Skin alterations have been seen more frequently during the pandemic due to the side effects of covid or those produced by their respective vaccines. Shingles is one of the most frequent symptoms in these cases, a virus that can reawaken with the vaccine and manifest as chickenpox
With the passage of the pandemic, dermatological consultations have treated numerous skin alterations related to the disease (covid-19) and its vaccines.
Among them, herpes zoster is one of the most frequent effects found after vaccination.
The dermatologist at the University Hospital of Móstoles (Madrid) Cristina Galv á n points out: “At the beginning, we were so immersed in the scare of the new disease that we did not pay attention to the skin.”
“We have seen very different manifestations, very varied, whose exact meaning or whose relationship with the virus we do not fully understand. In addition, these manifestations have been modified over the course of the pandemic, even many of them we have stopped seeing ”.
Adverse effects on the skin after vaccination
The dermatologist at the Hospital of Barcelona Alba Catalá Gonzalo explained at the II National Congress COVID-19, in the presentation organized by the Spanish Academy of Dermatology and Venereology (AEDV), that after inoculation symptoms such as “acute skin manifestations or retarded ”.
“One of the most typical manifestations is what has been described as COVID-ARM. It is a large erythema-edematous plaque of up to 10 to 15 centimeters in the area of the injection ”, reports Dr. Catalá.
It can appear in the first days at the injection site, and also delayed between 5 and 8 days later.
The dermatologist Cristina Galván explains that the effects with which patients are most frequently consulting after vaccination are urticaria and reactivations of the viruses of the herpes group: herpes simplex and herpes zoster, “whose appearance has been more frequent after the Pfizer vaccine. ”
“There are immediate urticarial reactions that can be related to an allergy to the vaccine, and they are the ones that can be of more concern and should be investigated, in case it is necessary to decide not to put a second dose,” says the expert.
Many of the alterations produced by the vaccine are similar to those produced by covid, such as “hives, rashes similar to pityriasis rosea and shingles.”
The World Health Organization (WHO) transmits these effects “should not cause alarm, they indicate that the immune system is responding to the vaccine.”
He also emphasizes that “the absence of side effects does not mean that the vaccine is not effective, because each person reacts differently to vaccines.”
Dermatological history and skin changes due to the vaccine
Those people who suffer from skin problems, such as atopic dermatitis or psoriasis, after the administration of the vaccine may suffer a temporary worsening of their disease, explains the dermatologist.
“People with these previous dermatological pathologies, it is known that they can also have this temporary worsening of their skin problem after the use of other vaccines or when they suffer other diseases, different from COVID-19.”
Adverse effects on aesthetic touch-ups
The first studies on vaccines in the population described that some people who had previously implanted fillers for cosmetic purposes could experience swelling or edema in the retouched area.
“It was also known, we all dermatologists know it, that these late reactions to a filling put in a long time before can happen after other vaccines and after some infections,” says Cristina Galván.
The expert says that, “although this adverse effect is documented, with the large number of vaccines that have been inoculated, we can say that it is very rare.”
In the more than 400 cases they studied in their analysis, only one of the subjects suffered this type of reaction. Therefore “it is rare.” Furthermore, all reported cases “have been resolved well.”
What is herpes zoster?
The varicella-zoster virus (VZV) is one of the eight known viruses of the herpes family, reports the Spanish Association of Vaccination. After the first contagion, it produces the clinical picture known as “chickenpox”.
This contagion usually happens in childhood. Chickenpox usually resolves itself in children, without treatment, but adults have a more aggressive clinical picture.
Patients with impaired immunity are a higher risk group and may have complications such as pneumonia, hepatitis, or encephalitis .
Herpes zoster is nothing more than the clinical manifestation of the reactivation of the VZV, which is stationed in our body after having suffered from chickenpox.
“In the study that we did, we analyzed more than 400 reactions after the vaccine over a period of two months, and one of the most frequent reactions was this”, explains Cristina Galván.
How can I get VVZ?
In the case of never having had contact with VZV, the contagion occurs from another infected person, either by being exposed to their respiratory secretions, or by contact with skin lesions. The resulting clinical picture is that of chickenpox.
In some cases, people with poor immunity can become infected again because their immunity has lost the memory of the first chickenpox.
“People vaccinated for chickenpox can also get the disease. Although in these cases it tends to occur in a much less serious way, with fewer injuries and fewer complications ”, emphasizes the AEDV.
After passing chickenpox, VZV falls asleep in one area of the body, “generally along a nerve trunk,” and can wake up at any time in adult life.
In that case, the skin manifestation is “shingles” or herpes zoster. “It is therefore a reactivation, not a contagion,” explains the dermatologist.
Herpes zoster characteristics
According to the Spanish Association of Vaccination, herpes zoster is painful and follows the path of a thoracic or lumbar nerve. In people with good immunity, the lesions dry up in about 7 to 10 days and are no longer contagious.
The development of new lesions after 1 week after onset will only occur in people with a depressed immune system.
Less than 20% of patients have significant general symptoms, such as headache, fever, malaise, or tiredness.
Inflammation of the nerve is the cause of the pain. It is the most common symptom of shingles. Approximately 75% of patients initially have pain in the area where the rash will later appear.
The pain can be constant, intermittent, burning, stabbing, or stabbing. Sometimes there is no pain and the patient simply complains of itching.
Skin reactions after covid infection
After analyzing the cases of the study in which the expert participates, they established five skin patterns of covid-19 .
Acral eruptions similar to perniosis or “chilblains”.
Vesicular pattern: small monomorphic vesicles (very similar lesions between them) unlike those that appear in chickenpox.
Urticarial pattern: with the presence of hives on the skin that usually produce intense itching.
Maculo-papular pattern: on specific occasions, such as peri-follicular distribution, or similar to pityriasis rosea or erythema multiforme.
Livedo-necrosis: in the form of reticular livedo, purplish marks on the skin that resemble a network, or frank areas of necrosis.
Although the study has been very helpful in guiding the clinical diagnosis during the development of the pandemic, we do not know much information about the cause-effect relationship between the virus and the skin reaction, “there are still many questions to be resolved”, explains the specialist.
Gels and masks, also responsible for skin disorders
The constant use of hydroalcoholic gels and masks has generated an increase in consultations for contact eczema, acne, seborrheic dermatitis and rosacea.
“All the methods that we have used to defend ourselves against this disease have put our skin, which is the border organ with the outside, at risk,” says Cristina Galván.
According to the expert, the mask generates two different problems. On the one hand, “it creates a microenvironment with excess humidity and temperature for which our skin is not prepared.”
On the other hand, “the masks are made of substances such as antiseptics, among others, and a sustained and direct contact with the skin” can cause irritation and contact allergy.
The support of its hardest areas, “has even produced erosions and ulcers, especially in health professionals.”
As for the hands, constant cleaning has caused “our skin to wear out.”
“We have seen a true pandemic, secondary to the covid, of hand dermatitis in all ages. Before, this disease was more common in people who work with their hands and now we have even seen it in children, ”says Dr. Galván.
Tips to avoid eczema according to the expert:
- Dry your hands well and gently and apply moisturizer after washing or after applying the hydroalcoholic gel.
- It is advisable to sanitize with hydrogel when the hands are not visibly dirty.
- Reserve soap and water washing for when hands are dirty and avoid rubbing excessively.
- Hands should not be washed with extreme temperatures, very hot or very cold water, and the gentlest soap possible should be used.