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| CORRESPONDENCE |
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| Year : 2020 | Volume
: 38
| Issue : 4 | Page : 258-259 |
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Psoriasis vaccinalis
Pei-Rong Gao, Yu-Huei Huang, Chau Yee Ng
Department of Dermatology, Chang Gung Memorial Hospital, Linkou; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| Date of Submission | 13-May-2020 |
| Date of Acceptance | 22-Jun-2020 |
| Date of Web Publication | 16-Dec-2020 |
Correspondence Address:
Dr. Chau Yee Ng
No. 5, Fuxing Stree, Guishan District, Taoyuan City 333
Taiwan
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/ds.ds_35_20
How to cite this article:
Gao PR, Huang YH, Ng CY. Psoriasis vaccinalis. Dermatol Sin 2020;38:258-9 |
Dear Editor,
A 2-month-old boy presented to our emergency department with impetigo-like lesions after Bacille Calmette–Guérin (BCG) vaccination. Erythematous papules and pustules started to appear on the face and trunk 3 days after vaccination [Figure 1]a. He also developed erythematous, moist, and scaly patches on the gluteal cleft [Figure 1]b. The lesions evolved into annular erythematous plaques covered with whitish-yellow scales on the trunk [Figure 1]c and scalp [Figure 1]d. Nails and joints were uninvolved. The patient was otherwise healthy with regular vaccination on schedule. The patient had no family history of tuberculosis and/or psoriasis. | Figure 1: A 2-month-old child with psoriasis vaccinalis, presenting with (a) erythematous papules with pustules on the trunk, (b) erythematous, moist, and slightly scaly patches on the gluteal cleft, (c and d) annular erythematous plaques with whitish-yellow scale/crust on the trunk and scalp; purple ink arrow indicates biopsy site on the abdomen
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Examinations including potassium hydroxide preparation, Tzanck smear, and culture for bacteria were negative. Lesional biopsy from the plaque showed parakeratosis with Munro's microabscess and spongiform pustules resembling psoriasis [Figure 2]. Neither bacteria nor fungi were found by Gram stain and periodic acid–Schiff–diastase stain. A diagnosis of plaque and napkin psoriasis following BCG vaccination was made. The patient was successfully treated with topical corticosteroids within 3 months, however, he had a relapse of symptoms 1 year later. | Figure 2: Biopsy of the skin demonstrating parakeratosis with Munro's microabscess, spongiform pustules, moderate acanthosis, and neutrophilic exocytosis (hematoxylin and eosin staining, original magnification ×200); compatible with psoriasis
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Psoriasis is an immune-mediated inflammatory disease with an estimated worldwide prevalence of 0.02%–2% in children.[1],[2] Pediatric psoriasis is less commonly seen compared to adult psoriasis with chronic course and particular distributions that tend to involve facial, scalp, intertriginous, and diaper area. Pediatric psoriasis can be categorized into congenital, infantile, and childhood psoriasis.[2] The definition is based on the time of onset: psoriasis presenting at birth, in the 1st year of life, and between ages 1 and 18 years, respectively.[2] Napkin psoriasis is the most frequent clinical type in infants.[1] The skin finding is typically well-demarcated erythema without scales. The initial stages of napkin psoriasis are easily confused with other diaper rashes, including irritant dermatitis, Candida infection, and seborrheic dermatitis.[2] The diagnosis can be supported by dissemination of psoriasis beyond the anogenital area. First-line treatment of skin-limited disease is topical therapies.[1]
BCG is a live strain of Mycobacterium bovis for use as an attenuated vaccine to provide protection against tuberculosis and other mycobacterial infections. Localized skin reactions following BCG vaccination are common.[3] Less common manifestations include injection-site abscess and regional lymphadenitis.[3] “Psoriasis vaccinalis” is a rare condition describing psoriasis following vaccination. BCG vaccination and immunotherapy has been reported to cause psoriatic reactions.[4],[5],[6],[7],[8] Possible mechanism may be related to BCG vaccination reaction causing the generation of interleukin-22-producing Th17 cells, which activates epidermal Stat-3 and results in a psoriatic skin reaction.[5]
BCG mass vaccination is necessary in many developing countries for the purpose of public health. This case is a reminder that psoriasis can be induced by BCG vaccination.
Ethical approval
This study was approved by the IRB of Chang Gung Medical Foundation (approval number 202000832B0 obtained on May 13th, 2020) and the patient consent was waived by IRB.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | |  |
| 1. | Mahé E. Childhood psoriasis. Eur J Dermatol 2016;26:537-48.  |
| 2. | Eichenfield LF, Frieden IJ, Zaenglein A, Mathes E. Neonatal and Infant Dermatology E-Book. Oxford : Saunders; 2014. |
| 3. | Turnbull FM, McIntyre PB, Achat HM, Wang H, Stapledon R, Gold M, et al. National study of adverse reactions after vaccination with Bacille Calmette-Guérin. Clin Infect Dis 2002;34:447-53. |
| 4. | Koca R, Altinyazar HC, Numanoğlu G, Unalacak M. Guttate psoriasis-like lesions following BCG vaccination. J Trop Pediatr 2004;50:178-9. |
| 5. | Takayama K, Satoh T, Hayashi M, Yokozeki H. Psoriatic skin lesions induced by BCG vaccination. Acta Derm Venereol 2008;88:621-2. |
| 6. | Queiro R, Ballina J, Weruaga A, Fernández JA, Riestra JL, Torre JC, et al. Psoriatic arthropathy after BCG immunotherapy for bladder carcinoma. Br J Rheumatol 1995;34:1097. |
| 7. | Dudelzak J, Curtis AR, Sheehan DJ, Lesher JL Jr. New-onset psoriasis and psoriatic arthritis in a patient treated with Bacillus Calmette-Guérin (BCG) immunotherapy. J Drugs Dermatol 2008;7:684. |
| 8. | Hung CT, Wang WM, Tsao CW, Chiang CP. New-onset guttate psoriasis following intravesical immunotherapy of Bacillus Calmette–Guerin. Dermatologica Sinica 2012;30:108-11. |
[Figure 1], [Figure 2]
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