As coronavirus disease (COVID-19)
vaccines continue to be administered, dermatologists play a critical role in recognizing and treating the cutaneous manifestations (CM) associated with the
vaccines. Adverse cutaneous reactions of
COVID-19 vaccines reported in the literature range from common urticarial to rare vesiculobullous reactions. In this study, we performed a (1) scoping review to assess the occurrences of vesicular, papulovesicular, and bullous CMs of
COVID-19 vaccines and their respective treatments, and (2) a narrative review discussing other common and uncommon CMs of
COVID-19 vaccines. Thirty-six articles were included in the scoping review, and 66 articles in the narrative review. We found that vesicular, papulovesicular, and
bullous lesions are infrequent, reported mostly after the first dose of Moderna or Pfizer
vaccines. Eleven of the 36 studies reported vesicular reactions consistent with activation or reactivation of the herpes zoster virus. Most vesicular and
bullous lesions were self-limited or treated with topical
corticosteroids. Other CMs included injection-site, urticarial or morbilliform reactions,
vasculitis,
toxic epidermal necrolysis, and flaring of or new-onset
skin diseases such as
psoriasis. Treatments for CMs included topical or oral
corticosteroids,
antihistamines, or no treatment in self-limited cases. Although most CMs are benign and treatable, the data on the effect of systemic
corticosteroids and immunosuppressive therapies on the immunogenicity of
COVID-19 vaccines is limited. Some studies report reduced immunogenicity of the
vaccines after high-dose
corticosteroids use. Physicians may consult local guidelines where available when recommending
COVID-19 vaccines to immunosuppressed patients, and when using
corticosteroids to manage the CMs of
COVID-19 vaccines.