Dr. Emma Brierly: A U.K. Physician’s Observations Skin Reactions Post Covid-19 Jab
Dr. Emma Brierly (UK) joined the General Assembly on Monday, June 27, 2022 to give a doctor’s observation of Skin reactions post Covid-19 Jab.
Dr. Emma Brierly is a general practitioner who has been practicing for 22 years. She’s witnessed an explosion of skin problems in the last year. She has experience in community cardiology and A&E clinics and will give us update of what is happening on the ground.
Dr. Emma Brierly: Thank you very much for the lovely welcome and good evening everybody. I’m going to start by I’ll sharing my screen now. Thank you very much for inviting me to talk about skin conditions following the COVID 19 vaccine.
Dr. Emma Brierly: So when I was writing this talk in order to make it interesting and helpful, I asked myself four questions. [00:01:00] What does the literature tell us so far about the effects of these vaccines on the skin? What do the adverse event reporting systems tell us? What are we seeing, so a view from the ground, I’ll give you a view and also I’m going present some case histories, which are real life experiences in photographs from colleagues.
Dr. Emma Brierly: So what are the dermatological manifestations of the COVID-19 vaccination? There are lots of different reactions in the skin that have been reported. Some are seen very commonly, for example, local injection site reactions and urticaria enteritis and also varicella zoster. Others are less commonly, but are nevertheless there in the literature when I looked at it.
Dr. Emma Brierly: This is an article from Jaad, the [00:02:00] journal of the American Academy of Dermatology. This was a case series of 870 patients and the authors detailed 2063 reactions in these patients. And they noted the following key points. Multiple reactions were seen simultaneously. It was difficult to compartmentalize the reactions into local, distant or generalized. They captured an extensive vaccine reactogenicity profile. This means that they were seeing reactions not just in the skin and they felt that likely this was a spike protein driving phenomena, but they did acknowledge that there were likely to other mechanisms as well. And I’ve listed those here. These are delayed hypersensitivity, T-cell response, viral reactivation, bullous pemphigoid, vasculitis, and T1 interferon [00:03:00] reaction.
Dr. Emma Brierly: So I’m gonna look at the adverse reaction data. Now this is something that’s familiar to most of us, this is the UK Yellow Card summary to the 8th of June. And we can see that so far 1.5 million adverse reactions reported. This is just in the UK, in the Yellow Card system.
Dr. Emma Brierly: How many of those relate to the skin? Here’s a breakdown and we can see that so far, we’ve got 102,041 listed in our UK Yellow Card system that relate to the skin. I then went on and looked at Pfizer’s own data. This was a report from Pfizer which was a cumulative analysis of post-authorization adverse events and the dates of this report were from the 1st of December 2020 through to the 28th February, [00:04:00] 2021. So that’s a three month period. And we can see from this data that Pfizer knew about 42,086 adverse reactions that were reported. And these reactions came from several sites. They came from people directly to the organization. They were reported from health authorities, from medical literature and from clinical studies. And so it’s very difficult to know the limitations and magnitude and under reporting in this data.
Dr. Emma Brierly: And here’s the leaderboard. Skin we can see here is the sixth biggest number of reports in this particular set of data
Dr. Emma Brierly: is the breakdown. Pruritis, which means itching, rash, erythema, meaning redness, hyperhydrosis, meaning sweating and urticaria. Total number 5,657 events.
Dr. Emma Brierly: So I’ve written a list here of [00:05:00] some of the skin conditions that I personally have seen. That’s the first six in this list here. And I think what’s been notable is that they’re occurring in unusual age groups and, and that’s why it caught my attention. I’ve seen shingles infections in young, previously healthy people and this is unusual. I’ve seen a genital herpes infection in an 80 year old lady who’s never had herpes in the past and it was a very, very nasty infection, took some weeks to get her better. Certainly I’ve seen several cases of glandular fever in youngsters, that’s not uncommon. I’ve had one case of hand, foot and mouth in a 30 year old and what was surprising about it was that she went on to have a really, quite a severe bronchitis following on, and that’s uncommon in a healthy 30 year old. I’ve seen [00:06:00] two breast abscesses on the left side , same site as the injection in healthy premenopausal, non lactating women, and two cases of very severe dermatitis and I’ve got some case reports of, of this as well later on in my presentation.
Dr. Emma Brierly: I’m also gonna talk about injection-site reactions, ITP, covid toes and erythema multiforme. We’re so lucky with dermatology. It’s such a nice specialty very visual and I’ve got some slides photo to share with you.
Dr. Emma Brierly: The first condition I’m gonna talk about is herpes zosta, otherwise known as shingles. I think probably most people are familiar with this infection. It’s caused by the varicella zosta virus and after a person, usually a child, recovers from chicken pox, the virus remains dormant in the dorsal root ganglion [00:07:00] region of the spinal cord. During times of stress, intercurrent illness or immunosuppression, the virus can be reactivated and travel down the nerve to the dermatome of the skin, usually unilateral on the trunk and you get this quite characteristic vesicular rash, which you can see in this photograph which will heal over in about a week to 10 days. Herpes simplex one, this is the, virus which causes oral and genital herpes. Very common. 90% of adults have antibodies by the age of 50. Here we can see herpes simplex one causing cold sores or blisters on the mouth.
Dr. Emma Brierly: This is glandular fever, Epstein-Barr, also a herpes virus. We can [00:08:00] see the tonsillitis in this photograph. And this illnes s, it’s usually self-limiting, it can be unpleasant and it can last 2-6 weeks. Most adults will have achieved immunity by the age of 25 though.
Dr. Emma Brierly: This is coxsackie virus, hand, foot and mouth. This is another viral family. This is entero virus. This is an illness which usually occurs in preschool children, very mild, self limiting presents with a fever and blisters, which you can see in this slide on the hands, on the feet and sometimes in the mouth.
Dr. Emma Brierly: I wanted to find a picture of a breast abscess, but I’m using library slides tonight I couldn’t find one, but I wanted to show you a picture of an abscess. And here is one. What is an abscess? Well, it’s a collection of pus, usually bacterial, under the skin associated with redness, swelling, and pain. If [00:09:00] left untreated, it will self discharge which you can see is happening in this photograph. And it will drain and heal.
Dr. Emma Brierly: Moving on to dermatitis. This is a really big topic, a very common skin condition , commonly known as eczema. I wrote this list just to show the variety of different types of eczema and different causes of it really is a, a very big topic.
Dr. Emma Brierly: And I wanted to show these slides just to show you how different eczema can look. We can see a young adult in the slide on the left side with a red, scaly, itchy rash, a baby, on the right side with, red inflamed cheeks. This usually recovers by about the age of two or three.
Dr. Emma Brierly: This is allergic contact dermatitis [00:10:00] to a nickel belt, very common that people react to nickel in belts and jewelry. This is atopic dermatitis in the baby can see the red, raised areas on the child’s back. And this is a chronic dermatitis in and adult on the leg, you can see the thickening and darkening of the skin. And this is another common one penicillin reaction. We see this commonly bright red itchy rash all over.
Dr. Emma Brierly: Moving on to injection site reactions. I mean, these are common with injections, especially vaccines. Most people are familiar with those. They usually self limit
Dr. Emma Brierly: ITP. So this is an unusual illness. I’ve only ever seen one case. I haven’t seen a case since the COVID vaccines have come out. But I wanted to talk about it because there have been some case reports. It’s an immune condition, associated [00:11:00] with a fall in platelet count, sometimes presents with bruising or abnormal bleeding and you get this rash, which is sort of purple red dots under the skin due to micro hemorrhage. In children, the condition is usually triggered by infection and in adults it has a more chronic picture.
Dr. Emma Brierly: Moving on to COVID toes. This was reported early in the pandemic, rather an unusual thing to see really, more commonly seen, I think in teenagers who are otherwise asymptomatic from the viral infection And this is, this is, has a pernio or chilblaine type appearance. You can see the [00:12:00] redness and the purple discoloration and swelling of the toes.
Dr. Emma Brierly: And I found a really lovely case report, it was beautifully written up, about Covid toes following a vaccine 76 year old man, one week after the , second dose of his Moderna COVID 19 vaccine presented to A&E with feet looking like this. Investigations at the time showed no evidence of venous or, or arterial thrombosis and no evidence of vasculitis or autoimmunity. And when he was antibody tested, he was found to be negative to the SARS-Cov-2 nucleocapsid antibody, but positive to the spike protein one, suggesting that this was a vaccine reaction and not a reaction from a natural infection. And this resolved completely within six weeks. Erythema multiforme. This is a common skin reaction, a [00:13:00] dramatic hypersensitivity reaction, usually caused by drugs such as penicillins, sulfonomides, or barbiturates or infections such as herpes simplex or streptococcus. You can see in these photos, these quite stunning multiforme erythema discs, which are bilateral, symmetrical and peripheral, affecting hands, arms, legs and feet, with a marginal urticaria, you can see that around the edges of the discs and blistering on the inside. And here were four case reports of erythema multiforme reactions, following COVID-19 vaccines, you can see the discs in the photographs on these patients.
Dr. Emma Brierly: So I want move on now to present some cases. My first case is from a GP colleague who works in France and she sent me a photograph of a 38 year old patient [00:14:00] after her second Pfizer jab. You can see on the upper arm, this circular area looks a little bit like a fungal infection. It might be, it’s difficult to know. And this lady went on to have Epstein-Barr virus and is now suffering from chronic fatigue syndrome.
Dr. Emma Brierly: Case two, this was reported in an African newspaper. This is an 89 year old care home resident who a few days after her second Pfizer jab a year ago, developed these bullae vesicles on her feet and extremities ranging in size between one and 10 centimeters. And this, this, unfortunately this poor lady, I believe, has been very difficult to treat. She’s had several courses of steroids and conventional treatment, which has improved things a little bit, not settled down her symptoms, which have been very distressing for her. I believe her biopsy was inconclusive as to, as to causation and I think she’s now seeing a naturopathic doctor to try and improve [00:15:00] her illness.
Dr. Emma Brierly: This is a case from a colleague in Australia. This is an 88 year old lady who presented with a rash on her chest four weeks after her fourth Pfizer vaccine. She’s a lady with, with asthma and who had previously suffered with eczema, but has never had anything quite so bad as this. Differential diagnosis of dermatitis has been made and you can see where the biopsy has been, they’re waiting for confirmation, but so far, I believe she hasn’t responded to conventional treatment.
Dr. Emma Brierly: And this is my final case. This is a 77 year old man with chronic disease, hypertension and diabetes, history of eczema and stress who’s had three doses of the Pfizer jab last booster in February 22. And in June he developed a very severe dermatitis all over his body. And so far hasn’t responded [00:16:00] well to conventional treatment. And you can see on these slides here, the difficulties of managing a patient such as this, because he’s got signs of acute inflammation vesicle formations, scabbing, and also, I don’t know if you can see the top right hand picture lichenification indicating chronicity on his hand.. And, and so here we have an elderly patient with chronic disease, probably on several, if not many medications who’s had three boosters and developed unexpected and quite a severe skin condition that despite best efforts has been very difficult to treat.
Dr. Emma Brierly: And so this brings me onto my last slide, which is skin conditions cause much s uffering. Skin conditions are complex and often difficult to diagnose and to treat. How can we improve and where do we go from here?
Dr. Tess Lawrie: [00:17:00] Thanks very much Emma, Dr. Brierly. It’s really fascinating to hear what you and your colleagues are seeing on the ground. I did a quick check on VigiAccess the World Health Organization’s database, just to see how many adverse reactions are related to skin conditions that they’ve had reported and it’s nearly half a million. So it’s a really quite dramatic. And the vast majority of those are just called rash, you know, 132,000 are just rash. So we don’t really know, you know, which categories they fall into. But certainly all of those mentioned, including the erythema multiformare, are listed in high numbers. There was a question about alopecia or hair loss from the newsroom. And I had a look at that too, and there’s 9,000 reported cases of hair loss on the VigiAccess database and a thousand over a thousand on the UK Yellow Card database. It [00:18:00] seems to be a really a common reaction. And that’s also substantiated by some of the, the doctors in our meeting this evening.
Dr. Tess Lawrie: So, there are quite a number of questions. Some of them relate to shedding, so, I’ll ask you those from the newsroom and let’s hear what you, what you have to say. So there’s someone who says that they’ve been exposed after staying for one month with relatives and have now had a rash for a year. Could that be related to the vaccinations?
Dr. Emma Brierly: Yeah, I mean, this is such a big question Tess isn’t it. And we’ve talked about this before and I think the, to that question is we just don’t know. What we do know is that there are case reports of [00:19:00] babies falling ill from vaccinated breast-feeding mothers, so it, it does seem possible that the spike protein could be shed, but we don’t know the, the full answer yet. And we’ve also heard stories of menstrual irregularities in non vaccinated women as well, who cohabit with vaccinated partners and so on. So I, you know, it’s a difficult question to answer. I, I would guess the answer is yes, it’s a possibility.
Dr. Tess Lawrie: Yes, and there’s, there’s another person asking about getting scalp psoriasis, sleeping with their partner who’s who’s vaccinated. So I presume the answer to that would be the same that we really just don’t know. But the suggestions are that well, certainly that shedding is a thing and what it causes [00:20:00] it is still to be documented.
Dr. Tess Lawrie: Yes, there’s another comment side effects, the, the Pfizer study confirms the COVID vaccinated people can shed spike proteins and harm the unvaccinated. This is never mentioned. What should we do? Do you have any suggestions for people who are concerned?
Dr. Emma Brierly: Well, that’s difficult to answer again. We obviously can’t isolate the unvaccinated from the vaccinated, nor should we, but I think it, it boils down to looking after your health as best you can taking care of your wellbeing, making sure you eat healthily exercise regularly and don’t become overweight. And those are, you know, good principles to live by in order to take care of your health. And I think we, we need to do more of that. Probably work harder at that than we ever [00:21:00] have.
Dr. Tess Lawrie: Thank you. A question from the newsroom. My mom has been diagnosed with discoid eczema since her second jab, but was told that this is not on the list of post jab reactions. I wonder if you have seen more people with this type of eczema, post jab.
Dr. Emma Brierly: I certainly have seen eczema post jab. The discoid eczema is quite unusual. The rashes that I’ve seen are more generalized and quite extensive actually, but I would guess that the mechanism, is similar, whether or not you have discoid or generalized eczema, it’s a type of dermatitis. It’s an inflammatory response. In many ways, if the discord eczema is localized, it can sometimes be easier to treat because you’ve got a smaller area of skin that you can focus on. But, you know, I think, I think, yes, it’s, you know, [00:22:00] I’m really sorry to hear this.
Dr. Tess Lawrie: Thanks. And then, and then lastly, there’s, there’s another comment about hair loss. Can hair loss result from the jab, have you experience with that?
Dr. Emma Brierly: I haven’t seen this personally. No, I haven’t. But I did, I did see it in, in the literature, when, when I was doing my search myself. Yes. But, but no, this isn’t something I’ve seen. No.
Dr. Tess Lawrie: I see Dr. Beck in the chat says that we’ve seen a lot of hair loss in the hair clinics around the world. Massive increase and so it looks like we’ll have someone to come in and speak about that in, in one of our upcoming meetings. So we can get a, a better idea of the situation on alopecia it is called. So there’s the last question is from Dr. Shapira, he [00:23:00] says in Israel there’s a significant number of flare ups and herpes zoster. What is your experience with, with that? Are you seeing a lot of herpes zoster, shingles?
Dr. Emma Brierly: Yes. Yes I am. And I hear anecdotally from colleagues that they are too, and the cases that I’ve seen have been unusual in that they’ve been in, young, otherwise healthy people. And also, I, I felt perhaps it been a, a little worse than what would, I would normally see lasting longer, perhaps the rash more severe, more extensive. And you know, yes, this has been very noticeable.
Dr. Emma Brierly: Well, Dr. Brierly, thanks very much for that. It’s really fascinating. If there are any other questions for Dr. Brierly, please put them in the chat and we will get them to her before the end of the session this evening. Thanks very much. You’re [00:24:00] welcome.
Uwe Alschner: Thank you very much, Dr. Brierly.