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Table of Contents
CORRESPONDENCE
Year : 2020  |  Volume : 38  |  Issue : 3  |  Page : 180-181

Impact of the COVID-19 pandemic on dermatology clinic visits: Experience from a tertiary medical center in Taiwan


1 Department of Dermatology, Taipei Veterans General Hospital; School of Medicine, National Yang-Ming University, Taipei, Taiwan
2 School of Medicine, National Yang-Ming University, Taipei; Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, New Taipei City; Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
3 Department of Dermatology, Taipei Veterans General Hospital; School of Medicine; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
4 School of Medicine, National Yang-Ming University; Department of Family Medicine; Department of Medical Research, Big Data Center, Taipei Veterans General Hospital, Taipei, Taiwan

Date of Submission21-May-2020
Date of Decision19-Jun-2020
Date of Acceptance30-Jun-2020
Date of Web Publication10-Sep-2020

Correspondence Address:
Ying-Xiu Dai
Department of Dermatology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Road, Beitou District, Taipei City 11217
Taiwan
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ds.ds_34_20

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How to cite this article:
Ma SH, Tai YH, Dai YX, Chen CC, Chen TJ, Chang YT. Impact of the COVID-19 pandemic on dermatology clinic visits: Experience from a tertiary medical center in Taiwan. Dermatol Sin 2020;38:180-1

How to cite this URL:
Ma SH, Tai YH, Dai YX, Chen CC, Chen TJ, Chang YT. Impact of the COVID-19 pandemic on dermatology clinic visits: Experience from a tertiary medical center in Taiwan. Dermatol Sin [serial online] 2020 [cited 2020 Sep 20];38:180-1. Available from: http://www.dermsinica.org/text.asp?2020/38/3/180/294711



Dear Editor,

After initial onset in China in December 2019, the new coronavirus (SARS-CoV-2) spread throughout the world, causing a devastating disease (COVID-19). In the face of the pandemic, adaptive measures and education are mandatory to ensure the safety and effectiveness of dermatologic services.[1] Understanding changes in dermatologic services during this pandemic provides important implications for decisions on allocating healthcare resources. This study was conducted to elucidate the impact of COVID-19 on dermatology clinic visits.

Data were obtained from the medical records of outpatients who visited the dermatology clinic of Taipei Veterans General Hospital between January 1 and April 30 in 2018, 2019, and 2020. The information for analysis included age, sex, domestic or international patients, veterans or nonveterans, and diagnostic codes. The Cochran–Armitage test and general linear models were used for categorical and continuous variables in trend tests. Logistic regression model was used to assess the association between dermatology outpatient visits and patient characteristics. A stepwise forward model selection procedure with an entry criterion of 0.05 and removal criterion of 0.10 was performed to identify the independent factors associated with the dermatologic outpatient visits during the COVID-19 pandemic.

The number of visits decreased significantly in 2020 compared to 2018 and 2019 (P< 0.001; [Supplementary Table 1]. Patients aged 20–39 and 40–59 years (vs. <20 years) and males were significantly more likely to visit the dermatology clinic, while veterans and international patients were less likely to visit dermatology clinic [Table 1]. Regarding patient diagnoses, skin cancer was associated with increased clinic visits during the pandemic period compared to nonpandemic period, while fungal infection, parasitic infection, and vitiligo were associated with decreased clinic visits.
Table 1: Relationship between dermatology clinic visits during COVID-19 pandemic (2020 vs. 2018-2019) and patient characteristics

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To our knowledge, this is the first study to compare the patient characteristics of dermatology outpatient visits between COVID-19 pandemic and nonpandemic period. We found a significant association between decreased clinic visits and some diagnoses, including fungal infection, parasitic infection, and vitiligo.

Given that the majority of dermatology patients have ailments which are nonlife-threatening, some authors recommend cancelling all nonurgent visits to minimize the potential for COVID-19 transmission.[2],[3] This study found that the majority of our dermatology clinic visits were nonemergent. In addition, patients with certain nonemergent dermatoses, including fungal infection, parasitic infection, and vitiligo, were less likely to visit the dermatology clinic. On the contrary, both the number of patients and visits for melanoma and nonmelanoma increased during the pandemic period, probably because most skin cancers were managed at medical centers in Taiwan.[4],[5] Recent studies have reported an increased risk of hand eczema during the COVID-19 pandemic due to frequent hand washing.[6] In our study, however, there was no significant association between increased clinic visits and eczema, which may be explained by patient preferences for local clinics during the pandemic.

There are some limitations in our study. First, the external validity of our findings is uncertain as the pandemic is relatively under control in Taiwan and most of the clinics still operated during the pandemic period. Second, our data lacked information on disease severity of each dermatosis. Thus, the effect of treatment discontinuation due to the pandemic and subsequent dermatosis flare-up was not elucidated in our study.

In conclusion, COVID-19 has changed the daily practice of dermatologists dramatically. We determined that in contrast to patients with skin cancer, those with nonemergent dermatosis were unlikely to visit the dermatology clinic during the pandemic. These findings provide important implications for dermatology care during the COVID-19 pandemic.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Lee CH. Role of dermatologists in the uprising of the novel corona virus (COVID-19): Perspectives and opportunities. Dermatol Sin 2020;38:1-2.  Back to cited text no. 1
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2.
Pathoulas JT, Stoff BK, Lee KC, Farah RS. Ethical outpatient dermatology care during the coronavirus (COVID-19) pandemic. J Am Acad Dermatol 2020;82:1272-3.  Back to cited text no. 2
    
3.
Kwatra SG, Sweren RJ, Grossberg AL. Dermatology practices as vectors for COVID-19 transmission: A call for immediate cessation of nonemergent dermatology visits. J Am Acad Dermatol 2020;82:e179-80.  Back to cited text no. 3
    
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Dai YX, Chen TJ, Chang YT. Skin care services and disease prevalence in Taiwan: A nationwide study. Dermatol Sin 2018;36:124-30.  Back to cited text no. 4
    
5.
Dai YX, Chen TJ, Chang YT. Ambulatory practice of dermatologists in Taiwan: A nationwide survey. J Chin Med Assoc 2018;81:729-34.  Back to cited text no. 5
    
6.
Singh M, Pawar M, Bothra A, Choudhary N. Overzealous hand hygiene during the COVID 19 pandemic causing an increased incidence of hand eczema among general population. J Am Acad Dermatol 2020;83:e37-41.  Back to cited text no. 6
    



 
 
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