By Marica Micallef
On 24th May 2022, a report was published by Yingjie Zhang, from the Department of Dermatology, First Hospital of Shanxi Medical University, Taiyuan, People’s Republic of China, et al., in which the authors report two cases of bullous pemphigoid (BP) that occurred shortly after COVID-19 vaccination. Bullous pemphigoid is a rare skin condition that mainly affects older people. It usually starts with an itchy, raised rash. As the condition develops, large blisters can form on the skin. It may last a few years and sometimes causes serious problems.
The first case states that one day after receiving a third dose of the inactivated COVID-19 vaccine, a 23-year-old man with prior eczema presented himself with pruritic and tight bullae on the bilateral upper limbs which then spread over the entire body in ten days. There was no reaction at the site of the first two injections. In the dermis and bulla cavity, histology revealed the development of sub-epidermal blisters and an inflammatory infiltrate primarily made up of eosinophils. At the intersection of the epidermis and dermis, linear IgG and C3 deposits were seen using direct immunofluorescence.
The second case involved an 81-year-old man with hypertension. After the first two injections, there was no injection reaction or blister. Blisters started to occur all over the body 15 days after receiving the third dosage of the inactivated COVID-19 vaccine, and they gradually got worse over the course of a month. Physical examination revealed severe erosion of the oral mucosa, a negative Nikolsky sign, and oedematous black erythema, blisters, blood blisters, and crusts on the bilateral upper limbs, groin, and dorsum of the foot. The subepidermal blister, inflammatory infiltrate in the blister and dermis adjacent to the blister, antibodies against BP 180 (1:32), and IgG and C3 deposition at the basement membrane zone supported the diagnosis of BP.
BP is the most common autoimmune subepidermal blistering disease of the skin. Approximately 20 new cases of BP linked to the Pfizer and Moderna’s SARS-CoV-2 mRNA vaccines have been documented thus far.
The authors observed and I quote:
“Recent studies have shown that booster vaccine doses can rapidly evoke a SARS-COV-2 specific immune response. Therefore, it has been suggested that vaccination may induce an enhanced autoimmune response in patients with associated immune predisposition or subclinical BP. Reported cases of recurrent BP after vaccination with COVID-19 vaccine may confirm this standpoint. Since BP is most common in the elderly and occasionally in teenagers, we speculate that vaccination may have facilitated the transition from eczema to BP for the first patient, however, the trigger for BP in the second patient remains unclear” and “When patients develop blisters after COVID-19 vaccination, dermatologists should consider this possible complication.”
Again, although these studies only show that those who are suffering from bullous pemphigoid are two cases, it does not mean that there aren’t more! This is another proof that the Covid-19 vaccines are messing up with the recipients’ immune system.