Development of De Novo Pemphigus Vulgaris Following COVID-19 Vaccination

Main Article Content

Faraz Yousefian, DO
Farah Tiab
Sujitha Yadlapati, MD
Rodolfo E Chirinos, MD, FAAD
Daniel Rivlin, MD, FAAD


Pemphigus vulgaris, autoimmune blistering disease, COVID-19, mRNA vaccine, vaccination


The vaccines manufactured by Pfizer, Moderna, and AstraZeneca to prevent the spread of SARS-CoV-2 have been reported to cause a wide range of adverse cutaneous reactions. The most common of these include delayed large local reactions, injection site reactions, urticaria, and morbilliform eruptions. The rarest and severe cutaneous reactions include the development of autoimmune blistering diseases such as pemphigus vulgaris and bullous pemphigoid. In this case report, we present a 73-year-old female patient who developed de novo pemphigus vulgaris two weeks after receiving the Pfizer-BioNTech COVID-19 vaccine. To the best of our knowledge, ours is the first case of new-onset pemphigus vulgaris following the Pfizer COVID-19 vaccine in the United States and only the third worldwide. This report confirms a suspected association between COVID-19 vaccination and the onset of pemphigus vulgaris, although it is exceedingly rare. It also highlights the importance of considering the COVID-19 mRNA vaccines as etiologies for new-onset pemphigus vulgaris and potentially other autoimmune blistering disorders. This knowledge may be important for medical providers when considering a differential diagnosis of new-onset blistering disease to expedite accurate diagnosis and initiation of treatment.


1. McMahon, Devon E., et al. "Cutaneous reactions reported after Moderna and Pfizer COVID-19 vaccination: a registry-based study of 414 cases." Journal of the American Academy of Dermatology 85.1 (2021): 46-55.

2. Thongprasom K, Pengpis N, Phattarataratip E, Samaranayake L. Oral pemphigus after COVID-19 vaccination. Oral Dis. 2021 Sep 28:10.1111/odi.14034. doi: 10.1111/odi.14034. Epub ahead of print. PMID: 34582621; PMCID: PMC8662146.

3. Tomayko, Mary M., et al. "Subepidermal blistering eruptions, including bullous pemphigoid, following COVID-19 vaccination." Journal of Allergy and Clinical Immunology 148.3 (2021): 750-751.

4. Ingold CJ, Khan MAB. Pemphigus Vulgaris. [Updated 2022 Jun 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from:

5. Akoglu G. Pemphigus vulgaris after SARS-CoV-2 vaccination: A case with new-onset and two cases with severe aggravation. Dermatol Ther. 2022 May;35(5):e15396. doi: 10.1111/dth.15396. Epub 2022 Mar 15. PMID: 35187768; PMCID: PMC9111794.

6. Kasperkiewicz, M., Ellebrecht, C. T., Takahashi, H., Yamagami, J., Zillikens, D., Payne, A. S., & Amagai, M. (2017). Pemphigus. Nature reviews Disease primers, 3(1), 1-18.

7. Kasperkiewicz, Michael, and David T. Woodley. “Association between Vaccination and Autoimmune Bullous Diseases: A Systematic Review.” Journal of the American Academy of Dermatology, vol. 86, no. 5, 23 Apr. 2021, pp. 1160–1164.,

8. Tan, S. W., Tam, Y. C., & Pang, S. M. (2022). Cutaneous reactions to covid-19 vaccines: A Review. JAAD International, 7, 178–186.

9. Solimani, F., Mansour, Y., Didona, D., Dilling, A., Ghoreschi, K. and Meier, K. (2021). Development of severe pemphigus vulgaris following SARS-CoV-2 vaccination with BNT162b2. J Eur Acad Dermatol Venereol, 35: e649-e651.

10. Knechtl, G., Seyed Jafari, S., Berger, T., Rammlmair, A., Feldmeyer, L. and Borradori, L. (2022), Development of pemphigus vulgaris following mRNA SARS-CoV-19 BNT162b2 vaccination in an 89-year-old patient. J Eur Acad Dermatol Venereol, 36: e251-e253.

11. Calabria E, Canfora F, Mascolo M, Varricchio S, Mignogna MD, Adamo D. Autoimmune mucocutaneous blistering diseases after SARS-Cov-2 vaccination: A Case report of Pemphigus Vulgaris and a literature review. Pathol Res Pract. 2022 Apr;232:153834. doi: 10.1016/j.prp.2022.153834. Epub 2022 Mar 5. PMID: 35278817; PMCID: PMC8896864.

12. Koutlas, I. G., Camara, R., Argyris, P. P., Davis, M. D. P., & Miller, D. D. (2021). Development of pemphigus vulgaris after the second dose of the mRNA-1273 SARS-Cov-2 vaccine. Oral Diseases, 00, 1–2.

13. Damiani G, Pacifico A, Pelloni F, Iorizzo M. The first dose of COVID-19 vaccine may trigger pemphigus and bullous pemphigoid flares: is the second dose therefore contraindicated? J Eur Acad Dermatol Venereol. 2021 Oct;35(10):e645-e647. doi: 10.1111/jdv.17472. Epub 2021 Jul 13. PMID: 34169578; PMCID: PMC8447358.

14. Avallone, G., Giordano, S., Astrua, C., Merli, M., Senetta, R., Conforti, C., ... & Quaglino, P. (2022). Reply to ‘The first dose of COVID-19 vaccine may trigger pemphigus and bullous pemphigoid flares: is the second dose therefore contraindicated?’by Damiani G et al. Journal of the European Academy of Dermatology and Venereology.

15. Ong SK, Darji K, Chaudhry SB, Severe flare of pemphigus vulgaris after first dose of COVID-19 vaccine, JAAD Case Reports (2022), doi:

Most read articles by the same author(s)