Generalized morphea profunda following COVID-19 messenger ribonucleic acid vaccination

Morphea is an uncommon inflammatory disorder characterized by progressive sclerosis of the skin and soft tissues. We describe the novel occurrence of generalized morphea profunda arising in close temporal association with the COVID-19 messenger ribonucleic acid vaccination series. An 80-year-old man presented with numerous areas of firm, tight skin across his trunk and extremities with associated itching and burning. He denied characteristic symptoms of systemic sclerosis. Physical examination revealed numerous indurated plaques, some with porcelain-white or sclerotic yellow centers, on the bilateral dorsal forearms, anterior waistline, and bilateral legs. There was no evidence of sclerodactyly or inflammatory arthritis. Punch biopsies showed thickened collagen bundles in the reticular dermis, diminished periadnexal fat, and a perivascular and interstitial mononuclear cell infiltrate. The hyalinizing fibrosing reaction extended into the fat and was manifested by notable expansion of the interlobular septa of the fat by dense collagen. He was started on oral methotrexate with significant improvement in symptoms and lesion induration at 14-month follow-up. This case report provides further insight into the potential dermatologic adverse events associated with COVID-19 messenger ribonucleic acid vaccination. Further investigation is needed to determine any predisposing patient-specific intrinsic factors, unrecognized pathophysiologic mechanisms, and approximate incidence of such adverse events.