Cutaneous reactions to COVID-19 vaccines in pediatric patients and non-White patients
| Category | Clinical presentation | Timing | Prognostic value | Notes |
|---|---|---|---|---|
| Multisystem inflammatory syndrome in children22 | Kawasaki-like clinical presentation in pediatric patients22 | Majority developed fever prior or concurrently with mucocutaneous findings22 | Cutaneous findings not correlated with more severe clinical course22 | Patients tend to be older and have more gastrointestinal symptoms than in Kawasaki disease22 |
| Non-White patients17–21,23,24 | Small reports of decreased rates of specific COVID-19 skin findings23,24 Scalp involvement and telogen effluvium may be more common17–20 | Hyperpigmentation may provide insight into previous inflammatory process21 | No definitive data comparing outcomes based on cutaneous findings | Palpation can be identify cutaneous eruptions when erythema is subtle21 |
| Messenger RNA COVID-19 vaccines9,12,25–28 | Acute and delayed local reactions most commonly seen, followed by urticarial and morbilliform eruptions9 | Median time to onset after first dose was 7 days, occurring in 2 clusters between day 1–3 and day 7–89 Shorter median time from second dose, occurring at day 19 | Burgeoning data suggest local reactions not strongly associated with immunogenicity25–28 | Many non-local reactions mimic the skin findings seen in COVID-19 infection12 |
| Adenoviral vector COVID-19 vaccines29–32 | Overall, rare dermatologic adverse events include urticaria and local reactions29 | Majority of local dermatologic events were transient with a median duration of 2–3 days29 | Associated petechiae may suggest a rare but life-threatening thrombotic reaction30,31 | Rare case reports of unusual reactions including generalized Sweet syndrome, leukocytoclastic vasculitis, and a widespread pustular eruption32 |