Impact of COVID ‐19 outbreak on dermatology services: Dermatology in isolation

Abstract

The current pandemic of COVID-19 demanded fast reorganization, as well as the necessity to adapt existing and administered extraordinary working protocols of dermatological services worldwide. 1 We present a unique experience from Republic of Macedonia where an abrupt interruption of the dermatology service on a national level, and the COVID-19 outbreak, occurred simultaneously, with a significant impact on the quality of care.The fourth diagnosed case of COVID-19 in the Republic of Macedonia was a dermatologist employed at the University Clinic for Dermatology in Skopje, the only tertiary care hospital in the country.Prior to being diagnosed, the doctor made direct contact with nearly all medical and non-medical personnel of the Clinic. The doctor also held a previously scheduled seminar, which was attended by an additional 95 dermatologists and dermatology residents from across the country.In the first hours following the diagnosis, rapid action was taken by government officials, and 128 dermatologists and dermatology residents were put in home quarantine for 14 days. Only 9 dermatologists in secondary care could resume practice in the period from 9 March 2020 to 26 March 2020, unevenly distributed geographically and in terms of subspecialty.At the same time, a number of socially restrictive measures were implemented, further reducing the availability of the dermatological services.The Macedonian dermatological body reacted with notable initiative and self-organization. In the absence of an official teledermatology platform, commonly used social media platforms and conventional telecommunications were used to sustain communication with other specialties and patients. As a result, the management of the majority of chronic patients proceeded without interruption.In an effort to discover which of the dermatological conditions demanded immediate attention, we conducted a survey where we asked colleagues about the number and reasons for teledermatological consults.Overall, 77 dermatologists participated in the survey. Ninety-one percent of respondents had received requests for consultations by patients. Eighty-two percent felt that consultation via a communication application was useful for patient follow-up; however, these methods were appropriate in less than 30% of cases for initial consultations.The most common motives for consultations with patients were therapy follow-ups, acute exacerbations of chronic diseases, and deficiencies of certain medications due to difficulties in drug importations.Most frequently, dermatology input was requested from general practitioners (GPs) and pediatrics ( Table 1).The dermatologists, who were not subject to the home isolation measure, held 163 outpatient examinations, in the majority of which pediatric dermatological pathology dominated (Table 2).A total of 11 patients were admitted during this period in a secondary care hospital; the most frequent admissions were for bullous dermatoses and cutaneous infections (Table 2).Korting, Hammerschmidt, and Miovski constituted the ini...

Influence of COVID ‐19 pandemic on hospitalizations at the tertiary dermatology department in south‐west Poland

“…In Skopje, Republic of Macedonia, bullous disorders and cutaneous infections also constituted main reasons for patients hospitalizations. 6 Similarly to Italian colleagues, 5 we also observed reduced, however not significant, number of patients with skin cancers. All the surgical procedures were limited to minimum as suggested.…”

“…We maintained admitting limited number of patient mainly with acute dermatoses (eg, dermatitis due to substances taken internally, erysipelas, erythema multiforme) as well as severe disorders (eg, cutaneous lymphomas, bullous disorders). In Skopje, Republic of Macedonia, bullous disorders and cutaneous infections also constituted main reasons for patients hospitalizations 6 . Similarly to Italian colleagues, 5 we also observed reduced, however not significant, number of patients with skin cancers.…”

Teledermatology in the time of COVID‐19

“… 2 Besides, several dermatologists had to get home or hospital isolated for being infected or contacting patients with COVID‐19. 3 These factors together have restricted access to dermatological care and reduced the capacity of dermatological practice.…”

“…Routine investigations, screenings, elective surgeries and follow‐ups have been also discouraged as the hospitals and clinics could be sources of infection 2 . Besides, several dermatologists had to get home or hospital isolated for being infected or contacting patients with COVID‐19 3 . These factors together have restricted access to dermatological care and reduced the capacity of dermatological practice.…”

The impact of COVID‐19 pandemic in dermatology outpatient clinics in Turkey: A survey study

“…With the increasing number of cases in the COVID‐19 pandemic, the need for health services has increased, and the necessity to change the functioning of health services has arisen 3 . Inpatient services, intensive care units, and outpatient clinics were revised according to the needs, elective procedures were postponed, and interventional practices were limited 3‐6 . The effects of the pandemic on dermatologists in different countries have been shown in various studies 6,7 …”