DP06: Clinical and histopathological correlation of the mucocutaneous COVID-19 vaccine reactions: a prospective observational study

Alpana Mohta

Sardar Patel Medical College, Bikaner, India

The development of mucocutaneous reactions following COVID-19 vaccination has been increasingly documented. However, to date, there is still a dearth of studies that delve into the pathogenesis of these reactions. This study was aimed at correlating the spectrum of cutaneous reactions with histopathological findings developing after the administration of COVID-19 vaccination. In this prospective observational study all individuals developing any self-reported mucocutaneous adverse events within 3 weeks of receiving the COVID-19 vaccine were included. The lesions were classified into various reaction patterns on the basis of histopathological features. Of the 103 vaccine-related reactions, only 53 patients agreed to get a skin biopsy done. The most common histological pattern of reaction was spongiotic dermatitis (n = 23), clinically manifesting as pityriasis rosea-like reaction, a maculopapular rash with fine scaling, and vaccine-related eruptions of papules and plaques (V-REPP). Other histopathological patterns included lichenoid dermatitis (n = 18), leucocytoclastic vasculitis (n = 4), dermal hypersensitivity reaction (n = 2), subepidermal blistering (n = 4) and granulomatous reaction (n = 2). Other clinical patterns included lichenoid skin eruptions, urticaria, vasculitis, pseudoangiomatosis, bullous pemphigoid, guttate psoriasis, herpes zoster, chilblains and pityriasis lichenoides et varioliformis acuta. A majority of cases developed the reaction only after the second dose of vaccination, suggesting the role of type IV hypersensitivity reaction. Clinicohistopathological correlation helps in categorizing the various vaccine-related mucocutaneous reactions. Our work highlights that skin manifestations of the COVID-19 vaccine are often self-limiting and benign.