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Disclosures: Blumenthal reports no relevant financial disclosures.
June 28, 2021
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Skin of color representation needed when discussing COVID-19 vaccine cutaneous reactions

Disclosures: Blumenthal reports no relevant financial disclosures.
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Including Black, Indigenous and people of color is necessary in photographs and studies of cutaneous reactions after the mRNA COVID-19 vaccines, according to correspondence published in The New England Journal of Medicine.

A vaccine allergy and hypersensitivity reaction registry has been tracking cutaneous reactions after the COVID-19 vaccines. In April, data were published showing the reactions to the Pfizer and Moderna mRNA-based vaccines were mostly minor and should not discourage anyone from receiving a vaccine or getting their second dose. However, these data and the educational materials derived from it were lacking representation from BIPOC.

“Originally, all the cases of skin reactions that we were seeing, as well as those published elsewhere, were in white people, and it was unclear whether there was a reporting bias, people weren’t detecting skin reactions in people of color or whether the difference represented different vaccination rates,” Kimberly Blumenthal, MD, MSc, co-director of the Clinical Epidemiology Program at Massachusetts General Hospital and one of the authors of both the first paper and the recent letter, told Healio.

The researchers put out a call for images and reaction data from people of color and found that 55 of 510 registry reactions (11%) occurred in this population. Five percent of reactions were in Asian subjects, 4% in mixed race subjects, which included American Indian-Alaska Native and Native Hawaiian-Pacific Islander, 11% in Hispanic subjects and 1% in Black subjects.

Kimberly Blumenthal

The published case series and letter to the editor included eight images of large, local cutaneous reactions that occurred after the Pfizer and Moderna vaccines in skin of color, which the authors said are necessary for representation purposes.

“These reactions may unnecessarily contribute to vaccine hesitancy, potentially resulting in not completing an initial mRNA vaccine course or lead to hesitation about future booster doses,” Blumenthal said. “If we don’t recognize, diagnose, and support all individuals through the identification of these reactions and explanations regarding what its implication is ... then we will contribute to under-vaccination or incomplete vaccination unnecessarily.”