COVID-19 Vaccine Triggers Prurigo Nodularis in 63-Year-Old Man

Two weeks after receiving the first dose of the Pfizer-BioNTech SARS-CoV-2 vaccine, a 63-year-old man developed a generalized itchy papulonodular rash that was later confirmed to be prurigo nodularis, according to a case report published in Cureus.

“The SARS-CoV-2 vaccine has been reported to be a possible trigger for the development of multiple dermatologic conditions including prurigo nodularis,” wrote corresponding author Ghassan Barnawi of King Abdulaziz Medical City, Jeddah, Saudi Aribia, and coauthors. “Due to the important role of the immune system in the pathogenesis of prurigo nodularis, it was thought that our patient had an immune dysregulation elicited by his SARS-CoV-2 vaccination.”

According to the report, the man was referred to the authors’ dermatology clinic 5 months after the start of symptoms. Although subsequent booster doses of the vaccine did not lead to new skin lesions or worsening of previous lesions according to the patient, the existing rash was severe enough to disturb his sleep. Previous attempts to relieve the itching using over-the-counter moisturizing creams, topical herbal treatments, and honey had not helped.

The clinical presentation was consistent with prurigo nodularis, and tissue biopsy and microscopic analysis confirmed the diagnosis, the authors explained. For treatment, clinicians prescribed topical steroids, emollients, and oral antihistamines. They also scheduled narrowband ultraviolet B phototherapy because of the widespread skin involvement.

“The immune system plays a crucial role in the pathogenesis of prurigo nodularis, and dysregulation in the immune system elicited by the SARS-CoV-2 vaccine can trigger the development of this condition in predisposed individuals,” the authors advised. “It is important to continue to further investigate the pathophysiology of this skin condition and its association with the SARS-CoV-2 vaccine.”

Reference:
Barnawi G, Alghamdi FS, Almuqati AS, Alamri A. Prurigo nodularis eruption triggered by SARS-CoV-2 vaccine. Cureus. Published online October 4, 2022. doi:10.7759/cureus.29914