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Gonzalez C, Duque-Clavijo V, Kroumpouzos G, Garcia Concha AM, Olmos Perez M. Ultrasonographic features of nonvascular complications of hyaluronic acid fillers: a retrospective study at a reference center for dermatologic ultrasonography. Clin Dermatol 2024:S0738-081X(24)00080-4. [PMID: 38763380 DOI: 10.1016/j.clindermatol.2024.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2024]
Abstract
Hyaluronic acid filler injections have been associated with early, temporary, and delayed-onset complications. High-resolution ultrasound with Doppler analysis has been increasingly used to detect and identify such complications. We comprehensively describe the most common ultrasonographic findings of nonvascular complications associated with hyaluronic acid filler injections. This retrospective, cross-sectional, observational study was conducted at a reference center for dermatologic ultrasound in Bogotá, Colombia. Ultrasound reports documented the ultrasonographic findings of nonvascular complications of hyaluronic acid filler injections. Fifty-two complications were documented in a cohort of 50 patients (women, 88%). The infraorbital region was the most common site affected (23%), followed by the nasolabial region (22%). The Tyndall effect was the most common complication (25% of all), followed by changes in rheology (21%) and pseudosarcoidal (foreign body granuloma) reaction (15%). The Tyndall effect stood out for its distinctive ultrasonographic characteristics. We discuss the ultrasonographic findings and pathogenesis of other complications, including filler migration, early hypersensitivity, aseptic abscess, overcorrection, and filler material interaction. The clinical presentation of hyaluronic acid filler complications can be confusing, delaying timely diagnosis and treatment. High-resolution ultrasound with Doppler analysis is a valuable tool for avoiding unnecessary treatments and ensuring timely diagnosis and treatment.
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Affiliation(s)
- Claudia Gonzalez
- Department of Radiology, Rosario University, Bogotá D.C., Colombia.
| | | | - George Kroumpouzos
- Department of Dermatology, Warren Alpert Medical School at Brown University, Providence, Rhode Island, USA
| | - Ana Maria Garcia Concha
- Department of Dermatology, Fundación Universitaria de Ciencias de la Salud (FUCS), Bogotá D.C., Colombia
| | - Miguel Olmos Perez
- Dermatology Department, San José Hospital, Fundación Universitaria de Ciencias de la Salud (FUCS), Bogotá D.C., Colombia
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2
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Poleva I, Szomolai E, Hegedus B, Zhukova O. Multicentric observational study of the possible side effects of the COVID-19 vaccine in relation to absorbable thread insertion. J Cutan Aesthet Surg 2024; 17:100-104. [PMID: 38800814 PMCID: PMC11126218 DOI: 10.4103/jcas.jcas_93_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2024] Open
Abstract
Background Coronavirus disease 2019 (COVID-19) vaccination programs in Europe began in December 2020, and as the number of vaccinated people increased, more information emerged about the possible side effects of vaccines. Recently, some reports appeared around the association of adverse reactions following soft-tissue filler injections and the COVID-19 vaccines. This fact raised the concerns of esthetic practitioners regarding the possibility of the association of the COVID-19 vaccine and adverse effects in other esthetic treatments. Many of us wonder if botox injection, biostimulation, or other procedure could trigger the same or other adverse reactions after the COVID-19 vaccination. Many colleagues postpone esthetic treatments, canceling the appointments. Objective The objective of our investigation was to understand if any adverse reactions have been observed in the patients who underwent threads implantation before and after the vaccination. Materials and Methods Four medical centers have collected the data of the patients treated with absorbable threads before the vaccination and after vaccination for COVID-19. The dossiers of 190 patients with a mean age of 50.4 years were evaluated. Three questionnaires were administered 1 week, 1 month, and 3 months after thread implantation. Results There were no adverse reactions in the groups of patients under monitoring. Only one patient presented signs of inflammation and infection, but they are more probably attributable to the contamination during thread insertion. Conclusions No patients treated with absorbable threads developed adverse events in relation to the COVID-19 vaccine. The only case of inflammation is attributable probably to the contamination of the thread during the procedure.
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Affiliation(s)
- Irina Poleva
- Dermatology Department, CGH Compagnie Generale des Hopitaux di Roma, Roma, Italy
| | | | | | - Olga Zhukova
- Dermatology Department, Moscow Clinic and Science Centre of Aesthetic Medicine, Moscow, Russia
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3
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Schmid U, Galambos J, Pfaltz K, Hegyi I, Courvoisier S, Kempf W. Cutaneous Reactions after COVID-19 Vaccines: Analysis of the Clinical and Histopathological Spectrum-Case Series and Review of the Literature. Dermatopathology (Basel) 2024; 11:130-141. [PMID: 38534266 DOI: 10.3390/dermatopathology11010013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Revised: 03/09/2024] [Accepted: 03/12/2024] [Indexed: 03/28/2024] Open
Abstract
(1) Background: Various cutaneous adverse drug reactions (ADRs) are observed with the implementation of mRNA COVID-19 vaccines. To gain insight into the clinicopathologic features, we analyzed the correlation of histological and clinical data in 48 patients with these ADRs. (2) Methods: Single-center retrospective study in patients with ADRs after mRNA COVID-19 vaccination (mRNA-1273 and BNT162b2 vaccines). (3) Results: Distant generalized ADRs prevailed (91%), often appearing clinically as spongiotic dermatitis or maculopapular exanthema. Histopathological analysis revealed spongiotic changes (46%) and dermal superficial perivascular predominantly lymphocytic infiltrates (17%). Eosinophils were found in 66% of biopsies, neutrophils in 29%, and plasma cells only in 8% of biopsies. Most ADRs occurred after the second vaccine dose (44%). Histologically spongiotic changes were associated with clinical features of spongiotic dermatitis in only 50% of patients and maculopapular exanthema in the remaining patients. ADRs represented an aggravation of preexisting skin disease in 23% of patients. ADRs regressed within 28 days or less in 53% of patients and persisted beyond a month in the remaining patients. (4) Conclusions: Our study demonstrates a diverse spectrum of generalized ADRs, revealing correlations between histology and clinical features but also instances of divergence. Interestingly, in about half of our patients, ADRs were self-limited, whereas ADRs extended beyond a month in the other half.
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Affiliation(s)
- Ursina Schmid
- Kempf und Pfaltz Histologische Diagnostik, Affolternstrasse 56, CH-8050 Zurich, Switzerland
- Department of Dermatology, University Hospital Zurich, CH-8091 Zurich, Switzerland
| | - Jörg Galambos
- Kempf und Pfaltz Histologische Diagnostik, Affolternstrasse 56, CH-8050 Zurich, Switzerland
| | - Katrin Pfaltz
- Kempf und Pfaltz Histologische Diagnostik, Affolternstrasse 56, CH-8050 Zurich, Switzerland
| | - Ivan Hegyi
- Kempf und Pfaltz Histologische Diagnostik, Affolternstrasse 56, CH-8050 Zurich, Switzerland
| | | | - Werner Kempf
- Kempf und Pfaltz Histologische Diagnostik, Affolternstrasse 56, CH-8050 Zurich, Switzerland
- Department of Dermatology, University Hospital Zurich, CH-8091 Zurich, Switzerland
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4
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Landau M, Silikovich F, Fida M, Cartier H, Kroumpouzos G. Oral Methotrexate Treatment of Delayed-Onset Inflammatory Reactions to Dermal Fillers. Aesthet Surg J Open Forum 2024; 6:ojae011. [PMID: 38690015 PMCID: PMC11060488 DOI: 10.1093/asjof/ojae011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024] Open
Abstract
Background In aesthetic practice, delayed-onset (late) inflammatory reactions (DIRs) to dermal fillers are encountered. The treatment of DIRs can be challenging, with a response to established therapies, including oral antibiotics, intralesional and oral steroids, and hyaluronidase injection, occasionally reported as unsatisfactory. Objectives Evaluate the efficacy of low-dose oral methotrexate (MTX) therapy in treating recalcitrant DIRs. Methods We retrospectively reviewed cases of recalcitrant DIRs treated with oral MTX. Data collected included individuals' gender and age, medical history, filler type, facial area(s) injected, previous treatments attempted to dissolve the DIR, MTX treatment dosage and duration, and outcome. Adverse events were monitored throughout the treatment. Results Thirteen females with a mean age of 52.6 years (range, 31-67 years) who developed recalcitrant DIRs to dermal filler injection are included. Eight reactions were triggered by the injection of hyaluronic acid (HA) fillers, 4 by liquid injectable silicone (LIS), and 1 by polymethylmethacrylate (PMMA). The average starting dosage of MTX was 12.1 mg/week (range, 7.5-12.5 mg/week). Patients were treated for 2 to 3 months in most cases. The average follow-up post-MTX therapy was 11.8 months (range, 2-36 months). A complete response to MTX treatment was observed in 10 patients (6 HA and 4 LIS cases), partial response in 1 (HA case), and an unsatisfactory response in 2 (HA and PMMA cases). Treatment was well tolerated. Conclusions A short course of low-dose oral MTX is a possible treatment for DIRs that have not responded to established therapies. The promising results of this report require validation by powered studies. Level of Evidence 4
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Affiliation(s)
| | | | | | | | - George Kroumpouzos
- Corresponding Author: Dr George Kroumpouzos, 541 Main St, Suite 320, South Weymouth, MA 02190, USA. E-mail:
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Kroumpouzos G, Treacy P. Hyaluronidase for Dermal Filler Complications: Review of Applications and Dosage Recommendations. JMIR DERMATOLOGY 2024; 7:e50403. [PMID: 38231537 PMCID: PMC10836581 DOI: 10.2196/50403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 10/17/2023] [Accepted: 12/11/2023] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND Hyaluronidase (Hyal) can reverse complications of hyaluronic acid (HA) fillers, which has contributed substantially to the popularity of such procedures. Still, there are differing opinions regarding Hyal treatment, including dosage recommendations in filler complication management. OBJECTIVE We aimed to address unanswered questions regarding Hyal treatment for HA filler complications, including timing and dosage, skin pretesting, properties of various Hyals and interactions with HA gels, and pitfalls of the treatment. METHODS PubMed and Google Scholar databases were searched from inception for articles on Hyal therapy for filler complications. Articles were evaluated regarding their contribution to the field. The extensive literature review includes international leaders' suggestions and expert panels' recommendations. RESULTS There are limited controlled data but increasing clinical experience with Hyal treatment. The currently used Hyals provide good results and have an acceptable safety profile. Nonemergent complications such as the Tyndall effect, noninflamed nodules, and allergic or hypersensitivity reactions should be treated with low or moderate Hyal doses. Hyal should be considered with prior or simultaneous oral antibiotic treatment in managing inflammatory nodules. Hyal may be tried for granulomas that have not responded to intralesional steroids. Emergent complications such as vascular occlusion and blindness require immediate, high-dose Hyal treatment. Regarding blindness, the injection technique, retrobulbar versus supraorbital, remains controversial. Ultrasound guidance can increase the efficacy of the above interventions. CONCLUSIONS Hyal is essential in aesthetic practice because it can safely treat most HA filler complications. Immediate Hyal treatment is required for emergent complications. Aesthetic practitioners should be versed in using Hyal and effective dosage protocols.
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Affiliation(s)
- George Kroumpouzos
- GK Dermatology, PC, South Weymouth, MA, United States
- Department of Dermatology, Warren Alpert Medical School at Brown University, Providence, RI, United States
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6
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Hansen E, Feldmann R, Pirker R, Jochmann J, Breier F, Posch C. New onset of systemic lupus erythematosus following COVID-19 mRNA vaccination. J Eur Acad Dermatol Venereol 2024; 38:e6-e7. [PMID: 37709553 DOI: 10.1111/jdv.19513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 09/08/2023] [Indexed: 09/16/2023]
Affiliation(s)
- E Hansen
- Department of Dermatology, Klinik Hietzing, Vienna, Austria
| | - R Feldmann
- Department of Dermatology, Klinik Hietzing, Vienna, Austria
| | - R Pirker
- Department of Dermatology, Klinik Hietzing, Vienna, Austria
| | - J Jochmann
- Department of Dermatology, Klinik Hietzing, Vienna, Austria
| | - F Breier
- Department of Dermatology, Klinik Hietzing, Vienna, Austria
| | - C Posch
- Department of Dermatology, Klinik Hietzing, Vienna, Austria
- Faculty of Medicine, Sigmund Freud University Vienna, Vienna, Austria
- Department of Dermatology and Allergy, School of Medicine, Technical University of Munich, Munich, Germany
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7
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Berrino V, Berrino P. Lower Eyelid Complication After Blepharoplasty and COVID-19 Vaccination. Aesthetic Plast Surg 2023; 47:2573-2578. [PMID: 37580564 DOI: 10.1007/s00266-023-03532-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 07/17/2023] [Indexed: 08/16/2023]
Abstract
BACKGROUND Following COVID-19 mass vaccination campaign, new- and unknown-related reactions have emerged. CASE REPORT Four months after transcutaneous lower blepharoplasty and few days after the second dose of SARS-CoV-2 Pfizer mRNA vaccination, a 57-year-old man developed a bilateral palpebral ecchymosis. While the lesion healed spontaneously on the left side, the ecchymosis on the right lower lid did not regress. It presented swelling and hard consistency, clinically involving only skin layer. No alterations were revealed upon blood tests and instrumental evaluations. Histological examination showed lymphovascular hyperplasia on a probable reactive basis. The lesion was resistant to medical and surgical therapies. After 15 months, it regressed spontaneously. CONCLUSIONS In the reported case, an evident chronological relationship exists between surgical site and vaccine reaction, while other etiopathogenetic factors were excluded. This case represents a previously undescribed condition linking postvaccination reaction and long-term surgical outcome. LEVEL OF EVIDENCE V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Valeria Berrino
- Chirurgia Plastica Genova Srl, Via A.M. Maragliano 2, 16121, Genoa, Italy.
| | - Pietro Berrino
- Chirurgia Plastica Genova Srl, Via A.M. Maragliano 2, 16121, Genoa, Italy
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8
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Kroumpouzos G, Harris S, Bhargava S, Wortsman X. Complications of fillers in the lips and perioral area: Prevention, assessment, and management focusing on ultrasound guidance. J Plast Reconstr Aesthet Surg 2023; 84:656-669. [PMID: 37002059 DOI: 10.1016/j.bjps.2023.01.048] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 11/30/2022] [Accepted: 01/29/2023] [Indexed: 03/09/2023]
Abstract
An ever-increasing interest in perioral rejuvenation with dermal fillers reflects the esthetic importance of this region. However, filler injections in the lips and perioral area have been associated with various complications. Such complications are classified according to severity (mild, moderate, severe) or by the time of onset: immediate (within 24 h after injection), early (24 h to 4 weeks post-procedure), and late or delayed (>4 weeks after injection). While most complications are mild and manageable, vascular compromise, infections, and the development of delayed-onset nodules may significantly undermine the ultimate esthetic outcome and cause substantial morbidity. These more serious complications often require more invasive treatment modalities. This article details the prevention and management of such adverse events and discusses safe filler injection principles, including safety recommendations for the lips. Lastly, we highlight the use of ultrasound guidance in complication prevention (vascular mapping, filler identification, location, and extent), assessment (identification of intravascular embolus or external vascular compression by the filler implant), and management (real-time imaging of hyaluronidase or other drug injection in the affected area). Esthetic practitioners should be versed in injection anatomy, and the prevention, recognition, and management of filler complications in the perioral area.
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Affiliation(s)
- George Kroumpouzos
- Department of Dermatology, Warren Alpert Medical School at Brown University, Providence, RI, USA.
| | | | - Shashank Bhargava
- Department of Dermatology, R.D. Gardi Medical College and C.R. Gardi Hospital, Ujjain, India.
| | - Ximena Wortsman
- Institute for Diagnostic Imaging and Research of the Skin and Soft Tissues, Santiago, Chile; Department of Dermatology, Faculty of Medicine, Universidad de Chile, Santiago, Chile; Department of Dermatology, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile.
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9
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Célia de Souza Campos Fernandes R, Vieira Nunes D, Fragoso de Almeida N, da Cruz Assad Monteiro N, Amanda Maron Pimenta L, Medina-Acosta E. Henoch-Schönlein purpura in a 6-year-old boy after initial COVID-19 vaccination. Vaccine X 2023:100333. [PMID: 37362023 PMCID: PMC10281031 DOI: 10.1016/j.jvacx.2023.100333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 04/30/2023] [Accepted: 06/15/2023] [Indexed: 06/28/2023] Open
Abstract
The COVID-19 pandemic has significantly impacted global health, and the widespread immunization of adults against SARS-CoV-2 has played a pivotal role in altering the course of the disease. While COVID-19 vaccine adverse events are generally uncommon and mild, the recent vaccination of the pediatric population has emphasized the need for vigilance and reporting of potential side effects. In this case report, we present a 6-year-old boy who developed Henoch-Schönlein purpura following the administration of the first dose of Pfizer-BioNTech BNT16B2b2 mRNA COVID-19 vaccine, making it the earliest reported case of such an adverse event. Our report highlights the importance of continued monitoring and reporting of adverse events in pediatric patients receiving the COVID-19 vaccine, as well as the need for prompt diagnosis and management of potential vaccine-related complications.
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Affiliation(s)
- Regina Célia de Souza Campos Fernandes
- Faculdade de Medicina de Campos, Avenida Alberto Torres 217, Campos dos Goytacazes, Rio de Janeiro, CEP 28035-581, Brazil
- Universidade Estadual do Norte Fluminense, Avenida Alberto Lamego 2000, Campos dos Goytacazes, Rio de Janeiro, CEP 28013-602, Brazil
| | - Daniela Vieira Nunes
- Faculdade de Medicina de Campos, Avenida Alberto Torres 217, Campos dos Goytacazes, Rio de Janeiro, CEP 28035-581, Brazil
| | - Nathália Fragoso de Almeida
- Faculdade de Medicina de Campos, Avenida Alberto Torres 217, Campos dos Goytacazes, Rio de Janeiro, CEP 28035-581, Brazil
| | | | - Luiza Amanda Maron Pimenta
- Faculdade de Medicina de Campos, Avenida Alberto Torres 217, Campos dos Goytacazes, Rio de Janeiro, CEP 28035-581, Brazil
| | - Enrique Medina-Acosta
- Universidade Estadual do Norte Fluminense, Avenida Alberto Lamego 2000, Campos dos Goytacazes, Rio de Janeiro, CEP 28013-602, Brazil
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10
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Messas T, Lim RK, Burns L, Yumeen S, Kroumpouzos G. A critical review of COVID-19 course and vaccination in dermatology patients on immunomodulatory/biologic therapy: recommendations should not differ between non-pregnant and pregnant individuals. Front Med (Lausanne) 2023; 10:1121025. [PMID: 37332768 PMCID: PMC10272467 DOI: 10.3389/fmed.2023.1121025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 04/24/2023] [Indexed: 06/20/2023] Open
Abstract
COVID-19 can have detrimental effects on immunosuppressed patients. Here, we evaluate the evidence regarding continuing immunomodulatory/biologic (IMBI) therapy in pregnant dermatology patients during the COVID-19 pandemic. Also, we discuss the risks of COVID-19 vaccination in pregnant dermatology patients on IMBI therapy. As indicated in this review, regarding continuing IMBI therapy in pregnant dermatology patients during the pandemic, there is no compelling reason for treating them differently than non-pregnant. The body of evidence indicates that mRNA COVID-19 vaccines are safe during pregnancy. Studies on rheumatology patients, a group that overlaps significantly with the dermatology group, provided essential findings. IMBI in a non-pregnant rheumatology patient was not associated with COVID-19 mortality (except for rituximab), and vaccination of the rheumatology patient during pregnancy improved the obstetric outcomes compared to the unvaccinated patient. Based on this data, it can be stated that after weighing the benefit-risk profile of the available COVID-19 vaccines, the recommendation for the pregnant dermatology patient speaks in favor of the COVID-19 vaccination. COVID-19 vaccine recommendations in pregnant dermatology patients on IMBI should not differ from those for their non-pregnant counterparts.
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Affiliation(s)
- Tassahil Messas
- Department of Dermatology, University Hospital Centre, University of Constantine III, Constantine, Algeria
| | - Rachel K. Lim
- Alpert Medical School, Brown University, Providence, RI, United States
| | - Laura Burns
- Department of Dermatology, Alpert Medical School, Brown University, Providence, RI, United States
| | - Sara Yumeen
- Department of Dermatology, Alpert Medical School, Brown University, Providence, RI, United States
| | - George Kroumpouzos
- Department of Dermatology, Alpert Medical School, Brown University, Providence, RI, United States
- GK Dermatology, PC, South Weymouth, MA, United States
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11
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Paolino G, Caputo V, Schroeder J, Marzano AV, Bonoldi E, Moltrasio C, Maronese CA, Borgonovo L, Rongioletti F. The clinical and pathologic spectrum of mucocutaneous reactions after COVID-19 vaccinations in three tertiary referral centers of northern Italy. Clin Dermatol 2023; 41:312-319. [PMID: 36863621 PMCID: PMC9970914 DOI: 10.1016/j.clindermatol.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
Adverse cutaneous reactions after COVID-19 vaccinations have increased, highlighting not only how SARS-CoV-2 infection but also COVID-19 vaccines may induce adverse cutaneous manifestations. We evaluated the clinical and pathologic spectrum of mucocutaneous reactions after COVID-19 vaccinations, observed consecutively within three large tertiary centers of the Metropolitan City of Milan (Lombardy), comparing our results with the currently available literature. We retrospectively reviewed medical records and skin biopsies of patients diagnosed with mucocutaneous adverse events after COVID-19 vaccinations and followed at three Italian tertiary referral centers in the Metropolitan City of Milan. One hundred twelve patients (77 women and 35 men (112 total); median age, 60 years) have been included in the present study; a cutaneous biopsy was performed in 41 cases (36%). The trunk and arms were the most involved anatomic areas. Autoimmune reactions after COVID-19 vaccinations, urticaria, morbilliform eruptions, and eczematous dermatitis have been the most commonly diagnosed disorders. Compared to the currently available literature, we performed many more histologic examinations, allowing us to make more precise diagnoses. Most of the cutaneous reactions were self-healing and/or responded to topical and systemic steroids and systemic antihistamines, thus not discouraging the general population from carrying out vaccinations, which currently have a good safety profile.
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Affiliation(s)
- Giovanni Paolino
- Dermatologia Clinica, Università Vita-Salute San Raffaele, Milan, Italy; Unità di Dermatologia, Ospedale San Raffaele, Milan, Italy.
| | - Valentina Caputo
- Department of Surgical Pathology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Jan Schroeder
- Allergy and Clincal Immunology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Angelo Valerio Marzano
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Emanuela Bonoldi
- Department of Surgical Pathology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Chiara Moltrasio
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Carlo Alberto Maronese
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Linda Borgonovo
- Allergy and Clincal Immunology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Franco Rongioletti
- Dermatologia Clinica, Università Vita-Salute San Raffaele, Milan, Italy; Unità di Dermatologia, Ospedale San Raffaele, Milan, Italy
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12
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Gamonal SBL, Marques NCV, Pereira HMB, Gamonal ACC. Pityriasis rubra pilaris (type I) following administration of the BNT162b2 mRNA COVID-19 vaccine: Successful treatment with ustekinumab and acitretin. Dermatol Ther 2022; 35:e15899. [PMID: 36196603 PMCID: PMC9874643 DOI: 10.1111/dth.15899] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 09/04/2022] [Accepted: 10/01/2022] [Indexed: 01/28/2023]
Affiliation(s)
- Shirley Braga Lima Gamonal
- Department of Dermatology, Faculty of MedicineFederal University of Juiz de Fora (UFJF)Juiz de ForaBrazil
| | | | - Heitor Motta Bini Pereira
- Department of DermatologySchool of Medical Sciences and Health of Juiz de Fora (FCMS/JF)Juiz de ForaBrazil
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13
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Nicaise-Roland P, Granger V, Soria A, Barbaud A, Pallardy M, Chollet-Martin S, de Chaisemartin L. Immediate hypersensitivity to COVID-19 vaccines: Focus on biological diagnosis. FRONTIERS IN ALLERGY 2022; 3:1007602. [PMID: 36249342 PMCID: PMC9561365 DOI: 10.3389/falgy.2022.1007602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 09/15/2022] [Indexed: 11/18/2022] Open
Abstract
Soon after the release of the new anti-COVID mRNA vaccines, reports came in from the US and the UK of anaphylactic reactions. Fueled by the necessary caution toward these new vaccine platforms, these reports had a great impact and were largely commented upon in the scientific literature and global media. The current estimated frequency is of 5 cases per million doses. Very little biological data are presented in the literature to support the anaphylaxis diagnosis in these patients in addition to skin tests. Allergic reactions to vaccines are rare and mostly due to vaccine excipient. Therefore, the poly-ethylene-glycol (PEG) present in both mRNA formulation, and already known to be immunogenic, was soon suspected to be the potential culprit. Several hypersensitivity mechanisms to PEG or to other vaccine components can be suspected, even if the classical IgE-dependent anaphylaxis seems to be one of the most plausible candidates. In the early 2022, the international guidelines recommended to perform skin prick tests and basophil activation tests (BAT) in people experiencing allergic reaction to the first dose of COVID-19 vaccine or with a history of PEG allergy. The aim of this review is to discuss the main potential mechanisms of immediate allergy to COVID19 vaccines based on published data, together with the various techniques used to confirm or not sensitization to one component.
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Affiliation(s)
- Pascale Nicaise-Roland
- Service d’Immunologie Biologique, Hôpital Bichat, DMU BIOGÉM, APHP, Paris, France
- Université Paris Cité, Inserm PHERE, Paris, France
| | - Vanessa Granger
- Service d’Immunologie Biologique, Hôpital Bichat, DMU BIOGÉM, APHP, Paris, France
- Université Paris-Saclay, Inserm, Inflammation Microbiome Immunosurveillance, Orsay, France
| | - Angèle Soria
- Département de Dermatologie et Allergologie, Sorbonne Université, Hôpital Tenon, Paris, France
- Centre D'immunologie et des Maladies Infectieuses - Paris (Cimi-Paris), INSERM, Paris, France
| | - Annick Barbaud
- Département de Dermatologie et Allergologie, Sorbonne Université, INSERM, Institut Pierre Louis D'Epidémiologie et de Santé Publique, AP-HP. Sorbonne Université, Hôpital Tenon, Paris, France
| | - Marc Pallardy
- Université Paris-Saclay, Inserm, Inflammation Microbiome Immunosurveillance, Orsay, France
| | - Sylvie Chollet-Martin
- Service d’Immunologie Biologique, Hôpital Bichat, DMU BIOGÉM, APHP, Paris, France
- Université Paris-Saclay, Inserm, Inflammation Microbiome Immunosurveillance, Orsay, France
- Correspondence: Sylvie Chollet-Martin
| | - Luc de Chaisemartin
- Service d’Immunologie Biologique, Hôpital Bichat, DMU BIOGÉM, APHP, Paris, France
- Université Paris-Saclay, Inserm, Inflammation Microbiome Immunosurveillance, Orsay, France
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14
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Wei K, Chang Y, Huang Y. Influenza vaccine and subsequent development of zoster. Influenza Other Respir Viruses 2022; 17:e13055. [PMID: 36114790 PMCID: PMC9835400 DOI: 10.1111/irv.13055] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 07/29/2022] [Accepted: 09/04/2022] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Herpes zoster (HZ), which is caused by reactivation of the latent varicella zoster virus, was not listed as a side effect of any vaccines until the introduction of coronavirus disease 2019 (COVID-19) vaccine. This study used a nationwide population database to examine whether the HZ risk is increased after receiving the influenza vaccination. METHODS This population-based retrospective self-controlled case series evaluated the association between influenza vaccine exposure and HZ risk. Data were collected from Taiwan's National Health Insurance Research Database between 2015 and 2017. Patients with HZ diagnosed within 6 months before and after receiving the influenza vaccination were included. After receiving the influenza vaccine, the first 15 and 30 days were defined as risk intervals, while the other periods were defined as control intervals. Poisson regression was used to compare the incidence rate ratio (IRR) for HZ during the risk interval vs. the control interval. RESULTS In total, 13,728 patients were diagnosed with HZ before and after receiving the influenza vaccine. The IRR for days 1-15 was significantly higher (IRR = 1.11; 95% confidence interval [CI], 1.02-1.20), but insignificant for days 1-30 (IRR = 1.04; 95% CI, 0.98-1.10). In a subgroup analysis, the IRRs were significantly higher in participants, including 50-64 years old (1.16; 95% CI, 1.02-1.33), males (1.14; 95% CI, 1.01-1.28), and healthier individuals (i.e., no history of cancer or autoimmune diseases). CONCLUSIONS There was a slight increase in risk of HZ in people receiving influenza vaccine in the first 1-15 days after vaccination.
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Affiliation(s)
- Kai‐Che Wei
- Department of DermatologyKaohsiung Veterans General HospitalKaohsiungTaiwan,School of MedicineNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
| | - Yu‐Chia Chang
- Department of Long‐Term Care, College of Health and NursingNational Quemoy UniversityKinmen CountyTaiwan,Department of Healthcare Administration, College of Medical and Health ScienceAsia UniversityTaichungTaiwan
| | - Yu‐Tung Huang
- Center for Big Data Analytics and Statistics, Department of Medical Research and DevelopmentChang Gung Memorial Hospital Linkou Main BranchTaoyuanTaiwan,Department of Health Care ManagementChang Gung UniversityTaoyuanTaiwan
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15
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Kato J, Kamiya T, Handa T, Kobayashi E, Hida T, Yamashita T, Uhara H. Linear lichen planus after COVID-19 vaccination. Australas J Dermatol 2022; 63:e385-e387. [PMID: 35877179 PMCID: PMC9349488 DOI: 10.1111/ajd.13902] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 07/09/2022] [Accepted: 07/14/2022] [Indexed: 12/11/2022]
Affiliation(s)
- Junji Kato
- Department of Dermatology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Takafumi Kamiya
- Department of Dermatology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Toshiya Handa
- Department of Dermatology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Eri Kobayashi
- Department of Dermatology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Tokimasa Hida
- Department of Dermatology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Toshiharu Yamashita
- Department of Dermatology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Hisashi Uhara
- Department of Dermatology, Sapporo Medical University School of Medicine, Sapporo, Japan
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16
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Hooper MJ, Veon FL, LeWitt TM, Chung C, Choi J, Zhou XA, Guitart J. Cutaneous T-Cell-Rich Lymphoid Infiltrates After SARS-CoV-2 Vaccination. JAMA Dermatol 2022; 158:1073-1076. [PMID: 35857292 DOI: 10.1001/jamadermatol.2022.2383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Madeline J Hooper
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Francesca L Veon
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Tessa M LeWitt
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Christopher Chung
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Jaehyuk Choi
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Xiaolong A Zhou
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Joan Guitart
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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17
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Nashwan AJ, Yassin MA, Soliman AT, De Sanctis V, Ibrahim MI. mRNA-based COVID-19 Vaccines Booster Dose: Benefits, Risks and Coverage. ACTA BIO-MEDICA : ATENEI PARMENSIS 2022; 93:e2022236. [PMID: 35775753 PMCID: PMC9335425 DOI: 10.23750/abm.v93i3.13103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 04/27/2022] [Indexed: 11/13/2022]
Abstract
The number of COVID-19 vaccine-rich countries that have started COVID-19 third-dose booster programs is growing dramatically despite the lack of robust evidence on the effectiveness, safety, and frequency of the required booster doses that makes the individuals/populations immune to COVID -19 infection. Beyond the ethical dilemma, the scarcity of studies on the optimal timing for offering booster doses, eligibility criteria, and if there is any association between premature or delayed administration and the degree of protection against infection. The aim of this mini- review was to collect and analyze published data on this topic in a trial to answer some questions related to the benefits versus the risks of offering frequent boosters of mRNA vaccines for increasing the population immunity against COVID-19 infection considering the current policy of providing SARS-CoV-2 vaccine booster doses in rich countries versus those in relatively poor countries with limited access to vaccination. (www.actabiomedica.it).
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Affiliation(s)
- Abdulqadir J. Nashwan
- Director of Nursing for Education & Practice Development, Hamad Medical Corporation, PO Box 3050, Doha, Qatar, College of Health Sciences, QU Health, Qatar University, P. O. Box:2713, Doha, Qatar
| | - Mohamed A. Yassin
- Department of Hematology/Oncology, National Cancer Institute, HMC, Doha, Qatar
| | | | - Vincenzo De Sanctis
- Pediatric and Adolescent Outpatients Clinic, Quisisana Hospital, Ferrara, Italy
| | - Mohamed I. Ibrahim
- College of Pharmacy, QU Health, Qatar University, PO Box 2713, Doha, Qatar
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