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Massachusetts General Hospital Board-Certified Dermatologist: Update on COVID-19 Vaccine Reactions and Virus Symptoms

American Academy of Dermatology

Since the first cases of COVID-19 were reported in the U.S. more than a year ago, board-certified dermatologist Esther Freeman, MD, PhD, DTM&H, FAAD — director of Global Health Dermatology at Massachusetts General Hospital and principal investigator of the international COVID-19 Dermatology Registry — has been at the forefront of advancing the medical community’s understanding of dermatologic manifestations of the virus and vaccine side effects.

Dr. Freeman is available to provide an update on what is known so far and why it’s important to get the COVID-19 vaccination.

 Vaccine Reactions:

  • COVID vaccine arm: This rash is red, sometimes itchy and painful to the touch and can be as much as five or six inches across. The rash typically shows up five to nine days after the first immunization shot and is considered a “delayed hypersensitivity” reaction. This happens most frequently with the Moderna vaccine.
  • Facial swelling: Although this is very rare, a few patients with dermal fillers have reported temporary facial swelling after receiving the COVID vaccine.

 COVID-19 Dermatology Symptoms:

  • Morbilliform/viral rash: the most common skin sign found in patients with the virus.
  • COVID toes: While COVID toes can appear at any age, children, teenagers, and young adults seem most likely to develop this condition, which is characterized by swelling and red or purple discoloration on one or more toes usually 1-4 weeks after infection with Sars-CoV-2. COVID toes can also cause blisters, itch, or pain.
  • Retiform purpura / Net-like rash: This rash was found in a small percentage of patients hospitalized and critically ill.
  • COVID tongue: A swollen, discolored tongue or mouth ulcers.
  • Long COVID/COVID long haulers: Patients can experience COVID symptoms on their skin after the acute phase of COVID, that can last many months. These include COVID toes.

 The American Academy of Dermatology has resources available to the public that provide more information about how to care for your hair, skin and nails during the pandemic:



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