Pityriasis rosea like eruption: A dermatological manifestation of Coronavac-COVID-19 vaccine.

Abstract

The COVID-19 infection causes numerous dermatological eruptions.1 However, we have recently begun to see dermatological eruptions developing after COVID-19 vaccination. Although pityriasis rosea like eruption due to COVID-19 infection has been described, similar rashes associated with vaccination have not to date been reported. In the presented case, pityriasis rosea like eruption was observed after the Coronavac-COVID-19 vaccine. The patient in this manuscript has given written informed consent to the publication of his case details. A 68-year-old male patient was admitted to the outpatient clinic, due to itchy rashes on the trunk and back. These lesions had existed for a week, started with a large rash on the abdomen, and then spread to the entire body. He had no chronic disease, no history of psychological stress and medication. When examined in terms of triggering factors, he had the first dose of the Coronavac-COVID-19 vaccine 10 days before the onset of the lesions. Dermatological examination revealed erythematous, collarette scaly plaques on the trunk and back, also herald plaque on the abdomen. Pretreatment photograph is presented in Figure 1. Histopathological examination was not performed, as the lesions and clinical history were characteristic for pityriasis rosea like eruption. Laboratory tests revealed no pathological findings. Since the patient had a history of COVID-19 vaccine and exhibited no symptoms secondary to COVID-19 infection, this dermatological condition was thought to have developed due to Coronavac-COVID-19 vaccine. After the treatment, the patient's lesions completely regressed. Pityriasis rosea is a characterized by a “herald patch,” followed by scaly oval patches on the trunk and proximal extremities in a “Christmas tree” pattern. Collarette scaling is often observed, and with this feature, it can be diagnosed without histopathological examination.2 In the presented case, the lesions were similar in character to a “Christmas tree” pattern with collarette scales, and medical history also included “herald patch.” Although the exact cause of pityriasis rosea is unknown, seasonal changes, stress, drugs such as ACE inhibitors, hydrochlorothiazide, captopril, barbiturates, gold, metronidazole, allopurinol, nimesulide, and infections such as HHV-6 and HHV-7 are thought to trigger the disease.3, 4 Also, there are case reports of pityriasis rosea, occurring after Bacillus-Calmette-Guerin, influenza, H1N1, diphtheria, smallpox, hepatitis B vaccines.2 There were no signs of infection or drug use in the presented case, and no trigger was identified other than the Coronavac-COVID-19 vaccine. The most important key to control pandemic is vaccination. Some types of COVID-19 vaccines have been approved by the World Health Organization. The most frequently used vaccines are Coronavac and Pfizer-BioNTech, and they have been produced with different techniques.5 However, the common side-effects of these vaccines are similar. The most frequently observed dermatological reaction are localized redness, swelling and pain around the injection site.6 Hypersensitivity reactions are rare, but severe side effects. Non-severe but rare side effects can be understood with community vaccination. Hiltun et al., reported a case of 56-year-old woman with a history of lichen planus 7 years previously that had been successfully treated with topical therapy.7 This patient presented with itchy, papules on the wrists, ankles and mammary region 48 h after BioNTech-COVID-19 vaccine, dermoscopic and histopathological examinations were compatible with lichen planus. Another dermatological eruption after BioNTech-COVID-19 vaccine is erythema multiforme, reported by Gambichler et al.8 That patient was 74 years old and admitted to the hospital the day after vaccination with widespread erythematous macules and patches throughout the body. Erythema multiforme was considered secondary to the vaccine, as the patient had no other medication history. Bostan et al. reported a 78-year-old patient with herpes zoster, developing 5 days after the Coronavac-COVID-19 vaccine.9 In conclusion, the dermatological eruptions not only present secondary to COVID-19 infection but also secondary to the vaccine. Therefore, we should examine every patient in terms of COVID-19 infection and vaccination history. The patient in this manuscript has given written informed consent to the publication of their case details. The authors report no conflict of interest. This case report was not presented at a meeting. The data that support the findings of this study are available from the corresponding author upon reasonable request.