Association Between COVID-19 Vaccine and Grover's Disease
There is a rare but documented association between COVID-19 vaccination and the development or reactivation of Grover's disease (transient acantholytic dermatosis), though this should not preclude vaccination given the overwhelming mortality and morbidity benefits of COVID-19 vaccines.
Evidence for the Association
The temporal relationship between COVID-19 vaccination and Grover's disease has been documented in case reports:
A case of acantholytic dyskeratosis mimicking Grover disease developed after the Moderna (mRNA-1273) COVID vaccine, with histopathology showing suprabasal acantholysis with dyskeratotic keratinocytes and inflammatory infiltrate 1
The patient in this case had a history of previously treated and resolved Grover disease, raising the possibility that the vaccine acted as a trigger factor for reactivation rather than causing de novo disease 1
Grover-like skin eruptions have also been reported in association with SARS-CoV-2 infection itself, suggesting that both the virus and vaccine may trigger similar cutaneous responses through immune activation 2, 3
Clinical Presentation
When Grover's disease occurs post-vaccination, it typically presents as:
- Eruptive, erythematous, vesiculopapular rash developing after vaccine administration 1
- Intensely pruritic papules or vesicles primarily affecting the trunk 2
- Histopathology demonstrates focal acantholysis within the epidermis, dyskeratotic cells (corps ronds and grains), and perivascular lymphocytic infiltrate 1, 2
Risk-Benefit Analysis
Despite this rare association, vaccination remains strongly recommended:
- COVID-19 vaccines are safe and effective in protecting against serious outcomes including hospitalization and death 4
- The benefits of vaccinating vulnerable individuals outweigh theoretical risks of exacerbating dermatologic conditions, as established for other autoimmune and inflammatory conditions 5
- There are no additional contraindications to COVID-19 vaccination beyond known allergies to vaccine components (polyethylene glycol for mRNA vaccines, polysorbate for adenoviral vector vaccines) 5
Management Approach
If Grover's disease develops or reactivates post-vaccination:
- The condition typically responds to oral corticosteroids 2
- Direct immunofluorescence should be performed to exclude other blistering disorders 1
- The temporal relationship to vaccination should be documented, but this does not contraindicate future vaccine doses unless there is a severe allergic reaction 5
Important Caveats
- Grover's disease has multiple recognized triggers including heat, sweating, sun exposure, and certain medications, so causality with vaccination cannot be definitively established in all cases 2
- The rarity of this association (only isolated case reports) means the absolute risk is extremely low 1
- Patients with pre-existing Grover's disease should still receive COVID-19 vaccination, as the disease can be managed if reactivation occurs 1