Let me begin this article with a caveat. First, I'm not a medically qualified doctor, so the information below is a combined result of the anecdotal experiences people have shared with me or their GPs, and facts I've established through my own research (linked within the article). Secondly, the Covid vaccine is in its infancy, so studies of its impact on specific population groups are relatively small, or in some cases nonexistent. As is normal in preliminary studies, both the Pfizer and Moderna trials, for example, excluded volunteers on immunosuppressive therapy, so we don't yet know exactly how these patients might respond.

Skin Rash Response to Covid Vaccine

A common question for me right now, asked most often by psoriasis and eczema patients, is 'should I have the covid vaccine?'. I've felt compelled for a while to write about about the injection and how it might impact those of us with chronic skin disease. That said, the evidence is still relatively absent as the Covid vaccine is less than a year old, so in this article I'm considering input from doctors, dermatologists, skin organisations and anecdotal reports from people coming to me with their shared experience. If you believe your condition has worsened as a result of the covid vaccine, you also have the option to report it - please see the links at the bottom of the page. 

Let's look first at reported instances of allergic skin reactions.

Allergic Skin Reaction

A statement from The Center for Disease Control and Prevention reports that some people have experienced a red, itchy, swollen, or painful rash where they received their injection. Evidence suggests the rash can begin a few days to more than a week after the first injection and sometimes covers quite a large area of skin.

Known as 'covid arm', the advice is, if you do experience this response after getting the first shot, you should still get the second shot at the recommended interval. 

More scientifically titled "delayed cutaneous hypersensitivity", essentially, this means a delayed reaction on the skin that is typically harmless and nothing to be concerned about. It's also been reported in people receiving vaccines for other illnesses. Do tell your healthcare provider that you experienced a rash after the first jab, they may recommend that you get the second shot in the opposite arm.

Severe Skin Reactions After Covid Vaccine

Reports of serious allergic reactions after receiving the covid jab are so far thankfully very rare. One man in Virginia, USA did experience a severe skin response to the vaccine. What began as an itchy rash, turned to pain, redness, swelling, and then peeling skin across his body. Seventy Four year old Richard Terrell was hospitalised for five days before his skin flare subsided. Doctors determined that Terrell's symptoms were a rare reaction to the Covid-19 vaccine. They suspect he may have some rare genetic traits that interacted with ingredients in the Johnson & Johnson shot to trigger his particular reaction.

Goochland County man suffers 'rare' severe reaction to COVID-19 vaccine https://t.co/SA5AsMBHoy #Virginia

— 8News WRIC Richmond (@8NEWS) March 30, 2021

Shingles Reaction to Covid Vaccine

Shingles, also known as herpes zoster, is an infection of a nerve and the skin around it. A study published just last week, conducted by two centres in Israel, suggests there have been six instances of shingles experienced shortly after administration of the Pfizer vaccine in patients with comorbid autoimmune / inflammatory diseases. While the causality between both events cannot be proven based on such a small number of cases, authors of the study recommend further vigilance and safety monitoring of the COVID-19 vaccination and its possible side effects.

Allergic Reactions and Covid Vaccine

Use of the Pfizer vaccine in people with a history of severe allergies was temporarily halted in the UK in December last year, after two healthcare workers experienced anaphylactic reactions. At the time, the Medicines and Healthcare Products Regulatory Agency (MHRA) stated that “any person with a history of anaphylaxis to a vaccine, medicine, or food should not receive the Pfizer/BioNTech vaccine.”

However, after careful consideration, at the end of 2020 the MHRA revised its statement based on close surveillance of over one million doses administered in both the UK and North America - including areas where people with serious allergies were never advised against receiving the vaccine.

Only a very small handful of allergic reactions have so far been reported - approximately two to five people per one million. The majority of people have not experienced an allergic reaction to the vaccine.

Known Allergies and the Vaccine

Combined statistics from the UK and US suggest 20 to 40% of the population have at least one 'allergic disease', this covers multiple clinical syndromes including;

• allergic rhinitis
• anaphylaxis
• allergic asthma
• conjunctivitis, eczema
• contact dermatitis
• food allergies
• urticaria

These are most commonly caused by food, airborne allergens (such as pollen), and immunologically mediated adverse effects of medicines.

Health experts suggest that a history of severe allergy should not prevent vaccination, unless that allergy is specifically to components of the vaccine itself. Only one of the ingredients in the Pfizer vaccine is a known potential allergen 'polyethylene glycol' (PEG 2000), and this is an inactive ingredient in over a thousand medications. If you're concerned about triggering an allergic response, evaluation by an allergy specialist may be advisable before taking the jab.

With specific studies on vaccination reactions for those of us with allergies still lacking, we can only take into consideration less reliable, anecdotal evidence until more research is available. Dr Peter Lio, MD, FAAD at the Chicago Integrative Eczema Center point outs 'I am hearing some reports of eczema flaring up after the vaccine. This is not unexpected: many times we see eczema flare in children after different vaccines or when fighting off a cold, and it stands to reason that when the immune system is "ramped up", inflammatory conditions can temporarily worsen'.

Covid Vaccine and Eczema

Despite Dr Lio's anecdotal report, according to The Eczema Society, there is so far, 'no evidence to suggest that Covid-19 vaccines will worsen eczema, and no reason to think they would'.

They ask that if you do experience side effects following receipt of the vaccine, including worsening of your eczema, to please report it to the Medicines & Healthcare products Regulatory Agency (MHRA)’s Coronavirus Yellow Card reporting site. Or alternatively, highlight concerns to your GP.

The Eczema Society advise people taking systemic treatments that affect the immune system (for example, prednisolone, azathioprine, ciclosporin, methotrexate, mycophenelate mofetil and dupilumab) to avoid ‘live’ vaccines. The three Covid-19 vaccines that are currently being rolled-out in the UK are not ‘live’ vaccines and have no Covid-19 virus in them. Meaning people using existing immune system treatments can take the vaccine.

Autoimmune Skin Conditions and Covid Vaccine

Since we're talking here about immunity, let's consider autoimmune conditions, these include skin problems such as lupus and psoriasis. In autoimmune disease, the body has an overactive immune system which causes it to attack itself. Around four million people in the UK suffer with an autoimmune condition, and strikingly, almost 80% of these diseases occur in women.

Despite there being no solid data yet available for the safety of the Covid vaccine administered in populations with autoimmune disease, the consensus of opinion appears to be that patients in this group are far safer getting the Covid vaccine than not. The Centers for Disease Control and Prevention (CDC) recommends that those of us with autoimmune conditions and those with weakened immune systems should receive the vaccine. Similarly the National Psoriasis Foundation suggests that in most cases, patients with psoriatic disease who don’t have contraindications should take the first authorised COVID-19 vaccine that becomes available to them.

A statement from The International Federation of Psoriasis Associations confirms there is currently 'no evidence that COVID-19 vaccines have any effect on the severity of psoriasis or psoriatic arthritis.' They claim, 'further studies will reveal whether COVID-19 vaccines can worsen or improve symptoms of psoriatic disease.' And recommend 'decision making [over having the vaccine] takes place together with your healthcare provider.'  

At present, any further recommendations when it comes to autoimmune disease and vaccinations are difficult to source. Societies and governing bodies are generally standing in agreement that the risks of not having the vaccine far outweigh those of having the jab. 

Results of a study published in the Lancet in February, reveal vaccine hesitancy amongst people with autoimmune conditions. The study included 1531 participants from 56 countries. Among the participants, 83% were patients with systemic autoimmune or inflammatory rheumatic diseases. The main concerns reported by these patients centred around the scarcity of experience and background information regarding new vaccines, and the possible induction of a flare of their disease, or the risk to develop a local reaction and side-effects.

Dr Jeffrey Curtis, chair of the COVID-19 Vaccine Clinical Guidance Task Force at the American College of Rheumatology is keen to reassure us that, despite there being limited data “it appears that patients with autoimmune and inflammatory conditions are at a higher risk for developing hospitalised COVID-19 compared to the general population, and have worse outcomes associated with infection,” Based on this concern, he suggests "the benefit of COVID-19 vaccination outweighs any small, possible risks for new autoimmune reactions or disease flare after vaccination.”

Avoid Live-attenuated Vaccines

Just like the Eczema Society, the International Psoriasis Council (IPC) recommends avoiding 'live-attenuated vaccines if receiving an immunosuppressive /  immunomodulatory medication', they also suggest to be aware an injection might be less effective if you're taking drugs that directly impact the immune system. The vaccines most commonly offered to protect against Covid-19 are either RNA-based (Pfizer/BioNTech, Moderna) or based on replication deficient virus (Oxford/AstraZeneca). Thus, they are not live attenuated vaccines.  

The council acknowledge that psoriasis patients have raised concerns about potential adverse effects of vaccines on their skin. They confirm there is currently no evidence to suggest that vaccines affect psoriasis onset or severity. However they do suggest registry data ought to be collected to establish whether vaccines either positively or negatively affect psoriasis outcomes.

The IPC have also reassured us they will continue to provide updates to the global dermatology community as we learn more about vaccines and their impact on psoriasis. 

NEW STUDIES AUTOIMMUNE DISEASE AND COVID VACCINE

The good news is, further studies are underway. In January 2021, Washington University began researching patients with rheumatic disease, inflammatory bowel disease, uveitis, autoimmune dermatologic conditions, and multiple sclerosis. Their main objectives are to;

• Determine the quantity and quality of the antibody response to the COVID-19 vaccine in people who have autoimmune diseases and who may be on immunosuppressive medication
• And to characterise the adverse events in people with autoimmune conditions. For example, does the vaccine cause different or worse side effects in these patients compared with the general population

Alfred Kim, MD, PhD, Assistant Professor of Medicine, Pathology, and Immunology at Washington University, in charge of the study, expects they will soon be able to offer some preliminary data about responses to the vaccine in terms of antibody levels and side effects.

Anecdotal Reports of Skin Flares

Whilst the scientific evidence so far points to there being no strong correlation between the vaccine and instances of psoriasis flares, anecdotally patients have come to me to question a correlation. So far each week I've received a handful of emails from people with psoriasis, highlighting a worsening of their condition post-jab. It's early days and there could of course be other coincidental factors for these noted flares. If you do notice a change in your symptoms, please contact me or consider using the links below to share your experience with PsoProtectMe.

IMMUNOCOMPROMISED TREATMENT OPTIONS

It's suggested that for patients with rare, genetic immune deficiencies, chronic illness that impairs the immune system (such as rheumatoid arthritis), plus cancer and organ-transplant patients who take immunosuppressive drugs, Covid vaccines may not be as effective. This is because these patients are less capable of making their own antibodies to neutralise the virus. According to a recent article in National Geographic, pharmaceutical companies around the world are racing to develop alternative treatments that have the ability to bypass the immune system altogether.

Should I Have the Covid Vaccine? 

The decision as to whether or not to have the vaccine, is a very personal one. You should carefully consider all the available information and make a decision based on your personal circumstances.  If you are still unsure, I would recommend discussing the options further with your doctor or dermatologist. 

FURTHER COMMENT AND RESEARCH

REPORT ANY ADVERSE REACTIONS

The Yellow Card Reporting System is in place to enable patients to report suspected side effects to medicines, vaccines, medical device and test kit incidents used in coronavirus testing and treatment to the Medicines and Healthcare products Regulatory Agency to ensure safe and effective use.

Click Here to share your experience which will go on to help inform others. 

REPORT PSORIASIS WORSENING

If you currently suffer from psoriasis, you are invited to share your experience during the pandemic via PsoProtectMe (whether you have had COVID-19 or not). Go to psoprotectme.org. 

If you are a healthcare professional, please report cases of COVID-19 in your psoriasis patients to psoprotect.org and partner registries.  

REPORT ECZEMA WORSENING

The Eczema Society are asking people to complete the SECURE-AD online patient survey if they have eczema and have also been diagnosed with Covid-19 or experienced Covid-19 symptoms. It takes only 10 minutes and the results will help improve the medical care for people with eczema who are infected with Covid-19. More details here about this ground-breaking global research initiative.

As an eczema patient, if you experience side effects following receipt of the vaccine, including worsening of your eczema, to please report it to the Medicines & Healthcare products Regulatory Agency (MHRA)’s Coronavirus Yellow Card reporting site. Or alternatively, highlight concerns to your GP.