Case report
A 50-year-old woman presented to our outpatient dermatology clinic with an erythematous, pruritic skin rash over the upper chest and neck one month before referral. The lesions started one week after the second dose of the SARS-CoV-2 vaccine (Sinopharm, China). Similar lesions (less extensive and less symptomatic) had developed after the first dose of vaccine, injected three weeks before the second dose.
The patient is a known case of breast cancer (invasive ductal carcinoma) of the left breast that had undergone radical mastectomy and post-operation chemotherapy and radiotherapy 15 years ago. Since then, she has had a routine follow up without any relapse of breast cancer.
On examination of the skin, relatively ill-defined erythematous plaque with focal scaling and mild lichenification was observed on the upper chest, on the irradiation window area marked by tattoo (Figure 1a). A skin punch biopsy was performed and the histopathological examination revealed hyperkeratosis, parakeratosis, mild irregular acanthosis, mild spongiosis, focal basal cell degeneration with few Civatte bodies, and high apoptotic cells. The upper dermis was infiltrated by perivascular lymphocytes and eosinophils and contained dilated blood vessels (Figure 2a-d). Some mast cells were also visible in the upper dermis (Figure 3).
According to the clinical and histopathological features, diagnosis of radiation recall dermatitis was made, and she was treated with oral prednisolone (15 mg daily) for three days, once-daily application of mometasone furoate ointment, and frequent application of emollient. The signs and symptoms improved in a 10-day follow-up. (Figure 1b)
The patient signed written informed consent to permit the publication of the case report without identifying data and to use the photography for publication. The researchers committed to maintaining the patient confidentiality. Institutional ethics committee approved the case report (ethics code: IR.sums.med.rec.1400.325).