key: cord-322963-r0fhnpdn
authors: Katerina, Damevska; Lence, Neloska; Viktor, Simeonovski; Andrej, Petrov; Irena, Dimitrovska; Natasa, Teovska‐Mitrevska; Anita, Najdova; Nora, Pollozhani
title: Impact of COVID‐19 outbreak on dermatology services: Dermatology in isolation
date: 2020-05-22
journal: Dermatol Ther
DOI: 10.1111/dth.13552
sha: 
doc_id: 322963
cord_uid: r0fhnpdn

nan

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 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 ( 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 dermatologist in the pediatric care.

The authors declare no conflict of interest. 

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