Self-resolving flare of psoriasis after COVID-19 vaccination
A 63-year-old female presented with worsening skin psoriasis. She was
diagnosed with plaque psoriasis 45 years ago, well-controlled with
as-needed topical corticosteroid ointment. Two weeks after receiving the
second dose of the COVID-19 vaccine, she developed itchy erythematous
scaly rashes on extremities, chest, abdomen, and back. The physical
examination revealed erythematous pustular plaques all over the body.
(Figure 1A-D) She was advised to use topical triamcinolone 0.1% cream.
Before even initiating immunosuppressive therapy, her rash started
resolving and completely resolved within six weeks of onset. (Figure
1E-H)
COVID-19 can cause immune-overactivation and is associated with
exacerbation of rheumatic and musculoskeletal diseases (RMDs) as well as
new incident RMDs (1). Concerns about autoimmunity caused by vaccines
due to molecular mimicry exist, with rare reports of psoriasis flare
after COVID-19 vaccinations (2). Fortunately, similar to our case, most
cases were successfully treated with topical treatment, with few
requiring systemic therapy. Our report illustrates that though vaccines
may increase the risk of RMDs flares, the flares are usually mild and
self-resolving. Given the overall safety and efficacy of COVID-19
vaccination, the proven benefits of vaccinating vulnerable patients
outweigh the potential theoretical risk of disease flare, and
vaccination shall be strongly encouraged.