Lichen planopilaris flare after COVID 19 Vaccination

Lichen planopilaris: Another Lichenoid Reaction to Add to the List of Possible Vaccine Reactions

A variety of “lichen planus-like” reactions are now understood to be possible after receipt of a COVID 19 vaccines. These reactions include cutaneous, lichen planus, oral lichen planus and have been reported as both new onset disease as well as a flare. One study suggested a nearly 2.5 fold increased risk of oral lichen planus after COVID vaccines. A new report in the March issues of Dermatologic Therapy highlights the possibility of a flare of lichen planopilaris as well.

Diab et al, 2022

Diab and colleagues present a case of a 60 year old woman who developed multiple erythemato-violaceous patches and plaques on her face and scalp that were consistent with a diagnosis of lichen planus and lichen planopilaris. The lesions appeared 14 days after the second dose of AstraZeneca vaccine.

The patient’s past medical history was notable for hypertension and previous lichen planopilaris, successfully treated with methotrexate and prednisolone 4 years ago. She had been in complete remission without the need for medication prior to the receipt of the COVID vaccine.

She was prescribed intralesional corticosteroids and tofacitinib and experienced a gradual improvment in her skin and hair.

Vaccines Causing Flares of Lichen Planus:

It is well recognized that several vaccines can cause new onset lichen planus or a flare of preexisting lichen planus. The known vaccines are shown below with COVID 19 vaccines now added to this list.

REFERENCE

Diab R et al. Lichen planus and lichen planopilaris flare after COVID-19 vaccination. Dermatol Ther. 2022 Mar;35(3):e15283.

Hertel M et al. Onset of Oral Lichenoid Lesions and Oral Lichen Planus Following COVID-19 Vaccination: A Retrospective Analysis of about 300,000 Vaccinated Patients. Vaccines (Basel) 2022 Mar 20;10(3):480.