Guttate Psoriasis Flare Following the Third Dose of mRNA COVID-19 Vaccine in a 36-Year-Old Male: A Case Report
DOI:
https://doi.org/10.26911/theijmed.2025.10.4.879Abstract
Background: Psoriasis is a chronic, immune-mediated skin disease known to flare in response to various environmental and immunologic triggers, including infections, stress, medications, and vaccinations. With the global rollout of COVID-19 vaccines, rare instances of psoriatic eruptions have been reported. This study aimed to report the case of guttate psoriasis flare following the third dose of mRNA COVID-19 vaccine in a 36-year-old male.
Case Presentation: We report the case of a 36-year-old male with a history of guttate psoriasis that occurred seven years prior, which resolved spontaneously without recurrence. The patient had remained disease-free until five days after receiving a third (booster) dose of an mRNA COVID-19 vaccine, when he developed a sudden, widespread eruption of erythematous, drop-like papules and small plaques, predominantly involving the trunk and extremities. Initial management with topical corticosteroids yielded minimal response. Skin biopsy revealed histopathological features consistent with psoriasis. The patient was subsequently started on low-dose methotrexate, resulting in significant clinical improvement within four weeks.
Conclusion: This case highlights the possibility that mRNA COVID-19 vaccination may, in rare cases, trigger guttate psoriasis even in individuals with a remote history of the disease and prolonged remission. While vaccination remains a crucial public health intervention, healthcare providers should remain aware of potential cutaneous adverse events and provide prompt, individualized management to maintain both optimal patient care and public vaccine confidence.
Keywords:
Covid-19 vaccine, guttate psoriasis, psoriasis flare, vaccine-induced psoriasisReferences
Al-Beltagi M, Saeed NK, Bediwy AS (2022). COVID-19 disease and autoimmune disorders: A mutual pathway. World J Methodol. 12(4): 200–223. doi: 10.5662/-wjm.v12.i4.200.
Armstrong AW, Read C (2020). Pathophy-siology, clinical presentation, and treatment of psoriasis: a review. JAMA. 323(19): 1945–1960. doi: 10.-1001/jama.2020.4006.
Berna-Rico E, Perez-Bootello J, Abbad-Jaime de Aragon C, Gonzalez-Cantero A (2023). Genetic Influence on Treatment Response in Psoriasis: New Insights into Personalized Medicine. Int J Mol Sci. 24(12). doi: 10.3390/-ijms24129850
Burlando M, Herzum A, Cozzani E, Parodi A (2023). Psoriasis flares after COVID-19 vaccination: adherence to biologic therapy reduces psoriasis exacerbations: a case-control study. Clin Exp Vaccine Res. 12(1): 80–81. doi: 10.7774/cevr.2023.12.1.80.
Gananandan K, Sacks B, Ewing I (2020). Guttate psoriasis secondary to COVID-19. BMJ Case Reports CP. 13(8). doi: 10.1136/bcr-2020-237367
Greb JE, Goldminz AM, Elder JT, Lebwohl MG, Gladman DD, Wu JJ, Mehta NN, et al (2016). Psoriasis. Nat Rev Dis Primers. 2(1). doi: 10.1038/nrdp.20-16.82.
Huang YW, Tsai TF (2021). Exacerbation of Psoriasis Following COVID-19 Vaccination: Report From a Single Center. Front Med. 8: 812010. doi: 10.3389/fmed.2021.812010
Hunter HJA, Griffiths CEM, Kleyn CE (2013). Does psychosocial stress play a role in the exacerbation of psoriasis?. Br J Dermatol. 169(5): 965–974. doi: 10.1111/bjd.12478
Karampinis E, Papadopoulou MM, Chai-daki K, Georgopoulou KE, Magaliou S, Roussaki Schulze AV, Bogdanos DP, et al (2024). Plaque Psoriasis exacerbation and covid-19 vaccination: assessing the characteristics of the flare and the exposome parameters. Vaccines. 12(2): 178. doi: 10.3390/vaccines120-20178
Lehmann M, Schorno P, Hunger RE, Heidemeyer K, Feldmeyer L, Yawalkar N (2021). New onset of mainly guttate psoriasis after COVID-19 vaccination: a case report. J Eur Acad Dermatol Venereol. 35(11): e752–e755. doi: 10.1111/jdv.17561
Liu Y, Xu Z, Zhou J, Chen A, Zhang J, Kang X, Jiang X, et al (2024). Clinical characteristics and outcomes of pso-riasis patients with COVID-19: A retrospective, multicenter cohort study in China. Chin Med J. 137(14): 1736–1743. doi: 10.1097/CM9.0000000000003024.
McMahon DE, Amerson E, Rosenbach M, Lipoff JB, Moustafa D, Tyagi A, Desai SR, et al (2021). Cutaneous reactions reported after Moderna and Pfizer COVID-19 vaccination: A registry-based study of 414 cases. J Am Acad Dermatol. 85(1): 46–55. doi: 10.1016/j.jaad.2021.03.092
Nair PA, Badri T (2025). Psoriasis. StatPearls. https://www.ncbi.nlm.-nih.gov/books/ NBK448194/
Potestio L, Battista T, Cacciapuoti S, Ruggiero A, Martora F, Fornaro L, Camela E, Megna M (2023). New Onset and Exacerbation of Psoriasis Following COVID-19 Vaccination: A Review of the Current Knowledge. Biomed. 11(8): 2191. doi: 10.3390/bio-medicines11082191
Potestio L, Lauletta G, Tommasino N, Portarapillo A, Salsano A, Battista T, Martora F, et al (2024). Risk factors for psoriasis flares: a narrative review. Psoriasis: Targets and Therapy. 14: 39–50. doi: 10.2147/ptt.s323281
Railton J, Volonté M, Isoletta E, Bonelli A, Barruscotti S, Brazzelli V (2024). Psoriasis and biological drugs at the time of SARS-CoV-2 infection: a mini review outlining risk of infection, seroprevalence, and safety and efficacy of the BNT162b2 vaccine. Front Immunol. 15: 1–10. doi: 10.3389/fimmu.2024.1354729
Sbidian E, Madrange M, Viguier M, Salmona M, Duchatelet S, Hovnanian A, Smahi A, et al (2019). Respiratory virus infection triggers acute psoriasis flares across different clinical subtypes and genetic backgrounds. Br J Derma-tol. 181. doi: 10.1111/bjd.18203
Soewando W, Putro PS, Hermansah ML, Lestari L, Reviono R, Harsini H, Adhi-putri A (2021). Long Covid-19, Radio-logical Findings, and Its Management: A Systematic Review. Indones J Med. 06(04): 387-392. doi: 10.26911/theij-med.2021.6.4.446
Song WJ, Lim Y, Jo SJ (2021). De novo guttate psoriasis following corona-virus disease 2019 vaccination. J Dermatol. 49(1). doi: 10.1111/1346-8138.16203
Sotiriou E, Tsentemeidou A, Bakirtzi K, Lallas A, Ioannides D, Vakirlis E (2021). Psoriasis exacerbation after COVID‐19 vaccination: a report of 14 cases from a single centre. J Europ Acad Dermatol Venereol. 35(12). doi: 10.1111/jdv.17582
Tran TNA, Nguyen TTP, Pham NN, Pham NTU, Vu TTP, Nguyen HT (2022). New onset of psoriasis following COVID-19 vaccination. Dermatol Ther. 35(8): e15590. doi: 10.11-11/dth.15590
Wu PC, Huang IH, Wang CW, Tsai CC, Chung WH, Chen CB (2022). New Onset and Exacerbations of Psoriasis Following COVID-19 Vaccines: A Sys-tematic Review. Am J Clin Dermatol. 23(6): 775–799. doi: 10.1007/s40257-022-00721-z
Zhang H, Wang M, Zhao X, Wang Y, Chen X, Su J (2024). Role of stress in skin diseases: A neuroendocrine-immune interaction view. Brain Behav Immun. 116: 286–302. doi: 10.10-16/j.bbi.2023.12.005.