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Year : 2022  |  Volume : 67  |  Issue : 4  |  Page : 427-428
Lichenoid drug reaction post-COVID vaccination with the modified chimpanzee adenovirus

1 From the General Physician, Department of Mycology, General Hospital Dr. Manuel Gea González, Mexico City, Mexico
2 Dermatopathology, Private Practice, Mexico City, Mexico
3 Dermatologist, Mycology Department, General Hospital Dr. Manuel Gea González. Mexico City, Mexico

Date of Web Publication2-Nov-2022

Correspondence Address:
Gabriela Moreno-Coutiño
Dermatologist, Mycology Department, General Hospital Dr. Manuel Gea González. Mexico City
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijd.ijd_747_21

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How to cite this article:
Garcia-Mendoza P, Espinoza-Hernández J, Moreno-Coutiño G. Lichenoid drug reaction post-COVID vaccination with the modified chimpanzee adenovirus. Indian J Dermatol 2022;67:427-8

How to cite this URL:
Garcia-Mendoza P, Espinoza-Hernández J, Moreno-Coutiño G. Lichenoid drug reaction post-COVID vaccination with the modified chimpanzee adenovirus. Indian J Dermatol [serial online] 2022 [cited 2023 Feb 8];67:427-8. Available from:


Development of traditional vaccines is an extensive and complex process that may last up to many years; however, because of the SARS-CoV-2 pandemic, time had to be significantly reduced. This could be attained due to pre-existing preclinical studies of candidate vaccines for SARS-CoV and MERS-CoV, resulting in the first clinical trial for a candidate vaccine in March 2020.[1]

The University of Oxford and AstraZeneca developed the second approved vaccine against SARS-Cov-2, known as ChAdOx1 nCoV-19 (AZD1222), from a recombinant chimpanzee adenovirus that expressed the spike glycoprotein of SARS CoV-2 and was first authorized in the UK in December 2020.

Local adverse effects include pain, local warmth or sensitivity at the injection site, erythema, swelling and itching; these are reported to occur among 1/10 patients.[2] Additionally, late reactions could appear up to 14 days later, which have been reported in variable percentages according to the type (or brand?) of vaccine (84% Moderna, 17% Pfizer).[2],[3] Below, we describe a case involving lichenoid drug eruption (LDE) associated with this vaccine that has not been described before in literature.

A 66-year-old male, smoker, without any relevant medical history attended for presenting a five-day dermatosis in the lower abdomen, otherwise asymptomatic [Figure 1]. He received his first dose of AstraZeneca COVID-19 vaccine a week earlier; aside from these lesions, he was unaware of other systemic or local symptoms. Moreover, he did not receive medication, neither systemic nor oral, for the dermatosis. A punch biopsy was performed and histopathology reported a lichenoid interface dermatitis, by lymphocytes with necrotic keratinocytes [Figure 2]. The capillary vessels were congestive and pigment incontinence was also observed. PAS stain was negative for infectious structures.
Figure 1: Lichenoid erythematous plaques in lower abdomen

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Figure 2: Histology, H&E 5× Parakeratosis, dense inflammatory infiltrate in dermo-epidermal junction, mainly by lymphocytes and scarce histiocytes

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He was diagnosed with probable lichenoid eruption associated with the SARS-CoV-2 vaccine according to WHO-UMC causality categories and could be classified within level 1 of the Hartwig's Severity Assessment Scale.[4],[5] He received topical betamethasone without improvement after being treated for two weeks. Until now, the lesions remain asymptomatic and under observation without any treatment.

Lichen planus (LP) and LDE are chronic inflammatory dermatoses and have been identified as rare cutaneous adverse drug reactions. It is known to be a T-cell-mediated autoimmune disorder that arises after exposure to different drugs such as thiazide diuretics, beta-blockers, non-steroidal anti-inflammatory drugs, among others. Similarly, cases of LDE have been previously linked to vaccines such as hepatitis B, influenza, rabies and Tdap (tetanus, diphtheria, pertussis).[3],[6],[7]

As the immunological changes triggered by SARS-Cov-2 are similar to those observed in the pathogenesis of LP, it has been postulated that SARS-Cov-2 may trigger this dermatosis.[4]

So far, there are only two reported cases of LDE associated with the COVID-19 vaccine, both related to the Pfizer-BioNTech vaccine. It is essential to keep registering all new cases and presentations of adverse effects related to this relatively new vaccine and to recognize LP and LDE as potential adverse effects.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

   References Top

Krammer F. SARS-CoV-2 vaccines in development. Nature 2020;586:516-27.  Back to cited text no. 1
Galván-Casas C, Català A, Muñoz-Santos C. Vacunas frente a SARS-CoV-2 y piel. Actas Dermosifiliogr 2021;112:828-36.  Back to cited text no. 2
Rumbo-Prieto JM. Reacciones cutáneas asociadas a la vacuna Covid, ¿Qué sabemos? Enferm Dermatol 2021;15:6-7.  Back to cited text no. 3
Parida S. Clinical causality assessment for adverse drug reactions. Indian J Anaesth 2013;57:325-6.  Back to cited text no. 4
[PUBMED]  [Full text]  
Petrova G, Stoimenova A, Dimitrova M, Kamusheva M, Petrova D, Georgiev O. Assessment of the expectancy, seriousness and severity of adverse drug reactions reported for chronic obstructive pulmonary disease therapy. SAGE Open Med 2017;5:2050312117690404. doi: 10.1177/2050312117690404.  Back to cited text no. 5
McMahon DE, Amerson E, Rosenbach M, Lipoff JB, Moustafa D, Tyagi A, et al. Cutaneous reactions reported after Moderna and Pfizer COVID-19 vaccination: A registry-based study of 414 cases. J Am Acad Dermatol 2021;85:46-55.  Back to cited text no. 6
Hiltun I, Sarriugarte J, Martínez-de-Espronceda I, Garcés A, Llanos C, Vives R, et al. Lichen planus arising after COVID-19 vaccination. J Eur Acad Dermatol Venereol 2021;35:e414-5.  Back to cited text no. 7


  [Figure 1], [Figure 2]


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