Cutaneous reactions after COVID-19 vaccination are heterogeneous. Most of the cutaneous reactions were mild-to-moderate and self-limiting. However, severe/very severe reactions were also reported.

This nationwide cross-sectional observational study aimed to characterize and classify cutaneous reactions following SARS-CoV-2 vaccination.

In this multicentre study, people (mean patient age 50·7 years, 80·2% females) having cutaneous reactions within twenty-one days of any dose of the approved vaccines were incorporated. Following a face-to-face visit with a dermatologist, collection of information on cutaneous reactions was done with the aid of an online professional survey. The clinical photographs were sent via email. Researchers searched for consensus on the classification and clinical patterns.

In total, 405 reactions were reported after vaccination with BNT162b2 (40·2%), mRNA-1273 (36·3%) and AZD1222 (23·5%) vaccines. Evaluation of the cutaneous reactions after SARS-CoV-2 vaccination revealed 6 morphologic reaction patterns: Injection site ('COVID arm', 32·1%), purpuric (4%), urticaria (14·6%), pityriasis rosea-like (4·9%), papulovesicular (6·4%), and morbilliform (8·9%) reactions. Herpes simplex virus and varicella-zoster reactivations accounted for about 13·8% of the reactions. The COVID arm was found to be almost exclusive to females (95·4%).

The most commonly reported reactions in each of the vaccine groups were COVID arm (mRNA-1273, 61·9%), urticaria (AZD1222, 21·1%), and varicella-zoster virus reactivation (BNT162b2, 17·2%). Most of the reactions to the mRNA-1273 vaccine were reported in females (90·5%). In total, 80 reactions (21%) were categorized as severe/very severe and 81% needed therapy.

Following SARS-CoV-2 vaccination, most of the cutaneous reactions were mild/moderate and self-limiting, but some were severe/very severe. Better knowledge of such cutaneous reactions can aid the healthcare professionals during mass vaccination and also aid to counsel patients regarding vaccination.