Age: 69.0
Sex: F
Vaccine: COVID19
Symptoms: Pain in extremity, Paraesthesia, Pruritus, Rosacea, Skin erosion
Clinical narrative: On 10/4/2021, I received my first Pfizer booster for COVID-19. Either in November or December 2021, I began to have issues with my toes. The big toe and the second toe on both feet began to have a tingling sensation and redness. There was also mild pain when the water hit it in the shower. I noticed that the toes became more sensitive over time. The skin was thinner and peeling. Reddish purple marks also appeared on the toes; it looked as if that area wasn't getting proper blood flow. Eventually, this condition spread to the rest of the toes on both feet. I saw my PCP, who said that it looked like chilblains associated with Raynaud's disease. She told me that if I kept my feet warm, they should get better over the spring. My toes were often itchy, especially at night, and they would sometimes keep me from sleeping. I was given a topical steroid for the itch; it helped a little with the itching, but it also caused further thinning of the skin. Lesions then started appearing on the toes shortly thereafter. I also had some edema-like swelling in the toes. During the spring of 2022, the condition didn't improve. The condition remained the same, except the lesions began to spread from the bottoms of the toes to the tops of both feet. It looked almost like a second-degree burn, because my feet were raw and painful. I then saw a vascular specialist to see if my feet were getting insufficient blood flow. However, according to the vascular specialist's findings, my blood flow was normal. She also commented that the lesions looked like chemical burns. The itching persisted, so I was given various steroid creams in different dosages, but they didn't help much. If anything, they seemed to make things worse because the creams came into contact with the lesions and because the skin was extremely thin. The vascular specialist even wondered if she should refer me to a wound specialist, but I decided not to go, because it would have taken too long to get an appointment. I received my second Pfizer booster (FJ9943) on 4/13/2022. I talked to my PCP, and since my problem wasn't vascular, she wondered if it was an autoimmune issue. She decided to refer me to a dermatologist. I saw my current dermatologist for the first time sometime during the latter part of 2022. She initially wondered if I had a metabolic disorder or diabetes, but after she got my medical history from my PCP, she decided that my skin condition was not caused by diabetes or a metabolic disorder. I went through a battery of blood tests to see if there were inflammatory or autoimmune markers, but none were detected. My blood looked normal. I had a persistent flush in the skin of my face that had started maybe around the same time I began having issues with my feet, or possibly shortly before. The dermatologist did a biopsy of my facial skin, and it tested positive for rosacea. I was given a topical gel to manage the condition. She later did a biopsy of the skin on my left second toe on 3/10/2023. The result of that biopsy indicated that I had lichenoid interface dermatitis with eosinophils. The diagnosis indicated a drug eruption. She explained that it could be medication-induced, so we went over the various medications I had taken. I never took any prescription medications, though, so it was puzzling. I stopped taking my nutritional supplements for several weeks to see if there would be a difference. However, there was no change in the condition of my toes. My dermatologist suggested that the presence of eosinophils indicated that an autoimmune issue was at play. She also said that I have neuropathy, because I never flinched or indicated that I was in pain during the biopsy. My dermatologist then referred me to a specialist in autoimmune skin issues at a local hospital, and I am scheduled to see her in the very near future. I saw a neurologist at one point prior to the biopsies, The neurologist performed a tuning fork test and a pin prick test on my toes, and she concluded that I had neuropathy, though it was not severe. I also have an upcoming appointment with a rheumatologist to see if the issue is autoimmune. At the present time, I am orally taking prednisone (40mg) once a day for the foot condition and doxycycline once a day for rosacea. I am also taking topical brimonidine for the rosacea and mupirocin (2%) for the toes. The brimonidine helps constrict the blood vessels in my face during the day, but at night, I have a rebound effect when it wears off, and this disturbs my sleep. I sometimes take ZYRTEC for allergies, and it seems to help some with the itching in the toes. On 10/24/2022, I got the Pfizer bivalent (GH9702) booster.