/\/dermnetnz.org\/quizzes)  \n [Glossary](https:\/\/dermnetnz.org\/glossary)  \n [Translate](https:\/\/dermnetnz.org\/about\/translate)\n\n**CONTACT**\n\n[Contact us](https:\/\/dermnetnz.org\/contact-us)  \n [Website feedback](https:\/\/dermnetnz.org\/contact-us\/website-feedback)  \n [Volunteer](https:\/\/dermnetnz.org\/volunteer)  \n [Donate](https:\/\/dermnetnz.org\/donate)\n\n**ABOUT**\n\n[About DermNet](https:\/\/dermnetnz.org\/about)  \n [Editorial process](https:\/\/dermnetnz.org\/about\/editorial-process)  \n [Website terms](https:\/\/dermnetnz.org\/terms)  \n [Image licence](https:\/\/dermnetnz.org\/image-licence)  \n [FAQ](https:\/\/dermnetnz.org\/faq)\n\n[![DermNet®](https:\/\/dermnetnz.org\/topics\/_resources\/themes\/mercury\/dist\/images\/svg\/logo-white-tm.svg)](https:\/\/dermnetnz.org\/ \"DermNet®\")\n\n[Privacy policy](https:\/\/dermnetnz.org\/privacy-policy)   © DermNet® 2026\n\n[![Social link facebook](https:\/\/dermnetnz.org\/topics\/_resources\/themes\/mercury\/dist\/images\/svg\/footer-facebook.svg)](https:\/\/www.facebook.com\/dermnetnz\/)   [![Social link instagram](https:\/\/dermnetnz.org\/topics\/_resources\/themes\/mercury\/dist\/images\/svg\/footer-instagram.svg)](https:\/\/www.instagram.com\/dermnet)   [![Social link x](https:\/\/dermnetnz.org\/topics\/_resources\/themes\/mercury\/dist\/images\/svg\/footer-x.svg)](https:\/\/twitter.com\/dermnetnz)\n\n**IMPORTANT NOTICE:** DermNet does not provide a free online consultation service. If you have any concerns with your skin or its treatment, see a dermatologist for advice.","attrs_readable_markdown":"[![DermNet](https:\/\/dermnetnz.org\/_resources\/themes\/mercury\/dist\/images\/svg\/logo-white-tm.svg)](https:\/\/dermnetnz.org\/ \"DermNet\")\n\nSkin reactions to COVID-19 vaccines — extra information\n\nSynonyms:\n\ncoronavirus vaccine skin reactions, SARS-CoV-2 vaccination, Coronavirus vaccine reactions\n\nCategories:\n\nReactions\n\nICD-10:\n\nT50.B95A\n\nICD-11:\n\nXM68M6\n\nSNOMED CT:\n\n1156256003, 1142181004, 1145003007\n\n**[Reactions](https:\/\/dermnetnz.org\/topics?category=Reactions)**\n\nAuthors: Dr Sarah Elyoussfi (Dermatology Registrar) and Dr Ian Coulson (Consultant Dermatologist), Department of Dermatology, East Lancashire NHS Trust, United Kingdom. Copy edited by Gus Mitchell. December 2021. Further updated May 2023\n\n[Introduction](https:\/\/dermnetnz.org\/topics\/skin-reactions-to-covid-19-vaccines#Introduction<br%20\/>)  [Vaccine differences](https:\/\/dermnetnz.org\/topics\/skin-reactions-to-covid-19-vaccines#Vaccine%20differences<br%20\/>)  [Common skin reactions](https:\/\/dermnetnz.org\/topics\/skin-reactions-to-covid-19-vaccines#Common%20skin%20reactions<br%20\/>)  [Incidence of skin reactions](https:\/\/dermnetnz.org\/topics\/skin-reactions-to-covid-19-vaccines#Incidence%20of%20skin%20reactions<br%20\/>)  [Uncommon mild skin reactions](https:\/\/dermnetnz.org\/topics\/skin-reactions-to-covid-19-vaccines#Uncommon%20mild%20skin%20reactions<br%20\/>)  [Uncommon serious skin reactions](https:\/\/dermnetnz.org\/topics\/skin-reactions-to-covid-19-vaccines#Uncommon%20serious%20skin%20reactions<br%20\/>)  [Skin reaction treatment](https:\/\/dermnetnz.org\/topics\/skin-reactions-to-covid-19-vaccines#Skin%20reaction%20treatment)\n\n## What are the COVID-19 vaccines?\nThe [coronavirus disease 2019 (COVID-19)](https:\/\/dermnetnz.org\/topics\/covid-19) pandemic has led to the development and approval of vaccines against the responsible virus — severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). More than 100 companies and institutions worldwide have developed vaccine candidates.\n\n## How do the COVID-19 vaccines differ?\nCurrent approved [vaccines](https:\/\/dermnetnz.org\/topics\/covid-19-immunisation-and-immunomodulatorsbiologic-agents) rely on a nucleic-acid-based vaccine platform\n\n- Messenger ribonucleic acid (mRNA) eg, Pfizer\/BioNTech + Fosun Pharma, Moderna + National Institute of Allergy and Infectious Diseases\n- Viral vector platforms eg, AstraZeneca + University of Oxford, Janssen Pharmaceutical\n- Inactivated virus eg, Sinopharm + China National Biotec Group Co\n- Protein subunit vaccines eg, Novavax (not yet approved in any country)\n## What are the common types of skin reaction to COVID-19 vaccines?\nThe majority of current literature regarding cutaneous reactions relate specifically to mRNA COVID-19 vaccinations.\n\nThe spectrum of reported cutaneous reactions after mRNA vaccination include:\n\n- [Local site reaction](https:\/\/dermnetnz.org\/topics\/adverse-cutaneous-reactions-to-vaccines)\n  - Swelling, erythema, and pain in the vaccinated arm.\n  - Median onset of 1 day after vaccination.\n- [Urticaria](https:\/\/dermnetnz.org\/topics\/urticaria-an-overview)\n  - Median onset reported on day 2–3 after vaccination.\n  - Common sites include arms (68%), trunk (57%), and legs (46%).\n- Morbilliform eruptions\n  - Median onset reported on day 2–3 after vaccination.\n  - Common sites include the arm (62%), legs (27%), and trunk (42%).\n- Delayed large local reaction (“COVID arm\")\n  - The COVID-19 vaccines may cause a delayed localized hypersensitivity reaction presenting as a pruritic and painful erythematous reaction near the injection site.\n  - Median development of 7 days after vaccine administration with a median duration of 5 days, but can persist for up to 21 days.\n  - Pink plaques are variably oedematous and typically homogenous or less commonly annular.\n  - [Sweet syndrome](https:\/\/dermnetnz.org\/topics\/acute-febrile-neutrophilic-dermatosis)\\-like local reactions have been reported.\n  - Treatments include [topical steroids](https:\/\/dermnetnz.org\/topics\/topical-steroid), [oral antihistamines](https:\/\/dermnetnz.org\/topics\/antihistamines), and [cool compresses](https:\/\/dermnetnz.org\/topics\/compression-therapy), but lesions are usually self-limiting.\n  - [Eosinophilic pustular folliculitis](https:\/\/dermnetnz.org\/topics\/eosinophilic-pustular-folliculitis) may be triggered by Covid vaccines.\n## How common are cutaneous reactions after COVID-19 vaccination?\nIn one study, cutaneous reactions within 3 days after receiving the vaccine were reported in 1.9% of individuals after receiving their first dose of the mRNA COVID vaccine (Pfizer-BioNtech and Moderna).\n\nThe majority of cutaneous reactions after COVID-19 vaccination occur in women (around 90%). Erythema and itching (other than at the injection site) was the most common cutaneous reaction, which was reported by 1%.\n\nIn a study (May, 2021) of those with a self-reported cutaneous reaction to the first dose, 95% received their second dose. Among those who completed a symptom survey after the second dose, 83% reported no recurrent cutaneous reactions.\n\nHowever, a different study (July, 2021) reported that 43% of patients receiving an mRNA COVID-19 vaccine who reported first-dose reactions, experienced a second-dose recurrence.\n\n## What are the uncommon mild skin reactions to COVID-19 vaccines?\n- Filler reactions\n  - Swelling at the site of cosmetic fillers has been reported after COVID-19 vaccination. Reports have identified patients with facial swelling after both Moderna and Pfizer vaccines associated with prior use of injectable cosmetic filler.\n  - May indicate delayed hypersensitivity to filler following introduction of an immunologic trigger. Similar reactions have been previously noted after other viral illnesses and influenza vaccines.\n- [Erythromelalgia](https:\/\/dermnetnz.org\/topics\/erythromelalgia)\n  - Erythromelalgia has also been reported in response to other vaccines such as those for influenza and hepatitis B.\n- [Pernio\/chilblains](https:\/\/dermnetnz.org\/topics\/chilblains)\n  - Mimics dermatologic manifestations of COVID-19 (COVID toes)\n  - Potentially suggests that the host immune response to the virus is being replicated by the vaccine\n- [Pityriasis rosea](https:\/\/dermnetnz.org\/topics\/pityriasis-rosea)\n  - Reported with both COVID-19 infection and COVID-19 vaccines.\n- [Varicella zoster](https:\/\/dermnetnz.org\/topics\/chickenpox) and [herpes simplex](https:\/\/dermnetnz.org\/topics\/herpes-simplex) flares\n  - Case reports have documented flares following COVID-19 vaccination.\n- [Raynaud phenomenon](https:\/\/dermnetnz.org\/topics\/raynaud-phenomenon)\n  - A case has been reported occurring 2 weeks after the COVID-19 vaccine.\n## What are the uncommon serious skin reactions to COVID-19 vaccines?\n- [Bullous pemphigoid](https:\/\/dermnetnz.org\/topics\/bullous-pemphigoid)\n  - Relapses of autoimmune bullous disease have been reported\n  - Onset within 3 days – 2 weeks following vaccination.\n- [Subacute cutaneous lupus erythematosus](https:\/\/dermnetnz.org\/topics\/subacute-cutaneous-lupus-erythematosus)\n  - Induction and flares have been reported.\n  - Onset days to weeks following vaccination.\n- Exacerbation of underlying skin condition\n  - COVID-19 vaccination may trigger exacerbation of a pre-existing inflammatory skin condition such as [psoriasis](https:\/\/dermnetnz.org\/topics\/psoriasis) and [atopic dermatitis](https:\/\/dermnetnz.org\/topics\/atopic-dermatitis). However, a recent study involving over 2000 individuals did not show that vaccination statistically significantly exacerbated either atopic eczema or psoriasis.\n- [Lichen planus](https:\/\/dermnetnz.org\/topics\/lichen-planus)\n  - The vaccine leads to increased levels of IL-2, TNF\\-α, and IFN-γ — the exact cytokines involved in the development of lichen planus. Reports of this condition following vaccination have been made.\n- [Erythema multiforme](https:\/\/dermnetnz.org\/topics\/erythema-multiforme)\n  - Linked to the first dose of Moderna COVID-19 vaccine.\n  - It should be noted that major-type EM is considered to be a continuous spectrum with life-threatening toxic anti-epithelial reactions (e.g., Stevens–Johnson syndrome, toxic epidermal necrolysis).\n- Neutrophilic and Pustular Drug Reactions\n  - Both [acute generalised exanthematous pustulosis (AGEP)](https:\/\/dermnetnz.org\/topics\/acute-generalised-exanthematous-pustulosis) and a [pustular flare of psoriasis](https:\/\/dermnetnz.org\/topics\/generalised-pustular-psoriasis) associated with an inactivated viral vector COVID-19 vaccine have been published.\n  - A further case report was classified as an overlap between AGEP and [drug reaction with eosinophilia and systemic symptoms (DRESS)](https:\/\/dermnetnz.org\/topics\/drug-hypersensitivity-syndrome) associated with COVID-19 vaccination.\n- [Anaphylaxis](https:\/\/dermnetnz.org\/topics\/anaphylaxis)\n  - Rare even with rates of 4.7 cases\/million doses of the Pfizer-BioNTech and 2.5 cases\/million doses of the Moderna vaccine\n  - Anaphylaxis to vaccines generally is usually due to individual vaccine components, such as egg protein, gelatin, and other additives. However, the cause of vaccine anaphylaxis with the COVID-19 vaccine cases is unclear, but polyethylene glycol (PEG 2000) is a candidate allergen.\n  - Common signs and symptoms include generalised [urticaria](https:\/\/dermnetnz.org\/topics\/urticaria-an-overview), [angioedema](https:\/\/dermnetnz.org\/topics\/angioedema), and respiratory and airway obstruction symptoms.\n  - Onset is typically within minutes to hours of administration.\n\nAlthough the Pfizer\/BioNTech vaccine contains a number of excipients, PEG 2000 is the only one reported to cause anaphylaxis. The Oxford-AstraZeneca vaccine does not contain PEG 2000 so is an alternative for people with a history of allergy to PEG 2000. However, there is occasional cross-reactivity between PEG and polysorbate 80, an ingredient in the Oxford-AstraZeneca vaccine. Evaluation by an allergy specialist may be advisable before vaccination in anyone with a suspected PEG allergy.\n\nContraindications for receipt of the mRNA COVID-19 vaccines include:\n\n- Known history of a severe allergic reaction to any vaccine component, including the excipient PEG 2000\n- An allergic reaction to a previous dose of an mRNA vaccine.\n\nIdentification of risk factors for allergy symptoms after COVID-19 vaccination will guide safe vaccination practices for individuals at the highest risk.\n\n## How are the COVID-19 skin reactions treated?\nSevere cutaneous adverse reactions are very rare. The established vaccines have a satisfactory safety profile. Management should be directed at the presenting skin condition, however most of the encountered skin reactions are self-limiting.\n\n[Anaphylaxis](https:\/\/dermnetnz.org\/topics\/anaphylaxis) requires prompt treatment with intramuscular adrenaline and oxygen.\n\nUnlike anaphylaxis, cutaneous adverse reactions alone are not a contraindication to re-vaccination. The available evidence supports that cutaneous reactions to COVID-19 vaccination are generally minor, self-limiting, and should not discourage vaccination.\n\n### Bibliography\n- Al-Jighefee HT, Najjar H, Ahmed MN, Qush A, Awwad S, Kamareddine L. COVID-19 Vaccine Platforms: Challenges and Safety Contemplations. Vaccines (Basel). 2021;9(10):1196. doi: 10.3390\/vaccines9101196. [PubMed Central](https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC8537163\/)\n- Busto-Leis JM, Servera-Negre G, Mayor-Ibarguren A, et al. Pityriasis rosea, COVID-19 and vaccination: new keys to understand an old acquaintance. J Eur Acad Dermatol Venereol. 2021;35(8):e489–e491. doi:10.1111\/jdv.17301. [PubMed Central](https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC8242646\/)\n- Hiltun I, Sarriugarte J, Martínez-de-Espronceda I, et al. Lichen planus arising after COVID-19 vaccination. J Eur Acad Dermatol Venereol. 2021;35(7):e414–e415. doi:10.1111\/jdv.17221. [PubMed Central](https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC8250777\/)\n- Johnston MS, Galan A, Watsky KL, Little AJ. Delayed Localized Hypersensitivity Reactions to the Moderna COVID-19 Vaccine: A Case Series. JAMA Dermatol. 2021;157(6):716–20. [Journal](https:\/\/jamanetwork.com\/journals\/jamadermatology\/fullarticle\/2779643)\n- Joseph AK, Chong BF. Subacute cutaneous lupus erythematosus flare triggered by COVID-19 vaccine. Dermatol Ther. doi: 10.1111\/dth.15114. [Journal](https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/dth.15114)\n- Lospinoso K, Nichols CS, Malachowski SJ, Mochel MC, Nutan F. A case of severe cutaneous adverse reaction following administration of the Janssen Ad26.COV2.S COVID-19 vaccine. JAAD Case Rep. 2021;13:134–7. doi:10.1016\/j.jdcr.2021.05.010. [PubMed Central](https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC8149168\/)\n- McMahon DE, Amerson E, Rosenbach M, et al. Cutaneous reactions reported after Moderna and Pfizer COVID-19 vaccination: A registry-based study of 414 cases. J Am Acad Dermatol. 2021;85(1):46–55. doi:10.1016\/j.jaad.2021.03.092. [PubMed Central](https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC8024548\/)\n- Niebel D, Novak N, Wilhelmi J, et al. Cutaneous Adverse Reactions to COVID-19 Vaccines: Insights from an Immuno-Dermatological Perspective. Vaccines (Basel). 2021;9(9):944. doi:10.3390\/vaccines9090944. [PubMed Central](https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC8470727\/)\n- Robinson LB, Fu X, Hashimoto D, et al. Incidence of Cutaneous Reactions After Messenger RNA COVID-19 Vaccines. JAMA Dermatol. May 2021;157(8):1000–2. doi:10.1001\/jamadermatol.2021.2114. [Journal](https:\/\/jamanetwork.com\/journals\/jamadermatology\/fullarticle\/2781364)\n- Sellaturay P, Nasser S, Islam S, Gurugama P, Ewan PW. Polyethylene glycol (PEG) is a cause of anaphylaxis to the Pfizer\/BioNTech mRNA COVID-19 vaccine. Clin Exp Allergy. 2021;51(6):861–3. doi: 10.1111\/cea.13874. [Journal](https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/cea.13874)\n- Shimabukuro TT, Cole M, Su JR. Reports of Anaphylaxis After Receipt of mRNA COVID-19 Vaccines in the US-December 14, 2020-January 18, 2021. JAMA. 2021;325(11):1101–2. doi:10.1001\/jama.2021.1967. [Journal](https:\/\/jamanetwork.com\/journals\/jama\/fullarticle\/2776557)\n### On DermNet\n- [COVID-19](https:\/\/dermnetnz.org\/topics\/covid-19)\n- [COVID-19 immunisation and immunomodulators\/biologic agents](https:\/\/dermnetnz.org\/topics\/covid-19-immunisation-and-immunomodulatorsbiologic-agents)\n- [Dermatology patients and COVID-19](https:\/\/dermnetnz.org\/topics\/dermatology-patients-and-covid-19)\n- [Adverse cutaneous reactions to vaccines](https:\/\/dermnetnz.org\/topics\/adverse-cutaneous-reactions-to-vaccines)\n### Other websites\n- [COVID-19 vaccines](https:\/\/www.who.int\/emergencies\/diseases\/novel-coronavirus-2019\/covid-19-vaccines) — The World Health Organization (WHO)\n- [COVID-19 vaccine safety](https:\/\/www.cdc.gov\/coronavirus\/2019-ncov\/vaccines\/safety\/safety-of-vaccines.html) — Centre for Disease Control and Prevention (CDC)\n### Books about skin diseases\n- [Books about the skin](https:\/\/dermnetnz.org\/topics\/books-about-the-skin\/)\n- [*Dermatology Made Easy* - second edition](https:\/\/www.amazon.com\/Dermatology-Made-second-Amanda-Oakley-dp-1914961161\/dp\/1914961161\/ref=dp_ob_title_bk?&_encoding=UTF8&tag=nzdermnet-20&linkCode=ur2&linkId=2addc7901a76f7726fa42eeeea7a28ea&camp=1789&creative=9325)\n\nOther recommended articles","meta_canonical":null}

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Boilerpipe Text	Skin reactions to COVID-19 vaccines — extra information Synonyms: coronavirus vaccine skin reactions, SARS-CoV-2 vaccination, Coronavirus vaccine reactions Categories: Reactions ICD-10: T50.B95A ICD-11: XM68M6 SNOMED CT: 1156256003, 1142181004, 1145003007 Reactions Authors: Dr Sarah Elyoussfi (Dermatology Registrar) and Dr Ian Coulson (Consultant Dermatologist), Department of Dermatology, East Lancashire NHS Trust, United Kingdom. Copy edited by Gus Mitchell. December 2021. Further updated May 2023 Introduction Vaccine differences Common skin reactions Incidence of skin reactions Uncommon mild skin reactions Uncommon serious skin reactions Skin reaction treatment What are the COVID-19 vaccines? The coronavirus disease 2019 (COVID-19) pandemic has led to the development and approval of vaccines against the responsible virus — severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). More than 100 companies and institutions worldwide have developed vaccine candidates. How do the COVID-19 vaccines differ? Current approved vaccines rely on a nucleic-acid-based vaccine platform Messenger ribonucleic acid ( mRNA ) eg, Pfizer/BioNTech + Fosun Pharma, Moderna + National Institute of Allergy and Infectious Diseases Viral vector platforms eg, AstraZeneca + University of Oxford, Janssen Pharmaceutical Inactivated virus eg, Sinopharm + China National Biotec Group Co Protein subunit vaccines eg, Novavax (not yet approved in any country) What are the common types of skin reaction to COVID-19 vaccines? The majority of current literature regarding cutaneous reactions relate specifically to mRNA COVID-19 vaccinations. The spectrum of reported cutaneous reactions after mRNA vaccination include: Local site reaction Swelling, erythema , and pain in the vaccinated arm. Median onset of 1 day after vaccination. Urticaria Median onset reported on day 2–3 after vaccination. Common sites include arms (68%), trunk (57%), and legs (46%). Morbilliform eruptions Median onset reported on day 2–3 after vaccination. Common sites include the arm (62%), legs (27%), and trunk (42%). Delayed large local reaction (“COVID arm") The COVID-19 vaccines may cause a delayed localized hypersensitivity reaction presenting as a pruritic and painful erythematous reaction near the injection site. Median development of 7 days after vaccine administration with a median duration of 5 days, but can persist for up to 21 days. Pink plaques are variably oedematous and typically homogenous or less commonly annular. Sweet syndrome -like local reactions have been reported. Treatments include topical steroids , oral antihistamines , and cool compresses , but lesions are usually self-limiting. Eosinophilic pustular folliculitis may be triggered by Covid vaccines. How common are cutaneous reactions after COVID-19 vaccination? In one study, cutaneous reactions within 3 days after receiving the vaccine were reported in 1.9% of individuals after receiving their first dose of the mRNA COVID vaccine (Pfizer-BioNtech and Moderna). The majority of cutaneous reactions after COVID-19 vaccination occur in women (around 90%). Erythema and itching (other than at the injection site) was the most common cutaneous reaction, which was reported by 1%. In a study (May, 2021) of those with a self-reported cutaneous reaction to the first dose, 95% received their second dose. Among those who completed a symptom survey after the second dose, 83% reported no recurrent cutaneous reactions. However, a different study (July, 2021) reported that 43% of patients receiving an mRNA COVID-19 vaccine who reported first-dose reactions, experienced a second-dose recurrence. What are the uncommon mild skin reactions to COVID-19 vaccines? Filler reactions Swelling at the site of cosmetic fillers has been reported after COVID-19 vaccination. Reports have identified patients with facial swelling after both Moderna and Pfizer vaccines associated with prior use of injectable cosmetic filler. May indicate delayed hypersensitivity to filler following introduction of an immunologic trigger. Similar reactions have been previously noted after other viral illnesses and influenza vaccines. Erythromelalgia Erythromelalgia has also been reported in response to other vaccines such as those for influenza and hepatitis B. Pernio/chilblains Mimics dermatologic manifestations of COVID-19 (COVID toes) Potentially suggests that the host immune response to the virus is being replicated by the vaccine Pityriasis rosea Reported with both COVID-19 infection and COVID-19 vaccines. Varicella zoster and herpes simplex flares Case reports have documented flares following COVID-19 vaccination. Raynaud phenomenon A case has been reported occurring 2 weeks after the COVID-19 vaccine. What are the uncommon serious skin reactions to COVID-19 vaccines? Bullous pemphigoid Relapses of autoimmune bullous disease have been reported Onset within 3 days – 2 weeks following vaccination. Subacute cutaneous lupus erythematosus Induction and flares have been reported. Onset days to weeks following vaccination. Exacerbation of underlying skin condition COVID-19 vaccination may trigger exacerbation of a pre-existing inflammatory skin condition such as psoriasis and atopic dermatitis . However, a recent study involving over 2000 individuals did not show that vaccination statistically significantly exacerbated either atopic eczema or psoriasis. Lichen planus The vaccine leads to increased levels of IL-2, TNF -α, and IFN-γ — the exact cytokines involved in the development of lichen planus. Reports of this condition following vaccination have been made. Erythema multiforme Linked to the first dose of Moderna COVID-19 vaccine. It should be noted that major-type EM is considered to be a continuous spectrum with life-threatening toxic anti- epithelial reactions (e.g., Stevens–Johnson syndrome, toxic epidermal necrolysis). Neutrophilic and Pustular Drug Reactions Both acute generalised exanthematous pustulosis (AGEP) and a pustular flare of psoriasis associated with an inactivated viral vector COVID-19 vaccine have been published. A further case report was classified as an overlap between AGEP and drug reaction with eosinophilia and systemic symptoms (DRESS) associated with COVID-19 vaccination. Anaphylaxis Rare even with rates of 4.7 cases/million doses of the Pfizer-BioNTech and 2.5 cases/million doses of the Moderna vaccine Anaphylaxis to vaccines generally is usually due to individual vaccine components, such as egg protein, gelatin, and other additives. However, the cause of vaccine anaphylaxis with the COVID-19 vaccine cases is unclear, but polyethylene glycol (PEG 2000) is a candidate allergen. Common signs and symptoms include generalised urticaria , angioedema , and respiratory and airway obstruction symptoms. Onset is typically within minutes to hours of administration. Although the Pfizer/BioNTech vaccine contains a number of excipients , PEG 2000 is the only one reported to cause anaphylaxis. The Oxford-AstraZeneca vaccine does not contain PEG 2000 so is an alternative for people with a history of allergy to PEG 2000. However, there is occasional cross-reactivity between PEG and polysorbate 80, an ingredient in the Oxford-AstraZeneca vaccine. Evaluation by an allergy specialist may be advisable before vaccination in anyone with a suspected PEG allergy. Contraindications for receipt of the mRNA COVID-19 vaccines include: Known history of a severe allergic reaction to any vaccine component, including the excipient PEG 2000 An allergic reaction to a previous dose of an mRNA vaccine. Identification of risk factors for allergy symptoms after COVID-19 vaccination will guide safe vaccination practices for individuals at the highest risk. How are the COVID-19 skin reactions treated? Severe cutaneous adverse reactions are very rare. The established vaccines have a satisfactory safety profile. Management should be directed at the presenting skin condition, however most of the encountered skin reactions are self-limiting. Anaphylaxis requires prompt treatment with intramuscular adrenaline and oxygen. Unlike anaphylaxis, cutaneous adverse reactions alone are not a contraindication to re-vaccination. The available evidence supports that cutaneous reactions to COVID-19 vaccination are generally minor, self-limiting, and should not discourage vaccination. Bibliography Al-Jighefee HT, Najjar H, Ahmed MN, Qush A, Awwad S, Kamareddine L. COVID-19 Vaccine Platforms: Challenges and Safety Contemplations. Vaccines (Basel). 2021;9(10):1196. doi: 10.3390/vaccines9101196. PubMed Central Busto-Leis JM, Servera-Negre G, Mayor-Ibarguren A, et al. Pityriasis rosea, COVID-19 and vaccination: new keys to understand an old acquaintance. J Eur Acad Dermatol Venereol. 2021;35(8):e489–e491. doi:10.1111/jdv.17301. PubMed Central Hiltun I, Sarriugarte J, Martínez-de-Espronceda I, et al. Lichen planus arising after COVID-19 vaccination. J Eur Acad Dermatol Venereol. 2021;35(7):e414–e415. doi:10.1111/jdv.17221. PubMed Central Johnston MS, Galan A, Watsky KL, Little AJ. Delayed Localized Hypersensitivity Reactions to the Moderna COVID-19 Vaccine: A Case Series. JAMA Dermatol. 2021;157(6):716–20. Journal Joseph AK, Chong BF. Subacute cutaneous lupus erythematosus flare triggered by COVID-19 vaccine. Dermatol Ther. doi: 10.1111/dth.15114. Journal Lospinoso K, Nichols CS, Malachowski SJ, Mochel MC, Nutan F. A case of severe cutaneous adverse reaction following administration of the Janssen Ad26.COV2.S COVID-19 vaccine. JAAD Case Rep. 2021;13:134–7. doi:10.1016/j.jdcr.2021.05.010. PubMed Central McMahon DE, Amerson E, Rosenbach M, et al. Cutaneous reactions reported after Moderna and Pfizer COVID-19 vaccination: A registry-based study of 414 cases. J Am Acad Dermatol. 2021;85(1):46–55. doi:10.1016/j.jaad.2021.03.092. PubMed Central Niebel D, Novak N, Wilhelmi J, et al. Cutaneous Adverse Reactions to COVID-19 Vaccines: Insights from an Immuno-Dermatological Perspective. Vaccines (Basel). 2021;9(9):944. doi:10.3390/vaccines9090944. PubMed Central Robinson LB, Fu X, Hashimoto D, et al. Incidence of Cutaneous Reactions After Messenger RNA COVID-19 Vaccines. JAMA Dermatol. May 2021;157(8):1000–2. doi:10.1001/jamadermatol.2021.2114. Journal Sellaturay P, Nasser S, Islam S, Gurugama P, Ewan PW. Polyethylene glycol (PEG) is a cause of anaphylaxis to the Pfizer/BioNTech mRNA COVID-19 vaccine. Clin Exp Allergy. 2021;51(6):861–3. doi: 10.1111/cea.13874. Journal Shimabukuro TT, Cole M, Su JR. Reports of Anaphylaxis After Receipt of mRNA COVID-19 Vaccines in the US-December 14, 2020-January 18, 2021. JAMA. 2021;325(11):1101–2. doi:10.1001/jama.2021.1967. Journal On DermNet COVID-19 COVID-19 immunisation and immunomodulators/biologic agents Dermatology patients and COVID-19 Adverse cutaneous reactions to vaccines Other websites COVID-19 vaccines — The World Health Organization (WHO) COVID-19 vaccine safety — Centre for Disease Control and Prevention (CDC) Books about skin diseases Books about the skin Dermatology Made Easy - second edition Other recommended articles
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Copy edited by Gus Mitchell. December 2021. Further updated May 2023 [Introduction](https://dermnetnz.org/topics/skin-reactions-to-covid-19-vaccines#Introduction<br%20/>%0A) [Vaccine differences](https://dermnetnz.org/topics/skin-reactions-to-covid-19-vaccines#Vaccine%20differences<br%20/>%0A) [Common skin reactions](https://dermnetnz.org/topics/skin-reactions-to-covid-19-vaccines#Common%20skin%20reactions<br%20/>%0A) [Incidence of skin reactions](https://dermnetnz.org/topics/skin-reactions-to-covid-19-vaccines#Incidence%20of%20skin%20reactions<br%20/>%0A) [Uncommon mild skin reactions](https://dermnetnz.org/topics/skin-reactions-to-covid-19-vaccines#Uncommon%20mild%20skin%20reactions<br%20/>%0A) [Uncommon serious skin reactions](https://dermnetnz.org/topics/skin-reactions-to-covid-19-vaccines#Uncommon%20serious%20skin%20reactions<br%20/>%0A) [Skin reaction treatment](https://dermnetnz.org/topics/skin-reactions-to-covid-19-vaccines#Skin%20reaction%20treatment) ## What are the COVID-19 vaccines? The [coronavirus disease 2019 (COVID-19)](https://dermnetnz.org/topics/covid-19) pandemic has led to the development and approval of vaccines against the responsible virus — severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). More than 100 companies and institutions worldwide have developed vaccine candidates. ## How do the COVID-19 vaccines differ? Current approved [vaccines](https://dermnetnz.org/topics/covid-19-immunisation-and-immunomodulatorsbiologic-agents) rely on a nucleic-acid-based vaccine platform - Messenger ribonucleic acid (mRNA) eg, Pfizer/BioNTech + Fosun Pharma, Moderna + National Institute of Allergy and Infectious Diseases - Viral vector platforms eg, AstraZeneca + University of Oxford, Janssen Pharmaceutical - Inactivated virus eg, Sinopharm + China National Biotec Group Co - Protein subunit vaccines eg, Novavax (not yet approved in any country) ## What are the common types of skin reaction to COVID-19 vaccines? The majority of current literature regarding cutaneous reactions relate specifically to mRNA COVID-19 vaccinations. The spectrum of reported cutaneous reactions after mRNA vaccination include: - [Local site reaction](https://dermnetnz.org/topics/adverse-cutaneous-reactions-to-vaccines) - Swelling, erythema, and pain in the vaccinated arm. - Median onset of 1 day after vaccination. - [Urticaria](https://dermnetnz.org/topics/urticaria-an-overview) - Median onset reported on day 2–3 after vaccination. - Common sites include arms (68%), trunk (57%), and legs (46%). - Morbilliform eruptions - Median onset reported on day 2–3 after vaccination. - Common sites include the arm (62%), legs (27%), and trunk (42%). - Delayed large local reaction (“COVID arm") - The COVID-19 vaccines may cause a delayed localized hypersensitivity reaction presenting as a pruritic and painful erythematous reaction near the injection site. - Median development of 7 days after vaccine administration with a median duration of 5 days, but can persist for up to 21 days. - Pink plaques are variably oedematous and typically homogenous or less commonly annular. - [Sweet syndrome](https://dermnetnz.org/topics/acute-febrile-neutrophilic-dermatosis)\-like local reactions have been reported. - Treatments include [topical steroids](https://dermnetnz.org/topics/topical-steroid), [oral antihistamines](https://dermnetnz.org/topics/antihistamines), and [cool compresses](https://dermnetnz.org/topics/compression-therapy), but lesions are usually self-limiting. - [Eosinophilic pustular folliculitis](https://dermnetnz.org/topics/eosinophilic-pustular-folliculitis) may be triggered by Covid vaccines. ## How common are cutaneous reactions after COVID-19 vaccination? In one study, cutaneous reactions within 3 days after receiving the vaccine were reported in 1.9% of individuals after receiving their first dose of the mRNA COVID vaccine (Pfizer-BioNtech and Moderna). The majority of cutaneous reactions after COVID-19 vaccination occur in women (around 90%). Erythema and itching (other than at the injection site) was the most common cutaneous reaction, which was reported by 1%. In a study (May, 2021) of those with a self-reported cutaneous reaction to the first dose, 95% received their second dose. Among those who completed a symptom survey after the second dose, 83% reported no recurrent cutaneous reactions. However, a different study (July, 2021) reported that 43% of patients receiving an mRNA COVID-19 vaccine who reported first-dose reactions, experienced a second-dose recurrence. ## What are the uncommon mild skin reactions to COVID-19 vaccines? - Filler reactions - Swelling at the site of cosmetic fillers has been reported after COVID-19 vaccination. Reports have identified patients with facial swelling after both Moderna and Pfizer vaccines associated with prior use of injectable cosmetic filler. - May indicate delayed hypersensitivity to filler following introduction of an immunologic trigger. Similar reactions have been previously noted after other viral illnesses and influenza vaccines. - [Erythromelalgia](https://dermnetnz.org/topics/erythromelalgia) - Erythromelalgia has also been reported in response to other vaccines such as those for influenza and hepatitis B. - [Pernio/chilblains](https://dermnetnz.org/topics/chilblains) - Mimics dermatologic manifestations of COVID-19 (COVID toes) - Potentially suggests that the host immune response to the virus is being replicated by the vaccine - [Pityriasis rosea](https://dermnetnz.org/topics/pityriasis-rosea) - Reported with both COVID-19 infection and COVID-19 vaccines. - [Varicella zoster](https://dermnetnz.org/topics/chickenpox) and [herpes simplex](https://dermnetnz.org/topics/herpes-simplex) flares - Case reports have documented flares following COVID-19 vaccination. - [Raynaud phenomenon](https://dermnetnz.org/topics/raynaud-phenomenon) - A case has been reported occurring 2 weeks after the COVID-19 vaccine. ## What are the uncommon serious skin reactions to COVID-19 vaccines? - [Bullous pemphigoid](https://dermnetnz.org/topics/bullous-pemphigoid) - Relapses of autoimmune bullous disease have been reported - Onset within 3 days – 2 weeks following vaccination. - [Subacute cutaneous lupus erythematosus](https://dermnetnz.org/topics/subacute-cutaneous-lupus-erythematosus) - Induction and flares have been reported. - Onset days to weeks following vaccination. - Exacerbation of underlying skin condition - COVID-19 vaccination may trigger exacerbation of a pre-existing inflammatory skin condition such as [psoriasis](https://dermnetnz.org/topics/psoriasis) and [atopic dermatitis](https://dermnetnz.org/topics/atopic-dermatitis). However, a recent study involving over 2000 individuals did not show that vaccination statistically significantly exacerbated either atopic eczema or psoriasis. - [Lichen planus](https://dermnetnz.org/topics/lichen-planus) - The vaccine leads to increased levels of IL-2, TNF\-α, and IFN-γ — the exact cytokines involved in the development of lichen planus. Reports of this condition following vaccination have been made. - [Erythema multiforme](https://dermnetnz.org/topics/erythema-multiforme) - Linked to the first dose of Moderna COVID-19 vaccine. - It should be noted that major-type EM is considered to be a continuous spectrum with life-threatening toxic anti-epithelial reactions (e.g., Stevens–Johnson syndrome, toxic epidermal necrolysis). - Neutrophilic and Pustular Drug Reactions - Both [acute generalised exanthematous pustulosis (AGEP)](https://dermnetnz.org/topics/acute-generalised-exanthematous-pustulosis) and a [pustular flare of psoriasis](https://dermnetnz.org/topics/generalised-pustular-psoriasis) associated with an inactivated viral vector COVID-19 vaccine have been published. - A further case report was classified as an overlap between AGEP and [drug reaction with eosinophilia and systemic symptoms (DRESS)](https://dermnetnz.org/topics/drug-hypersensitivity-syndrome) associated with COVID-19 vaccination. - [Anaphylaxis](https://dermnetnz.org/topics/anaphylaxis) - Rare even with rates of 4.7 cases/million doses of the Pfizer-BioNTech and 2.5 cases/million doses of the Moderna vaccine - Anaphylaxis to vaccines generally is usually due to individual vaccine components, such as egg protein, gelatin, and other additives. However, the cause of vaccine anaphylaxis with the COVID-19 vaccine cases is unclear, but polyethylene glycol (PEG 2000) is a candidate allergen. - Common signs and symptoms include generalised [urticaria](https://dermnetnz.org/topics/urticaria-an-overview), [angioedema](https://dermnetnz.org/topics/angioedema), and respiratory and airway obstruction symptoms. - Onset is typically within minutes to hours of administration. Although the Pfizer/BioNTech vaccine contains a number of excipients, PEG 2000 is the only one reported to cause anaphylaxis. The Oxford-AstraZeneca vaccine does not contain PEG 2000 so is an alternative for people with a history of allergy to PEG 2000. However, there is occasional cross-reactivity between PEG and polysorbate 80, an ingredient in the Oxford-AstraZeneca vaccine. Evaluation by an allergy specialist may be advisable before vaccination in anyone with a suspected PEG allergy. Contraindications for receipt of the mRNA COVID-19 vaccines include: - Known history of a severe allergic reaction to any vaccine component, including the excipient PEG 2000 - An allergic reaction to a previous dose of an mRNA vaccine. Identification of risk factors for allergy symptoms after COVID-19 vaccination will guide safe vaccination practices for individuals at the highest risk. ## How are the COVID-19 skin reactions treated? Severe cutaneous adverse reactions are very rare. The established vaccines have a satisfactory safety profile. Management should be directed at the presenting skin condition, however most of the encountered skin reactions are self-limiting. [Anaphylaxis](https://dermnetnz.org/topics/anaphylaxis) requires prompt treatment with intramuscular adrenaline and oxygen. Unlike anaphylaxis, cutaneous adverse reactions alone are not a contraindication to re-vaccination. The available evidence supports that cutaneous reactions to COVID-19 vaccination are generally minor, self-limiting, and should not discourage vaccination. ADVERTISEMENT ### Bibliography - Al-Jighefee HT, Najjar H, Ahmed MN, Qush A, Awwad S, Kamareddine L. COVID-19 Vaccine Platforms: Challenges and Safety Contemplations. Vaccines (Basel). 2021;9(10):1196. doi: 10.3390/vaccines9101196. [PubMed Central](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8537163/) - Busto-Leis JM, Servera-Negre G, Mayor-Ibarguren A, et al. Pityriasis rosea, COVID-19 and vaccination: new keys to understand an old acquaintance. J Eur Acad Dermatol Venereol. 2021;35(8):e489–e491. doi:10.1111/jdv.17301. [PubMed Central](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8242646/) - Hiltun I, Sarriugarte J, Martínez-de-Espronceda I, et al. Lichen planus arising after COVID-19 vaccination. J Eur Acad Dermatol Venereol. 2021;35(7):e414–e415. doi:10.1111/jdv.17221. [PubMed Central](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8250777/) - Johnston MS, Galan A, Watsky KL, Little AJ. Delayed Localized Hypersensitivity Reactions to the Moderna COVID-19 Vaccine: A Case Series. JAMA Dermatol. 2021;157(6):716–20. [Journal](https://jamanetwork.com/journals/jamadermatology/fullarticle/2779643) - Joseph AK, Chong BF. Subacute cutaneous lupus erythematosus flare triggered by COVID-19 vaccine. Dermatol Ther. doi: 10.1111/dth.15114. [Journal](https://onlinelibrary.wiley.com/doi/10.1111/dth.15114) - Lospinoso K, Nichols CS, Malachowski SJ, Mochel MC, Nutan F. A case of severe cutaneous adverse reaction following administration of the Janssen Ad26.COV2.S COVID-19 vaccine. JAAD Case Rep. 2021;13:134–7. doi:10.1016/j.jdcr.2021.05.010. [PubMed Central](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8149168/) - McMahon DE, Amerson E, Rosenbach M, et al. Cutaneous reactions reported after Moderna and Pfizer COVID-19 vaccination: A registry-based study of 414 cases. J Am Acad Dermatol. 2021;85(1):46–55. doi:10.1016/j.jaad.2021.03.092. [PubMed Central](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8024548/) - Niebel D, Novak N, Wilhelmi J, et al. Cutaneous Adverse Reactions to COVID-19 Vaccines: Insights from an Immuno-Dermatological Perspective. Vaccines (Basel). 2021;9(9):944. doi:10.3390/vaccines9090944. [PubMed Central](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8470727/) - Robinson LB, Fu X, Hashimoto D, et al. Incidence of Cutaneous Reactions After Messenger RNA COVID-19 Vaccines. JAMA Dermatol. May 2021;157(8):1000–2. doi:10.1001/jamadermatol.2021.2114. [Journal](https://jamanetwork.com/journals/jamadermatology/fullarticle/2781364) - Sellaturay P, Nasser S, Islam S, Gurugama P, Ewan PW. Polyethylene glycol (PEG) is a cause of anaphylaxis to the Pfizer/BioNTech mRNA COVID-19 vaccine. Clin Exp Allergy. 2021;51(6):861–3. doi: 10.1111/cea.13874. [Journal](https://onlinelibrary.wiley.com/doi/10.1111/cea.13874) - Shimabukuro TT, Cole M, Su JR. Reports of Anaphylaxis After Receipt of mRNA COVID-19 Vaccines in the US-December 14, 2020-January 18, 2021. JAMA. 2021;325(11):1101–2. doi:10.1001/jama.2021.1967. 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Readable Markdown	[![DermNet](https://dermnetnz.org/_resources/themes/mercury/dist/images/svg/logo-white-tm.svg)](https://dermnetnz.org/ "DermNet") Skin reactions to COVID-19 vaccines — extra information Synonyms: coronavirus vaccine skin reactions, SARS-CoV-2 vaccination, Coronavirus vaccine reactions Categories: Reactions ICD-10: T50.B95A ICD-11: XM68M6 SNOMED CT: 1156256003, 1142181004, 1145003007 [Reactions](https://dermnetnz.org/topics?category=Reactions) Authors: Dr Sarah Elyoussfi (Dermatology Registrar) and Dr Ian Coulson (Consultant Dermatologist), Department of Dermatology, East Lancashire NHS Trust, United Kingdom. Copy edited by Gus Mitchell. December 2021. Further updated May 2023 [Introduction](https://dermnetnz.org/topics/skin-reactions-to-covid-19-vaccines#Introduction<br%20/>) [Vaccine differences](https://dermnetnz.org/topics/skin-reactions-to-covid-19-vaccines#Vaccine%20differences<br%20/>) [Common skin reactions](https://dermnetnz.org/topics/skin-reactions-to-covid-19-vaccines#Common%20skin%20reactions<br%20/>) [Incidence of skin reactions](https://dermnetnz.org/topics/skin-reactions-to-covid-19-vaccines#Incidence%20of%20skin%20reactions<br%20/>) [Uncommon mild skin reactions](https://dermnetnz.org/topics/skin-reactions-to-covid-19-vaccines#Uncommon%20mild%20skin%20reactions<br%20/>) [Uncommon serious skin reactions](https://dermnetnz.org/topics/skin-reactions-to-covid-19-vaccines#Uncommon%20serious%20skin%20reactions<br%20/>) [Skin reaction treatment](https://dermnetnz.org/topics/skin-reactions-to-covid-19-vaccines#Skin%20reaction%20treatment) ## What are the COVID-19 vaccines? The [coronavirus disease 2019 (COVID-19)](https://dermnetnz.org/topics/covid-19) pandemic has led to the development and approval of vaccines against the responsible virus — severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). More than 100 companies and institutions worldwide have developed vaccine candidates. ## How do the COVID-19 vaccines differ? Current approved [vaccines](https://dermnetnz.org/topics/covid-19-immunisation-and-immunomodulatorsbiologic-agents) rely on a nucleic-acid-based vaccine platform - Messenger ribonucleic acid (mRNA) eg, Pfizer/BioNTech + Fosun Pharma, Moderna + National Institute of Allergy and Infectious Diseases - Viral vector platforms eg, AstraZeneca + University of Oxford, Janssen Pharmaceutical - Inactivated virus eg, Sinopharm + China National Biotec Group Co - Protein subunit vaccines eg, Novavax (not yet approved in any country) ## What are the common types of skin reaction to COVID-19 vaccines? The majority of current literature regarding cutaneous reactions relate specifically to mRNA COVID-19 vaccinations. The spectrum of reported cutaneous reactions after mRNA vaccination include: - [Local site reaction](https://dermnetnz.org/topics/adverse-cutaneous-reactions-to-vaccines) - Swelling, erythema, and pain in the vaccinated arm. - Median onset of 1 day after vaccination. - [Urticaria](https://dermnetnz.org/topics/urticaria-an-overview) - Median onset reported on day 2–3 after vaccination. - Common sites include arms (68%), trunk (57%), and legs (46%). - Morbilliform eruptions - Median onset reported on day 2–3 after vaccination. - Common sites include the arm (62%), legs (27%), and trunk (42%). - Delayed large local reaction (“COVID arm") - The COVID-19 vaccines may cause a delayed localized hypersensitivity reaction presenting as a pruritic and painful erythematous reaction near the injection site. - Median development of 7 days after vaccine administration with a median duration of 5 days, but can persist for up to 21 days. - Pink plaques are variably oedematous and typically homogenous or less commonly annular. - [Sweet syndrome](https://dermnetnz.org/topics/acute-febrile-neutrophilic-dermatosis)\-like local reactions have been reported. - Treatments include [topical steroids](https://dermnetnz.org/topics/topical-steroid), [oral antihistamines](https://dermnetnz.org/topics/antihistamines), and [cool compresses](https://dermnetnz.org/topics/compression-therapy), but lesions are usually self-limiting. - [Eosinophilic pustular folliculitis](https://dermnetnz.org/topics/eosinophilic-pustular-folliculitis) may be triggered by Covid vaccines. ## How common are cutaneous reactions after COVID-19 vaccination? In one study, cutaneous reactions within 3 days after receiving the vaccine were reported in 1.9% of individuals after receiving their first dose of the mRNA COVID vaccine (Pfizer-BioNtech and Moderna). The majority of cutaneous reactions after COVID-19 vaccination occur in women (around 90%). Erythema and itching (other than at the injection site) was the most common cutaneous reaction, which was reported by 1%. In a study (May, 2021) of those with a self-reported cutaneous reaction to the first dose, 95% received their second dose. Among those who completed a symptom survey after the second dose, 83% reported no recurrent cutaneous reactions. However, a different study (July, 2021) reported that 43% of patients receiving an mRNA COVID-19 vaccine who reported first-dose reactions, experienced a second-dose recurrence. ## What are the uncommon mild skin reactions to COVID-19 vaccines? - Filler reactions - Swelling at the site of cosmetic fillers has been reported after COVID-19 vaccination. Reports have identified patients with facial swelling after both Moderna and Pfizer vaccines associated with prior use of injectable cosmetic filler. - May indicate delayed hypersensitivity to filler following introduction of an immunologic trigger. Similar reactions have been previously noted after other viral illnesses and influenza vaccines. - [Erythromelalgia](https://dermnetnz.org/topics/erythromelalgia) - Erythromelalgia has also been reported in response to other vaccines such as those for influenza and hepatitis B. - [Pernio/chilblains](https://dermnetnz.org/topics/chilblains) - Mimics dermatologic manifestations of COVID-19 (COVID toes) - Potentially suggests that the host immune response to the virus is being replicated by the vaccine - [Pityriasis rosea](https://dermnetnz.org/topics/pityriasis-rosea) - Reported with both COVID-19 infection and COVID-19 vaccines. - [Varicella zoster](https://dermnetnz.org/topics/chickenpox) and [herpes simplex](https://dermnetnz.org/topics/herpes-simplex) flares - Case reports have documented flares following COVID-19 vaccination. - [Raynaud phenomenon](https://dermnetnz.org/topics/raynaud-phenomenon) - A case has been reported occurring 2 weeks after the COVID-19 vaccine. ## What are the uncommon serious skin reactions to COVID-19 vaccines? - [Bullous pemphigoid](https://dermnetnz.org/topics/bullous-pemphigoid) - Relapses of autoimmune bullous disease have been reported - Onset within 3 days – 2 weeks following vaccination. - [Subacute cutaneous lupus erythematosus](https://dermnetnz.org/topics/subacute-cutaneous-lupus-erythematosus) - Induction and flares have been reported. - Onset days to weeks following vaccination. - Exacerbation of underlying skin condition - COVID-19 vaccination may trigger exacerbation of a pre-existing inflammatory skin condition such as [psoriasis](https://dermnetnz.org/topics/psoriasis) and [atopic dermatitis](https://dermnetnz.org/topics/atopic-dermatitis). However, a recent study involving over 2000 individuals did not show that vaccination statistically significantly exacerbated either atopic eczema or psoriasis. - [Lichen planus](https://dermnetnz.org/topics/lichen-planus) - The vaccine leads to increased levels of IL-2, TNF\-α, and IFN-γ — the exact cytokines involved in the development of lichen planus. Reports of this condition following vaccination have been made. - [Erythema multiforme](https://dermnetnz.org/topics/erythema-multiforme) - Linked to the first dose of Moderna COVID-19 vaccine. - It should be noted that major-type EM is considered to be a continuous spectrum with life-threatening toxic anti-epithelial reactions (e.g., Stevens–Johnson syndrome, toxic epidermal necrolysis). - Neutrophilic and Pustular Drug Reactions - Both [acute generalised exanthematous pustulosis (AGEP)](https://dermnetnz.org/topics/acute-generalised-exanthematous-pustulosis) and a [pustular flare of psoriasis](https://dermnetnz.org/topics/generalised-pustular-psoriasis) associated with an inactivated viral vector COVID-19 vaccine have been published. - A further case report was classified as an overlap between AGEP and [drug reaction with eosinophilia and systemic symptoms (DRESS)](https://dermnetnz.org/topics/drug-hypersensitivity-syndrome) associated with COVID-19 vaccination. - [Anaphylaxis](https://dermnetnz.org/topics/anaphylaxis) - Rare even with rates of 4.7 cases/million doses of the Pfizer-BioNTech and 2.5 cases/million doses of the Moderna vaccine - Anaphylaxis to vaccines generally is usually due to individual vaccine components, such as egg protein, gelatin, and other additives. However, the cause of vaccine anaphylaxis with the COVID-19 vaccine cases is unclear, but polyethylene glycol (PEG 2000) is a candidate allergen. - Common signs and symptoms include generalised [urticaria](https://dermnetnz.org/topics/urticaria-an-overview), [angioedema](https://dermnetnz.org/topics/angioedema), and respiratory and airway obstruction symptoms. - Onset is typically within minutes to hours of administration. Although the Pfizer/BioNTech vaccine contains a number of excipients, PEG 2000 is the only one reported to cause anaphylaxis. The Oxford-AstraZeneca vaccine does not contain PEG 2000 so is an alternative for people with a history of allergy to PEG 2000. However, there is occasional cross-reactivity between PEG and polysorbate 80, an ingredient in the Oxford-AstraZeneca vaccine. Evaluation by an allergy specialist may be advisable before vaccination in anyone with a suspected PEG allergy. Contraindications for receipt of the mRNA COVID-19 vaccines include: - Known history of a severe allergic reaction to any vaccine component, including the excipient PEG 2000 - An allergic reaction to a previous dose of an mRNA vaccine. Identification of risk factors for allergy symptoms after COVID-19 vaccination will guide safe vaccination practices for individuals at the highest risk. ## How are the COVID-19 skin reactions treated? Severe cutaneous adverse reactions are very rare. The established vaccines have a satisfactory safety profile. Management should be directed at the presenting skin condition, however most of the encountered skin reactions are self-limiting. [Anaphylaxis](https://dermnetnz.org/topics/anaphylaxis) requires prompt treatment with intramuscular adrenaline and oxygen. Unlike anaphylaxis, cutaneous adverse reactions alone are not a contraindication to re-vaccination. The available evidence supports that cutaneous reactions to COVID-19 vaccination are generally minor, self-limiting, and should not discourage vaccination. ### Bibliography - Al-Jighefee HT, Najjar H, Ahmed MN, Qush A, Awwad S, Kamareddine L. COVID-19 Vaccine Platforms: Challenges and Safety Contemplations. Vaccines (Basel). 2021;9(10):1196. doi: 10.3390/vaccines9101196. [PubMed Central](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8537163/) - Busto-Leis JM, Servera-Negre G, Mayor-Ibarguren A, et al. Pityriasis rosea, COVID-19 and vaccination: new keys to understand an old acquaintance. J Eur Acad Dermatol Venereol. 2021;35(8):e489–e491. doi:10.1111/jdv.17301. [PubMed Central](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8242646/) - Hiltun I, Sarriugarte J, Martínez-de-Espronceda I, et al. Lichen planus arising after COVID-19 vaccination. J Eur Acad Dermatol Venereol. 2021;35(7):e414–e415. doi:10.1111/jdv.17221. [PubMed Central](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8250777/) - Johnston MS, Galan A, Watsky KL, Little AJ. Delayed Localized Hypersensitivity Reactions to the Moderna COVID-19 Vaccine: A Case Series. JAMA Dermatol. 2021;157(6):716–20. [Journal](https://jamanetwork.com/journals/jamadermatology/fullarticle/2779643) - Joseph AK, Chong BF. Subacute cutaneous lupus erythematosus flare triggered by COVID-19 vaccine. Dermatol Ther. doi: 10.1111/dth.15114. [Journal](https://onlinelibrary.wiley.com/doi/10.1111/dth.15114) - Lospinoso K, Nichols CS, Malachowski SJ, Mochel MC, Nutan F. A case of severe cutaneous adverse reaction following administration of the Janssen Ad26.COV2.S COVID-19 vaccine. JAAD Case Rep. 2021;13:134–7. doi:10.1016/j.jdcr.2021.05.010. [PubMed Central](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8149168/) - McMahon DE, Amerson E, Rosenbach M, et al. Cutaneous reactions reported after Moderna and Pfizer COVID-19 vaccination: A registry-based study of 414 cases. J Am Acad Dermatol. 2021;85(1):46–55. doi:10.1016/j.jaad.2021.03.092. [PubMed Central](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8024548/) - Niebel D, Novak N, Wilhelmi J, et al. Cutaneous Adverse Reactions to COVID-19 Vaccines: Insights from an Immuno-Dermatological Perspective. Vaccines (Basel). 2021;9(9):944. doi:10.3390/vaccines9090944. [PubMed Central](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8470727/) - Robinson LB, Fu X, Hashimoto D, et al. Incidence of Cutaneous Reactions After Messenger RNA COVID-19 Vaccines. JAMA Dermatol. May 2021;157(8):1000–2. doi:10.1001/jamadermatol.2021.2114. [Journal](https://jamanetwork.com/journals/jamadermatology/fullarticle/2781364) - Sellaturay P, Nasser S, Islam S, Gurugama P, Ewan PW. Polyethylene glycol (PEG) is a cause of anaphylaxis to the Pfizer/BioNTech mRNA COVID-19 vaccine. Clin Exp Allergy. 2021;51(6):861–3. doi: 10.1111/cea.13874. [Journal](https://onlinelibrary.wiley.com/doi/10.1111/cea.13874) - Shimabukuro TT, Cole M, Su JR. Reports of Anaphylaxis After Receipt of mRNA COVID-19 Vaccines in the US-December 14, 2020-January 18, 2021. JAMA. 2021;325(11):1101–2. doi:10.1001/jama.2021.1967. [Journal](https://jamanetwork.com/journals/jama/fullarticle/2776557) ### On DermNet - [COVID-19](https://dermnetnz.org/topics/covid-19) - [COVID-19 immunisation and immunomodulators/biologic agents](https://dermnetnz.org/topics/covid-19-immunisation-and-immunomodulatorsbiologic-agents) - [Dermatology patients and COVID-19](https://dermnetnz.org/topics/dermatology-patients-and-covid-19) - [Adverse cutaneous reactions to vaccines](https://dermnetnz.org/topics/adverse-cutaneous-reactions-to-vaccines) ### Other websites - [COVID-19 vaccines](https://www.who.int/emergencies/diseases/novel-coronavirus-2019/covid-19-vaccines) — The World Health Organization (WHO) - [COVID-19 vaccine safety](https://www.cdc.gov/coronavirus/2019-ncov/vaccines/safety/safety-of-vaccines.html) — Centre for Disease Control and Prevention (CDC) ### Books about skin diseases - [Books about the skin](https://dermnetnz.org/topics/books-about-the-skin/) - [Dermatology Made Easy - second edition](https://www.amazon.com/Dermatology-Made-second-Amanda-Oakley-dp-1914961161/dp/1914961161/ref=dp_ob_title_bk?&_encoding=UTF8&tag=nzdermnet-20&linkCode=ur2&linkId=2addc7901a76f7726fa42eeeea7a28ea&camp=1789&creative=9325) Other recommended articles
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