Scleroderma after COVID-19 Infection and Vaccination

Scleroderma is a rare autoimmune connective tissue disorder characterized by fibrotic hardening and tightening of the skin. Scleroderma develops as a drug-induced and paraneoplastic phenomenon; however, scleroderma associated with COVID-19 has been rarely discussed. We present an updated review of scleroderma after the COVID-19 infection and vaccination. Literature searches were conducted on MEDLINE (PubMed), Embase, Scopus, and Google Scholar from 2019 to January 2023. In all, 13 studies were selected based on the subject relevance, with screening of references contained in the selected papers. As of January 2023, we had four patients with scleroderma after the COVID-19 infection (M_age = 54.50 years; R_age = 47-61 years; man-woman ratio = 1:3) and 10 patients with scleroderma after the COVID-19 vaccination (M_age = 62.8 years; R_age = 45-73 years; man-woman ratio = 1:9). Moderna's Spikevax accounted for two patients, Pfizer-BioNTech's Tozinameran accounted for seven patients, and Oxford-Astra Zeneca's Vaxzevria accounted for one patient. Hypotheses for the pathogenesis of scleroderma after the COVID-19 infection and vaccination included molecular mimicry, cytokine activation, and endothelial injury. Although the benefits of the COVID-19 vaccines still outweigh the risks, we advise clinicians to monitor for this rare potential complication.