Objectives: The COVID-19 outbreak is a serious threat to public health and social distancing on the part of individuals can help contain the epidemic. It is unknown if dermatologists are assisting with the public health officials' recommendations for social distancing by closing their practice or limiting their practice to the treatment of emergency conditions. This study examines the activity level of dermatology practices during the United States COVID-19 outbreak. Methods: We performed scripted phone calls to 60 dermatology practices in six different counties in the United Stated during the COVID-19 outbreak. We assessed if practices are open and if they are serving patients with urgent and non-urgent conditions. Results: Of the 60 dermatologists selected for the study, 55 were successfully contacted (92% contact rate). Of these practices, 29 (53%) were open, 17 (31%) were only seeing urgent patients and 9 (16%) were closed. New York, New York had 2 (20%) open offices which was the lowest proportion of any county (p ¼ .04). Counties with higher prevalence had fewer open offices (p < .01, R 2 ¼ .7). Conclusions: Many practices have restricted their level of operation especially in higher areas of COVID-19 prevalence, likely to help facilitate social distancing. ARTICLE HISTORY

BACKGROUND Melasma is an acquired disorder of hyperpigmentation that is often recalcitrant to current therapies. Microneedling is used to treat scars, striae, and rhytides and has a relatively low risk of post-treatment dyspigmentation. Several studies have examined its use in melasma. OBJECTIVE To review the published evidence on the efficacy and safety of microneedling in the treatment of melasma. METHODS A systematic review was performed. A meta-analysis could not be performed because of methodological differences across studies and data heterogeneity. RESULTS Eight studies were included for analysis. Most studies assessed the utility of microneedling in combination with other topical therapies and detected some success. However, microneedling-mediated transdermal delivery of medications is not superior to microinjections of medications. There is less evidence supporting the use of microneedling as monotherapy. Microneedling, when used with a 1064-nm Q-switched Nd:YAG laser, may provide additional benefit, although with a risk of post-treatment dyspigmentation. CONCLUSION Based on low-quality evidence, microneedling may play a role in the treatment of melasma, with the mechanism of action likely being the facilitation of delivery of topical therapies to the epidermis and dermis, and one ancillary benefit of this approach being the very low risk of postinflammatory hyperpigmentation.

Urticaria has a high socioeconomic burden worldwide. However, the global epidemiology of urticaria and its geographical and temporal trends are not well studied. Using the Global Burden of Disease dataset, the aim of this study was to analyse the age-standardized prevalence, incidence, years lived with disability, and mean duration of urticaria in 195 countries from 1990 to 2017. In addition, the relationship between socioeconomic development and urticaria was evaluated. The global prevalence of urticaria in 2017 was 86 million people. Females and children aged 1–4 years were more commonly affected than males and adults, respectively: these differences were outside the 95% uncertainty intervals. Regression analyses showed that a lower gross domestic product per capita was associated with a higher prevalence and incidence of urticaria ( p < 0.001). The global prevalence of urticaria, incidence, and years lived with disability have remained stable from 1990 to 2017.

ongoing and evolving regulations and practice adaptations, 15.7 million patient visits and $3.5 billion in practice revenue could be lost through 2020.Practices most frequently identified patient social distancing (67.1%; 95% CI, 63.8%-70.3%), patient COVID-19 concerns (67.2%; 95% CI, 63.9%-70.4%), and office workflow and personal protective equipment requirements (56.3%; 95% CI, 52.9%-59.7%) as significant challenges to recovery. Among those who responded, 1% specifically noted they retired from dermatology due to COVID-19 implications.Limitations include estimations could have led to recall bias, and methodology could have introduced sampling and nonresponse bias. Those with lower work volumes potentially could have had more time to respond, but this bias was minimized by weekend-only data collection. A consistent large sample magnitude, crowdsourced responses, 4 representative demographic distribution, and CIs further mitigate biases and demonstrated significance. Our predictive model also does not account for the impact of a potential second wave or earlier than anticipated vaccine availability.Our findings demonstrate the significant impact COVID-19 had on US dermatologic care and provide a better understanding of national trends. From an estimated pre-COVID baseline of 50 million annual US dermatology office visits, 5 a 30% decrease may lead to material adverse patient morbidity and practice economics. Telemedicine had mitigating effects, but the implications and magnitude of future integration are unclear. Further analyses will be required to assess the longer-term implications of COVID-19 on dermatology practice, identifying key factors influencing success in the ''new normal.''

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