Age: 48.0
Sex: F
Vaccine: COVID19
Symptoms: Biopsy skin, Dermatologic examination, Lichen planus
Clinical narrative: Unilateral blaschkoid lichen planus; This literature-non-study case was reported in a literature article and describes the occurrence of LICHEN PLANUS (Unilateral blaschkoid lichen planus) in a 48-year-old female patient who received SPIKEVAX NOS (SPIKEVAX NOS) for COVID-19 prophylaxis.        Concurrent medical conditions included Atopic dermatitis.    On an unknown date, the patient received second dose of SPIKEVAX NOS (SPIKEVAX NOS) (unknown route) 1 dosage form. On an unknown date,  after starting SPIKEVAX NOS (SPIKEVAX NOS), the patient experienced LICHEN PLANUS (Unilateral blaschkoid lichen planus) (seriousness criterion medically significant). The patient was treated with CLOBETASOL PROPIONATE (CLOBETASOL 0.05%) (topical) at an unspecified dose and frequency; PREDNISONE (oral use) at a dose of tapering; METHOTREXATE (oral use) at a dose of 20 milligram once a week and UPADACITINIB (oral use) at a dose of 15 milligram once a day. At the time of the report, LICHEN PLANUS (Unilateral blaschkoid lichen planus) was resolving.      DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On an unknown date, Biopsy skin: Histopathology demonstrated mild orthohyperkeratosis overlying basilar degeneration with a lichenoid inflammatory infiltrate and sawtooth rete ridges consistent with LP. On an unknown date, Dermatologic examination: On examination, brown to violaceous polygonal papules with surrounding erythema and hyperpigmentation were noted in a curvilinear distribution along the patients left medial arm extending to the chest as well as along the left side of the abdomen and back of the left leg following lines of Blaschko. No lesions were present in any distribution on her right side and the oral mucosa was clear. and Six month follow-up after initiation of upadacitinib demonstrated only mild postinflammatory hyperpigmentation at sites of previous eruptions.     For SPIKEVAX NOS (SPIKEVAX NOS) (Unknown), the reporter considered LICHEN PLANUS (Unilateral blaschkoid lichen planus) to be related.    Concomitant medications were not reported.  Patient presented to clinic with a 2-month history of new cutaneous lesions confined to her left side. She first noticed lesions along her left leg with similar appearing lesions arising along her left trunk and arm over the ensuing weeks.  She noted associated pruritus and denied any previous, similar eruptions.  At follow-up visit 2 weeks later, the patient reported only mild improvement with topical therapy.  Along with treatment medications, the patient began 3-times-weekly narrowband UV-B. Three months later, the patient returned to clinic reporting only moderate improvement of pruritus and the spread of lesions to involve her genitalia.  At 1 month follow-up, the patient reported near complete resolution of pruritus and stabilization of skin disease. Six months later, the patient demonstrated resolution of cutaneous findings, with only mild post inflammatory hyperpigmentation. A brief attempt to taper the patient to every other day dosing for 1 month resulted in subjective worsening of pruritus, but the patient has otherwise been well controlled on continued daily dosing since then.  Company Comment: This is a literature non-study concerning a 48-year-old, female patient with relevant medical history of Atopic dermatitis, who experienced the serious (due to medically significant) unexpected event of Lichen planus (LP), reported as "Unilateral blaschkoid lichen planus". The event occurred approximately 2 weeks of receiving the second dose of the mRNA-1273 vaccine. As reported, the patient presented 2-months history of new cutaneous lesions confined to her left side. She first noticed lesions along her left leg with similar appearing lesions arising along her left trunk and arm over the ensuing weeks; brown to violaceous polygonal papules with surrounding erythema and hyperpigmentation were noted in a curvilinear distribution along the patients left medial arm extending to the chest as well as along the left side of the abdomen and back of the left leg following lines of Blaschko; oral mucosa was clear. A 4-mm punch biopsy of the skin was performed, and the patient was started on topical clobetasol 0.05% cream. Histopathology demonstrated LP. At her follow-up visit 2 weeks later, the patient reported only mild improvement with topical therapy, and a 3-week oral prednisone taper with transition to methotrexate (20 mg by mouth weekly) was prescribed. Additionally, the patient began 3-times-weekly narrowband UV-B. Three months later, the patient returned to clinic reporting only moderate improvement of pruritus and the spread of lesions to involve her genitalia. Given the patient's concomitant diagnosis of atopic dermatitis, she agreed to attempt treatment with upadacitinib (15 mg by mouth every day). At 1 month follow-up, the patient reported near complete resolution of pruritus and stabilization of skin disease. Six months later, the patient demonstrated resolution of cutaneous findings, with only mild postinflammatory hyperpigmentation. A brief attempt to taper the patient to every other day dosing for 1 month resulted in subjective worsening of pruritus, but the patient had otherwise been well controlled on continued daily dosing since then. The outcome of the event was reported as recovering. The mentioned medical history remains as a confounder. The benefit-risk relationship of mRNA-1273 vaccine is not affected by this report.