In response to the rapid spread of COVID‐19 at the start of the pandemic, governments introduced severe measures of home confinement and isolation of the population in an effort to prevent their health systems from collapsing. On March 14, with more than 4000 confirmed cases 1 , Spain began its nationwide lockdown which has extended for almost three months

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A previous report showed a 10% complete remission rate after an average follow-up of 3.5 years in 150 patients with pretibial myxedema. 2 According to another study of long-term outcome of pretibial myxedema in 178 patients with pretibial myxedema, a 50% complete remission rate was achieved after 17 years in patients who had gone untreated for cutaneous lesions. 3 In contrast, our patient developed a marked deterioration over a period of 14 years. Mild cases may show spontaneous regression, while severe cases such as elephantiasic pretibial myxedema are refractory to therapies. Fibroblast stimulation is suggested to play an important role in the increased production of glycosaminoglycan in myxedema; however, the differences between progressive and smoldering types are unknown. A recent report suggested a possible novel treatment with complete decongestive physiotherapy for elephantiasic enlargement of the lower legs. 4 Because our patient had stopped visiting the hospital, untreated thyroid disease, diabetes, hyperlipidemia, hypertension, and abnormality in echocardiogram were newly discovered when she revisited us after the interval. Due to the metabolic syndrome, surgical treatment for her nodular and elephantiasic myxedema of the lower legs could not be performed. In conclusion, even though the symptoms were mild at the initial presentation, long-term follow-up of pretibial myxedema is necessary to confirm the disease progression.

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personal protective equipment (PPE); however, hospital supplies were subsequently assured and local policies changed. Fortunately, we were able to avoid reliance on teledermatology and its associated limitations that may miss important diagnoses. 6 Acute dermatitis featured more in 2020, similar to findings from other countries, 5 and as expected subacute referrals reduced (e.g. NMSC). Interestingly, there was a rise in scabies presentations, which was experienced by other local private practices. This is contrary to the expectation that lockdown and social distancing would reduce opportunities for intimate or close contact. Similar observations have been made regarding sexually transmitted diseases, wherein delayed diagnosis can have more serious implications. 4,5,7 It is thus important to encourage testing for STIs despite COVID-19. Unlike our international counterparts, we did not experience a sustained significant reduction in consults and have not needed to dramatically change our practice. However, the long-term consequences of potentially delayed diagnosis of subacute conditions in Australian dermatology practice need to be further evaluated, including trends in private and primary care practices. Our experience also shows that demand for hospital dermatology services continues and departments should learn from the experiences of international counterparts for better preparedness for future pandemics. ETHICALEthical committee review was not sought as guided by the 2014 NHMRC Guidelines for Quality Assurance and Evaluation Activities, and this was a clinical audit. FINANCIAL SUPPORTNo funding was acquired or utilised for this report.