In a peer-reviewed study Autoimmune Bullous Dermatosis Following Covid-19 Vaccination: A Series of Five Cases, published in March 2022 it was determined that five cases of Bullous Dermatosis were causally linked to the covid-19 vaccination.
The group of autoimmune bullous diseases (AIBDs) are characterized by cutaneous and mucosal vesicles, blisters, and erosions.
The study involved five cases of Autoimmune Bullous Dermatosis. While the abstract provides that several factors can trigger the onset of the disease which includes vaccinations, it maintains that cases are very rare. As a result of the observed increase in these ‘very rare’ cases it was hypothesized:
“That vaccination against coronavirus disease 2019 (covid-19) could trigger an immunological response in genetically predisposed individuals.”
Two of the cases were confirmed to be Bullous pemphigoid (BP), with Foliaceus pemphigus (FP) presenting in the other three cases. Three female patients and two male patients were aged between 50 to 68-years old.
The study suggests it highly suspected the cases of autoimmune bullous dermatosis to be vaccine-induced and supported this by noting –
“According to the French method of imputability (FMI), the pharmacovigilance investigation showed an I5B4 causality assessment score for the vaccines, interpreted as highly probable, for all the patients.”
The study made note that a vaccination campaign was launched in Morocco in January 2021 following the declaration of the covid-19 pandemic by the World Health Organisation (WHO) in March 2020.
The five cases were presented and reported on individually:
Case 1: Male, 51 years, with Bullous Pemphigoid (BP)
The patient had no specific medical history and was not taking other medications.
The patient suffered extensive bullous eruptions and lesions to 70 percent of his body including his trunk, back, and legs. The patient also suffered erosions of the mouth palate.
The study confirmed eruptions appeared seven days after the administration of the Oxford AstraZeneca covid-19 vaccine’s first booster dose.
Diagnosis of vaccine-induced BP is highly suspected with causality evident with an I5B4 assessment score according to FMI.
Case 2: Female, 54 years, with Bullous Pemphigoid (BP)
The patient had been previously well and had no specific medical history.
The patient suffered extensive rash and blistering that began at the injection site before spreading to her arms, abdomen, back, thighs, and lower legs. The patient also suffered erosions of the mouth palate.
The study confirmed eruptions appeared three days after the administration of the first dose of the Oxford AstraZeneca covid-19 vaccine.
Diagnosis of vaccine-induced BP is highly suspected with causality evident with an I5B4 assessment score according to FMI.
Case 3: Male, 68 years, with Bullous Pemphigoid (BP)
The patient had previous history of high cholesterol.
The patient suffered blistering beginning at the injection site initially misdiagnosed by others as post-traumatic lesions. Post and newly formed bullous eruptions were found on his trunk and limbs. The patient also suffered erosions of the mouth palate and genitalia.
The study confirmed eruptions appeared two weeks after the administration of the first dose of the Oxford AstraZeneca covid-19 vaccine. Symptoms worsened seven days after his second dose less than three weeks later.
Diagnosis of vaccine-induced BP is highly suspected with causality evident with an I5B4 assessment score according to FMI.
Case 4: Female, 50 years, with Foliaceus Pemphigus (FP)
The patient had no specific medical history.
The patient suffered extensive full-body erosions and extensive post bullous eruptions.
The study confirmed eruptions appeared 15 days after the administration of the Pfizer BioNTech covid-19 vaccine.
Diagnosis of vaccine-induced FP is highly suspected with causality evident with an I5B4 assessment score according to FMI.
Case 5: Female, 58 years with Pemphigus Vulgaris (PV)
Patient history of depression treated with sertraline.
The patient suffered extensive full-body erosions and extensive post bullous eruptions. The patient also suffered erosions of the mouth palate and genitalia.
The study confirmed patient presented with eruptions one month after the administration of the first dose of the Pfizer BioNTech covid-19 vaccine.
Diagnosis of vaccine-induced FP is highly suspected with causality evident with an I5B4 assessment score according to FMI.
The study offered several conclusions:
Vaccines form a substantial component of factors that affect the immune system, which may trigger the onset of AIBD in predisposed individuals.
Very few previous cases of Bullous Pemphigoid following vaccinations have been evident in available literature for adults and children.
The five probable vaccine-induced cases studied are hypothesised to be cross-reactivity of the vaccine antigens or its adjuvants which can trigger an immunological response in genetically predisposed individuals.
While the authors noted the uncertainty of causality between vaccinations and adverse events it said full vaccination against covid should continue to be encouraged but added
“Covid-19 vaccine probably needs to be added to the list of vaccine triggers of AIBD.”
“A very interesting aspect we observed is that the patients with new-onset BP had been administered inactivated covid-19 vaccines while the patients with induced pemphigus were diagnosed following mRNA covid-19 vaccinations,” the authors wrote.
