Two cases of pityriasis rosea after the injection of coronavirus disease 2019 vaccine.

Author contributions

LH took pictures and wrote the manuscript under the guidance of JZ and ZY. JZ organized the follow‐up. All authors cared for the patient.

Conflict of interest

The authors state no conflict of interest.

Funding sources

This work was supported by grants from National Nature Science Foundation of China (81903197) and the National Natural Science Foundation of China (81630083).

To the editor,

The incidence of cutaneous manifestation in coronavirus disease 2019 (COVID‐19) patients was around 20%. Among the reported cutaneous reactions after the inoculation of COVID‐19 vaccination till now, the most common reactions were delayed large local reactions, local injection site reactions, urticaria and morbilliform eruptions. Pityriasis rosea (PR) was found to be one of the rare cutaneous symptoms caused by the COVID‐19 vaccination. Here, we report 2 cases of PR after the COVID‐19 vaccination.

The first case was one 19‐year‐old man who came to the department of dermatology for 1‐month history of pruritus papulosquamous lesion. His lesion appeared 2 days after the first dose injection of COVID‐19 vaccine. This inactivated vaccine was produced by the Beijing Institute of Biological Products Company. His colleagues who had injected the same batch of vaccine had no similar symptoms till now. On physical examination, he had several oval pink‐to‐brown‐coloured thin scaly plaques on the trunk and proximal extremities (Fig. 1a–c). Blood routine was normal. Besides, he completed 3 times of PCR test for COVID‐19, and the latest test occurred the day before the visit. All negative results of the nucleic test indicated no infection of COVID‐19. He was diagnosed with PR according to the classical clinical feature. After 1‐week treatment of valaciclovir 300mg bid orally and mometasone furoate to inhibit itch when needed, the patient’s manifestation had obvious improvement. He did not get the second dose of vaccination due to the eruption of PR after the first dose inoculation.

Figure 1

(a‐c) Clinical manifestation of the 19‐year‐old man. Lesions locating on neck (a), trunk (b) and groins (c) were as shown. (d‐e) Clinical manifestation of the 51‐year‐old man. Lesions on the trunk (d) and proximal upper limb (e) were displayed.

The second case was a 51‐year‐old man. He got the vaccination from the same company as the first patient as mentioned above. He developed itchy fusiform patches in the trunk 7 days after the second dose injection of COVID‐19 vaccine and came to our department 3 days after the onset of the cutaneous symptom. He claimed slight similar lesions several days after the first dose inoculation without detailed picture. He reported no preceding disorder, no systemic discomfort, no cutaneous contacts or no new drug exposures. Physical examination indicated annular and oval lesion covering by thin scales across the neck, trunk, bilateral groins and proximal extremities, in a ‘Christmas tree’ pattern (Fig. 1d,e). During the process, the patient had no fever, cough or any other symptoms. Based on the diagnosis of PR, we treated him with ganciclovir 250 mg bid orally and got the improvement.

PR is a self‐limited papulosquamous disorder associated with virus infection. Previous study reported the onset of PR several days or several weeks after the injection of Pfizer/ BioNTech (BNT162b2) and Moderna (mRNA‐1273) COVID‐19 vaccines in white people mostly. It is still controversial to define this phenomenon as PR or PR‐like eruption. The described cases here are the first report of PR after the COVID‐19 vaccination produced by the Beijing Institute of Biological Products Company in China. Due to the small size of samples and limitation of follow‐up after both doses in the vaccination population, it is still hard to calculate the incidence or define the median time of PR onset. Besides, the disparities of reactions between different races are also important issues. This eruption of PR may be caused by the similar component of allergen between the inactivated vaccine and COVID‐19 mediated by T cells. It will be helpful for the dermatologist to be familiar with COVID‐19 vaccine‐related cutaneous manifestations.