Case report of exacerbation of pre-existing Seborrheic Dermatitis following COVID-19 vaccines 一例先前存在的脂溢性皮炎接种疫苗后病情加重
Multiple common cutaneous reactions, eczeam, psoriasis, lichen planus, pityriasis rubra pilaris, urticaria have been attributed to vaccinations, including the messenger RNA COVID-19 vaccine (Moderna and Pfizer). A Case report of exacerbation of pre-existing Seborrheic Dermatitis following COVID-19 vaccines is presented.
Case Report
A 53-year-old man with a history of diabetes and seborrheic dermatitis, managed with metformin and Tacrolimus (protopic) respectively, had his seborrheic dermatitis under control and stable. However, a few days after receiving his third Pfizer vaccination, he developed scaly redness and scaling around the nasolabial folds and peri-oral area. The timing of these skin issues pointed to a connection with the vaccine. Despite treatments prescribed by his dermatologist, including topical corticosteroids and ketoconazole cream, the rash worsened over the following weeks. A prednisone taper was attempted but discontinued after 5 days due to minimal improvement and worsening of the rash. Tacrolimus (protopic) also did not alleviate his symptoms.
Seeking further evaluation, the patient came to our clinic for alternative Traditional Chinese Medicine (TCM) herbal management. We recommended discontinuing his existing immunosuppressant treatment for 10 days to allow the effects to wash out before starting our customized herbal medicinal formula tailored to his unique clinical presentation. He provided updates via WhatsApp every two days (Fig. Baseline to Day 10), showing the seborrheic lesions enlarging and worsening. The patient began herbal TCM medicine on day 10. In the first three months of treatment, he experienced a continusing flare-up of lesions, attributed to a rebound effect after withdrawing immunosuppressants. However, with time, the lesions gradually subsided, ultimately achieving complete clearance after eight months of treatment. Concurrently, TCM therapy was discontinued. At the one-year follow-up visit, there was no recurrence of the condition.
Clinical Brief
Seborrheic dermatitis is a chronic and often mild form of dermatitis that can occur in both infants and adults. Its severity can range from minor, asymptomatic scalp scaliness (commonly known as dandruff) to more widespread skin involvement. Typically, those affected are in good health, although seborrheic dermatitis has been linked to conditions such as human immunodeficiency virus (HIV) infection, Parkinson’s disease, various neurological disorders, and the use of certain neuroleptic medications.
This condition may emerge either soon after puberty or later in life. It is characterized by distinct, reddish plaques with greasy-looking, yellowish scales. These plaques are commonly found in areas rich in sebaceous glands, including the scalp, external ear, central face, upper trunk, and skin folds.
On the face, seborrheic dermatitis often affects the forehead below the hairline, the eyebrows and glabella (the space between the eyebrows), and the nasolabial folds. Sometimes, the lesions extend to the cheeks and malar areas in a butterfly-like distribution. In men with facial hair, the mustache and beard areas are frequently involved. Shaving can be helpful in managing and controlling the condition.
Reference
- Shafie’ei M, Jamali M, Akbari Z, Sarvipour N, Ahmadzade M, Ahramiyanpour N. Cutaneous adverse reactions following COVID-19 vaccinations: A systematic review and meta-analysis. J Cosmet Dermatol. 2022 Sep;21(9):3636-3650.
- D.E. McMahon, E. Amerson, M. Rosenbach, et al. Cutaneous reactions reported after Moderna and Pfizer COVID-19 vaccination: a registry-based study of 414 cases. J Am Acad Dermatol, 85 (1) (2021), pp. 46-55
- Etsubdenk M. Ajebo, John D. Howard, Dipti Anand, Loretta S. Davis,
Pityriasis rubra pilaris potentially triggered by messenger RNA–1273 COVID vaccine, JAAD Case Reports, Volume 23, 2022, Pages 114-116,
Privacy
In situations where the disease information had already been made publicly available (as evidenced by prior articles), genuine names of individuals have been utilized. Conversely, in instances where there was no pre-existing public disclosure or at the explicit request of patients for privacy, pseudonyms have been employed. Furthermore, identities have been deliberately obscured, and certain contextual details and diagnoses have been modified to hinder any attempts at identification. It is essential to emphasize that the patients and encounters described in this work are authentic, and their consent for publication was duly obtained. As responsible authors, we earnestly implore all our readers to honor the privacy and confidentiality of these individuals. Additionally, certain scenarios, assessments, and clinical interventions have been altered to safeguard the anonymity of both patients and healthcare providers.
