The American Academy of Dermatology (AAD) Virtual Meeting Experience (VMX) featured a comprehensive session, COVID-19 Symposium, bringing together nine experts from across the country to discuss the intersection of dermatology and the pandemic. Esther Freeman, MD, PhD, shared updates, emphasizing reassuring evidence that COVID-19 vaccines are safe and well-tolerated in terms of skin reactions.
Over the year, the registry has accumulated more than 2000 total reports from 52 countries across all continents other than Antarctica. Initial data of 318 patients showed pernio-like lesions, but subsequent analysis with 716 patients revealed a more full spectrum of dermatologic manifestations:
- Penio in more mild cases
- Vesicular, urticarial, macular erythema, and morbilliform lesions in moderate cases
- Retiform purpura in severe cases of COVID-19
The registry has also revealed long-COVID symptoms (ie, >60 days infection).
In December 2020, cutaneous vaccine reactions were added as a reporting option, and the registry now has more than 600 reports. Dr Freeman pointed to a recent study published in New England Journal of Medicine, which analyzed reactions to mRNA-1273 (Moderna vaccine). “What is interesting is not so much that they developed a reaction on the vaccinated arm. We’re all used to people getting large injection reactions at the site of vaccines, but what was really unusual here is these delayed, large local reactions were happening on day 7 or day 8 after [the first dose],” she highlighted.
The second dose reports, however, were reassuring, with reactions either not recurring or being less severe and presenting 2 to 3 days post vaccination. It is not clear what is causing the reactions, especially as 93% of the localized reactions are seen with the Moderna vaccine vs BNT162b2 (Pfizer vaccine).
The clinical trials for the Moderna and Pfizer vaccines demonstrated the vaccines are well-tolerated. The phase 1/2a trial data for Ad26.COV2.S (J&J) reported similar tolerability, with single-digit percentages in erythema and swelling at injection site.
Dr Freeman emphasized, however, that trial data was relatively limited in terms of reporting on skin and turned attention to a mid-April 2021 report in Journal of the American Academy of Dermatology. Of 414 individuals who reported one or more cutaneous reactions to an mRNA vaccine, 83% received Moderna vs 17% received Pfizer. The most common morphologies after mRNA vaccines were delayed large local reactions, local injection site reactions, urticaria, and morbilliform eruptions. The analysis did not include the J&J adenovirus vaccine and we expect to report on it in the future, said Dr Freeman.
Most importantly, based on this real-world evidence, patients and providers alike should know that less than half of patients who experienced a cutaneous reaction after a first dose experienced a recurrence following their second dose. Dermatologists should encourage their patients to continue with their second dose regardless of reactions more than 4 hours post vaccination.
In addition to Dr Freeman, the COVID-19 Symposium included presentations by:
- Lindy Fox, MD, on the dermatologic manifestations of COVID-19
- Elena Haryluk, MD, PhD, on the pediatric patient population
- Marlys Fassett, MD, PhD, on the immunology of COVID-19
- Seemal Desai, MD, on COVID-19 in skin of color
- April Armstrong, MD, MPH, on the relationship between biologics and COVID-19
- George Hruza, MD, on essential practice management strategies during the pandemic
- Misha Rosenbach, MD, and Sara Samimi, MD, on dermatologic training during the pandemic
—Lauren Mateja
Reference
Freeman EE. COVID-19 symposium. Presented at: American Academy of Dermatology Virtual Meeting Experience 2021; April 23-25, 2021; virtual.
