Autoimmune Bullous Dermatosis Following COVID-19 Vaccination: A Series of Five Cases

March 13, 2022

“We hypothesize that #Covidvaccination triggers an immunological response in genetically predisposed individuals. This type of dysregulation is then reinforced by other autoimmune mechanisms.”


Autoimmune bullous diseases (AIBDs) are a heterogeneous group of diseases characterized by cutaneous and mucosal vesicles, blisters, and erosions. Several factors can trigger this disease, including vaccines; but this entity remains very rare. We hypothesized that vaccination against coronavirus disease 2019 (COVID-19) could trigger an immunological response in genetically predisposed individuals. We report five cases of new-onset autoimmune bullous diseases triggered by the COVID-19 vaccine. Clinical and histopathological examinations confirmed the diagnosis of bullous pemphigoid (BP) in three patients and pemphigus in the other two. According to the French method of imputability, the pharmacovigilance investigation showed an I5B4 causality assessment score for the vaccines, interpreted as highly probable, for all the patients. The diagnosis of vaccine-induced autoimmune bullous dermatosis was highly suspected. One patient’s condition improved by dermocorticoids alone, while the other four required oral corticosteroid therapy at 0.5 mg/kg/day, which led to a favorable outcome.


These vaccine-induced manifestations can probably be attributed to either cross-reactivity between autoantigens and the antigens injected with the vaccine, or simply to the effects of the adjuvants. We hypothesize that vaccination against COVID-19 triggers an immunological response in genetically predisposed individuals. This type of dysregulation is then reinforced by other autoimmune mechanisms. COVID-19 vaccine probably needs to be added to the list of vaccine triggers of AIBD.

However, given the complications of SARS-CoV-2 infection, the uncertainty of the causality between vaccinations and adverse events, and the rarity of these events, clinicians should still encourage full vaccination against COVID-19, including the completion of boosters in those with induced blisters after the first and second doses. A very interesting aspect we observed is that patients with new-onset BP had been administered inactivated COVID-19 vaccines while the patients with induced pemphigus were diagnosed following mRNA COVID-19 vaccinations. This might be a simple coincidence given that a case of BP following the mRNA COVID-19 vaccination has been recently reported.


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