Response to 'A skin reaction with rust-like discolouration to mRNA COVID-19 vaccine'

We have read with the utmost interest the content of the recent letter by Pasternack et al , which deals with a rare skin reaction following the mRNA COVID-19 vaccine. Our report and the additional three cases discussed in the aforesaid letter suggests that this complication may be more common than appreciated or reported. In fact, a 30-year-old man with no significant past medical history was admitted to the hospital with multiple yellow-orange discolouration of the right hand. The patient reported the onset of lesions one day after the first dose of the SARS-COVID-19 vaccine 'pfizer'. In fact, a physical examination (Fig.1) revealed multiple non-infiltrated yellow-orange macular patches symmetrically distributed on the metacarpophalangeal and the proximal interphalangeal joints of the right hand. However, there were no areas of ulceration, discharge or infection. Then, the remaining physical examination was normal. Moreover, a laboratory examination for the presence of hepatic enzymes, thyroid hormone, creatinine, urea and vitamin A levels showed no abnormality and all lesions subsided in 48h with no recurrence.