31047 Erythrodermic psoriasis secondary to the COVID-19 Moderna vaccine

Abstract

Vaccination is an unusual trigger for dermatologic autoimmune conditions like psoriasis. Although a plausible association has been dilucidated between certain vaccines and psoriasis flares, to date, there have been no reports of psoriasis flares secondary to COVID vaccines. To our knowledge, we present the first case of a psoriasis flare secondary to the Moderna COVID-19 vaccine. Our patient is a 31-year-old Latino man with a medical history of well-controlled plaque psoriasis whose psoriasis flared 6 days after receiving the second dose of the Moderna COVID-19 vaccine. Upon presentation, he had approximately 15% body surface area (BSA) involvement. Interestingly, the patient had a severe COVID-19 infection 1 year prior to this but at that time had not flared from his psoriasis. He was treated with topical steroids, nbUVB, and oral prednisone, while awaiting risankizumab approval. During this time, the patient became erythrodermic. Once the patient started risankizumab injections, he achieved almost complete clearance by week 10 of treatment. The Moderna vaccine is an mRNA COVID-19 vaccine that induces a strong CD8 T cell response, along with a balanced Th1-Th2 antibody isotype response. In psoriasis, Th1 cells and CD8 T cells play a key role in keratinocyte proliferation; this upregulation in T cells by the Moderna vaccine could lead to a psoriatic flare. Clinicians should be aware of this side effect of the COVID-19 vaccine and advise patients to be compliant with psoriasis treatment and to inform their dermatologist if any worsening of their psoriasis occurs following the COVID-19 vaccination period.