Supplementary Material for: Interesting Mucocutaneous Manifestations in COVID-19 Infection or Vaccination Confirmed by Histopathology: A Case Series

Mucocutaneous complications or adverse events due to SARS-CoV-2 infection or vaccination have been well-delineated in the literature, respectively. Most eruptions are considered to be mild and self-limiting; however, for the atypical cases which have a tentative clinical diagnosis, performing a biopsy and histopathological assessment is pivotal to confirm the diagnosis and subsequently prescribe a more tailored treatment. Despite the diverse reporting of such incidents globally, the rate of biopsied cases is restricted to less than 15% in most studies.

This case series elucidates 20 patients referred to the tertiary dermatology clinic, including 14 COVID-19 infection-related eruptions such as Lichen Planus (LP), Cutaneous vasculitis, Pityriasis rosea (PR), Discoid lupus erythematosus, Guttate psoriasis, Sarcoidosis, Raynaud's phenomenon, non-specific lesions resembling genital warts, Beau's line and one severe case of purpura fulminans with a promising outcome. Moreover, we presented 6 vaccine-induced cases comprising LP, Urticarial vasculitis, PR, Parapsoriasis, and Localized Morphea. The diagnosis of all cases has been proven by histopathological evaluation. We included pertaining anamnesis details of each patient together with vivid classifying images to pinpoint the morphologic features of each condition.

In line with our previous studies, the vaccine-induced eruptions were less severe compared to infection-related complications of COVID-19 and are mostly controllable by antihistamines and corticosteroids administration. Therefore, reporting such events should not hinder COVID-19 vaccination in the general population.