Cutaneous Manifestations of COVID-19 Vaccination and COVID-19 Infection: a Questionnaire-based, Multi-center Study in Korea

Background: Infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can cause various cutaneous complications, including dermatologic adverse reactions to SARS-CoV-2 vaccines reported by several studies. Objective: To describe the clinical characteristics of cutaneous complications of SARS-CoV-2 infection and adverse reactions to SARS-CoV-2 vaccines, and to determine the risk factors for cutaneous manifestations. Methods: A questionnaire-based survey in 12 hospitals in Korea. Results: After receiving SARS-CoV-2 vaccinations, 20.23% and 5.94% of the respondents reported new-onset cutaneous lesions or aggravation of preexisting cutaneous conditions, respectively. Respondents who developed new cutaneous lesions after COVID-19 were significantly older than those who did not (p = 0.001). Systemic symptoms of SARS-CoV-2 vaccination (fever, chill, cough, sore throat, and myalgia) were associated with higher risk for new-onset cutaneous lesions (p < 0.05). Myalgia was the only systemic symptom of SARS-CoV-2 vaccination that was associated with higher risk for the aggravation of preexisting cutaneous conditions (p = 0.011). Following coronavirus 2019 (COVID-19) diagnosis, 13.3% and 9.7% of the respondents reported new skin lesions and aggravation of preexisting cutaneous conditions, respectively. Respondents with new cutaneous lesions were significantly older than those without new cutaneous lesions (p = 0.046). Systemic COVID-19 symptoms were significantly more common in respondents who developed new cutaneous lesions than in those who did not (p < 0.001). The proportion of respondents with underlying autoimmune diseases was significantly higher in those with cutaneous COVID-19 complications than in those without such complications (p = 0.038). Conclusion: This study offers insights into the characteristics of cutaneous manifestations of SARS-CoV-2 vaccination and infection in Korea.