— December 27, 2021 —
he vaccine clinic for kids ages 5-11 organized by our local school district was a hot mess.
Parents were required to confirm an appointment time, but it did nothing but guarantee a spot in a long, snaking line behind scores of other families that inched along the hallways of a junior high school before delivering them—nearly two hours later—to a gymnasium where pharmacists in white coats jabbed needles into little arms.
Despite the logistical letdown, my wife and I didn’t leave until our seven-year-old daughter was one of the hundreds of children that Saturday afternoon in November who got their first dose of the Pfizer-BioNTech COVID-19 vaccine. Ever since the vaccine was authorized by the Food and Drug Administration (FDA) for use in kids under 12, we never questioned whether we would get our daughter vaccinated.
We were especially heartened after trial data on more than 3,100 kids who received the Pfizer vaccine revealed that none developed myocarditis (inflammation of the heart muscle) or pericarditis (inflammation of the outer lining of the heart), a rare but treatable side effect.
In all, there are 21 reported side effects listed on the information sheet for the Pfizer vaccine (e.g., injection site pain, tiredness, headache, etc.), which notes “these may not be all the possible side effects of the vaccine.”
Three Days Later
Three days after my daughter’s first dose, I noticed a faint patch of discolored skin around and underneath her nostrils that was a few shades lighter than her normal color. I thought it might be a rash of some kind, so I made an appointment with a dermatologist to get it checked out.
During the two days before the visit, the patch seemed to grow whiter in appearance to the point where you could see a sharp contrast between the shades of skin—it looked as if a ring of pigment around her nose had vanished. It appeared to be vitiligo, a skin condition in which the pigment-producing cells die or stop functioning. I stopped short of believing this could be the case since there’s no known history of vitiligo in my family or that of my wife.
Please don’t be One Of Those Parents who point to this blog post as further justification for their vaccine hesitancy.
After a brief examination, the dermatologist confirmed my suspicion: the white patch was indeed vitiligo. It’s unknown what causes the condition, he explained, but it’s generally considered to be an autoimmune disorder in which the immune system attacks the pigment cells in the skin.
He asked if anyone in my family had an autoimmune condition. I shared that my wife has Sjogren’s syndrome, a chronic condition in which the immune system attacks the glands that produce saliva and tears. He suggested this family history of autoimmune disease may explain our daughter’s onset of vitiligo.
The dermatologist prescribed pimecrolimus ointment twice daily, a standard treatment that can help re-pigment skin, and recommended a six-week follow-up.
That would have been the end of the story, but my parental spidey-sense wouldn’t let it go. I had a nagging feeling something had been overlooked.
As someone trained in the practice of public health, I wondered if there had been any cases reported by medical professionals in peer-reviewed or peer-to-peer publications about the onset of vitiligo after COVID-19 vaccination.
The Case Reports
To my surprise, I found two reported cases, and recently learned of a third.
The first was published July 8, 2021 in Clinical and Experimental Dermatology, the journal of the British Association of Dermatologists for practicing clinicians and dermatological researchers. It described the case of a 58-year-old man who developed vitiligo across his face one week after receiving his first dose of the Pfizer vaccine. He had no family history of vitiligo, but did have a two-year history of ulcerative colitis, an autoimmune condition in which the immune system attacks healthy tissue in the gut.
The second was published July 28, 2021 in Clinical Case Reports, a case report journal that shares clinical scenarios from a variety of fields. It described the case of a 61-year-old woman who noticed faint, white patches on her neck several days after her first dose of the Moderna COVID-19 vaccine. She did not seek treatment until after her second dose, when the patches “progressed in size and degree of hypopigmentation, and she developed new and more widespread macules on other parts of her body,” according the report submitted by dermatologists Joshua Kaminetsky and Donald Rudikoff in New York.
The woman reported no personal or family history of vitiligo, autoimmune disease, or other skin disorders.
The factors and timelines of these cases were eerily similar to what occurred with my daughter. I immediately submitted a report about my daughter’s experience to the Vaccine Adverse Event Reporting System (VAERS) maintained by the FDA and the Centers for Disease Control and Prevention.
Given we’re in the early days of COVID vaccination for children ages 5-11, my wife and I believe our daughter is among what may be a small number of children who have experienced a dermatologic reaction to the vaccine.
Correlation is Not Causation
On November 21, eight days after my daughter’s first shot, I sent two emails: one to her dermatologist; the other to Dr. Kaminetsky, who reported the case of the 61-year-old woman. I shared the journal articles and asked for additional perspective.
“I’m glad you reported this so as we collectively gather more information on COVID-19 vaccination we can get a better picture of vaccination-associated adverse events,” my daughter’s dermatologist replied. “These things are tough since temporal relationships alone do not indicate causation, but if enough subject cases are aggregated it may point scientists in a direction that ultimately proves some sort of link.”
I encourage parents to get their children vaccinated as soon as possible. The unknown likelihood of a dermatologic reaction pales in comparison to the known risks of COVID-19 illness.
Dr. Kaminetsky responded: “I can say that you are among many individuals who have reached out with similar stories since we published our article,” noting my daughter was the first pediatric case he’d heard about. “Unfortunately, our article was only a report of an interesting case and a suggestion of a possible relationship; I am unaware of any formal research studies investigating the link.”
That hasn’t prevented others from pondering the biological response that may be at play.
In a September 9, 2021 response to the Clinical and Experimental Dermatology report, clinical specialists from the American University of Beirut Medical Center in Lebanon highlighted a possible link between two mechanisms that underly the immune response which may explain vitiligo development after COVID-19 vaccination.
And last month, a team in Italy suggested two other disease-causing mechanisms, including molecular mimicry by which infectious or chemical agents may induce autoimmunity.
A Sense of Relief
To be clear, vitiligo is not life-threatening but it can cause mental distress, especially if it appears on visible areas such as the face, and particularly among people of color whose condition is more noticeable. But please don’t be One Of Those Parents who point to this blog post as further justification for their vaccine hesitancy.
Although I believe my daughter’s vitiligo was vaccine-induced, I may never know for certain. There’s always the possibility the condition was triggered before her first vaccine shot, and my wife and I simply didn’t notice its faint signs until afterward.
Nevertheless, I encourage parents to get their children vaccinated as soon as possible. The unknown likelihood of a dermatologic reaction pales in comparison to the known risks of COVID-19 illness (long-term health problems, hospitalization, death).
As it turned out, the week my daughter reached “fully vaccinated” status (two weeks after her second shot) was the same week she had a close contact with someone at daycare who tested positive for COVID-19. It’s news no parent wants to hear, but I felt a sense of relief knowing she was as protected as she could be.
Through it all, my daughter remains bubbly and largely unfazed. She wears a mask at school and daycare, so I doubt anyone has noticed her vitiligo. And nearly six weeks later, the color has started to return to the white patch around her nose.
Sometimes when I apply ointment around my daughter’s nose, I barely notice the demarcation between the two tones of her skin. All I see is the face of the resilient little girl she’s become.
P.S. Have you or your child had a reaction to a COVID-19 vaccine? Do two things: 1) Contact your healthcare provider, and 2) Report an adverse event using the VAERS online form or the downloadable PDF.
UPDATE: In July 2022, Medical News Today published this article on how COVID-19 vaccination may correlate with the onset or worsening of vitiligo.
Featured image of my daughter: courtesy of the Briggs family
Banner image: by Kaja Reichardt on Unsplash
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