Erythrodermic Pityriasis Rubra Pilaris Following COVID-19 Vaccination

To the Editor: A 32-year-old man presented to our clinic with acuteonset erythroderma associated with severe itching of 1 month's duration.The patient developed the eruption after receiving the second dose of the Sinopharm BBIBP COVID-19 vaccine (BBIBP-CorV) 2 weeks prior to presentation.His medical history was unremarkable.There was no personal or family history of skin disease and no history of drug intake.Physical examination revealed orange-red erythroderma (Figure 1A) with islands of sparing, keratotic follicular orange-red papules on both legs and feet (Figure 1B), well-defined waxy palmoplantar keratoderma (Figures 1C and1D), and fine scales on the face and scalp.The clinical and laboratory workup were normal, including a negative test for HIV infection.Histopathology of two 4-mm punch biopsies of the skin on the trunk and lower limb showed irregular epidermal hyperplasia with thick suprapapillary plates and hypergranulosis (Figure 2A) along with alternating