Histology showed mild epidermal acanthosis, spongiosis, and sub-corneal vesicles. Eosinophils were raised at 0.54, and liver function tests (LFTs) were normal. Four weeks after rash onset, he was reviewed by dermatology.
He initially visited his general practitioner who commenced a short course of oral steroids in combination with potent topical steroids with no benefit. There was no mucous membrane involvement. One day following his second dose, he developed an extensive pruritic morbilliform eruption on his trunk and limbs affecting 35% of his body surface area (Fig. This resolved after 10 days without intervention. He developed widespread pruritus without rash four hours after his first vaccine. He had not taken any prescription or over the counter medication prior to this presentation. He had no dermatological history and had no family history of eczema or psoriasis. He had no significant medical history and no known allergies. A 59-year-old man presented with a widespread morbilliform rash after receiving the second dose of the Pfizer-BioNTech COVID-19 mRNA vaccine.