LAUSR

To the Editor: The dermal hypersensitivity reaction (DHR) is a nonspecific histologic finding seen in a variety of clinical scenarios, including bite reactions, urticarial dermatitis and vasculitis, drug eruptions, and eczematous dermatitis. DHR is described as perivascular, lymphocytic infiltrate with eosinophils involving the papillary and upper reticular dermis and sometimes minimally the epidermis. DHR has been very rarely reported in the setting of recent vaccination. Therefore, we read with great interest the case series by Sidlow et al describing a generalized urticarial and a morbilliform eruption in the setting of SARS-CoV-2 vaccination, similar to a case seen at our institution as described below. Nine days following her first dose of the Moderna SARS-CoV-2 vaccine in her left arm, a 56-year-old female health care worker presented with an intensely pruritic rash that started on the left hand and spread to the left elbow, both hands, and both feet. Five days of prednisone taper (40 mg daily for 2 days, 20 mg daily for 2 days, and 10 mg for 1 day) from her primary care physician slightly improved the pruritus. She had a dusky violaceous papule on the small finger of her left hand; edematous, violaceous papules on the palms of the hands and dorsal feet; and urticarial lesions on the dorsal aspect of the hands, elbows, and upper portion of thighs