It is unknown if this reaction may also occur with the Moderna mRNA COVID‐19 vaccine. In both cases, the patients had a personal or family history of atopy, perhaps making them more susceptible to an eczematous reaction. While the cause of these generalized eczematous reactions is unknown, the Pfizer‐BioNTech vaccine may act as an environmental trigger in a genetically susceptible individual. 2 Interestingly, both patients in this series had no involvement of the site of injection. This contrasts with what has been observed with delayed large local reactions, in which most patients with a first‐dose reaction did not develop a second‐dose reaction. We did observe a recurrence in the eczematous dermatitis with the second vaccine dose, but these recurrences were responsive to topical and oral glucocorticoids. Both of these cases suggest that patients who develop generalized eczematous reactions to the Pfizer‐BioNTech COVID‐19 vaccine can safely receive the second dose. Generalized eczematous reaction on the lower back.ĭespite experiencing generalized reactions, neither patient developed serious adverse events after the first or second vaccine dose. He received the second vaccine dose 7 weeks after his first dose, and two weeks after the second dose, he had a recurrence of the eruption that again responded to topical glucocorticoids. He was treated with topical glucocorticoids and oral antihistamines and improved over several weeks. A skin biopsy showed spongiosis, acanthosis, parakeratosis and an inflammatory infiltrate consistent with eczematous dermatitis. On examination, he had pink patches and papules with overlying excoriation on his back, arms and legs (Fig. He had a family history of atopic dermatitis but no personal history of atopic dermatitis. He presented to the dermatology clinic on day 5 postvaccine due to progression of the eruption. This first patient was a 43‐year‐old man with a history of seasonal allergies who developed a pruritic eruption on his extremities 3 days after his first dose of the Pfizer‐BioNTech COVID‐19 vaccine. Here, we present two patients who developed generalized eczematous eruptions after both doses of the (Pfizer‐BioNTech, Brooklyn, NY, USA) COVID‐19 vaccine. His atopic dermatitis flare resolved with oral glucocorticoids. 4 The previously described patient had moderate‐to‐severe atopic dermatitis on dupilumab and flared after vaccination. 1, 2, 3 However, eczematous cutaneous reactions after COVID‐19 mRNA vaccines have only been described once in the literature. Immediate and delayed local injection site reactions to mRNA vaccines against SARS‐CoV‐2 have been previously reported.
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