Cutaneous reactions to COVID-19 vaccines in pediatric patients and non-White patients

CategoryClinical presentationTimingPrognostic valueNotes
Multisystem inflammatory syndrome in children22Kawasaki-like clinical presentation in pediatric patients22Majority developed fever prior or concurrently with mucocutaneous findings22Cutaneous findings not correlated with more severe clinical course22Patients tend to be older and have more gastrointestinal symptoms than in Kawasaki disease22
Non-White patients1721,23,24Small reports of decreased rates of specific COVID-19 skin findings23,24
Scalp involvement and telogen effluvium may be more common1720
Hyperpigmentation may provide insight into previous inflammatory process21No definitive data comparing outcomes based on cutaneous findingsPalpation can be identify cutaneous eruptions when erythema is subtle21
Messenger RNA COVID-19 vaccines9,12,2528Acute and delayed local reactions most commonly seen, followed by urticarial and morbilliform eruptions9Median 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 immunogenicity2528Many non-local reactions mimic the skin findings seen in COVID-19 infection12
Adenoviral vector COVID-19 vaccines2932Overall, rare dermatologic adverse events include urticaria and local reactions29Majority of local dermatologic events were transient with a median duration of 2–3 days29Associated petechiae may suggest a rare but life-threatening thrombotic reaction30,31Rare case reports of unusual reactions including generalized Sweet syndrome, leukocytoclastic vasculitis, and a widespread pustular eruption32