Cutaneous small vessel vasculitis in the COVID-19 era: a systematic review.

Abstract

Background: Dermatological adverse effects may occur after COVID-19 infection or vaccine administration. Since the beginning of the pandemic, several case reports and systematic reviews have been published on vasculitis associated with both COVID-19 infection and vaccination. Fever, malaise, urticaria, and rash are common symptoms of COVID-19. These symptoms can also occur as adverse reactions to COVID-19 vaccines. However, the occurrence of serious autoimmune reactions due to COVID-19 infection or its vaccine is rare. Cutaneous small vessel vasculitis (CSVV) is an autoimmune disorder that manifests with palpable purpura and petechiae involving the extremities. It results from neutrophilic inflammation within and around dermal vessels and is usually self-limited.

Objective: We provide a thorough systematic review on CSVV occurring in the COVID-19 era.

Methods: We followed the PRISMA 2020 checklist for systematic review, searching PubMed, Google Scholar, Cochrane, and Embase. We included case reports, case series, correspondence articles, and letters to the editor written in English. Characteristics of each were then summarized and analyzed.

Results: 39 cases were included in our review - 27 due to the COVID-19 vaccine and 12 due to COVID-19 infection. Mean age of onset was similar, but mean time to onset was sooner in the vaccination group. Common treatments included systemic steroids, and almost all patients experienced complete recovery with the exception of a few patients in the COVID-19 infection cohort.

Conclusion: While most cases are self-limiting and resolve with no long-term sequalae, the occurrence of more severe reactions appears to be associated with COVID-19 infection rather than with vaccination.