Dermatologists understand people are concerned about getting “COVID arm” (also called “COVID vaccine arm”) – a rash that can develop on the arm where you got your COVID-19 shot. Seeing a large rash days after getting vaccinated can be scary, but it’s generally nothing to worry about.

COVID arm belongs to a wide variety of rashes that dermatologists are seeing. These rashes develop in a small percentage of people who have received the COVID-19 vaccine.

Rashes that appear more than four hours after getting the COVID-19 vaccine are not a sign of a severe allergic reaction. According to board-certified dermatologist Esther Freeman, ¹ this type of rash “may indicate that your body’s immune system is doing a good job of responding to the vaccine.”

If you develop a rash within 4 hours of getting your COVID-19 shot, get immediate medical attention

This can be a sign of a serious allergic reaction.

News of rashes that appear hours or days later comes from research reported in the Journal of the American Academy of Dermatology. All reported rashes developed in people who had received either the Moderna or Pfizer COVID-19 vaccine. These were the only COVID-19 vaccines authorized for emergency use in the United States at the time of this study.

The rashes reported in this study include:

• COVID arm (a rash that appears on the arm where the shot was given and often develops seven to eight days later)
  This rash can be raised, itchy, and warm to the touch.

• Toes (or fingers) swell, turn red or purple, and sometimes develop sores or bumps
  Dubbed “COVID toes,” this rash also develops in some people who become infected with the virus that causes COVID-19. When this reaction happens after getting the COVID-19 vaccine, there is no reason to worry. It’s not a sign that you have COVID-19.

• Rash all over the body that looks like tiny, flat (or raised) spots on your skin
  While this rash can look scary, it will usually go away on its own.

• Swelling where a cosmetic filler was injected
  Some people who have had a cosmetic filler injected into their face developed this reaction.

Dermatologists say these possible side effects shouldn’t stop you from getting the COVID-19 vaccine as soon as it’s available to you.

Here are three reasons why.

#1 The COVID-19 vaccine could save your life

The COVID-19 vaccine will help protect you from getting COVID-19.

If you get COVID-19, there’s no way to know how it will affect you. Many Americans have died of COVID-19. Getting the COVID-19 vaccine could save your life.

The vaccine can also prevent you from getting very sick. If you get infected with the virus that causes COVID-19 after getting the vaccine, you may have a very mild case of COVID-19 or not get sick. Without the vaccine, some people infected with COVID-19 spend weeks or months in the hospital.

And some unvaccinated people who get COVID-19 develop a condition called “long COVID.” These people, who are often referred to as “long-haulers,” have symptoms of COVID-19 that last for weeks or months. Common symptoms of long COVID include feeling too tired to do what you normally do, brain fog, and loss of taste or smell.

With so many vaccine benefits, the risk of developing a rash is minor by comparison. This is especially true given fact #2.

The COVID-19 vaccine is effective and safe

You cannot get COVID-19 from the vaccine.

#2 COVID arm, facial swelling, and other rashes that develop hours or days after getting the COVID-19 shot are temporary and harmless

If you develop one of these rashes after getting the COVID-19 vaccine, your skin will clear up on its own.

“COVID arm typically shows up seven to eight days after you get the first shot,” says Dr. Freeman.

Dr. Freeman adds that the rash known as COVID arm can stretch five or six inches across your arm. This can look concerning, but it won’t last. The rash tends to go away in 24 hours to a week.

COVID arm

Seven days after receiving her first COVID-19 shot, this woman developed a large rash, which disappeared three days later.

Swelling where you’ve had a cosmetic filler injection usually goes away in 24 to 48 hours.

#3 Skin reactions are rare after getting the COVID-19 vaccine

While many people feel some pain and soreness in their arm after getting their shot, the rashes that develop hours to days later are uncommon.

Exactly why some people develop a rash or facial swelling is unclear.

“It’s not necessarily a bad thing,” says Dr. Freeman. "It shows that the vaccine is doing its job. You’re developing defenses to the virus that causes COVID-19."

If you develop swelling where you had a cosmetic filler injected, you can still get a cosmetic filler in the future

To protect your health and safety, wait until your reaction to the vaccine goes away and see a board-certified dermatologist who has expertise injecting cosmetic fillers.

Developing swelling where you had a cosmetic filler injected is very rare. During the clinical trials that led up to the FDA authorizing the Moderna and Pfizer COVID-19 vaccines for emergency use, a few people developed swelling where they had a filler injected into their face.

Here’s a summary of what happened:

• Who developed facial swelling: 3 out of 15,184 people who received Moderna’s COVID-19 vaccine

• Where the swelling developed: In the area a filler was injected into their face

• When people saw the swelling: 1 to 2 days after receiving their first dose of Moderna’s vaccine

While a few more people have developed this side effect since this study was run, facial swelling is still rare. It has been reported in a few people who had a filler and received either the Moderna or Pfizer COVID-19 vaccine.

When a COVID-19 vaccine becomes available to you, get it

Getting vaccinated is an important step that you can take to protect yourself and others from COVID-19. The Centers for Disease Control and Prevention (CDC) recommends the vaccine for people 16 years of age and older.

Related AAD resources

• AAD Coronavirus Resource Center

• Fillers: Overview

• Who should provide your cosmetic treatment?

¹ Board-certified dermatologist Esther Freeman, MD, PhD, FAAD, is the Director of Global Health Dermatology at Massachusetts General Hospital. She is also a principal COVID-19 researcher who has helped advance the understanding of how the coronavirus and the COVID-19 vaccines can affect the skin.

Images

• Images 1 and 3: Getty Images

• Image 2: Image used with permission of JAAD Case Reports. (JAAD Case Rep, 2021;10:92-5.)

References
American Academy of Dermatology (resources for dermatologists)

• COVID-19 vaccine administration guidance

• Massachusetts General Hospital Board-certified dermatologist: Update on COVID-19 vaccine reactions and virus symptoms

• Side effects of the COVID-19 vaccines

American Academy of Dermatology. “Largest study of COVID-19 vaccine skin reactions shows a wide range of reactions possible – but none severe.” News release issued 4.7.2021. Last accessed 4.7.2021.

Anderson EJ, Rouphael NG, et al. “Safety and immunogenicity of SARS-CoV-2 mRNA-1273 vaccine in older adults.” N Engl J Med. 2020;383(25):2427-38.

Avram M, Bertucci V, et al. “Guidance regarding SARS-CoV-2 mRNA vaccine side effects in dermal filler patients.” American Society for Dermatologic Surgery. Based on information available as of 28 December 2020.

Centers for Disease Control and Prevention (CDC):

• “Long-term effects of COVID-19.” Page last updated on November 13, 2020. Last accessed February 25, 2021.

• “Benefits of getting a COVID-19 vaccine.” Page lasted updated on January 5, 2021. Last accessed February 25, 2021.

• “What to Expect after Getting a COVID-19 Vaccine.” Last updated February 23, 2021. Last accessed February 25, 2021.

McMahon DE, Amerson E, et al. “Cutaneous Reactions Reported after Moderna and Pfizer COVID-19 Vaccination: A Registry-Based Study of 414 Cases.” J Am Acad Dermatol 2021; (journal pre-proof). Last accessed 4.7.2021.

Walsh EE, Frenck RW, Jr., et al. “Safety and immunogenicity of two RNA-based Covid-19 vaccine candidates.” N Engl J Med. 2020;383(25):2439-50.

Wei N, Fishman M, et al. “‘COVID arm’: A reaction to the Moderna vaccine.” JAAD Case Rep. 2021;10:92-5

Written by:
Paula Ludmann, MS

Reviewed by:
Esther Freeman, MD, PhD, FAAD
Carrie L. Kovarik, MD, FAAD
Ivy Lee, MD, FAAD

Last updated: 4/20/21

All content solely developed by the American Academy of Dermatology

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