Cutaneous reactions to vaccination

Vaccination reactions are possible but typical symptoms after a vaccination: depending on the vaccine, these include redness, swelling and pain at the vaccination site, as well as general reactions such as fever, headache, aching limbs and malaise. These reactions are an expression of the immune system's desired reaction to the vaccine and usually subside completely after a few days. Information on the type and frequency of ADRs can be found in the product information for the respective vaccine.

A vaccine is a biological agent that serves to stimulate the immune system so that it develops a protective immune response against the antigenic components contained in the agent.

Cutaneous vaccination reactions can be classified into three pathogenetic types:

Overshooting (hyperergic) reactions of the immune system activated by the vaccination

• Local reactions
• Disseminated reactions
  • morbilliform, papulo-vescular papulosquamous exanthema
  • Pityriasis rosea-like exanthema (no primary medallion)
  • urticaria
  • Angioedema
  • Rarely
    • Erythema exsudativum multiforme (COVID, HPV, measles-mumps-rubella, VAri cells, influenza, hepatitis B, meningo- pneumococci)
    • Acute febrile neutrophilic dermatosis

Allergic reactions to the vaccine or the adjuvants added to it (alpha-gal, dextrans, egg white, PEG)

• Local reactions (itchy lumps or plaques at the vaccination site)
• Disseminated reactions
  • Anaphylactic reactions
  • Serum sickness
  • Vasculitis
  • Rarely
    • Stevens-Johnson syndrome
    • Toxic epidermal necrolysis (TEN )
    • Generalized exanthematous pustulosis (AGEP)
    • DRESS

Immunological dysregulation with reactivation or aggravation of other diseases

• Reactivated herpes simplex infections
• Pityriasis rosea
• Guttata type of psoriasis vulgaris (usually as a flare-up reaction of pre-existing psoriasis)
• Lichen (ruber) planus
• Exacerbation of atopic dermatitis
• Recall reactions (e.g. in areas previously treated with imiquimod)

Cutaneous vaccination reactions can be classified into three pathogenetic types:

• excessive (hyperergic) reactions of the immune system activated by the vaccination
• allergic reactions to the vaccine or the adjuvants added to it
• immunological dysregulation with reactivation or aggravation of other diseases

w>m

Surveys on the incidence of cutaneous vaccination reactions showed that >70% of those vaccinated developed localized and about 3-5% generalized skin reactions.

Autoimmune reactions following vaccination: The mechanism of autoimmune reactions following vaccination is still unclear. On the one hand, a genetic predisposition to vaccine-induced autoimmunity is suspected, as only a few test subjects developed autoimmune diseases after vaccination. On the other hand, the immune system could trigger autoimmune diseases through cross-reactivity due to the similarity of some vaccine components with certain human proteins (so-called molecular mimicry). In addition, it has been postulated that activation of the toll-like receptors of antigen-presenting cells may play a role in the recurrence of autoimmune diseases after vaccination (Sagy I et al. 2022). It is known that tetanus toxoid, influenza and polio vaccines as well as other vaccines have an influence on the formation of autoantibodies and the development of autoimmune diseases such as rheumatoid arthritis, bullous pemphigoid, pemphigus vulgaris, autoimmune myositis and systemic lupus erythematosus (Hinterseher J et al. 2023). Furthermore, influenza vaccines have been reported to trigger a transient flare in approximately 19.4% of patients with SLE within 6 weeks (Crowe SR et al. 2011). There are also some cases in which SLE occurred after vaccination against hepatitis B, tetanus or typhoid fever.

See also Autoimmune diseases of the skin and SARS-CoV-2 vaccination

1. Crowe SR et al. (2011) Influenza vaccination responses in human systemic lupus erythematosus: impact of clinical and demographic features. Semin Arthritis Rheum. 63: 2396-2406.
2. Hinterseher J et al. (2023) Autoimmune skin diseases and SARS-CoV-2 vaccination - a meta-analysis.JDDG 21: 853-862

3. Kussini J et al. (2025) Cutaneous reactions to vaccination. J Dtsch Dermatol Ges 23:195-209.

4. Sagy I et al. (2022) New-onset systemic lupus erythematosus following BNT162b2 mRNA COVID-19 vaccine: a case series and literature review. Rheumatol Int 42: 2261-2266.

5. Communications of the Robert Koch Institute (RKI) in Berlin. Retrieved on 26.1.2021