Lichen planus after the Pfizer COVID-19 vaccine has been described in a small number of case reports, and it is a question many people ask when an itchy purple rash appears weeks after vaccination. Lichen planus (LP) is a chronic inflammatory disease that mainly affects the skin, and may also affect the nails, scalp, mouth and genital area. This page explains what lichen planus is, what the published reports say about a link with the vaccine, why that link is unproven, what to do if you develop the rash, and how treatment, including homeopathic care at Welling Homeopathy, can be approached.
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Lichen planus after the vaccine at a glance
- Is there a link? a few case reports describe new or flared lichen planus after COVID-19 vaccination; a cause-and-effect link has not been proven, and cases are rare.
- Why might it happen? vaccines activate the immune system, and in rare people this may trigger the T-cell overactivity that drives lichen planus.
- Typical signs: itchy, purplish, flat-topped bumps on the wrists, ankles and back, white lacy patches in the mouth, nail changes or scalp scarring.
- Treatment: topical steroids are usually effective; stronger treatment may be needed.
- Vaccination advice: talk to your doctor before deciding on further doses; the benefits of vaccination are usually considered to outweigh this rare risk.
What is lichen planus?
Lichen planus (LP) is a complex, chronic inflammatory disease that mainly affects the skin and may also involve the nails, scalp and the lining of the mouth and genital area. The key event is an attack by cytotoxic CD8+ T-cells, immune cells that normally protect us from disease, on cells of the skin and mucous membranes. This causes inflammation and the characteristic purplish, itchy, flat-topped bumps.
What the reports show about the Pfizer vaccine
Lichen planus has been reported after several vaccines, including hepatitis B and influenza vaccines. More recently, new cases of LP have been reported after vaccination with the Pfizer-BioNTech COVID-19 vaccine. The vaccines mobilise the immune system to build protection against the SARS-CoV-2 virus, and it is conjectured that this heightened state of immune activation may inadvertently trigger LP in certain individuals. However, this proposition still requires more research to confirm.
- A study published in July 2021 described a new-onset lichen planus case triggered by the Pfizer-BioNTech COVID-19 vaccine
- An article published in September 2022 reported on a patient who developed new-onset LP 48 hours after the first dose of the vaccine, with symptoms exacerbating after the second dose; after treatment with topical corticosteroids, the patient’s LP was controlled within 21 days
- A review of LP cases following COVID-19 infection and vaccination was presented in December 2022
The number of reported cases is limited and the exact relationship between LP and the COVID-19 vaccine remains to be fully understood. These findings are a starting point for further research and do not prove that the vaccine causes lichen planus.
Symptoms of lichen planus
- Itchy, purple or violet, flat-topped, shiny bumps, often on the wrists, forearms, ankles and lower back
- Fine white lines on the surface of the bumps (Wickham striae)
- White, lacy patches, sores or burning in the mouth (oral lichen planus)
- Nail ridging, thinning or loss
- Patchy hair loss and scarring on the scalp
- Darker skin marks after the rash heals
Vaccine-related rash or something else?
| Possibility | Clues |
|---|---|
| Lichen planus triggered by vaccination | New itchy purple bumps starting days to weeks after a dose; typical features on examination |
| Normal vaccine reaction | Soreness, redness or a rash near the injection site, lasting a few days |
| Drug reaction | Rash after starting a new medicine; lichenoid pattern |
| Pityriasis rosea, eczema or psoriasis | Different shape, scale and distribution; confirmed by a dermatologist |
| Hepatitis C or other infection-related lichen planus | Blood tests; lichen planus is more common in some infections |
Only a dermatologist can tell these apart, sometimes after a skin biopsy.
What to do if you develop lichen planus after vaccination
- See a dermatologist to confirm the diagnosis; a skin biopsy may be advised.
- Treat the rash as advised, usually with a potent topical steroid, which controlled lichen planus within weeks in the reported cases.
- Tell your doctor about all vaccines and medicines you have had, and about any other autoimmune condition.
- Discuss further doses with your doctor and the vaccinating clinic before deciding; most people with mild reactions can safely be vaccinated.
- Report the reaction to the vaccination adverse-event reporting system, as advised by your doctor.
Treatment options
- Topical corticosteroids, the first-line treatment
- Topical calcineurin inhibitors such as tacrolimus, especially for the mouth and genitals
- Oral antihistamines for itch
- Oral retinoids, phototherapy, methotrexate or other immunosuppressants for widespread or stubborn disease
- Medicines such as apremilast (Otezla) are used in some countries for difficult cases, under specialist care
- Regular check-ups for oral lichen planus, because of a small risk of long-term change in the mouth lining
Welling Homeopathy’s approach to lichen planus
Welling Homeopathy offers individualised homeopathic treatment for lichen planus, alongside the dermatologist’s care. Please do not stop topical steroids or other prescribed medicines on your own. For our main page on this condition, see treatment of lichen planus.
Our clinical experience with lichen planus
Welling Homeopathy presents their CUREplus™ treatment, a comprehensive, personalized approach for lichen planus.
CUREplus™ combines traditional homeopathy with modern science to address the root cause of the condition.
Welling Homeopathy bolsters its approach with up-to-date medical research, offering effective and targeted care.
With an extensive history and recognition from a myriad of patients across 108 countries, CUREplus™ has shown a high level of success and patient satisfaction, making it a promising alternative for lichen planus.
Sources
- PubMed Central: lichen planus and COVID-19 (PMC9734460)
- PubMed Central (PMC9111398)
- PubMed Central (PMC8250777)
- PubMed 36164291
- PubMed Central (PMC8447319)
Frequently asked questions about lichen planus after COVID-19 vaccine
1. Can the Pfizer COVID-19 vaccine cause lichen planus?
A few case reports describe new or flared lichen planus after Pfizer-BioNTech vaccination, but a direct cause has not been proven, and cases are rare.
2. How soon after vaccination can lichen planus appear?
In the reports, it appeared within days to a few weeks. One report described onset 48 hours after the first dose, with worsening after the second.
3. What does vaccine-related lichen planus look like?
Itchy purple, flat-topped bumps on the wrists, ankles and back, sometimes with white lacy patches in the mouth.
4. How is lichen planus after a vaccine treated?
Usually with a potent topical corticosteroid, which controlled the rash within weeks in reported cases. Stronger treatment is used for severe disease.
5. Should I get a second dose if I developed lichen planus after the first?
Discuss it with your doctor. The benefits of vaccination are usually considered to outweigh the rare risk, and many people with mild reactions are vaccinated safely.
6. Is lichen planus permanent?
Skin lichen planus often clears within months to a couple of years, but oral and scalp forms can last longer and need long-term care.
7. Can homeopathy help lichen planus?
Welling Homeopathy offers individualised treatment for lichen planus alongside the dermatologist’s care, as described above. Results vary from person to person.
8. Is lichen planus contagious?
No. It is not contagious and cannot be passed on by touch.
Related Reading
- Best Homeopathy Treatment For Lichen Planus
- What is Lichen Planus?
- Treatment of Oral Lichen Planus
- Polymorphous Light Eruption (PLE/PMLE) Treatment: Sun Allergy Symptoms, Triggers and Homeopathy Care
- Actinic Prurigo: Symptoms, Causes, Diagnosis and Treatment of This Sun-Induced Skin Condition
To consult Welling Homeopathy experts, call +91 80 80 850 950.
Disclaimer: this page is for information only and is not a substitute for professional medical advice, diagnosis or treatment. Results vary from person to person.
