key: cord-258039-046s47v6
authors: Jindal, Anuradha; Noronha, Malcom; Mysore, Venkataram
title: Dermatological procedures amidst Covid‐19: when and how to resume
date: 2020-05-12
journal: Dermatol Ther
DOI: 10.1111/dth.13561
sha: 
doc_id: 258039
cord_uid: 046s47v6

The pandemic of covid‐19 has captivated more than 3 Million people across the globe affecting the dermatology practice as well. Due to the novel nature of the virus and concomitant lack of research, standard guidelines have not been set in place regarding the procedures. Currently, due to fear and spread of coronavirus aesthetic practice has taken a seat back. Dermatologic surgeon/aesthetician have to be prepared for the forthcoming alterations in the practice and adjust to the necessary precautionary methods. This articles aims to prepare dermatologist for the upcoming difficulties and precautions to be taken for conducting procedures in amidst of coronavirus. This article is protected by copyright. All rights reserved.

hence mental well-being of the patient. As a dermatologists we will have to cater to the needs of the patients.

Chose the patient wisely and cautiously considering the following factors; rapid spread of virus, incubation period of 14 days when the patient is asymptomatic but still transmitting the virus, more than 78% cases being asymptomatic, 3 low sensitivity of the rapid test being 35-80%, 4 uncertainty about the vaccine and drug for treatment of Covid-19 and upon that the worldwide scarcity of personal protective equipment and masks.

The ideal time to start practice would depend on the rules laid down by local or central governing bodies but the most important factor is that the treating physician should be prepared both mentally and administratively and be well informed about the current scenario. The prime thing would be to have a disinfection strategy in place and adequate supply of PPEs for protection for self and staff in the clinic.

Transmission -Current information suggests that the two main routes of transmission of the COVID-19 virus are respiratory droplets and contact. Vertical transmission has also been reported. 6 Respiratory droplets are generated when an infected person coughs or sneezes. Any person who is in close contact (within 1 m) with someone who has respiratory symptoms (coughing, sneezing) is at risk of being exposed to potentially infective respiratory droplets. Droplets may also land The virucidal efficacy of chemical germicides against coronavirus has been investigated. A study of disinfectants against human coronavirus 229E found several disinfectants were effective after a 1-minute contact time; these included sodium hypochlorite (at a free chlorine concentration of 1,000 ppm and 5,000 ppm), 70% ethyl alcohol, and povidone-iodine (1% iodine). A study also showed complete inactivation of the SARS coronavirus by 70% ethanol and povidoneiodine with an exposure time of 1 minute and 2.5% glutaraldehyde with an exposure time of 5 minute. 11 Although Glutaraldehyde (GA) is an effective disinfectant but it potential to cause severe allergic dermatitis and should be used cautiously. Studies have shown that SARS corona virus can survive on plastered walls, stainless steel surfaces, plastics and even glass slides from 24-72 hours. It is stable in feces and urine for at least 1-2 days. 9, 12 Hence, all the surfaces should be disinfected as they can act as potential source of infection before commencing and after finishing the procedures.

 Waiting time before procedures can be limited by providing pre-procedure instructions through telecommunication e.g. to trim/shave the area for laser hair reduction, apply topical anesthesia 45 min before procedure which can be done easily at home if given proper instructions.

This article is protected by copyright. All rights reserved.

HEPA filters and UPLA filters should be employed in the set up where lasers or other plumes generating procedures are being held. 19 The suction power of a smoke-evacuating system is defined by its ability to generate a threshold minimum amount of airflow. A minimum airflow of 0.012-0.017 m 3 /s was recommended by Hunter for electro cautery whereas even higher minimum airflow is required for procedures generating higher amount of plumes like laser hair reduction. A combination of charcoal filter with UPLA filter provides the best filtration. 14 Nozzle -To obtain maximum capture of smoke, nozzle should be placed within 2 inches of the site to be treated. 19 Ventilation of room -Perform procedures in an adequately ventilated room; i.e. 

This article is protected by copyright. All rights reserved. 

This article is protected by copyright. All rights reserved.

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