Psoriasis worsening related to COVID-19 vaccination: A single-center report
Ibtissame Boubnane1,2, Soumaya Faras1,2, Maryam Aboudourib1,2, Ouafa Hocar1,2, Said Amal1,2
1Dermatology Department, Cadi Ayyad University, Mohammed the VIth University Hospital, Marrakech, Morocco, 2Bioscience and Health Laboratory, Cadi Ayyad University, Mohammed the VIth University Hospital, Marrakech, Morocco
© Our Dermatology Online 2023. No commercial re-use. See rights and permissions. Published by Our Dermatology Online.
Background: Recently, reports have described cases of the onset or exacerbation of psoriasis related to COVID-19 vaccination. In this study, we sought to describe the clinical features and evolutionary aspects of psoriasis exacerbation after COVID-19 vaccination.
Materials and Methods: This was a prospective and descriptive study conducted over a period of eighteen months at the Department of Dermatology and Venereology of the Mohammed VI University Hospital in Marrakech. We included all patients followed for psoriasis who received at least one dose of Sinopharm, AstraZeneca, or Pfizer COVID-19 vaccine.
Results: A total of 148 patients were included in the study, among which 69 received a Sinopharm vaccine, 48 received an AstraZeneca vaccine, and 31 received a Pfizer vaccine. The mean age was 49 years. There were 82 males and 66 females, giving a sex ratio of 1.6. The comorbidities included hypertension in 27.7% of the cases, diabetes in 14.8%, dyslipidemia in 10.8%, and thyroiditis in 2%. Eight exacerbations of psoriasis after COVID-19 vaccination were noted. The mean duration of lesion development was 11.5 days. The vaccines involved were Sinopharm in 5 patients and AstraZeneca in 3 patients. The median PASI before vaccination was 7.8 and the median PASI after vaccination was 20.5. Three patients presented with severe erythematous lesions requiring hospitalization and the introduction of systemic therapy. Extension of the lesions to localized psoriasis was noted in five patients.
Conclusion: COVID-19 vaccination may be a trigger for psoriasis, as suggested by multiple studies. However, these events should in no way contraindicate vaccination in patients with psoriasis.
Key words: vaccination; COVID-19; psoriasis; exacerbation
The COVID-19 pandemic has had a significant impact on general health worldwide. Therefore, vaccination programs were created to protect and control viral transmission. There are certainly possible cutaneous adverse reactions of COVID vaccination, including urticaria, morbilliform rash, pityriasis rosea, and the exacerbation of pre-existing dermatoses [1,2]. Psoriasis is a chronic cutaneous inflammatory condition that may be triggered by stress, certain drugs, infection, including COVID-19, and less commonly, vaccines [3–10].
Recently, there have been reports describing cases of the onset or exacerbation of psoriasis related to COVID-19 vaccination [11–13]. The aim of our study was to describe the clinical features and evolutionary aspects of the aggravation of psoriasis after COVID-19 vaccination.
MATERIALS AND METHODS
We conducted a prospective and descriptive study over a period of eighteen months at the Department of Dermatology and Venereology of the Mohammed VI University Hospital in Marrakech. We included all patients followed for psoriasis who received at least one dose of Sinopharm, AstraZeneca, or Pfizer COVID-19 vaccination. We collected all anamnestic elements concerning age, sex, comorbidities, type of psoriasis, PASI score, current treatments, and evolution of psoriasis after the first, second, and third doses of the vaccine. Data entry and analysis were performed with SPSS.
A total of 148 patients were included in the study, among which 69 received a Sinopharm vaccine (46.6%), 48 received an AstraZeneca vaccine (32.4%), and 31 received a Pfizer vaccine (20.9%). Among all patients, 21 received only one dose of the vaccine (14.1%), 73 received two doses (49.3%), and 54 received three doses (36.4%). The mean age was 49 years, with extremes of 20 to 74 years. There were 82 males and 66 females, giving a sex ratio of 1.6. The comorbidities included hypertension in 27.7%, diabetes in 14.8%, dyslipidemia in 10.8%, and thyroiditis in 2%. All patients suffered from long-lasting psoriasis. Sixty-nine patients were on topical treatment, 51 were on methotrexate, 17 were on acitretin, and 11 were on biotherapy.
Among all patients, eight deteriorations of psoriasis after COVID-19 administration (5.4%) were noted (Figs. 1 and 2). No significant aggravating factors, such as stress, infection, and medications, were reported. The median duration of lesion development was 11.5 days (7–20 days). The vaccines involved were Sinopharm in 5 patients and AstraZeneca in 3 patients (Table 1).
|Figure 1: Psoriatic erythroderma following a Sinopharm vaccine.|
|Figure 2: Psoriasis exacerbation following an AstraZeneca vaccine.|
Psoriasis is a chronic inflammatory skin condition that may be triggered by stress, certain medications, and infections, including COVID-19 [3–5]. However, the association between vaccination and the worsening of psoriasis has been reported mainly after vaccines against influenza (H1N1), pneumococcal pneumonia, and yellow fever . Recently, this association has been suggested with COVID-19 vaccines [11–14].
To date, there have only been several studies reporting an exacerbation of psoriasis after a COVID-19 vaccine. In a study on 414 individuals with skin reactions after Pfizer/BioNTech and Moderna vaccines, McMahon et al. reported only two psoriasis flares . In addition, Safoura et al. reported three cases of the worsening of psoriasis after a Sinopharm vaccine . Besides, Wei et al. studied 83 patients at their center and found fifteen cases of psoriasis exacerbation after Moderna and AstraZeneca vaccines . Finally, Sotiriou et al. reported fourteen cases of a psoriasis flare; they observed six cases after the Pfizer vaccine, seven after the AstraZeneca vaccine, and one after the Moderna vaccine .
To the best of our knowledge, our series is the first study of psoriasis flares after COVID-19 vaccination reported in Africa. Herein, we report eight cases of the worsening of psoriasis after vaccination, including five cases with the Sinopharm vaccine and three with the AstraZeneca vaccine. In contrast, there were no cases with the Pfizer/BioNTech vaccine.
The median interval between vaccine injection and psoriasis deterioration was 11.5 days. This result was comparable to that reported by Sotiriou et al. (10.4 days) .
The median PASI in our study was significantly increased. Other authors made the same observation, notably, Wei et al., who found an increase from 3.1 to 8.0 .
Regarding treatment, three patients were hospitalized at our department and received biotherapy for two cases and methotrexate for one. Five patients were on topical therapy. While a majority of the patients reported by Wei et al. were receiving biotherapy, one was taking a topical steroid and one was receiving methotrexate .
The mechanism of psoriasis exacerbation after COVID-19 vaccination is still poorly elucidated. Nevertheless, it has been suggested that a Th17-mediated immunological response may play a role, especially as there is increasing evidence that Th17 cells play a role in the pathogenesis of psoriasis as well as in the immunopathology of COVID-19 and vaccine-induced immune enhancement [18,19].
Vaccination against COVID-19 may be a trigger for psoriasis, as suggested by multiple studies. However, these events should in no way contraindicate vaccination in patients with psoriasis. This recommendation is based on the documented efficacy of vaccines in preventing COVID-19 and reducing mortality in this high-risk population [20,21].
The association between psoriasis exacerbation and COVID-19 vaccines is still poorly elucidated. Therefore, further research and large controlled studies are needed to elaborate the relationship between psoriasis and COVID-19 vaccines.
Statement of Human and Animal Rights
All the procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the 2008 revision of the Declaration of Helsinki of 1975.
Statement of Informed Consent
Informed consent for participation in this study was obtained from all patients.
1. Niebel D, Novak N, Wilhelmi J, Ziob J, Wilsmann-Theis D, Bieber T, et al. Cutaneous adverse reactions to COVID-19 vaccines:Insights from an immuno-dermatological perspective. Vaccines. 2021;9:944.
2. Wollina U, Chiriac A, Kocic H, Koch A, Brzezinski P. Cutaneous and hypersensitivity reactions associated with COVID-19 vaccination:A narrative review. Wien Med Wochenschr. 2022;172:63-9.
3. Zitouni J, Bursztejn AC, Belloni Fortina A, Beauchet A, Di Lernia V, Lesiak A, et al;Groupe de Recherche sur le Psoriasis (GrPso) of the SociétéFrançaise de Dermatologie, the Groupe de recherche de la SociétéFrançaise de Dermatologie Pédiatrique (GR SFDP), the PsoProtect study group, the British Society of Paediatric Dermatology (BPSD), and the SocietàItaliana di Dermatologia Pediatrica (S.I.Der.P.). Children with psoriasis and COVID-19:Factors associated with an unfavourable COVID-19 course, and the impact of infection on disease progression (Chi-PsoCov registry). J Eur Acad Dermatol Venereol. 2022;36:2076-86.
4. Zitouni J, Bursztejn AC, Belloni Fortina A, Beauchet A, Di Lernia V, Lesiak A, et al;Groupe de recherche sur le psoriasis de la SFDGroupe de recherche de la Sociétéfrançaise de dermatologie pédiatriquePsoProtect study groupBritish Society of Paediatric DermatologySocietàItaliana di Dermatologia Pediatrica COVID-19 et psoriasis de l’enfant:facteurs associés àune évolution défavorable de la COVID-19 et impact de l’infection sur le psoriasis. Registre Chi-PsoCov. Annales de Dermatologie et de Vénéréologie. 2022;8:A115-6.
5. Vasileva M, Brishkoska Boshkovski V, Majhosheva M, Vasileva S, Vasilev S, Vasilev B, et al. Quality of life in patients with psoriasis vulgaris during the COVID-19 pandemic. Our Dermatol Online. 2020;11(Supp. 2):1-5.
6. Munguía-Calzada P, Drake-Monfort M, Armesto S, Reguero-Del Cura L, López-Sundh AE, González-LópezMA. Psoriasis flare after influenza vaccination in Covid-19 era:A report of four cases from a single center. Dermatol Ther. 2021;34:e14684.
7. Gunes AT, Fetil E, Akarsu S, Ozbagcivan O, Babayeva L. Possible triggering effect of influenza vaccination on psoriasis. J Immunol Res. 2015;2015:258430.
8. Kamiya K, Kishimoto M, Sugai J, Komine M, Ohtsuki M. Risk factors for the development of psoriasis. Int J Mol Sci. 2019;20:4347.
9. Shi CR, Nambudiri VE. Widespread psoriasis flare following influenza vaccination. Vaccine. 2017;35:4785-6.
10. Shin MS, Kim SJ, Kim SH, Kwak YG, Park HJ. New onset guttate psoriasis following pandemic H1N1 influenza vaccination. Ann Dermatol. 2013;25:489-92.
11. Sotiriou E, Tsentemeidou A, Bakirtzi K, Lallas A, Ioannides D, Vakirlis E. Psoriasis exacerbation after COVID-19 vaccination:A report of 14 cases from a single centre. J Eur Acad Dermatol Venereol. 2021;35:e857-9.
12. Krajewski PK, Matusiak Ł, Szepietowski JC. Psoriasis flare-up associated with second dose of Pfizer-BioNTech BNT16B2b2 COVID-19 mRNA vaccine. J Eur Acad Dermatol Venereol. 2021;35:e632-e4.
13. Chao J-P, Tsai T-F. Psoriasis flare following ChAdOx1-S/nCoV-19 vaccination in patients with psoriasis under biologic treatment. Dermatol Sin. 2021;39:208-9.
14. Oujennane K, Hocar O, Amal S, Aboudourib M. Erythrodermic psoriasis eruption following COVID-19 vaccination. Our Dermatol Online. 2023;14:101-2.
15. McMahon DE, Amerson E, Rosenbach M, Lipoff JB, Moustafa D, Tyagi A, et al. Cutaneous reactions reported after Moderna and Pfizer COVID-19 vaccination:A registry-based study of 414 cases. J Am Acad Dermatol. 2021;85:46-55.
16. Safoura S, Yasamin K, Maryam N, Nasim T, Mahshid Sadat A, Zahra R, et al. Cutaneous manifestations following COVID-19 vaccination:A report of 25 cases. Dermatol Ther. 2022;35:e15651.
17. Huang YW, Tsai TF. Exacerbation of psoriasis following COVID-19 vaccination:Report from a single center. Front Med. 2021;8:812010.
18. Peter JH, Maria EB, David BC. The potential role of Th17 immune responses in coronavirus immunopathology and vaccine-induced immune enhancement. Microb Inf. 2020;22:165-7.
19. Li B, Huang L, Lv P, Li X, Liu G, Chen Y, et al. The role of Th17 cells in psoriasis. Immunolog Res.2020;68:296-309.
20. Xing K, Tu XY, Liu M, Liang ZW, Chen JN, Li JJ, et al. Efficacy and safety of COVID-19 vaccines:A systematic review. Zhongguo Dang Dai Er Ke Za Zhi. 2021;23:221-8.
21. Mahil SK, Dand N, Mason KJ, Yiu ZZN, Tsakok T, Meynell F, et al. Factors associated with adverse COVID-19 outcomes in patients with psoriasis:Insights from a global registry-based study. J Allergy Clin Immunol. 2021;147:60-71.
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