COVID-19 vaccine-induced new-onset pustular psoriasis mimicking skin infection of the hand and foot: A report of two cases

Psoriasis after vaccination, namely “Psoriasis Vaccinalis”, has been described with several vaccines. More recently, emerging reports have linked coronavirus (COVID-19) vaccines to exacerbation or new-onset psoriasis. We report 2 female patients who developed severe new-onset palmoplantar pustular psoriasis following vaccination against COVID-19 (one received a deactivated vaccine, and one received an mRNA vaccine). The patients developed the psoriatic lesions 1 and 2 weeks after the vaccinations, respectively. The patients were primarily diagnosed in a primary care facility or through self-diagnosis with skin/deep soft tissue infections of the hand or foot, and started topical antibiotics before seeking dermatological consultations, where the diagnosis of psoriasis was concluded and confirmed by skin biopsies. The patients were successfully treated with anti-psoriasis topical and/or systemic medications. Psoriasis Vaccinalis has been previously described with several vaccines. COVID-19 vaccines are not an exception, and new-onset pustular psoriasis can occur after any type of COVID-19 vaccination, thereby mimicking a skin infection in its early stage. Primary care clinicians should remain vigilant for potential cases of vaccine-induced psoriasis to prevent misdiagnosis and facilitate a timely referral to dermatology.