2022 Apr 14;2022:9944727. doi: 10.1155/2022/9944727. Granuloma Annulare: An Updated Review of Epidemiology, Pathogenesis, and Treatment Options. An annular, irregular, sharply demarcated, pink-colored erythematous papular lesion, Multiple, asymptomatic, skin-colored to erythematous nodules. The study is based on data from the CDC and the FDA. Bookshelf Granuloma annulare after SARS-CoV-2 vaccination: A case report and a Clipboard, Search History, and several other advanced features are temporarily unavailable. This finding could be explained by lack of specificity against the spike proteins of SARS-CoV-2.6 Moreover, the real-time polymerase chain reaction test result for SARS-CoV-2 of the patients skin specimen was negative, further supporting the notion that GA represents a reaction pattern to a stimulus, in this case SARS-CoV-2 infection, as opposed to a direct result of the virus causing the skin lesions.6. Federal government websites often end in .gov or .mil. Although most vaccinations are considered relatively safe, there may be adverse effects associated with any vaccine. Granuloma annulare after SARS-CoV-2 vaccination: A case report and a 1B). sharing sensitive information, make sure youre on a federal The authors documented the clinical and histopathological features of an unexpected case of granuloma annulare (GA) arising a few days after the SARS-CoV-2 vaccination and reviewed all GAs reported in the literature following the SARS-CoV-2 vaccination and Cov-19-infection. Dermoscopy revealed linear arborizing vessels on a whitish-red background (Fig. Min M.S., Wu J., He H., Sanz-Cabanillas J.L., Del Duca E., Zhang N., Renert-Yuval Y., Pavel A.B., Lebwohl M., Guttman-Yassky E. Granuloma annulare skin profile shows activation of T-helper cell type 1, T-helper cell type 2, and Janus kinase pathways. an abnormal one at injection site), Injection site paraesthesia (abnormal skin sensations at injection site), Injection site pruritus (severe itching at injection site), Injection site urticaria (rash of round, red welts on the skin at injection site), Injection site vesicles (fluid- or air-filled cavity or sac at injection site), Ischaemic stroke (stroke; caused by an interruption in the flow of blood to the brain), Joint range of motion decreased (disease of joint movement), Leukocytosis (increased white blood cells), Lung consolidation (a condition whereby the lung tissues solidify because of the accumulation of solid and liquid material in the air spaces), Lung infiltration (a substance that normally includes fluid, inflammatory exudates or cells that fill a region of lung), Lymphadenitis (inflammation or enlargement of a lymph node), Lymph follicular hypertrophy (an increase in the size of the lymph node follicles), Lymphoedema (localized fluid retention and tissue swelling), Malaise (a feeling of general discomfort or uneasiness), Mastication disorder (disease of chewing food), Maternal exposure before pregnancy (use of substance before pregnancy), Maternal exposure during pregnancy (use of substance during pregnancy), Menstrual disorder (disease of menstrual cycle), Menstruation delayed (late menstruation cycle), Mental disorder (a psychological term for a mental or behavioural pattern or anomaly that causes distress or disability), Mental impairment (a condition affecting the body, perhaps through sight or hearing loss, a mobility difficulty or a health condition), Mental status changes (general changes in brain function, such as confusion, amnesia (memory loss), loss of alertness, loss of orientation), Metabolic encephalopathy (disorder or disease of the brain due to the body's disability to use energy), Micturition urgency (urgency to pass the urine), Middle ear effusion (fluid in middle ear), Migraine with aura (headache with vision weakness), Mitral valve incompetence (inefficient heart valve), Mobility decreased (ability to move is reduced), Monoplegia (a paralysis of a single limb), Mood swings (an extreme or rapid change in mood), Movement disorder (neurological syndromes where they may be excess of movement or a paucity of movement that is not connected to weakness), Multiple sclerosis (a nervous system disease that affects your brain and spinal cord. Please enable it to take advantage of the complete set of features! PMC Among these are vaccinations, which have been described as an infrequent cause of granuloma annulare. Indian Dermatol Online J. This content does not have an Arabic version. Martora F, Battista T, Marasca C, Genco L, Fabbrocini G, Potestio L. Clin Cosmet Investig Dermatol. McMahon D.E., Amerson E., Rosenbach M., Lipoff J.B., Moustafa D., Tyagi A., Desai S.R., French L.E., Lim H.W., Thiers B.H., Hruza G.J., Blumenthal K.G., Fox L.P., Freeman E.E. Different individuals may respond to medication in different ways. Epub 2015 Feb 4. An official website of the United States government. Nevertheless, less than a week after the Pfizer SARS-CoV-2 booster dose, the patient showed new lesions, increased itching, and redness of her rash [2]. Granuloma annulare triggered by SARS-CoV-2 infection. The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. 2022 Aug;61(8):923-929. doi: 10.1111/ijd.16222. The bumps that return after treatment tend to appear at the same spots, and 80% of those usually clear within two years. Cleveland Clinic is a non-profit academic medical center. Among these are vaccinations, which have been described as an infrequent cause of granuloma annulare. At dermoscopy, linear arborizing vessels on a whitish-red background. Generalized granuloma annulare after COVID-19 vaccination JAAD Case Rep. 2022 May 14;25:18-21. doi: 10.1016/j.jdcr.2022.05.003. Multiple papules coalescing into plaques with central clearing. Epub 2017 Jan 17. A. Clipboard, Search History, and several other advanced features are temporarily unavailable. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. See this image and copyright information in PMC. Disclaimer. FOIA Generalized granuloma annulare after pneumococcal vaccination. -, Barbieri J.S., Rosenbach M., Rodriguez O., Margolis D.J. Cutaneous reaction, Granuloma annulare, COVID-19 pandemic, SARS-CoV-2 vaccination. Granuloma annulare is found among people who get Pfizer BioNTech Covid Vaccine, especially for people who are female, 60+ old, and after 30 days of getting the vaccine. In chilblains-like lesions, the most studied vascular disease, an exaggerated immune response with significant type 1 interferon signaling necessary for viral eradication would generate a generalized inflammatory response [25], [26]. the contents by NLM or the National Institutes of Health. A. Vaccinations are important for infectious disease prevention; however, there are adverse effects of vaccines, many of which are cutaneous. Careers, Unable to load your collection due to an error. (A) A skin section showing the foci of chronic interstitial reticular dermis inflammation (Hematoxylin & eosin, 20). 2023 Apr;12(2):87-96. doi: 10.7774/cevr.2023.12.2.87. 2022 Nov 6;15:2369-2382. doi: 10.2147/CCID.S388245. Federal government websites often end in .gov or .mil. Pfizer second dose: lichen planus (2), granuloma annulare (1), morphea (1), Raynaud (1), pityriasis lichenoides (1); . Clin Exp Vaccine Res. The site is secure. 4th ed. doi: 10.1016/j.jemermed.2021.10.005. Back, flank, inguinal folds, and extremities. Finally, allergic contact dermatitis can develop at the injection site, typically due to adjuvant ingredients in the vaccine, such as thimerosal and aluminum. Epub 2021 Oct 23. Before Granuloma annulare is a benign (not harmful), often chronic (long-lasting) skin disorder. Lessons from dermatology about inflammatory responses in SARS-Cov-2. Cutaneous Reactions Following COVID-19 Vaccination: A Review of the Current Literature. JAAD Case Rep. 2022 Apr 14;24:38-41. doi: 10.1016/j.jdcr.2022.04.006. government site. 2021;157(7):817823. and transmitted securely. The https:// ensures that you are connecting to the A 58-year-old woman with a history of hyperlipidemia and bipolar disorder presented to our dermatology clinic because of a 3-month rash, which began 2weeks after her second dose of the Pfizer COVID-19 vaccine. Granuloma annulare is a chronic degenerative skin disorder. Vaccinations have also been associated in rare reports with generalized hypersensitivity reactions, such as erythema multiforme, Stevens-Johnson syndrome, urticaria, acute generalized exanthematous pustulosis, and drug hypersensitivity syndrome. 2014;41:109111. Would you like email updates of new search results? Granuloma annulare triggered by SARSCoV2 infection Significant clinical improvement was observed after 2months of therapy. sharing sensitive information, make sure youre on a federal 2023 Feb;242:154300. doi: 10.1016/j.prp.2022.154300. Calabria E., Canfora F., Mascolo M., Varricchio S., Mignogna M.D., Adamo D. Autoimmune mucocutaneous blistering diseases after SARS-Cov-2 vaccination: a case report of Pemphigus Vulgaris and a literature review. Introduction. Published by Elsevier Espaa, S.L.U. The https:// ensures that you are connecting to the Australas J Dermatol. Ann Dermatol. doi: 10.1016/j.jaad.2015.03.054. Careers. Before National Library of Medicine COVID-19 vaccines: comparison of biological, pharmacological characteristics and adverse effects of Pfizer/BioNTech and Moderna Vaccines. doi: 10.1111/1346-8138.15594. Wollina U., Karada A.S., Rowland-Payne C., Chiriac A., Lotti T. Cutaneous signs in SARS-COV-2 patients: a review. Skin findings on initial visit with erythematous papules with central clearing coalescing into annular plaques on the breasts, lower portion of the back, flanks, and inguinal folds. J. Wolf F, Grezard P, Berard F, Clavel G, Perrot H. Houcke-Bruge C, Delaporte E, Catteau B, Martin De Lassalle E, Piette F. Ann Dermatol Venereol. J. Dermatol. Federal government websites often end in .gov or .mil. Garca-Gil MF, lvarez-Salafranca M, Martnez Garca A, Ara-Martn M. An Bras Dermatol. Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. government site. For example, people have developed this skin condition after getting bit by an octopus, stung . Generalized granuloma annulare in infancy following bacillus Calmette-Gurin vaccination. doi: 10.1001/jamadermatol.2021.1805. Talotta R. Do COVID-19 RNA-based vaccines put at risk of immune-mediated diseases? With medical big data and AI algorithms, eHealthMe is running millions of phase IV trials and makes the results available to the public. Would you like email updates of new search results? She endorsed mild pruritus. Granuloma annulare may be caused by multiple triggers. The lesion was about 1,5cm in diameter and composed of multiple papules forming a plaque ( Case of Pilomatricoma After Coronavirus Disease 2019 Vaccination. National Library of Medicine 2008 Dec;30(6):622-4.doi: 10.1097/DAD.0b013e318185a691. In our case, the patient developed a reddish lesion seven days after SARS-CoV-2 vaccination and in the same site with a histological finding of interstitial GA. Penas P.F., Jones-Caballero M., Fraga J., Snchez-Prez J., Garca-Dez A. Perforating granuloma annulare. Ingravallo G., Mazzotta F., Resta L., Sablone S., Cazzato G., Cimmino A., Rossi R., Colagrande A., Ferrante B., Troccoli T., Bonifazi E. Inflammatory skin lesions in three SARS-CoV-2 swab-negative adolescents: a possible SARS-COV-2 sneaky manifestation? Epub 2020 Nov 9. -, Nomiyama T., Takenaka H., Kishimoto S., Katoh N. Granuloma annulare-like reaction to the bacillus Calmette-Gurin vaccination. Urticaria-like, vesicular/bullous and livedo-necrosis were also described. Careers. The patient was a 53-year-old woman with biopsy-proven GA on her left hand coinciding with the onset of headache, anosmia, and dysgeusia. Granuloma annulare in Moderna COVID Vaccine, Granuloma annulare in Johnson & Johnson COVID Vaccine, Abortion spontaneous (naturally occurring miscarriage), Acute myocardial infarction (acute heart attack), Acute upper airway obstruction (blockage occurs in the upper airway), Ageusia (loss of taste functions of the tongue), Agitation (state of anxiety or nervous excitement), Alopecia areata (patchy baldness that typically begins with rapid hair loss), Anaphylaxis (serious allergic reaction that is rapid in onset and may cause death), Angioedema (rapid swelling of the dermis), Appendicitis (inflammation of the appendix), Appetite - decreased (decreased appetite occurs when you have a reduced desire to eat), Appetite - increased (increased appetite is when you want to eat much more often or in larger quantities than your body requires), Ards (acute respiratory distress syndrome) (sudden failure of the respiratory (breathing) system), Arthritis (form of joint disorder that involves inflammation of one or more joints), Asthenopia (eyestrain-tiredness of the eyes caused by prolonged close work by a person with an uncorrected vision problem), Atelectasis (partial or complete collapse of the lung), Atrial fibrillation/flutter (atrial fibrillation and flutter are abnormal heart rhythms in which the atria, or upper chambers of the heart, are out of sync with the ventricles), Autoimmune disorder (a condition in which the immune system attacks the body's normal substances and tissue), Autonomic nervous system imbalance (autonomic nervous system is of net equal emphasis), Basedow's disease (autoimmune disease where the thyroid is overactive, producing an excessive amount of thyroid hormones), Belching (release of gas from the digestive tract), Blindness transient (sudden loss of vision), Blister (small pocket of fluid within the upper layers of the skin caused by forceful rubbing (friction), burning, freezing, chemical exposure), Blood thyroid stimulating hormone decreased, Blood thyroid stimulating hormone increased, Bradycardia (abnormally slow heart action), Breast lump (localized swelling that feels different from the surrounding breast tissue), Bronchitis (inflammation of the mucous membrane in the bronchial tubes), Bundle branch block right (absence of transmission of electric impulses from the atrioventricular (av) bundle of his to the right ventricle), Bursitis (inflammation of a bursa, typically one in the knee, elbow, or shoulder), Canker sores (painful, open sore in the mouth), Cardiomyopathy (weakening of the heart muscle), Cardio-respiratory arrest (sudden dysfunction of heart and lungs), Cerebral haemorrhage (bleeding within the brain), Cerebral infarction (less blood supply to brain resulting tissue damage), Cerebral thrombosis (blood clot in brain), Chapped lips (cracking, fissuring, and peeling of the skin f lip), Chronic obstructive pulmonary disease (a progressive disease that makes it hard to breathe), Cognitive disorder (mental health disorders affects learning, memory, perception, and problem solving), Concussion (short loss of normal brain function in response to a head injury), Coronary artery occlusion (complete obstruction of blood flow in a coronary artery), Coronary heart disease (narrowing or blockage of the coronary arteries), Crohn's disease (condition that causes inflammation of the gastrointestinal tract), Deep venous thrombosis (blood clot in a major vein that usually develops in the legs and/or pelvis), Dehydration (dryness resulting from the removal of water), Dermatitis (inflammation of the skin resulting from direct irritation by an external agent or an allergic reaction to it), Dermatitis contact (skin reaction (dermatitis) resulting from exposure to allergens), Diabetic ketoacidosis (diabetic ketoacidosis (dka) is high concentrations of ketone bodies), Diverticulitis (digestive disease which involves the formation of pouches (diverticula) within the bowel wall), Drooling (drop saliva uncontrollably from the mouth), Dyskinesia (abnormality or impairment of voluntary movement), Ear pruritus (pruritus or itching is ""the unpleasant skin sensation that frequently provokes scratching"" in ear), Eczema (patches of skin become rough and inflamed, with itching and bleeding blisters), Ejection fraction (the percentage of blood that is pumped out of a filled ventricle as a result of a heartbeat), Ejection fraction decreased (systolic heart failure), Encephalopathy (functioning of the brain is affected by some agent or condition), Euphoric mood (excessively happy but may become angry or irritable), Eyelid ptosis (falling of the upper or lower eyelid), Eyelid twitch (spontaneous and uncontrolled spasms of the muscles), Facial paralysis (loss of function of face muscle), Facial paresis (weakness in facial muscle movement), Fainting (loss of consciousness and postural tone), Feeding disorder (when children refuse to eat certain food groups), Fibromyalgia (a long-term condition which causes pain all over the body), Flank pain (a distressing sensation experienced around the lower back and the upper abdomen), Flatulence (flatus expelled through the anus), Fluid retention (an abnormal accumulation of fluid in the blood), Formication (a sensation that exactly resembles that of small insects crawling on (or under) the skin), Gastroesophageal reflux disease (a condition in which stomach contents leak backward from the stomach into the oesophagus), Gastrointestinal disorder (functional problems of gastrointestinal tract), Gastrointestinal haemorrhage (bleeding gastrointestinal tract), Gaze palsy (disorders affecting the ability to move both eyes in the same direction), General physical health deterioration (weak health status), Glossodynia (a burning or painful sensation in the tongue), Gout (uric acid crystals building up in the body), Guillain-barre syndrome (the body's immune system attacks its peripheral nervous system), Haematochezia (passage of stools containing blood), Haematoma (collection of blood outside the blood vessels), Hallucinations (sensations that appear real but are created by your mind), Heart palpitations (feelings or sensations that your heart is pounding or racing), Hemiparesis (weakness on one side of the body), Hemiplegia (paralysis of one side of the body), Herpes simplex (herpes simplex is a common viral infection), Hyperacusis (disorder in loudness perception), Hyperhidrosis (abnormally increased sweating), Hyperkalemia (damage to or disease of the kidney), Hyperthyroidism (over activity of the thyroid gland), Hypervolaemia (abnormally increased volume of blood), Hypoaesthesia (reduced sense of touch or sensation), Hypoaesthesia oral (reduced sense of touch or sensation in mouth), Hyponatremia (abnormally low level of sodium in the blood; associated with dehydration), Hyporesponsive to stimuli (abnormally low degree of responsiveness on an agent, action, or condition), Hypotension (abnormally low blood pressure), Hypothyroidism (abnormally low activity of the thyroid gland, resulting in retardation of growth and mental development), Idiopathic pulmonary fibrosis (chronic lung disease), Incoherent (talking in a confused and unclear way), Incontinence (lack of moderation or self-control), Injection site erythema (redness at injection site), Injection site haemorrhage (bleeding from injection site), Injection site nodule (small swelling or aggregation of cells in the body, esp. Bethesda, MD 20894, Web Policies Zhao Q., Fang X., Pang Z., Zhang B., Liu H., Zhang F. SARS-COV-2 and cutaneous manifestations: a systematic review. We study millions of patients and 5,000 more each day. eCollection 2022. Dermatol. Barbieri J.S., Rodriguez O., Rosenbach M., Margolis D. Incidence and prevalence of granuloma annulare in the United States. 1, 2, 3 In early 2021, authors described the first case of generalized GA . HHS Vulnerability Disclosure, Help The https:// ensures that you are connecting to the Testing of her skin biopsy specimen revealed a similar pattern of immunohistochemistry-based cytoplasmic staining in the GA histiocytes with the viral spike protein of SARS-CoV-2.6 However, similar results were also seen in negative control specimens of patients diagnosed with GA in 2019before the pandemic. doi: 10.1016/j.abd.2020.05.009. Sereflican B, Karapinar T, Duzcu SE, Turkoglu A. Skip to content Care at Mayo Clinic As discussed by Akinosoglou etal,7 there has been a well-established correlation with hyperactivation of the immune system, resulting in an inordinate cytokine release that led to multiorgan failure and death in patients with COVID-19. Generalized granuloma annulare after COVID-19 vaccination A Case of Leukocytoclastic Vasculitis Following SARS-COV-2 Vaccination. The patients disease flares 2weeks after she received the booster dose (left, before the booster dose; right, after the booster dose). Accessibility Accessibility sharing sensitive information, make sure youre on a federal Disclaimer. official website and that any information you provide is encrypted official website and that any information you provide is encrypted Granuloma annulare (GA) is a benign skin reaction with an incidence of 0.04% in the US, and has shown to be significantly associated with autoimmune disease, diabetes mellitus, and hyperlipidemia. These findings led to the diagnosis of interstitial GA. At the 3-month follow-up, the lesion showed signs of resolution. Unauthorized use of these marks is strictly prohibited. Among these are vaccinations, which have been described as an infrequent cause of granuloma annulare. government site. The https:// ensures that you are connecting to the Before This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). J Eur Acad Dermatol Venereol. Am J Dermatopathol. Significant clinical improvement was observed after 2 months of therapy. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). 2022 Jan;23(1):37-50. doi: 10.1007/s40257-021-00636-1. Granuloma annulare (GA) is a benign, self-limited skin condition of unknown etiology. Inflammation in your skin causes a raised, discolored rash or lumps under your skin. The clinicians performed a punch skin biopsy, and histology revealed an interstitial GA. A reddish lesion on left arm; B. Avallone G., Quaglino P., Cavallo F., Roccuzzo G., Ribero S., Zalaudek I., Conforti C. SARS-CoV-2 vaccine-related cutaneous manifestations: asystematic review. -. Discepolo V., Catzola A., Pierri L., Mascolo M., Della Casa F., Vastarella M., Smith G., Travaglino A., Punziano A., Nappa P., Staibano S., Bruzzese E., Fabbrocini G., Guarino A., Alessio M. Bilateral chilblain-like lesions of the toes characterized by microvascular remodeling in adolescents during the SARS-COV-2 pandemic. 14 days, with recurrence after the Pfizer SARS-CoV-2 booster dose. The authors report the first case of generalized granuloma annulare associated with pneumococcal vaccination in a 57-year-old woman, who presented cutaneous lesions 12 days after vaccination. FOIA Received 2022 Nov 21; Revised 2022 Dec 29; Accepted 2022 Dec 30. The third patient was a 63-year-old male with abrupt onset, multiple, asymptomatic, skin-colored to erythematous nodules involving abdomen, bilateral upper and lower limb, arising twenty days after a positive rapid antigen test for SARS-Cov-2. Bethesda, MD 20894, Web Policies sharing sensitive information, make sure youre on a federal 2017 Sep;36(3):300-301. doi: 10.1080/15569527.2016.1269336. The site is secure. The nebulous nature of the etiology of GA is likely the culprit reason for our patient not experiencing generalized GA after her first dose of the vaccine. Our original studies have been referenced on 600+ medical publications including The Lancet, Mayo Clinic Proceedings, and Nature. FIGURE 1 Immunohistochemical staining of granuloma annulare in biopsies from pre and postCOVID19 patients. Association of granuloma annulare with type 2 diabetes, hyperlipidemia, autoimmune disorders, and hematologic malignant neoplasms. Authors Miguel Fernando . It is important to acknowledge that since the majority of cases of GA are idiopathic, the onset of generalized disease in our patient following administration of the COVID-19 vaccine could simply be a temporal coincidence. 1995 Jan;20(1):51-3. doi: 10.1111/j.1365-2230.1995.tb01283.x. GA arising both after SARS-CoV-2 infection and vaccination are exceptional and unexpected events: three cases of GA after SARS-CoV-2 infection and one after SARS-CoV-2 vaccination have been reported in the literature (
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