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

Damevska, Katerina and Neloska, Lence and Simenonovski, Viktor and Petrov, Andrej and Dimitrovska, Irena and Najdova, Anita and Polozani, Nora (2020) Impact of COVID-19 outbreak on dermatology services: Dermatology in isolation. Dermatologic Therapy. 2020;33: e13552..

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Abstract

Dear Editor,
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 initial
development of the University Clinic for Dermatology in 1947, as part
of the Medical Faculty in Skopje,2 with the treatment of the vast number
of patients with skin infections as its main purpose.3,4 Since then,
TABLE 2 Undelayable visits and admissions in 2 weeks period
Outpatient visits
N = 163
Primary reason for admission to
hospital
N = 11
Pediatric (<18 years)
Atopic dermatitis (54)
Diaper dermatitis (13)
Acne (11)
Skin infections (9)
Drug rash (8)
Other (12)
Adult patients
Drug rash (16)
Dermatoses in pregnancy (6)
Acne (6)
Esthetic procedures (6)
Other (22)
Skin and soft tissue infections
• Erysipelas
• Diabetic foot
• Chronic venous ulcersPemphigus
Bullous pemphigoid
Psoriasis
Stevens-Johnson syndrome
Toxic epidermal necrolysis
Melanoma, surgical treatment
Pyoderma gangrenosum
TABLE 1 Most common dermatological input by specialty and by
reason
Specialties which asked
for dermatological consult
Common reasons for patient
consultation
GPs (43)
Pediatrics (23)
Infectious disease (4)
OBGYN (4)
Hematology (2)
Rheumatology (2)
Plastic surgery (1)
Treatment modifications (pemphigus,
AD, pemphigoid, psoriasis, acne)
Acute exacerbations of chronic
diseases (AD, acne, psoriasis,
pemphigus)
Patient education (AD, contact
dermatitis)
Initial consultation (skin trauma,
contact dermatitis, drug reactions)
Deficiencies of medications (retinoids,
dapsone, antimalarials)
Received: 23 April 2020 Revised: 2 May 2020 Accepted: 6 May 2020
DOI: 10.1111/dth.13552
Dermatologic Therapy. 2020;33:e13552. wileyonlinelibrary.com/journal/dth © 2020 Wiley Periodicals LLC. 1 of 2
https://doi.org/10.1111/dth.13552
the dermatological services on the national level have continued to
develop and have not once ceased work, not even during the events
of the great 1963 Skopje earthquake.
Dermatology is largely considered a nonacute, outpatientcentered
specialty, with a continued reduction in dedicated dermatology
beds.5,6 Our survey contributes by presenting the dermatoses,
which demanded dermatological consult and which were a diagnostic
and therapeutic challenge to the GPs and other specialties. These
included pediatric dermatoses, dermatoses of pregnancy, patients
with perennial retinoid therapy, bullous dermatoses, and cases of drug
eruptions, including SJS and TEN. This is deducted from a 14-day
period and concerned a population of a little over 2 million.
Pediatric dermatoses constitute roughly 50% of both urgent visits
and telecommunication consultations. The present results are broadly
in line with those of previous studies,7 confirming the role of the der

Item Type:	Article
Impact Factor Value:	1.75
Subjects:	Medical and Health Sciences > Clinical medicine
Divisions:	Faculty of Medical Science
Depositing User:	Andrej Petrov
Date Deposited:	16 Mar 2021 12:28
Last Modified:	16 Mar 2021 12:28
URI:	https://eprints.ugd.edu.mk/id/eprint/27938

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