CHESAPEAKE — Lying under the covers, Kimberly Parker could feel bumps rising on her arm.
She didn’t bother to flip on the lights to inspect them. Her body was an achy wreck. Parker had slammed into a wall of exhaustion and crash-landed in her bed.
It was not surprising. She had heard plenty of other people complain about feeling tired after getting their COVID-19 vaccines, and this was her second dose. She went to bed early March 30, hoping she could shrug off the fatigue by morning.
The next day, she felt pins and needles pricking under her skin and a swollen feeling in her arm. Strangely, though, not in the arm injected with the Moderna shot.
Standing in front of the mirror, she could finally see the rash. It looked like miniature cobblestone, paved down her arm.
As it progressed, it crept north, expanding to her chest. There was more — on a leg, the side of her face and smattered across her abdomen. The pelt of a shower helped her discover the pimple-like clusters that had reached her back.
“I’m literally staring at it so often, I can see it spreading,” she said a week later.
Parker, a 31-year-old Chesapeake resident who works at a commercial real estate company, is one of the rare people to experience a skin reaction spanning her body after receiving a COVID-19 vaccine. Her rash — a measles-like explosion — caused her severe burning for nearly three weeks, but is otherwise considered harmless.
About a month since the shot, the pain has dissipated, but her experience has left her frustrated with a health care system that allowed her to go weeks without answers. The pandemic — through its isolation — had caused her enough stress. Given the millions of people receiving vaccines she would have hoped for more attentiveness from medical professionals when something went awry.
In the the first two weeks, she visited two walk-in clinics, called the local health department and Moderna, and saw her primary care physician, but only after many days of waiting for an appointment. Along the way, a nurse had dissuaded her over the phone from making an appointment with a dermatologist. Had it not been for that advice, Parker believes she might have received the right care sooner.
She posted on Facebook, grasping for answers from the armchair experts. Unsure of where to turn next, she reached out to the newspaper for help.
After connecting with a reporter at The Virginian-Pilot, she was pointed to a dermatologist at Eastern Virginia Medical School. She also saw an allergy specialist the following week, through contacts The Pilot obtained from the Chesapeake Health Department.
“Moderna arm” and “COVID toes:” Those are nicknames for some of the vexing skin reactions vaccine recipients have experienced after getting their shots.
Doctors are seeing bluish and purplish skin on people’s feet, a reaction some have also had from the coronavirus itself. Experts don’t know the cause of the frostbitten look, but the thinking is blood vessels are contracting from inflammation, causing a sluggishness of the blood in the toes. Though uncomfortable, the swelling subsides, and color eventually returns.
Moderna arm, aka COVID arm, is an itchy, raised, red rash circling the injection site.
Dr. Richard “Hal” Flowers, assistant professor of dermatology at the University of Virginia, said the arm rashes are the most commonly reported skin reaction. They fade away after a few days, though it’s not quite clear what’s triggering them.
In the past, people with egg allergies have struggled with vaccines because they were developed in eggs. But some patients also are having delayed skin issues after receiving one of the new messenger RNA vaccines — Pfizer and Moderna’s shots — which were not made in eggs.
“An immune system recognizes something as foreign and reacts to it,” Flowers said. “It could be a reaction to the vaccine components, because it’s supposed to start to recognize this virus, or it could be the polyethylene glycol — something that kind of keeps the vaccines soluble — and it’s a common allergen.”
When Parker posted on social media her selfie pictures, friends suggested Moderna arm.
She Googled it herself. Was that it?
Hers was no itchy splotch. More to the point, it wasn’t on her injected arm.
“I see ‘COVID arm,’” she told them. “But that’s not my rash.”
Researchers recently looked at 414 skin reaction cases following COVID-19 vaccines between December and February and found that 83% came after Moderna shots, according to a paper published in the Journal of the American Academy of Dermatology. The study ended before Johnson & Johnson’s single-dose vaccine entered the fray, so it’s not included in the findings.
Other skin conditions included hives, measles-like flare-ups, full-body rashes and swelling linked to cosmetic fillers used to plump wrinkles.
Anecdotally, patients are reporting cases of shingles, too, the reactivation of a dormant chickenpox virus, which can cause painful skin blisters. But scientists have yet to establish a connection between the COVID-19 vaccines and that infection.
Based on the study, Parker’s condition, which most resembles a so-called “morbilliform eruption,” is even more unusual among the rare reactions. The term essentially means “measles-like,” though it isn’t measles.
Only 27 cases were documented in the study, with just 10 instances occurring after the second dose.
When Parker learned that her own doctor couldn’t see her for over a week, she made a trip to a walk-in clinic.
The health care provider who saw her wasn’t sure what it was, but suggested she be examined by a dermatologist.
The clinic also offered her an internal steroid — an option she refused because she feared it would wipe out the efficacy of her vaccine.
She spoke to someone at her primary care doctor’s office again, but still couldn’t get a timely appointment. When she mentioned the clinic wanted her to see a dermatologist, Parker said her doctor’s nurse told her by phone that wasn’t necessary.
She resolved to try to tough it out, but the burning only increased.
For the first few days, all she could do was take over-the-counter pain relievers. Sleep. Apply some calamine lotion. Repeat.
But even that seemingly mild cream — used on baby bottoms the world over — felt like gas on the fire. She wore loose shirts, sweaters and pajamas.
“Water burns. Now I have to use gloves to wash dishes,” Parker said. “Any speck of moisture that hits my arm or my chest, it feels like I have acid on my skin.”
Even a wisp of air across her arm stung.
After a friend suggested it could be shingles, she tried a telehealth visit. The video call concluded she needed to be seen in person.
So she went to a different clinic. That doctor, who examined her on April 3, didn’t think it was shingles because of the pattern and how dispersed it was on her body.
Again she was offered an internal steroid. Again she refused.
“I’d rather be fully vaccinated,” she said.
Many days passed, and Parker wasn’t sure if her rash was improving.
It certainly was changing. The skin that had bubbled was beginning to open and ooze. Pieces were sloughing off.
Underneath were dark, sensitive patches.
Was it scarring? She worried that it might be permanent.
She had been reporting her symptoms in the V-SAFE system, a federal tracker of side effects following COVID-19 vaccines. Surely, her reports would flag someone from the health department to contact her, she thought. After all, the website says: “Depending on your answers to the web surveys, someone from CDC may call to check on you and get more information.”
But no one did.
“I’m like, ‘Somebody must be dying out here,’ because they are not calling me,” she said laughing.
Finally, she had a visit with her primary care physician, after days of waiting for an appointment. The doctor told her the person she really needed to see was — wait for it — a dermatologist.
Ten days after that second dose of vaccine, she finally did. A dermatologist examined her and prescribed a topical steroid cream. She was instructed to slather it on to all of the rashes twice a day.
Over-the-counter hydrocortisone cream and antihistamine medications were also encouraged.
All along, Parker had feared taking an oral steroid could potentially undermine the vaccine. It’s not known whether internal steroid medications would interfere, said Dr. Abby Van Voorhees, chairwoman of dermatology at EVMS, but doctors try to avoid using them if they can.
“In theory, what we worry about is if we put people on internal steroids, we may suppress what we’re trying to accomplish, which is to have their body mount an immune response to the vaccine,” Van Voorhees said. “But nobody really knows how much of an immune response one needs.”
It took a few days on the topical treatment, but Parker began to feel the burning sensation subside.
One of the most important findings in the skin reactions study was that, while annoying and uncomfortable, none of the cases was life-threatening.
The silver lining could be that getting a rash is a sign of a person’s immune system working.
Dangerous types of skin reactions to look out for are hives that come on rapidly, sometimes within 30 minutes of receiving a shot, Flowers said. Those bumps, paired with difficulty breathing, would be seen as signs of anaphylaxis, or a severe allergic reaction.
“Very quick onset signs, or lips swelling, tongue swelling or difficulty breathing — that would be an emergency,” he said. “That’s the big, bad scary type of vaccine reaction.”
Otherwise, if you happen to be one of the few who gets a skin reaction, even one of the widespread ones, chances are you’ll be OK, Dr. Van Voorhees said.
“These reactions are usually very, very minor, in the long run, just really trivial in comparison to getting very sick with COVID,” she said. “I certainly would not let a concern about having a rash from the vaccine stand in the way of getting vaccinated.”
Wondering whether she was allergic to an ingredient in the vaccine, Parker went to an allergy specialist.
About a week ago, she was tested for an allergy to polyethylene glycol — also known as PEG — a substance used in the COVID-19 vaccines.
Her skin test was normal.
She’s still clueless as to why it happened, but she’s not as concerned anymore.
Now she’s waiting to see if the skin discoloration will fade. It may take months, she’s been told. Keep it protected from the sun, doctors said.
Even after all she’s been through, Parker says she wouldn’t hesitate to get a vaccine booster if public health experts ever recommend it.
On the day she got her second shot, she saw her 90-year-old uncle, who had been vaccinated two months earlier.
While wearing a mask, she gave him a hug. It reminded her of why she did this.