Summary
Background
Cutaneous reactions after severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) vaccines are poorly characterized.
Objective
To describe and classify cutaneous reactions ...after SARS‐CoV‐2 vaccination.
Methods
A nationwide Spanish cross‐sectional study was conducted. We included patients with cutaneous reactions within 21 days of any dose of the approved vaccines at the time of the study. After a face‐to‐face visit with a dermatologist, information on cutaneous reactions was collected via an online professional survey and clinical photographs were sent by email. Investigators searched for consensus on clinical patterns and classification.
Results
From 16 February to 15 May 2021, we collected 405 reactions after vaccination with the BNT162b2 (Pfizer‐BioNTech; 40·2%), mRNA‐1273 (Moderna; 36·3%) and AZD1222 (AstraZeneca; 23·5%) vaccines. Mean patient age was 50·7 years and 80·2% were female. Cutaneous reactions were classified as injection site (‘COVID arm’, 32·1%), urticaria (14·6%), morbilliform (8·9%), papulovesicular (6·4%), pityriasis rosea‐like (4·9%) and purpuric (4%) reactions. Varicella zoster and herpes simplex virus reactivations accounted for 13·8% of reactions. The COVID arm was almost exclusive to women (95·4%). The most reported reactions in each vaccine group were COVID arm (mRNA‐1273, Moderna, 61·9%), varicella zoster virus reactivation (BNT162b2, Pfizer‐BioNTech, 17·2%) and urticaria (AZD1222, AstraZeneca, 21·1%). Most reactions to the mRNA‐1273 (Moderna) vaccine were described in women (90·5%). Eighty reactions (21%) were classified as severe/very severe and 81% required treatment.
Conclusions
Cutaneous reactions after SARS‐CoV‐2 vaccination are heterogeneous. Most are mild‐to‐moderate and self‐limiting, although severe/very severe reactions are reported. Knowledge of these reactions during mass vaccination may help healthcare professionals and reassure patients.
What is already known about this topic?
In clinical trials, COVID‐19 vaccines were associated with cutaneous adverse events, especially local injection site reactions.
Previous descriptions of cutaneous reactions beyond the injection site were case reports or mostly reported by non‐dermatologists and lacked clinical images.
What does this study add?
We describe and classify a large, representative sample of patients with unexplained skin manifestations after COVID‐19 vaccination, using consensus to define associated morphological patterns.
We describe six morphological reaction patterns and herpesvirus reactivations, and their association with demographic factors and the medical record, and provide illustrations to allow for easy recognition.
Linked Comment: V. Bataille and S. Puig. Br J Dermatol 2022; 186:15.
Plain language summary available online
Resumen Objetivo Evaluar el impacto de la formación, en términos de competencia diagnóstica, de 2 médicos de atención primaria formados para realizar ecografías abdominales de baja complejidad. ...Diseño Estudio no aleatorio prospectivo a doble ciego de evaluación de las competencias adquiridas. La exploración ecográfica se realizó sucesiva e independientemente por el médico de atención primaria y por el radiólogo y los resultados se registraron en formularios distintos de un mismo cuestionario de recogida de datos. Emplazamiento Departamentos de radiología del Hospital General de Vic y del ambulatorio de especialidades de Vic del Instituto Catalán de la Salud. Participantes Participaron 120 pacientes que requerían una ecografía abdominal de baja complejidad de un total de 868 ecografías programadas. Mediciones principales Se calculó el índice kappa del diagnóstico principal (conclusión diagnóstica de la prueba) y el de los hallazgos ecográficos en cada órgano abdominal. Se consideró un buen nivel de formación si se alcanzaba un índice kappa mínimo de 0,80 entre el médico de atención primaria y el radiólogo. Resultados En un análisis ad interim a los 6 meses se obtuvo un índice kappa de 0,85 para el diagnóstico ecográfico principal; al finalizar el estudio fue de 0,89 (IC 0,95: 0,82-0,98). La concordancia por órganos fue alta (excepto para páncreas y bazo) y se alcanzó una sensibilidad superior al 75% y una especificidad superior al 90%. Conclusiones Los resultados del estudio demuestran cautelosamente que los médicos de atención primaria pueden realizar ecografías abdominales de baja complejidad con competencia diagnóstica.
To assess the impact of training two general practitioners (GPs), on performing low complexity ultrasound examinations of the abdomen with diagnostic competence.
A non-randomised, prospective, double ...blind evaluation study of the acquired competence. Ultrasound examinations were performed successively and independently by the GP and the radiologist, and registered on two sheets of an identical case report form.
Departments of Vic General Hospital and Vic Health Care Centre of the Catalan Health Institute.
A total of 120 patients who needed a low complexity abdominal ultrasound from a total amount of 868 ultrasound examinations scheduled.
The kappa index of the primary diagnosis (ultrasound diagnostic conclusion), as well as of the ultrasound findings for each abdominal organ was calculated. A good level of training was considered if a minimum kappa index of 0.80 was attained between general practitioner and radiologist.
After six month running, an "ad interim" analysis showed a kappa index for the primary ultrasound diagnosis of 0.85. At the end of the study, an overall kappa index of 0.89 (95% CI: 0.82-0.98) was achieved. The agreement by organs was also high (pancreas and spleen excluded), as well as sensitivity (>75%) and specificity (>90%).
The results of the study demonstrate the feasibility of the performance, by trained GPs, of ultrasound examinations of low complexity of the abdomen with diagnostic competence.
Actinic keratosis (AK) and field cancerization are increasing health problems insufficiently diagnosed by primary care physicians. The objective of this study was to assess the validity and ...reliability of teledermatology (TD) and teledermoscopy in the diagnosis of AK and field cancerization in a gatekeeper healthcare model. A prospective diagnostic test evaluation was done to assess the diagnostic concordance, accuracy, and performance parameters and the interobserver and intraobserver concordances of TD and teledermoscopy compared with dermatologists’ face-to-face evaluation or histopathology. A total of 636 patients with 1,000 keratotic skin lesions were included. TD diagnostic concordance for AK and field cancerization evaluation was very high and superior to primary care physicians’ diagnosis (92.4% vs. 62.4% and 96.7% vs. 51.8%, P < 0.001). TD sensitivity, specificity, and positive and negative predictive values for AK diagnosis and field cancerization were high (range = 82.2–95.0) and better than primary care physicians’ diagnosis. Teledermoscopy yielded better results in diagnostic concordance, performance parameters, and AK subtypes. Intraobserver and interobserver agreement was >0.83. TD and, to a greater extent, teledermoscopy may be valid and reliable tools for the diagnosis of AK and field cancerization and may improve diagnosis and correct allocation and management in gatekeeper healthcare systems. It can be an alternative tool to training primary care physicians in direct diagnosis of these lesions.
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