Scleroderma after COVID-19 Infection and Vaccination

Area of Science:

• Immunology
• Dermatology
• Rheumatology

Background:

• Scleroderma is a rare autoimmune connective tissue disorder causing skin hardening.
• While drug-induced and paraneoplastic cases are known, scleroderma linked to COVID-19 is infrequently discussed.
• This review focuses on scleroderma cases following COVID-19 infection and vaccination.

Purpose of the Study:

• To review and synthesize existing literature on scleroderma cases associated with COVID-19 infection and vaccination.
• To identify potential pathogenic mechanisms linking COVID-19 and scleroderma.
• To inform clinicians about this rare potential complication.

Main Methods:

• Comprehensive literature searches were performed on MEDLINE (PubMed), Embase, Scopus, and Google Scholar from 2019 to January 2023.
• 13 relevant studies were selected based on subject relevance and reference screening.
• Data on patient demographics, COVID-19 exposure (infection or vaccination), and scleroderma characteristics were extracted.

Main Results:

• Four cases of scleroderma were identified following COVID-19 infection (mean age 54.5 years).
• Ten cases of scleroderma were identified following COVID-19 vaccination (mean age 62.8 years), with Pfizer-BioNTech, Moderna, and Oxford-Astra Zeneca vaccines implicated.
• Proposed pathogenic mechanisms include molecular mimicry, cytokine activation, and endothelial injury.

Conclusions:

• Scleroderma is a rare but potential complication following COVID-19 infection and vaccination.
• While COVID-19 vaccines offer significant benefits, clinicians should remain vigilant for this rare adverse event.
• Further research is needed to fully understand the pathogenesis and incidence of post-COVID-19 scleroderma.