Title : Generalized granuloma annulare exacerbation after COVID-19 vaccination
Abstract:
Generalized granuloma annulare (GA) is a benign inflammatory skin condition characterized by annular plaques or nodules. While the etiology remains unclear, it has been linked to a delayed-type hypersensitivity reaction with a multitude of potential triggers, including trauma, systemic disease, and medication. Although this condition is self-limiting, treatment resistance and recurrence present unique challenges. We encountered a case of biopsy-confirmed recurring generalized GA that presented after discontinuation of isotretinoin therapy and administration of the COVID-19 vaccine. A previously healthy 64-year-old patient with a known history of recurring generalized GA presented with widespread, asymptomatic annular skin lesions in the area of the right deltoid, trunk, and feet approximately 2-3 weeks after receiving a COVID-19 vaccination in the right deltoid. Upon further questioning, it was discovered that the patient had self-discontinued their isotretinoin therapy for generalized GA six months prior due to worsening gastritis. Clinical examination revealed numerous erythematous annular plaques. A skin biopsy taken during the visit confirmed features consistent with generalized GA. It was determined that the recent discontinuation of oral isotretinoin therapy and a COVID-19 vaccination attributed to the acute GA flare. While isotretinoin-associated GA is rare, COVID-19 vaccination-associated inflammatory skin conditions such as general GA have emerged in recent literature, highlighting an immunological mechanism to generalized GA. This case highlights that disease triggers and effective management approaches are critical to managing generalized GA. Moreover, medication discontinuation and post-vaccination dermatologic reactions must be considered when approaching similar cases. Further research must be done to investigate this relationship.
