key: cord-0767334-g9p901zi authors: Marcantonio‐Santa Cruz, O.Y.; Vidal‐Navarro, A.; Pesqué, D.; Giménez‐Arnau, A.M.; Pujol, R.M.; Martin‐Ezquerra, G. title: Pityriasis rosea developing after COVID‐19 vaccination date: 2021-07-21 journal: J Eur Acad Dermatol Venereol DOI: 10.1111/jdv.17498 sha: 13ee7949b7ec3c47ba4ec59d11c75d49e7efc54e doc_id: 767334 cord_uid: g9p901zi Pityriasis rosea (PR) is an acute exanthematous disease. Typically preceded by a primary solitary herald patch followed by the onset of smaller scaly papulo-squamous lesions on the skin tension lines within days to weeks.1 Reactivation of herpes virus 6 and 7 has been incriminated as a possible aetiology, as well as bacterial infections, vaccines and certain drugs.2. Patients do not experience prodromal symptoms, and blood or/ and dermal eosinophilia may be found, and there are no signs of HHV-6/7 systemic reactivation. 2 Pityriasis rosea and PR-like eruptions have rarely been observed to develop after vaccinations. Cases of PR/PR-LE after vaccination for smallpox, tuberculosis, influenza, influenza A (H1N1), diphtheria, tetanus, diphtheria-pertussis-tetanus (DTP), papillomaviruses, yellow fever, hepatitis B and pneumoccus have been reported in the literature. 2, 6 In such instances, the average time lapse between vaccination and eruption onset ranged from 5 to 17 days, and the exanthema lasted from 2 to 6 weeks. Differentiation between 'true' PR and PR-LE was difficult and virological investigations for HHV-6/7 reactivation were performed only in a minority of cases. In cases of vaccineinduced PR, a high cytokine response to the vaccine leading to an immune deregulation and reactivation of latent viral infections, such as HHV6 and HHV7, has been hypothesized. 7 As far as we are concerned, no previous reports of PR developing after COVID-19 vaccination have been reported. In our cases, prodromal symptoms were absent; the presence of herald patch was present in one case; exacerbation after the second dose administration was observed in one patient; and histopathological findings were consistent with typical PR. Therefore, we suggest that COVID-19 vaccination should be included in the list of potential triggers of PR. Development of PR/PR-LE after COVID-19 vaccination seems to be a rare event. Only further additional reports will demonstrate the real significance and prevalence of this potential side effect of COVID-19 vaccination. Yes. Pityriasis rosea-an update Pityriasis rosea and pityriasis rosea-like eruptions: How to distinguish them? Classification of the cutaneous manifestations of COVID-19: a rapid prospective nationwide consensus study in Spain with 375 cases Pityriasis rosea as a cutaneous manifestation of COVID-19 infection Pityriasis rosea in otherwise asymptomatic confirmed COVID-19-positive patients: A report of 2 cases Pityriasis rosea. A statistical, clinical, and laboratory investigation of 826 patients and matched healthy controls Vaccine-induced pityriasis rosea and pityriasis rosea-like eruptions: a review of the literature The patients in this manuscript have given written informed consent to the publication of their case details.