COVID-19 vaccine-induced new-onset pustular psoriasis mimicking skin infection of the hand and foot: A report of two cases

Raghda S. El Mashaari; Ameera S. Al Ali; Zaidoon M. Abdel Hadi; Mahmoud Talaat Sabri; Ahmed Nageeb Mahmoud; Raghda S. El Mashaari; Ameera S. Al Ali; Zaidoon M. Abdel Hadi; Mahmoud Talaat Sabri; Ahmed Nageeb Mahmoud

doi:10.3934/Allergy.2025010

AIMS Allergy and Immunology

2025, Volume 9, Issue 2: 136-143. doi: 10.3934/Allergy.2025010

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Case report

COVID-19 vaccine-induced new-onset pustular psoriasis mimicking skin infection of the hand and foot: A report of two cases

1.
Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
2.
Seha Corporation, UAE
3.
Geisinger Medical Center, Danville, PA, USA
4.
Faculty of Medicine, Ain Shams University, Cairo, Egypt

Received: 21 November 2024 Revised: 21 May 2025 Accepted: 04 June 2025 Published: 16 June 2025

Psoriasis after vaccination, namely “Psoriasis Vaccinalis”, has been described with several vaccines. More recently, emerging reports have linked coronavirus (COVID-19) vaccines to exacerbation or new-onset psoriasis. We report 2 female patients who developed severe new-onset palmoplantar pustular psoriasis following vaccination against COVID-19 (one received a deactivated vaccine, and one received an mRNA vaccine). The patients developed the psoriatic lesions 1 and 2 weeks after the vaccinations, respectively. The patients were primarily diagnosed in a primary care facility or through self-diagnosis with skin/deep soft tissue infections of the hand or foot, and started topical antibiotics before seeking dermatological consultations, where the diagnosis of psoriasis was concluded and confirmed by skin biopsies. The patients were successfully treated with anti-psoriasis topical and/or systemic medications. Psoriasis Vaccinalis has been previously described with several vaccines. COVID-19 vaccines are not an exception, and new-onset pustular psoriasis can occur after any type of COVID-19 vaccination, thereby mimicking a skin infection in its early stage. Primary care clinicians should remain vigilant for potential cases of vaccine-induced psoriasis to prevent misdiagnosis and facilitate a timely referral to dermatology.
- psoriasis,
- COVID-19 vaccine,
- vaccine reaction,
- Psoriasis Vaccinalis
Citation: Raghda S. El Mashaari, Ameera S. Al Ali, Zaidoon M. Abdel Hadi, Mahmoud Talaat Sabri, Ahmed Nageeb Mahmoud. COVID-19 vaccine-induced new-onset pustular psoriasis mimicking skin infection of the hand and foot: A report of two cases[J]. AIMS Allergy and Immunology, 2025, 9(2): 136-143. doi: 10.3934/Allergy.2025010

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Abstract

Psoriasis after vaccination, namely “Psoriasis Vaccinalis”, has been described with several vaccines. More recently, emerging reports have linked coronavirus (COVID-19) vaccines to exacerbation or new-onset psoriasis. We report 2 female patients who developed severe new-onset palmoplantar pustular psoriasis following vaccination against COVID-19 (one received a deactivated vaccine, and one received an mRNA vaccine). The patients developed the psoriatic lesions 1 and 2 weeks after the vaccinations, respectively. The patients were primarily diagnosed in a primary care facility or through self-diagnosis with skin/deep soft tissue infections of the hand or foot, and started topical antibiotics before seeking dermatological consultations, where the diagnosis of psoriasis was concluded and confirmed by skin biopsies. The patients were successfully treated with anti-psoriasis topical and/or systemic medications. Psoriasis Vaccinalis has been previously described with several vaccines. COVID-19 vaccines are not an exception, and new-onset pustular psoriasis can occur after any type of COVID-19 vaccination, thereby mimicking a skin infection in its early stage. Primary care clinicians should remain vigilant for potential cases of vaccine-induced psoriasis to prevent misdiagnosis and facilitate a timely referral to dermatology.

Conflicts of interest

All authors declare that there are no competing interests.

Author contributions

Raghda Al Mashaari: Investigations, Methodology, Data Collection, Formal analysis; Ameera Al Ali: Investigations, Methodology, Data Collection, Formal analysis, Manuscript writing–original draft; Zaidoon Abdel Hadi: Investigations, Methodology, Data Collection, Formal analysis; Mahmoud Talaat Sabri: Data Curation, Conceptualization, Methodology; Ahmed Nageeb Mahmoud: Conceptualization, Data Curation, Methodology, Manuscript writing–original draft, Manuscript writing–review and editing.

Ethics approval of research

Informed consent has been obtained from the patients for the anonymous use of the clinical data for research purposes.
Institutional Review Board approval was waived due to the nature of the research (case report, two cases); however, the authors declare that the research complies with HIPAA.

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