COVID-19 Vaccine and Atopic Dermatitis

There is a great deal of excitement with the rollout of the COVID-19 vaccine and, as expected, many questions.

While it has passed its tests for both safety and efficacy in the general population, many patients with underlying conditions have specialized concerns, including those with atopic dermatitis.

As things were in the very beginning of the COVID-19 pandemic, the truth is: we honestly don't know enough to state anything with certainty at this point. We are all continuing to learn as we go.

Right now, from a skin standpoint alone, I do not think there is any direct, specific reason why patients with atopic dermatitis or eczema should have any increased issues or risks with the vaccine. So, at this time, I think it is reasonable to proceed for most people with eczema. I will point out that I am hearing some reports of eczema flaring up after the vaccine. This is not unexpected: many times we see eczema flare in children after different vaccines or when fighting off a cold, and it stands to reason that when the immune system is "ramped up", inflammatory conditions can temporarily worsen.

It is important to note that the Pfizer-BioNTech COVID-19 Vaccine is NOT a live vaccine. It is also free from eggs, preservatives, and latex--thankfully! 

The full ingredient list is:
mRNA, lipids ((4-hydroxybutyl)azanediyl)bis(hexane-6,1-diyl)bis(2-hexyldecanoate), 2 [(polyethylene glycol)-2000]-N,N-ditetradecylacetamide, 1,2-Distearoyl-sn-glycero-3- phosphocholine, and cholesterol), potassium chloride, monobasic potassium phosphate, sodium chloride, dibasic sodium phosphate dihydrate, and sucrose.

For my more severe patients, including those on dupilumab and those on conventional immunosuppressants, I'm asking them to help me keep a watchful eye on how things are going--we should be getting lots more information now that it's finally out in the real world. Right now, we think that it is likely safe--so long as you are not allergic to any of the ingredients in the vaccine (see above), and theoretically, the immunosuppressant is mostly of concern because it could blunt your body's ability to mount a good response. Dr. Fauci himself has been quoted as saying: “But some degree of immunity is better than no degree of immunity. So, for me, it would be recommended that these people [those who are immunosuppressed] do get vaccinated.”

This sounds very reasonable to me as well as the risks of being unprotected against COVID-19 may far outweigh the risks of the vaccine, even in these more sensitive individuals. 
I think the biggest question remaining is the risk of allergic reaction. We know that, in general, those with more severe atopic dermatitis tend to have more allergies and so it is possible that the risk of having a reaction will be higher in these more severe patients. We will have to watch things very carefully and hopefully will have more information soon, especially as the vaccine becomes available to more and more people.

Peter Lio, MD, FAAD
Updated January 14, 2021