BACKGROUND: Increasing cases of vaccine-related severe cutaneous adverse reactions (SCARs) are reported in the literature. OBJECTIVES: To provide comprehensive information regarding the clinical spectrum of vaccine-associated SCARs. METHODS: This was a systematic review and meta-analysis on case reports, case series, cohort studies, case-control studies, and post-market surveillance of SCARs following vaccination. Data on demographic information, classes of vaccination, past medical history and medications, and types, manifestations, management, and prognosis of SCARs, including acute generalized exanthematous pustulosis (AGEP), drug reaction with eosinophilia and systemic symptoms (DRESS), Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN), and generalized bullous fixed drug eruptions (GBFDE), were extracted. RESULTS: A total of 255 cases of SCARs following vaccination were identified. 231 (91%) of the reported cases of vaccine-associated SCARs were identified as SJS/TEN. The pooled incidence of SCARs following vaccination was 1.676 per million (95% confidence interval=0.136-20.668
I CONCLUSIONS: SCARs following vaccination were extremely rare, with a high proportion of these cases SJS/TEN. Most suspected culprits included the H1N1 vaccine, the influenza vaccine, the varicella vaccines, and COVID-19 vaccines especially mRNA vaccines. However, concurrent medication use may confound underlying attribution of SCARs to vaccines.