TNF and Autoimmunity: A prevailing hypothesis in the pathogenesis of COVID-19 vaccine-induced LP involves autoimmunity, whereby exposure to COVID-19 antigens via vaccination activates CD8+ (cytotoxic) T-cell lymphocyte response against basal keratinocytes in the epidermis leading to apoptosis and subsequent manifestation of LP.2,8,9 In addition, the activation of CD4+ (helper) T lymphocytes in the T-cell type 1 (Th1) response release proinflammatory cytokines, including IFN-γ and TNF-α, ultimately maintaining the Th1 response and promoting keratinocyte apoptosis.2,8,9