Viroj Wiwanitkit, MD

To the Editor:

We read with interest the case report from Abdelkader et al¹ (Cutis. 2024;113:E22-E24) of a 32-year-old man who received the Sinopharm BBIBP COVID-19 vaccine (BBIBP-CorV) and experienced acute-onset erythroderma and severe itching. The patient did not disclose any recent medication intake and had no noteworthy medical history. Physical examination revealed palmoplantar keratoderma, keratotic follicular papules on the legs and feet, and typical orange-red erythroderma. The laboratory workup was normal, including a negative test result for HIV infection.

The absence of details regarding the patient’s history of allergic reactions or sensitivities is one possible shortcoming in this case report and may have given important information about the possible reason for the erythroderma that occurred following vaccination. Furthermore, more research into the precise Sinopharm BBIBP vaccine ingredients that may have caused the skin reaction would have been helpful in deciphering the underlying mechanisms.

Larger-scale studies examining the frequency of cutaneous reactions following COVID-19 vaccination with various vaccine formulations may be the focus of future research efforts and could assist in determining the risk factors for experiencing such reactions, which would enable health care providers to offer advice on vaccination alternatives or preventative measures for those who are more vulnerable. Furthermore, collaboration among dermatologists and allergists could improve patient outcomes and improve management.

By highlighting an uncommon but noteworthy dermatologic manifestation following COVID-19 immunization, this case report emphasizes how crucial it is to keep an eye out for and report any possible side effects linked to vaccinations to protect patient safety. Subsequent investigations should concentrate on enhancing comprehension of the pathophysiology of cutaneous reactions following immunization and devising tactics to alleviate these hazards. Working together, researchers and health care professionals can effectively tackle the issues raised by these newly discovered vaccine-related skin responses.

To the Editor:

We read with interest the case report from Abdelkader et al¹ (Cutis. 2024;113:E22-E24) of a 32-year-old man who received the Sinopharm BBIBP COVID-19 vaccine (BBIBP-CorV) and experienced acute-onset erythroderma and severe itching. The patient did not disclose any recent medication intake and had no noteworthy medical history. Physical examination revealed palmoplantar keratoderma, keratotic follicular papules on the legs and feet, and typical orange-red erythroderma. The laboratory workup was normal, including a negative test result for HIV infection.

The absence of details regarding the patient’s history of allergic reactions or sensitivities is one possible shortcoming in this case report and may have given important information about the possible reason for the erythroderma that occurred following vaccination. Furthermore, more research into the precise Sinopharm BBIBP vaccine ingredients that may have caused the skin reaction would have been helpful in deciphering the underlying mechanisms.

Larger-scale studies examining the frequency of cutaneous reactions following COVID-19 vaccination with various vaccine formulations may be the focus of future research efforts and could assist in determining the risk factors for experiencing such reactions, which would enable health care providers to offer advice on vaccination alternatives or preventative measures for those who are more vulnerable. Furthermore, collaboration among dermatologists and allergists could improve patient outcomes and improve management.

By highlighting an uncommon but noteworthy dermatologic manifestation following COVID-19 immunization, this case report emphasizes how crucial it is to keep an eye out for and report any possible side effects linked to vaccinations to protect patient safety. Subsequent investigations should concentrate on enhancing comprehension of the pathophysiology of cutaneous reactions following immunization and devising tactics to alleviate these hazards. Working together, researchers and health care professionals can effectively tackle the issues raised by these newly discovered vaccine-related skin responses.

To the Editor:

We read with interest the case report from Abdelkader et al¹ (Cutis. 2024;113:E22-E24) of a 32-year-old man who received the Sinopharm BBIBP COVID-19 vaccine (BBIBP-CorV) and experienced acute-onset erythroderma and severe itching. The patient did not disclose any recent medication intake and had no noteworthy medical history. Physical examination revealed palmoplantar keratoderma, keratotic follicular papules on the legs and feet, and typical orange-red erythroderma. The laboratory workup was normal, including a negative test result for HIV infection.

The absence of details regarding the patient’s history of allergic reactions or sensitivities is one possible shortcoming in this case report and may have given important information about the possible reason for the erythroderma that occurred following vaccination. Furthermore, more research into the precise Sinopharm BBIBP vaccine ingredients that may have caused the skin reaction would have been helpful in deciphering the underlying mechanisms.

Larger-scale studies examining the frequency of cutaneous reactions following COVID-19 vaccination with various vaccine formulations may be the focus of future research efforts and could assist in determining the risk factors for experiencing such reactions, which would enable health care providers to offer advice on vaccination alternatives or preventative measures for those who are more vulnerable. Furthermore, collaboration among dermatologists and allergists could improve patient outcomes and improve management.

By highlighting an uncommon but noteworthy dermatologic manifestation following COVID-19 immunization, this case report emphasizes how crucial it is to keep an eye out for and report any possible side effects linked to vaccinations to protect patient safety. Subsequent investigations should concentrate on enhancing comprehension of the pathophysiology of cutaneous reactions following immunization and devising tactics to alleviate these hazards. Working together, researchers and health care professionals can effectively tackle the issues raised by these newly discovered vaccine-related skin responses.

Soin, et al, reported an interesting case of strongyloidiasis in a refugee in their Photo Rounds article, “Rash, diarrhea, and eosinophilia” (J Fam Pract. 2015;64:655-658). They mentioned the importance of having a high degree of suspicion for parasitic infections among refugees. Indeed, health screenings for refugees are necessary and should include testing for parasitoses. However, there are several other issues to consider.

First, a single screening may not be effective. Thus, results should be verified with repeat screening tests. In my experience in Thailand, a single screening of migrants from nearby Indochinese countries failed to detect several infectious cases, including tuberculosis, malaria, and intestinal parasite infections. To optimize early detection and infection control, a repeated check-up system is needed. It should be noted, however, that a false-negative result for strongyloidiasis is not common from a stool examination or immunological test.¹

Second, the mentioned symptoms of “rash, diarrhea, and eosinophilia” can be due to several etiologies and may have been caused by a completely separate illness. Or the findings might have been due to a forgotten condition, such as post-dengue infection illness.²

Finally, the existence of strongyloidiasis in the case presented by Soin, et al, could have been an incidental finding without a relationship to the exact pathology.

Viroj Wiwanitkit, MD
Bangkok, Thailand

Soin, et al, reported an interesting case of strongyloidiasis in a refugee in their Photo Rounds article, “Rash, diarrhea, and eosinophilia” (J Fam Pract. 2015;64:655-658). They mentioned the importance of having a high degree of suspicion for parasitic infections among refugees. Indeed, health screenings for refugees are necessary and should include testing for parasitoses. However, there are several other issues to consider.

First, a single screening may not be effective. Thus, results should be verified with repeat screening tests. In my experience in Thailand, a single screening of migrants from nearby Indochinese countries failed to detect several infectious cases, including tuberculosis, malaria, and intestinal parasite infections. To optimize early detection and infection control, a repeated check-up system is needed. It should be noted, however, that a false-negative result for strongyloidiasis is not common from a stool examination or immunological test.¹

Second, the mentioned symptoms of “rash, diarrhea, and eosinophilia” can be due to several etiologies and may have been caused by a completely separate illness. Or the findings might have been due to a forgotten condition, such as post-dengue infection illness.²

Finally, the existence of strongyloidiasis in the case presented by Soin, et al, could have been an incidental finding without a relationship to the exact pathology.

Viroj Wiwanitkit, MD
Bangkok, Thailand

Soin, et al, reported an interesting case of strongyloidiasis in a refugee in their Photo Rounds article, “Rash, diarrhea, and eosinophilia” (J Fam Pract. 2015;64:655-658). They mentioned the importance of having a high degree of suspicion for parasitic infections among refugees. Indeed, health screenings for refugees are necessary and should include testing for parasitoses. However, there are several other issues to consider.

First, a single screening may not be effective. Thus, results should be verified with repeat screening tests. In my experience in Thailand, a single screening of migrants from nearby Indochinese countries failed to detect several infectious cases, including tuberculosis, malaria, and intestinal parasite infections. To optimize early detection and infection control, a repeated check-up system is needed. It should be noted, however, that a false-negative result for strongyloidiasis is not common from a stool examination or immunological test.¹

Second, the mentioned symptoms of “rash, diarrhea, and eosinophilia” can be due to several etiologies and may have been caused by a completely separate illness. Or the findings might have been due to a forgotten condition, such as post-dengue infection illness.²

Finally, the existence of strongyloidiasis in the case presented by Soin, et al, could have been an incidental finding without a relationship to the exact pathology.

Viroj Wiwanitkit, MD
Bangkok, Thailand