14732165, 0, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/jocd.15550 by Nat Prov Indonesia, Wiley Online Library on [27/02/2023].

See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
| |
Received: 6 June 2022    Revised: 5 November 2022    Accepted: 23 November 2022

DOI: 10.1111/jocd.15550

REVIEW ARTICLE

Various aspects of the relationship between vitiligo and the

COVID-­19 pandemic or SARS-­CoV-­2 vaccines: Clinical pearls
for dermatologists

Zeinab Aryanian MD1,2 | Kamran Balighi MD1,3 | Parvaneh Hatami MD1  |

Azadeh Goodarzi MD4,5  | Alireza Janbakhsh MD6 | Zeinab Mohseni Afshar MD6

1
Autoimmune Bullous Diseases Research
Center, Tehran University of Medical Abstract
Sciences, Tehran, Iran
Background: Coronavirus disease 2019 (COVID-­19) has given rise to several new
2
Department of Dermatology, Babol
University of Medical Sciences, Babol, Iran
onset or exacerbated dermatologic disorders including vitiligo.
3
Department of Dermatology, School of Aim and Method: Here, we present different aspects of relationship between SARS-­
Medicine Razi Hospital, Tehran University CoV-­2 infection or its associated vaccines and vitiligo and aim to provide solutions to
of Medical Sciences, Tehran, Iran
4 overcome the potential challenges.
Department of Dermatology, Rasoul-­e-­
Akram Hospital, Iran University of Medical Results and Conclusion: In brief, as the benefits overweigh the risks and since vaccine-­
Sciences, Tehran, Iran
5
triggered de novo or flares of vitiligo are uncommon and benign, these patients are
Skin and Stem Cell Research Center,
Tehran University of Medical Sciences, recommended to get SARS-­CoV-­2 vaccines.
Tehran, Iran Moreover, in individuals with previously recognized vitiligo, who are at risk of devel-
6
Clinical Research Development Center,
oping SARS-­CoV-­2 infection or those who are currently infected, special dermatologic
Imam Reza Hospital, Kermanshah
University of Medical Sciences, consultation is needed in order to balance the immunosuppressive agents in their
Kermanshah, Iran
therapeutic regimen to prevent COVID-­related morbidity and mortality.
Correspondence
Zeinab Mohseni Afshar, Clinical Research KEYWORDS
Development Center, Imam Reza Hospital, biologic agents, COVID-­19 vaccine, immunosuppressant agents, SARS-­CoV-­2, vitiligo
Kermanshah University of Medical
Sciences, Kermanshah, Iran,
Email: z_moseni2001@yahoo.com

Parvaneh Hatami, Autoimmune Bullous

Diseases Research Center, Razi Hospital,
Tehran University of Medical Sciences,
Tehran, Iran.
Email: p_hatami2001@yahoo.com

1  |  I NTRO D U C TI O N (non-­s egmental) types.1 This condition occurs as a result of pro-

Vitiligo is a pigmentary disorder that is manifested as the devel-
opment of pale depigmented patches over any areas of the skin
or mucous membrane. It affects 0.5%–­2% of the world popula-
tion. Vitiligo is classified as localized (segmental) or generalized
gressive destruction of skin melanocytes. There are different
opinions about the etiopathogenesis of vitiligo; however, no exact
explanation has been found. Nevertheless, T-­cell autoimmunity
and prolonged cytokine release are believed to play an important
role. 2

This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium,
provided the original work is properly cited.
© 2022 The Authors. Journal of Cosmetic Dermatology published by Wiley Periodicals LLC.

J Cosmet Dermatol. 2022;00:1–5.  |

wileyonlinelibrary.com/journal/jocd     1
 |
2      ARYANIAN et al.
Vitiligo is more common in the black people, those with genetic
predisposition and those with psychological distress. Other risk fac-
tors include sunburn, cutaneous trauma, use of some chemicals such
as phenolic compounds, pregnancy, and autoimmunity.3
On the other hand, the coronavirus disease 2019 (COVID-­19) has
given rise to several new-­onset or exacerbated dermatologic disor-
ders.4 Moreover, medications used in the settings of SARS-­CoV-­2
infection, as well as various types of COVID vaccine, have also been
followed by cutaneous adverse events.5,6 The incidence and preva-
lence of vitiligo have increased considerably since the beginning of
the COVID-­19 pandemic. The reason could be the viral infection it-
self, medications used for the treatment, and vaccines introduced to
prevent the disease as well as psychologic distress of pandemics.7–­9
There are many aspects and conflicts on this issue that we want to
discuss in this article.
1.1  |  The impact of the COVID pandemic on
patients with vitiligo
In general, medical treatment of vitiligo is aimed to stop disease pro-
gression and achieve repigmentation. Phototherapy, topical agents,
and immunosuppressive agents, such as glucocorticoids, methotrex-
ate, mycophenolate mofetil (MMF), azathioprine, and apremilast, are
the basis of therapy.10 However, the decision to continue or cease
any of the aforementioned options should be made cautiously so as
preventing vitiligo from getting out of control while minimizing the
risk of SARS-­CoV-­2 infection.11,12 For example, topical treatment,
due to lack of systemic immunosuppressive effects, had been rec-
ommended to be continued. In addition, replacing high-­dose steroids
by regimens with lower doses, such as oral mini-­pulse therapy, had
been a good option to minimize the risk of infection.13 Methotrexate
and azathioprine, which were second-­line therapeutic options for
cases of rapidly progressive vitiligo without response to high-­dose
steroids, were administered with caution during the peaks of SARS-­
CoV-­2 infection, as they increase the risk and severity of COVID-­19
disease.14 Moreover, home phototherapy was proposed in order to
avoid frequent clinic visits during the quarantine.15
1.2  |  The impact of vitiligo on the morbidity and
mortality of SARS-­CoV-­2 infection
The impact of some comorbidities on the severity of SARS-­CoV-­2
infection has been a well-­established issue. However, some autoim-
mune underlying diseases are supposed to protect against COVID-­19
or modulate the course. This condition is an issue of conflict for viti-
ligo. Some authorities hypothesize that non-­segmental vitiligo (NSV)
may protect against severe SARS-­CoV-­2 infection through having
genes involved in immune activation and regulation, similar to pre-
viously reported protective effects of NSV against melanoma and
non-­melanoma skin cancer.16
14732165, 0, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/jocd.15550 by Nat Prov Indonesia, Wiley Online Library on [27/02/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
Moreover, the increased serum levels of pro-­inflammatory cyto-
kines such as TNF-­α and IL-­17 in autoimmune skin disorders such as
vitiligo is a well-­established fact, which can affect the clinical course
and severity of SARS-­CoV-­2 infection.17,18
1.3  |  SARS-­CoV-­2 infection-­associated vitiligo
Vitiligo is seldom associated with infectious pathogens unless in
the settings of autoimmune reactions. Previously, vitiligo had been
reported in individuals with human immunodeficiency virus (HIV),
hepatitis B virus (HBV), hepatitis C virus (HCV), Epstein–­Barr virus
(EBV), cytomegalovirus (CMV), smallpox, and helicobacter pylori
infection.19–­24
The effect of SARS-­CoV2 infection on the development of vit-
iligo could either be through direct invasion of melanocytes or ac-
tivating the immune system and shifting it toward adaptive type
1 immunity. In fact, immune activation during COVID-­19 disease
might increase vitiligo disease activity through a shift toward adap-
tive type 1 immunity (CD8 T cells and IFNγ).16
Not only vitiligo results in a devastating psychological distress
but also it can occur as a result of stressful conditions including lock-
down and the quarantine due to COVID-­19 pandemic. 25–­28 In fact,
stress can elevate serum levels of cortisol, catecholamines, and neu-
ropeptides, and increased oxidative stress stimulates high-­mobility
group box 1 (HMGB1) release, a skin component that is essential
for melanogenesis. On the other hand, oxidative stress leads to a
decrease in glutathione peroxidase level, which is related to the in-
flammatory response of vitiligo. 25,29
It has been shown that severe infection with SARS-­CoV-­2 can
cause transient immunosuppression and dysregulation of CD8+ lym-
phocytes, leading to disruption of previously established tolerance
to self-­antigens.30 On the other hand, dysregulation of CD8+ T cells
has also been described in the pathogenesis of vitiligo. 24 Hence, this
post-­viral inappropriate immune reconstitution could be considered
as a logical mechanism for developing vitiligo following some viral
infections, especially in HIV-­positive patients. 24,31
The COVID pandemic has also been related to vitiligo in another
interesting way; facial frictional dermatitis under skin areas covered
by face masks has led to vitiligo, called as “mask vitiligo.”32
1.4  |  COVID vaccine-­related vitiligo
In general, since vitiligo is a very common pigmentary disorder
throughout the world, and because vaccination program is held uni-
versally with expectable adverse events, the onset of vitiligo after
SARS-­CoV-­2 vaccination can be a mere incidence. Nonetheless, the
temporal relationship between vaccination and development of viti-
ligo and the reports of various autoimmune phenomena following
vaccination could raise the suspicion of the causal association be-
tween SARS-­CoV-­2 vaccination and vitiligo.33

ARYANIAN et al.
Besides the wide range of dermatologic manifestations and com-
plications following SARS-­CoV-­2 infection, COVID-­19 vaccines have
also given rise to a variety of cutaneous reactions and disorders.34,35
Many post-­COVID vaccine cutaneous reactions are mild and tem-
porary and do not cause great morbidity or mortality; nevertheless,
some adverse events such as vitiligo pose significant concerns due
to their disfigurement and the subsequent stigma and psychological
burden.
The incidence of COVID vaccine-­related cases of vitiligo has
been quite higher than the one following SARS-­C oV-­2 infec-
tion. Several cases of hypo pigmentations have been reported
after receiving COVID vaccines, resulting from cutaneous reac-
tions such as toxic epidermal necrolysis (TEN), subacute cutane-
36–­3 8
ous lupus erythematosus (SCLE), and pityriasis lichenoides.
However, vitiligo that is presented as skin depigmentation has also
been common after SARS-­C oV-­2 vaccination including mRNA-­
1273 (Moderna) vaccine and mRNA BNT162/Comirnaty vaccine
(Pfizer-­B ioNTech). 39–­41
Most cases of new-­onset COVID vaccine-­related vitiligo have
been reported within 1 week following receiving the first vaccine
39,42
dose, with progression after the second dose. The probability of
developing COVID vaccine-­related vitiligo is higher in patients with
pre-­existing autoimmune diseases, such as ulcerative colitis33 which
might reflect the advantage of maintaining a minimal treatment in
those cases with an autoimmune background to prevent develop-
ment of another autoimmune phenomenon following COVID vac-
cination. Since the COVID vaccination will continue after cession of
pandemic, a rigid surveillance for development of new autoimmune
disorders including vitiligo in genetically predisposed patients and
early treatment of them (but not too early which interfere with im-
munologic body response to vaccination) should be strongly consid-
ered by clinicians all over the world.
As a matter of fact, the immune system is stimulated by vaccines
to produce antibodies. Some of these antibodies harm the host,
rather than having benefit as they may trigger autoimmune disor-
ders in individuals with genetic susceptibility. The emerging of many
autoimmune diseases such as multiple sclerosis, Guillain–­Barré syn-
drome, and immune thrombocytopenic purpura following COVID
vaccination are some examples.43–­45
Molecular mimicry and bystander activation are the most
probable pathophysiologic mechanisms proposed for vaccine-­
induced autoimmunity. However, vaccine adjuvants may play a
role in bringing about autoimmune phenomena.42,46 On the other
hand, upregulation of Th1 response by the vaccines leads to an
increase in inflammatory cytokines such as IL-­2 , IFN-­γ, and TNF-­
α, thereby predisposing to skin autoimmune disorders including
vitiligo.47 Moreover, epitope spreading, polyclonal activation of
B cells, and cytokine production might be other explanations for
vaccine-­induced auto reactions which lead to autoimmune skin
48
disorders. Melanocytes can be affected like any other body
component in vaccine-­
induced autoimmune phenomena, and
since vitiligo results from destruction of melanocytes by T cells
immune response, the robust cell-­
m ediated immune response
|
14732165, 0, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/jocd.15550 by Nat Prov Indonesia, Wiley Online Library on [27/02/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
      3
induced by vaccines can give rise to the onset of vitiligo. 39,49 The
secondary trauma imposed by vaccine injection can also be a trig-
ger for vaccine-­induced vitiligo. 50
1.5  |  JAK inhibitors: a shared therapeutic option in
both vitiligo and COVID-­19
Janus kinases (JAKs) are a family of cytoplasmic tyrosine kinases,
acting through the JAK/STAT pathway.51 Medications inhibiting
this pathway have been recently shown to have a promising effect
in treating numerous Immune-­based disorders including vitiligo.52
Tofacitinib and baricitinib are the most commonly used JAK inhibi-
tors in treating vitiligo in various ways such as topical application,
systemic administration, or in combination with phototherapy.52 On
the other hand, several JAK inhibitors including baricitinib and tofac-
itinib have been suggested as alternative treatment in COVID-­1953
and baricitinib is even recommended as a first-­line treatment in se-
vere cases of COVID-­19 by the WHO due to its proven effect in
reducing mortality54 which might be resulted from its direct antiviral
effect separated from its anti-­inflammatory effects.55 Considering
the therapeutic effect of JAK inhibitors in both vitiligo and COVID-­19,
continuing these agents for treating vitiligo in COVID era seems a
wise choice. Moreover, JAK inhibitors seem to have the least ad-
verse effect regarding COVID vaccination, compared to other im-
munosuppressing agents56 which make them a favorable choice for
treating intractable patients in COVID era.
2  |  CO N C LU S I O N
The COVID-­19 pandemic has had a great impact on every field of
medicine, including dermatology. The SARS-­CoV-­2 infection and the
associated vaccines have brought about several dermatologic ad-
verse events, some of which are serious or disfiguring like vitiligo. On
the other hand, despite these complications, the benefits of getting
vaccinated against SARS-­CoV-­2 frequently outweigh the risks since
the incidence of these side effects is quite low in the whole popu-
lation. Moreover, in individuals with previously recognized vitiligo,
who are at risk of developing SARS-­CoV-­2 infection or those who
are currently infected, special dermatologic consultation is needed
in order to balance the immunosuppressive agents in their thera-
peutic regimen to prevent COVID-­related morbidity and mortality.
Although it seems that the pandemic is ending, COVID vaccina-
tion will continue in future. Hence, a rigid surveillance for develop-
ment of new autoimmune disorders including vitiligo in genetically
predisposed patients and early treatment of them (but not too early
which interfere with immunologic body response to vaccination)
should be strongly considered by clinicians all over the world.
AU T H O R C O N T R I B U T I O N S
P.H, A.G., A.J., and Z.A. performed the research. K.B. designed
the research. Z.A and K.B supervised the study. P.H, Z.M., and A.J.
 |
4      ARYANIAN et al.
10. Felsten LM, Alikhan A, Petronic-­Rosic V. Vitiligo: a comprehensive
analyzed the data. Z.M and A.G wrote the paper. All authors contrib-
uted to the preparation of data and finalization of this article.
11. Daniel BS, Wittal R. Vitiligo treatment update. Australas J Dermatol.
AC K N OW L E D G E M E N T
12. Mehta H, Soufila K, Kumar S, Sarkar R, Kumaran MS. Use of im-
The authors would like to thank Razi Hospital Clinical Research
Development Center and Autoimmune Bullous Diseases Research
Center for their technical and editorial assistance.
F U N D I N G I N FO R M AT I O N
We received no funding for this project.
C O N FL I C T O F I N T E R E S T
All the authors declare that there is no conflict of interest.
DATA AVA I L A B I L I T Y S TAT E M E N T
The data that support the findings of this study are available from
the corresponding author upon reasonable request.
E T H I C A L A P P R OVA L
The protocol of this study was approved by relevant ethics
committee.
ORCID
Parvaneh Hatami  https://orcid.org/0000-0002-3531-2907
Azadeh Goodarzi  https://orcid.org/0000-0002-1249-4429
REFERENCES
1. Roohaninasab M, Mansouri P, Seirafianpour F, Naeini AJ, Goodarzi
A. Therapeutic options and hot topics in vitiligo with special focus
on pediatrics' vitiligo: a comprehensive review study. Dermatol Ther.
2021;34(1):e14550.
2. Aryanian Z, Shirzadian A, Farzaneh S, Goodarzi A, Azizpour A,
Hatami P. Metabolic derangement in patients with vitiligo: a cross-­
sectional study. J Invest Med. 2022;70(4):963-­966.
3. Rodrigues M, Ezzedine K, Hamzavi I, Pandya AG, Harris JE, Group
VW. New discoveries in the pathogenesis and classification of vitil-
igo. J Am Acad Dermatol. 2017;77(1):1-­13.
4. Mohseni Afshar Z, Babazadeh A, Hasanpour A, et al. Dermatological
manifestations associated with COVID-­19: a comprehensive review
of the current knowledge. J Med Virol. 2021;93(10):5756-­5767.
5. Mohaghegh F, Hatami P, Aryanian Z, Fatemi F, Mohseni Afshar
Z. Acute generalized Exanthematous Pustulosis following SARS-­
CoV-­ 2 virus: Remdesivir as a suspected culprit. Case Rep Med.
2022;10(2022):9880827. doi:10.1155/2022/9880827
6. Aryanian Z, Balighi K, Hatami P, Afshar ZM, Mohandesi NA. The
role of SARS-­C oV-­2 infection and its vaccines in various types
of hair loss. Dermatol Ther. 2022;35(6):e15433. doi:10.1111/
dth.15433
7. Richardson VL, Garcia-­Albea VR, Bort NL, Mayne SL, Nolen ME,
Bobonich MA. Reflections of COVID-­19 on dermatology prac-
tice. J Dermatol Nurses Assoc. 2021;13(1):49-­53. doi:10.1097/
JDN.0000000000000586
8. Xu X, Zhang C, Jiang M, Xiang LF. Impact of treatment delays on
vitiligo during the COVID-­ 19 pandemic: a retrospective study.
Dermatol Ther. 2021;34(4):e15014.
9. Rodrigues M, Pandya AG, Hamzavi I, Ezzedine K, Bekkenk MW,
Harris JE. Treatment recommendations for patients with vitiligo
during COVID-­19. Australas J Dermatol. 2021;62(3):e481-­e 482.
doi:10.1111/ajd.13610
14732165, 0, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/jocd.15550 by Nat Prov Indonesia, Wiley Online Library on [27/02/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
overview: part II: treatment options and approach to treatment. J
Am Acad Dermatol. 2011;65(3):493-­514.
2015;56(2):85-­92.
munosuppressants in vitiligo during COVID-­19 pandemic: a quick
review. Pigment Int. 2021;8(1):8.
13. Youssef J, Novosad SA, Winthrop KL. Infection risk and safety of
corticosteroid use. Rheum Dis Clin North Am. 2016;42(1):157-­176.
14. Schneeweiss MC, Perez-­Chada L, Merola JF. Comparative safety
of systemic immunomodulatory medications in adults with atopic
dermatitis. J Am Acad Dermatol. 2021;85(2):321-­329.
15. Xu Z, Jin S, Dai X, Xiang LF, Zhang C. Association of home light
therapy with patient-­reported outcomes of vitiligo during the
COVID-­19 pandemic: an internet-­b ased survey. Photodermatol
Photoimmunol Photomed. 2021;37(5):425-­427. doi:10.1111/
phpp.12675
16. Post NF, Luiten RM, Wolkerstorfer A, Bekkenk MW, Böhm M.
Does autoimmune vitiligo protect against COVID-­19 disease? Exp
Dermatol. 2021;30(9):1254-­1257.
17. Bernardini N, Skroza N, Tolino E, et al. IL-­17 and its role in inflam-
matory, autoimmune, and oncological skin diseases: state of art. Int
J Dermatol. 2020;59(4):406-­411.
18. Pacha O, Sallman MA, Evans SE. COVID-­19: a case for inhibiting
IL-­17? Nat Rev Immunol. 2020;20(6):345-­3 46.
19. Antony F, Marsden R. Vitiligo in association with human im-
munodeficiency virus infection. J Eur Acad Dermatol Venereol.
2003;17(4):456-­458.
20. Doğan Z, Özdemir P, Ekşioğlu M, Filik L. Relationship between heli-
cobacter pylori infection and vitiligo: a prospective study. Am J Clin
Dermatol. 2014;15(5):457-­462.
21. Soylu S, Gül Ü, Gönül M, Kiliç A, Çakmak SK, Demiriz M. An uncom-
mon presentation of the Co-­existence of Morphea and vitiligo in a
patient with chronic hepatitis B virus infection. Am J Clin Dermatol.
2009;10(5):336-­338.
22. Rathinam S, Cunningham E. Vitiligo iridis in patients with a history
of smallpox infection. Eye. 2010;24(10):1621-­1622.
23. Pichler R, Sfetsos K, Auböck J, Badics B, Gutenbrunner S, Berg J.
Cytomegalovirus infection in central European vitiligo patients?
Autoimmunity. 2005;38(2):121-­122.
24. Dwivedi M, Laddha N, Begum R. Viral causes of vitiligo: a
new perspective for vitiligo pathogenesis. Virol Immunol J.
2018;2(181):10-­23880.
25. Rokni GR, Gholami A, Kazeminejad A, et al. The relationship be-
tween stress and vitiligo during COVID-­ 19 pandemic. J Cosmet
Dermatol. 2021;20(11):3387-­3388. doi:10.1111/jocd.14429
26. de Las HN, Martín Giménez VM, Ferder L, Manucha W, Lahera V.
Implications of oxidative stress and potential role of mitochon-
drial dysfunction in COVID-­19: therapeutic effects of vitamin D.
Antioxidants. 2020;9(9):897.
27. Hedayat K, Karbakhsh M, Ghiasi M, et al. Quality of life in patients
with vitiligo: a cross-­sectional study based on vitiligo quality of life
index (VitiQoL). Health Qual Life Outcomes. 2016;14(1):1-­9.
28. Shah P, Dorrell DN, Feldman SR, Huang WW. The impact of the
coronavirus disease 2019 pandemic on dermatologist burnout: a
survey study. Dermatol Online J. 2021;27(6):1.
29. Becatti M. Oxidative stress and high-­mobility group box 1 (HMGB
1) protein release in vitiligo. Br J Dermatol. 2017;176(6):1436-­1437.
3 0. Cañas CA. The triggering of post-­COVID-­19 autoimmunity phenom-
ena could be associated with both transient immunosuppression
and an inappropriate form of immune reconstitution in suscepti-
ble individuals. Med Hypotheses. 2020;145:110345. doi:10.1016/j.
mehy.2020.110345
31. Herzum A, Micalizzi C, Molle M, Parodi A. New-­onset vitiligo fol-
lowing COVID-­19 disease. Skin Health Dis. 2022;2(1):e86.

ARYANIAN et al.
32. Sinha S, Savitha B, Sardana K. "Mask vitiligo" secondary to frictional
dermatitis from surgical masks. Contact Dermatitis. 2021;85(1):121-­
123. doi:10.1111/cod.13813
33. Aktas H, Ertuğrul G. Vitiligo in a COVID-­19-­vaccinated patient with
ulcerative colitis: coincidence? Clin Exp Dermatol. 2022;47(1):143-­
144. doi:10.1111/ced.14842
3 4. Babazadeh A, Miladi R, Barary M, et al. COVID-­19 vaccine-­related
new-­onset lichen planus. Clin Case Rep. 2022;10(2):e05323.
35. Aryanian Z, Balighi K, Hatami P, Goodarzi A, Mohandesi NA, Afshar
ZM. SARS-­CoV-­2 vaccination and practical points in psoriasis
patients: a narrative review. Dermatol Ther. 2022;35(5):e15430.
doi:10.1111/dth.15430
36. Mäkilä T, Jeskanen L, Butina M, et al. Pityriasis lichenoides et va-
rioliformis acuta after SARS-­CoV-­2 infection and relapse after
vaccination. J Eur Acad Dermatol Venereol. 2022;36(6):e431-­e 433.
doi:10.1111/jdv.18024
37. Niebel D, Ralser-­Isselstein V, Jaschke K, Braegelmann C, Bieber T,
Wenzel J. Exacerbation of subacute cutaneous lupus erythemato-
sus following vaccination with BNT162b2 mRNA vaccine. Dermatol
Ther. 2021;34(4):e15017. doi:10.1111/dth.15017
38. Bakir M, Almeshal H, Alturki R, Obaid S, Almazroo A. Toxic epi-
dermal necrolysis Post COVID-­19 vaccination –­first reported case.
Cureus. 2021;13(8):e17215. doi:10.7759/cureus.17215
39. Kaminetsky J, Rudikoff D. New-­onset vitiligo following mRNA-­1273
(Moderna) COVID-­19 vaccination. Clin Case Rep. 2021;9(9):e04865.
4 0. Flores-­Terry MÁ, García-­Arpa M, Santiago-­Sánchez Mateo JL,
Romero AG. [translated article] facial vitiligo after SARS-­CoV-­2
vaccination. Actas Dermosifiliogr. 2022;113(7):T721. doi:10.1016/j.
ad.2022.06.012
41. Caroppo F, Deotto ML, Tartaglia J, Belloni Fortina A. Vitiligo wors-
ened following the second dose of mRNA SARS-­CoV-­2 vaccine.
Dermatol Ther. 2022;36(6):e15434.
42. Ciccarese G, Drago F, Boldrin S, Pattaro M, Parodi A. Sudden
onset of vitiligo after COVID-­ 19 vaccine. Dermatol Ther.
2021;35(1):e15196-­e.
43. Mohseni Afshar Z, Babazadeh A, Janbakhsh A, et al. Vaccine-­
induced immune thrombotic thrombocytopenia after vaccination
against Covid-­19: a clinical dilemma for clinicians and patients. Rev
Med Virol. 2022;32(2):e2273.
4 4. Havla J, Schultz Y, Zimmermann H, Hohlfeld R, Danek A, Kümpfel T.
First manifestation of multiple sclerosis after immunization with the
Pfizer-­BioNTech COVID-­19 vaccine. J Neurol. 2022;269(1):55-­58.
45. Trimboli M, Zoleo P, Arabia G, Gambardella A. Guillain-­Barré
syndrome following BNT162b2 COVID-­19 vaccine. Neurol Sci.
2021;42(11):4401-­4 402.
46. Chen Y, Xu Z, Wang P, et al. New-­onset autoimmune phenomena
post-­COVID-­19 vaccination. Immunology. 2022;165(4):386-­4 01.
|
14732165, 0, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/jocd.15550 by Nat Prov Indonesia, Wiley Online Library on [27/02/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
      5
47. Herzum A, Burlando M, Molle MF, Micalizzi C, Cozzani E, Parodi A.
Lichen planus flare following COVID-­19 vaccination: a case report.
Clin Case Rep. 2021;9(12):e05092.
48. Velikova T, Georgiev T. SARS-­CoV-­2 vaccines and autoim-
mune diseases amidst the COVID-­ 19 crisis. Rheumatol Int.
2021;41(3):509-­518.
49. Riding RL, Harris JE. The role of memory CD8+ T cells in vitiligo. J
Immunol. 2019;203(1):11-­19.
50. Lane C, Leitch J, Tan X, Hadjati J, Bramson JL, Wan Y. Vaccination-­
induced autoimmune vitiligo is a consequence of secondary trauma
to the skin. Cancer Res. 2004;64(4):1509-­1514.
51. Nada HR, El Sharkawy DA, Elmasry MF, Rashed LA, Mamdouh
S. Expression of Janus kinase 1 in Vitiligo & Psoriasis before and
after narrow band UVB: a case-­control study. Arch Dermatol Res.
2018;310(1):39-­46. doi:10.1007/s00403-­017-­1792-­6
52. Qi F, Liu F, Gao L. Janus kinase inhibitors in the treatment of vit-
iligo: a review. Front Immunol. 2021;18(12):790125. doi:10.3389/
fimmu.2021.790125
53. Gatti M, Turrini E, Raschi E, Sestili P, Fimognari C. Janus kinase
inhibitors and coronavirus disease (COVID)-­19: rationale, Clinical
Evidence and Safety Issues. Pharmaceuticals (Basel). 2021;14:738.
doi:10.3390/ph14080738
54. Levy G, Guglielmelli P, Langmuir P, Constantinescu S. JAK inhib-
itors and COVID-­ 19. J Immunother Cancer. 2022;10(4):e002838.
doi:10.1136/jitc-­2021-­0 02838
55. Stebbing J, Sánchez Nievas G, Falcone M, et al. Jak inhibition
reduces SARS-­CoV-­2 liver infectivity and modulates inflam-
matory responses to reduce morbidity and mortality. Sci Adv.
2021;7:eabe4724.
56. Seror R, Camus M, Salmon J-­H, et al. Do JAK inhibitors affect im-
mune response to COVID-­19 vaccination? Data from the MAJIKSFR
registry. Lancet Rheumatol. 2022;4:e8-­e11.
How to cite this article: Aryanian Z, Balighi K, Hatami P,
Goodarzi A, Janbakhsh A, Afshar ZM. Various aspects of the
relationship between vitiligo and the COVID-­19 pandemic or
SARS-­CoV-­2 vaccines: Clinical pearls for dermatologists. J
Cosmet Dermatol. 2022;00:1-5. doi:10.1111/jocd.15550