From the Research
There is a link between COVID-19 vaccines and lichenoid drug eruptions, as evidenced by multiple case reports and studies, including a recent narrative review published in 2025 1.
Overview of Lichenoid Drug Eruptions
Lichenoid drug eruptions are a type of skin reaction that can occur after vaccination, characterized by flat-topped, purple-red, itchy bumps. These reactions are believed to result from an immune-mediated response where the vaccine triggers T-cell activation against keratinocytes in the skin.
Association with COVID-19 Vaccines
The Pfizer-BioNTech, Moderna, and AstraZeneca vaccines have all been associated with lichenoid drug eruptions, though they remain relatively rare adverse events. A retrospective analysis of about 300,000 vaccinated patients found a significant increase in the risk of developing oral lichenoid lesions or oral lichen planus after COVID-19 vaccination, especially with mRNA vaccines 2.
Treatment and Management
If you develop a lichenoid eruption after vaccination, treatment typically involves:
- Topical corticosteroids like clobetasol 0.05% cream applied twice daily for 2-4 weeks
- Oral corticosteroids such as prednisone 20-40mg daily with a gradual taper over 2-3 weeks for more widespread or severe cases It is essential to consult with a dermatologist for proper diagnosis and management, as other conditions can present similarly.
Risk and Benefit
While lichenoid drug eruptions are a potential adverse reaction to COVID-19 vaccines, the benefit of vaccination generally outweighs this risk. A narrative review published in 2025 found that the number of cases of lichen planus and lichenoid eruption following COVID-19 vaccination is extremely low compared to the number of vaccines administered overall 1.