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CORRESPONDENCE |
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| Year : 2022 | Volume
: 67
| Issue : 6 | Page : 783-785 |
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| Covishield™ (ChAdOx1 nCoV-19) vaccine-induced systemic drug-related intertriginous and flexural exanthema in a young girl: A case report and literature review |
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Jaspriya Sandhu, Manisha Katha, Sunil Kumar Gupta
Department of Dermatology, Venereology and Leprology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| Date of Web Publication | 23-Feb-2023 |
Correspondence Address:
Jaspriya Sandhu
Department of Dermatology, Venereology and Leprology, Dayanand Medical College and Hospital, Ludhiana, Punjab
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/ijd.ijd_511_22
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How to cite this article:
Sandhu J, Katha M, Gupta SK. Covishield™ (ChAdOx1 nCoV-19) vaccine-induced systemic drug-related intertriginous and flexural exanthema in a young girl: A case report and literature review. Indian J Dermatol 2022;67:783-5 |
How to cite this URL:
Sandhu J, Katha M, Gupta SK. Covishield™ (ChAdOx1 nCoV-19) vaccine-induced systemic drug-related intertriginous and flexural exanthema in a young girl: A case report and literature review. Indian J Dermatol [serial online] 2022 [cited 2023 Mar 29];67:783-5. Available from: https://www.e-ijd.org/text.asp?2022/67/6/783/370310 |
Sir,
In the post-COVID vaccine world, where lockdowns and quarantines have gradually been eased out, COVID-19 vaccines have been increasingly associated with cutaneous adverse reactions. Cutaneous adverse effects are more unexpected and alarming for patients post-vaccination and are often what brings them to the clinic. A rare and uncommon vaccine-associated eruption is systemic drug-related intertriginous and flexural dermatitis (SDRIFE).
A 20-year-old girl reported for a dermatology consult for an itchy, reddish rash over flexures for a week. The rash appeared a week after the first vaccination dose for COVID-19 (CovishieldTM vaccine[ChAdOx1 nCoV-19), Serum Institute of India Pvt. Ltd.). Before the development of the rash, she developed a low-grade fever; however, no topical application or drug history could be elicited. On examination, a bright-red, flexural rash with an ill-defined margin and mild, fine scaling was seen symmetrically present predominantly over axillae, groynes, gluteal cleft, neck, and infra-mammary area [Figure 1]a, [Figure 1]b. Few flexural areas had some maceration [Figure 1b]. The scalp, hair, and mucosae were unremarkable. She was afebrile at the time of presentation; there was no lymphadenopathy; the systemic examination revealed no abnormalities. | Figure 1: Symmetric, flexural, erythematous exanthema: (a) axilla and (b) groyne
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We diagnosed her as a case of vaccine-associated SDRIFE and treated her with an emollient, topical mid-potency corticosteroid, and antihistamines. She followed up after 5 days with marked improvement in the lesions [Figure 2]a, [Figure 2]b. The patient did not follow up after the second visit. | Figure 2: Marked improvement in the lesions 5 days post-treatment: (a) axilla and (b) groyne
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The American Academy of Dermatology and The International League of Dermatologic Society COVID-19 Registry have recorded cutaneous adverse effects due to vaccines reported by physicians worldwide since late 2020.[1] Local injection reactions like pain, redness, and swelling with a mild flu-like illness are common and self-limiting; occasionally, more severe delayed local adverse reactions may occur.[2] These reactions vary from region to region, possibly due to the type of vaccine administered. With the Moderna vaccine, the dermatologic manifestations, though uncommon, may include hypersensitivity reactions, urticaria, and exanthema (maculopapular/morbilliform/vesicular); the Sputnik vaccine has also been associated with acneiform eruption and petechial rash.[3],[4] SDRIFE-like rash has been reported in four cases previously [Table 1].[5],[6],[7] However, only one out of the four was associated with the Oxford AstraZeneca vaccine.[5],[6],[7] To the best of our knowledge, this is the first case of SDRIFE associated with the Covishield/Oxford vaccine reported from India. | Table 1: COVID-19 vaccine-related SDRIFE-like rash reported by authors worldwide[5],[6],[7]
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Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
 References | |  |
| 1. | Freeman EE, Sun Q, McMahon DE, Singh R, Fathy R, Tyagi A, et al. Skin reactions to COVID-19 vaccines: An American academy of dermatology/international league of dermatological societies registry update on reaction location and COVID vaccine type. J Am Acad Dermatol 2022;86:e165-7.  |
| 2. | Shin E, Bae S, Jung J, Song WJ, Kwon HS, Kim HS, et al. Delayed local reactions after the first administration of the ChAdOx1 nCoV-19 vaccine. Allergy 2021;76:3520-2. |
| 3. | McMahon DE, Amerson E, Rosenbach M, Lipoff JB, Moustafa D, Tyagi A, et al. Cutaneous reactions reported after Moderna and Pfizer COVID-19 vaccination: A registry-based study of 414 cases. J Am Acad Dermatol 2021;85:46-55. |
| 4. | Niebel D, Novak N, Wilhelmi J, Ziob J, Wilsmann-Theis D, Bieber T, et al. Cutaneous adverse reactions to COVID-19 vaccines: Insights from an mmune-dermatological perspective. Vaccines (Basel) 2021;9:944. |
| 5. | Hai J, Shawa H, Kim-Lim P, Wang JZ, Vy M, Fung MA, et al. Systemic drug-related intertriginous and flexural exanthema induced by the Pfizer-BioNTech COVID-19 vaccine: A report of 2 cases. JAAD Case Rep 2021;18:57-60. |
| 6. | Orenay OM, Balta I, Yigit D, Eksioglu M. Systemic drug-related intertriginous and flexural exanthema like eruption after CoronaVac vaccine. J Eur Acad Dermatol Venereol 2021;35:e634-5. |
| 7. | Lim PN, Wylie G. Symmetrical drug-related intertriginous and flexural exanthema like eruption associated with COVID-19 vaccination. Clin Exp Dermatol 2022;47:175-6. |
[Figure 1], [Figure 2]
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