Aim
Covid-19 vaccination (C19V) has been shown to reduce the mortality, hospitalisation and complication rates associated with the infection. However, there have been increasing reports of cutaneous reactions associated with C19V, including drug-induced bullous pemphigoid (BP) as well as flaring of pre-existing blistering disease.
Method
We retrospectively identified patients with blistering disease from a private dermatology clinic in New South Wales, Sydney, from 22 February 2021 to 22 April 2022. Patients who experienced C19V induced flares of their pre-existing autoimmune blistering disease and patients with C19V induced BP were included in the study. Patient demographics and the disease activity (Bullous Pemphigoid Disease Area Index (BPDAI) and Pemphigus Disease Area Index (PDAI)) before and after C19V were collected.
Results
Over the study period, there were 29 BP patients and 30 pemphigus patients.
There were four (4/59; 6.8%) cases of C19V-induced new onset BP. The median age was 67 years old, three (75%) were male. The median time from their latest C19V dose to symptom onset was 29 (5-123) days. All patients had two doses of AstraZeneca C19V before developing BP. One patient had received BioNTech Pfizer booster C19V and one patient had a Moderna booster C19V.
There were five (5/59; 8.5%) cases of C19V-induced flaring of pre-existing bullous disorders, including three cases of BP and two cases of pemphigus. The median age was 82 years old, three (60%) were male. The median time from latest C19V dose to disease flare was 21 (6-92) days. Two (40%) had initial BioNTech Pfizer C19V while three (60%) had AstraZeneca C19V. Four of these five (80%) patients subsequently had BioNTech Pfizer booster C19V before another disease flare.
Conclusion
C19V induced BP and flaring of pre-existing blistering disease was common in our cohort of patients, with the majority receiving AstraZeneca or BioNTech Pfizer C19V.