COVID-19 Resource Center

COVID-19 Resource Center

Disclosures: Freeman reports she is part of the American Academy of Dermatology COVID-19 Ad Hoc Task Force and author of COVID-19 dermatology for UpToDate. Please see the study for all other authors’ relevant financial disclosures.
April 23, 2021
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Cutaneous reactions to Pfizer, Moderna COVID-19 vaccines minor

Disclosures: Freeman reports she is part of the American Academy of Dermatology COVID-19 Ad Hoc Task Force and author of COVID-19 dermatology for UpToDate. Please see the study for all other authors’ relevant financial disclosures.
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Cutaneous reactions to the mRNA-based COVID-19 vaccines were mostly minor and self-limited and should not discourage individuals from receiving a vaccine, according to a study.

Two mRNA vaccines have been approved for emergency use by the FDA: Pfizer/BioNTech (BNT162b2) and Moderna (mRNA-1273).

COVID vaccine
Cutaneous reactions to the mRNA-based COVID-19 vaccines were mostly minor and self-limited and should not discourage individuals from receiving a vaccine.

Local injection site reactions were reported for both vaccines during clinical trials.

Esther E. Freeman

The registry-based study evaluated morphology of cutaneous reactions, timing and duration of reactions, and treatments using an international registry of cutaneous manifestations after SARS-CoV-2 vaccinations.

“The most common vaccine skin reactions reported were delayed local reactions, which generally start 7 to 8 days after vaccination in the vaccinated arm,” study author Esther E. Freeman, MD, PhD, of Massachusetts General Hospital, Harvard Medical School, told Healio. “These are generally mild and self-limited and should not be confused with cellulitis.”

One or more cutaneous reactions were reported in 414 subjects, with 83% of those reactions in individuals who received the Moderna vaccine and 17% in those who received the Pfizer vaccine. Information about both vaccine doses was available in 180 (43%) of the 414 cases.

A reaction after the first dose but not the second dose was reported in 38 subjects (21%), and a reaction after the second dose only was reported in 113 subjects (63%). A reaction after both doses occurred in 29 subjects (16%).

Those who received the Moderna vaccine were more likely to experience a delayed large local arm reaction.

No anaphylaxis or severe adverse events were reported.

Topical corticosteroids, oral antihistamines and/or pain-relieving medications were helpful in those who had a reaction, with resolution in a median of 3 to 4 days.

“Overall, this data is reassuring that patients who develop skin reactions to the first COVID-19 vaccine do not necessarily have skin reactions to the second,” Freeman said. “We don’t recommend one COVID-19 vaccine over another. We saw more delayed large local reactions with Moderna, but for all the other skin reactions, they were relatively evenly split between the two vaccines. Whatever vaccine you can get first should be the vaccine you choose. The real-world efficacy data from all the different COVID-19 vaccines (which are currently in use in the United States) has been excellent.”