Age: 56.0
Sex: F
Vaccine: COVID19
Symptoms: Fungal test, Immunology test, Joint stiffness, Lichen planus, Nail disorder
Clinical narrative: About 3 months after the 2nd dose, I developed what appeared to be a dry blister on the pad of my right thumb.  I had been gardening so didn't think much about it.  The site did not improve and increased in size on my th over the next 2 months.  At that point, I made a dermatology appointment but could not get in for 3 months - note that it had now spread to my palm also and resembled psoriasis as it was red with plaques, painful, and itchy. #18 continued - My dermatology appointment was on 10/27/2021 - the PA thought it was contact dermatitis and prescribed Triamcinolone ointment BID for 2 weeks.  The scales did not improve so 11/23/2021 I followed back up and was prescribed TAC ointment for flares and tacrolimus for maintenance. I received the first booster on 10/25/2021. Pfizer lot 32030BD. No improvement with topicals so returned to dermatologist PA on 1/14/2022.  She continued to say it was dermatitis and added clabetasol ointment to the treatment regime. She felt I needed allergy testing to find out what was triggering the rash and appointment made with dermatologist on 2/2/2022. No improvements seen with ointments and now I had nail ridges on my thumb and middle finger on the right hand and the plaque locations were increasing in size on my right thumb, right palm, and right middle finger.  I had few papulopustules as well and discoloration of the side of the middle finger nail fold.  The dermatologist thought it might be Pyoderma and took bacterial and fungal cultures (both negative).  She stopped all other ointments and started mupirocin.  The rash worsened and clobetasol was restarted. 3/7/2022 - returned to dermatologist.  No improvement and with cultures negative, dermatologist diagnosed rash as psoriasis vulgaris.  No family history or personal history of psoriasis.  Started on Acitretin 25mg QD and ccalcipotriene ointment BID. 5/6/2022 - plaques still just on right hand but now includes my right 4th finger and lesions on thumb, palm, and middle finger larger.  Lesion developed on right thigh - punch biopsy done and came back lichen planus.  Acitretin causing many side effects. 5/20/2022 - 2nd biopsy done on thigh for IIF/ELISA.  Nonspecific findings.  And due to the continued side effects from acitretin, thi s medication was stopped and just used topicals while waiting for the  IIF/ELISA results.  When those came back, she started me on high dose steroids (tapering dose) for 18 days. The lesions cleared on the middle and ring finger but remained elsewhere. The plaques came back a week after steroids finished. 6/29/2022 - follow up appointment with dermatologist. Mild joint pain and plaques have returned but not on right ring finger. After infectious disease tests completed, I was started on Humira injections. 2nd booster 7/17/2022 Pfizer lot # FM7553- 2 weeks later my nails became soft, brittle, broke/bent easily and had ridges lengthwise in the nail. Saw the dermatologist on 8/26/2022 and she switched me to Taltz. Joint stiffness increasing so referral made to rheumatologist - appointment is in January 2023. Discussed articles of Dermatology on new onset or flares of psoriasis with my dermatologist and it was decided I should report this event.