Can the Moderna vaccine cause psoriasis?

Can the Moderna COVID-19 Vaccine Cause Psoriasis?

Yes, the Moderna COVID-19 vaccine can trigger new-onset psoriasis or exacerbate existing psoriasis in some individuals, though this is an uncommon adverse event that should not discourage vaccination in patients with psoriatic disease.

Evidence on COVID-19 Vaccines and Psoriasis

Documented Cases of Vaccine-Associated Psoriasis

Multiple studies have documented cases of psoriasis following COVID-19 vaccination:

• A study of 51 vaccinated psoriasis patients found 15 episodes of psoriasis exacerbation occurring approximately 9.3 ± 4.3 days after vaccination, with disease severity increasing from PASI 3.1 to 8.0 1
• Moderna's mRNA-1273 vaccine has been specifically implicated in psoriasis cases, along with other COVID-19 vaccines 2, 3
• The onset of psoriasis after COVID-19 vaccination ranges from 1 to 90 days (mean 15.75 ± 18.22 days) 2
• Plaque psoriasis is the most commonly reported phenotype, though pustular, guttate, and other types have also been reported 2

Patterns of Occurrence

• For patients receiving two vaccine doses, exacerbations were more common after the first dose than the second 1
• Among patients with autoimmune skin conditions (including psoriasis), symptoms occurred in 20% after the 1st dose, 82% after the 2nd dose, and 4% after the 3rd dose 4
• The median onset of symptoms was 7 days after the 1st dose, 14 days after the 2nd dose, and 18 days after the 3rd dose 4

Mechanism and Risk Factors

The exact mechanism behind vaccine-triggered psoriasis is not fully understood, but:

• Th17 cells induced by COVID-19 vaccines may play a role in psoriasis exacerbation 1
• This phenomenon is not unique to COVID-19 vaccines; influenza vaccination has also been associated with psoriasis flares 5
• No clear risk factors have been identified for predicting who will experience psoriasis after vaccination - studies found no association with age, sex, disease duration, psoriatic arthritis, family history, current biologics use, comorbidities, or baseline disease severity 1

National Psoriasis Foundation Guidance

Despite these potential adverse effects, the National Psoriasis Foundation COVID-19 Task Force recommends:

• Patients with psoriatic disease who do not have contraindications to vaccination should receive an mRNA-based COVID-19 vaccine as soon as it becomes available to them 6
• The benefits of COVID-19 vaccination in preventing severe COVID-19 disease and death outweigh the risk of psoriasis flares 6
• Patients should continue their psoriasis treatments during the vaccination period in most cases 6

Management Approach for Patients with Psoriasis

For patients with psoriasis considering COVID-19 vaccination:

1. Pre-vaccination counseling:

   • Inform patients about the small risk of psoriasis flare following vaccination
   • Emphasize that most cases resolve within 3 days to 4 months 3
   • Reinforce that the benefits of vaccination outweigh the risks

2. During vaccination:

   • Continue current psoriasis treatments in most cases 6
   • Use shared decision-making for patients with concerns about disease flares

3. Post-vaccination monitoring:

   • Watch for new or worsening psoriatic lesions for up to 3 months after vaccination
   • Treat flares promptly with appropriate topical steroids or other therapies as indicated

Clinical Perspective

While there is evidence supporting a temporal association between COVID-19 vaccines (including Moderna) and psoriasis flares, these events are relatively uncommon and generally manageable. The National Psoriasis Foundation explicitly recommends COVID-19 vaccination for patients with psoriatic disease, as the risk of severe COVID-19 outcomes far outweighs the risk of a treatable psoriasis flare 6.

Healthcare providers should acknowledge this potential side effect when counseling patients but should continue to strongly recommend vaccination for this population.