AUTHOR=Ghanaatpisheh Aref , Safari Mohadesseh , Haghshenas Hoda , Motamed-Sanaye Ali , Atefi Amir Homayoun , Kamangarpour Karo , Bagherzadeh Mohammad Aref , Kamran-Jahromi Amirhossein , Darayesh Mohammad , Kouhro Navid , Bahadori Amir Reza , Esfandiari Mohammad Ali 

TITLE=New-onset or flare-up of bullous pemphigoid associated with COVID-19 vaccines: a systematic review of case report and case series studies

JOURNAL=Frontiers in Medicine

VOLUME=Volume 11 - 2024

YEAR=2024

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2024.1293920

DOI=10.3389/fmed.2024.1293920

ISSN=2296-858X

ABSTRACT=Abstract
Background: Numerous cutaneous manifestations have been associated with the COVID-19 outbreak and vaccination, but new-onset bullous Pemphigoid (BP) or flaring up the pre-existing BP is a rare side effect of COVID-19 vaccines that mentioned in a lesser extent in the literature. Therefore, we aimed to conduct a systematic review focused on the association of new onset or flare-up BP and COVID-19 vaccination.
Method: A comprehensive literature search was conducted using PubMed (MEDLINE), Scopus, and Web of Science databases up to 11 March 2023. The search aimed to identify English-language studies reporting new-onset or flare-ups of BP as a potential side effect of COVID-19 vaccination. The search terms included bullous Pemphigoid and COVID-19 vaccination related mesh terms.
Results: The systematic review of 40 included articles investigating the incidence of BP in individuals who received various COVID-19 vaccines revealed pertinent findings. Among the 54 patients with new-onset BP, the median age was 72.42 years, and most were male (64%). Conversely, the median age of the 17 patients experiencing a flare-up of BP was 73.35 years, with a higher proportion of females (53%). Regarding vaccination types, a significant number of patients (56%) developed new-onset BP after receiving the BNT162b2 vaccine (Pfizer-BioNTech).
Conclusion: This study indicates a potential association between COVID-19 vaccinations, particularly mRNA vaccines, and the occurrence of BP. It suggests that this rare autoimmune disorder may be triggered as an adverse event following COVID-19 vaccination. However, it is important to note that the majority of BP patients in our study were unaffected by the COVID-19 vaccine, and even those who experienced worsening of their conditions were managed without significant consequences. These findings provide additional evidence supporting the safety of COVID-19 vaccines. Physicians should be mindful of this uncommon adverse event and encourage patients to complete their planned vaccination schedules.