COVID-19 Vaccine-Induced Lichenoid Drug Eruption

The global rollout of COVID-19 vaccines has been a significant step in controlling the SARS-CoV-2 pandemic. While the vaccines have proven to be generally safe, adverse reactions, including both local and systemic effects, have been observed. Cutaneous manifestations, though rare, have been reported in some instances. We report the case of a 67-year-old male who developed pruritic erythematous-to-violaceous papules and plaques three days after receiving the second dose of a COVID-19 vaccine. The lesions were found on the right inner thigh, forearms, trunk, and neck. Histopathological examination revealed findings consistent with a lichenoid drug eruption (LDE), a condition typically linked to medications or, in rarer cases, vaccines. Lichenoid drug eruptions are often seen in association with certain medications, and less commonly with Hepatitis B vaccination. However, this case presents an uncommon presentation of LDE following COVID-19 vaccination, with an atypical distribution of lesions, involvement of uncommon sites, and no history of prior drug or vaccine hypersensitivity. This case underscores the importance of recognizing rare or atypical skin manifestations, such as lichenoid drug eruptions, as potential vaccine-related adverse effects. Identifying these conditions allows clinicians to ensure accurate diagnosis and appropriate management.