Initially reported in Wuhan, China in December 2019, pneumonia of unknown cause led to respiratory disease spreading from person to person. It was later disclosed to be the new (novel) type of coronavirus or COVID 19. The outbreak was declared a Public Health Emergency of International Concern on January 30, 2020, by the World Health Organization. Since then, the SARS COVID 19 pandemic has spread to all continents and affected a vast majority of human population.
The specialty of dermatology often considered a non-emergency field of medicine is one of the worst affected in COVID times. A great number of dermatology practices have temporarily been shut down. Patients are often ignoring their skin problems and are scared to visit hospital. Many therapeutic and cosmetic procedures have been postponed. Teledermatology although a good means of doctor-patient interaction is mostly limited to cities and is very nascent in rural parts of our country.
COVID-related dermatology issues can be broadly classified into those related from the infection and those resulting from the modified lifestyle in current times. Also is needed to consider the skin issues faced by healthcare workers.
The incidence of skin lesions because of COVID-19 is reported between 0.2% and 29%. In asymptomatic or pre-symptomatic COVID-19 patients, skin lesions can often lead to the diagnosis of COVID-19.
Many skin lesions such as measles-like maculopapular rash and chickenpox like vesicular rashes are documented. Hives or urticaria rashes are common in COVID patients. Chilblain like patches on toes observed in COVID-19 named COVID TOES are a common finding. A few patients develop hemorrhagic rashes on body and legs. It’s still debatable that skin signs actually might help to assess the severity of disease clinically but they may be very useful in the diagnosis of early disease and to identify asymptomatic patients. Many treated patients also show skin manifestations. Acne-like eruptions in patients receiving steroids are common during recovery phase and may need prolonged management. Telogen effluvium presenting as sudden severe hair loss after a month or two of recovery is very worrying to patients. Although self-limiting and manageable with minor medications it can be of much concern in most patients. Delay in treatment of viral warts and molluscums have resulted in patient discomfort and persistence of these easily treatable conditions. Cosmetic surgeries, procedures like peels, LASER procedures getting postponed have resulted in lack of confidence in many patients.
Hygiene measures of more frequent hand wash and overuse of sanitizers can cause allergies. Rashes, dryness, rough patches, and itching on hands and fingers called as hand eczema often results due to over washing of hands and excessive use of hand sanitizers. After lockdowns habit of doing all household work and increase in hobbies has resulted in increased wet-work and exposure to detergents and harsh chemicals. People must be educated regarding avoidance of unnecessary hand washing, moisturizing hands properly, using gloves for wet work and to avoid contact with harsh detergents and other cleaning agents. Staying indoors and reduced social interaction can lead to stress that can cause increase in conditions like psoriasis and eczema. Lack of sun exposure may lead to vitamin D deficiency resulting in conditions like increased hair fall, dry skin, and increase in cases of atopic dermatitis. Ignoring hospital visits have caused increase in severity of common ailments like fungal infections and acne.
Skin problems related to personal protective equipment and personal hygiene measures also need to be mentioned. Pressure injury on nose and cheeks, acne, and itch due to occlusive clothing and tight-fitting masks are increased in health care workers. Exacerbations of preexisting dermatoses such as acne, rosacea, atopic dermatitis, have been reported. The occlusion generated by protective head caps and hats may provoke scalp itching and folliculitis or exacerbate dandruff. Frequent use of disinfectant and soap impair the lipid balance of the skin and increase the risk and incidence of contact dermatitis. The current stress generated by the global situation and confinement can also exacerbate dermatoses like urticaria and neurodermatitis.
To conclude, dermatology like all aspects of life has beared the brunt of COVID with issues and challenges for both patients and health care workers. Gradually scenarios are changing with more understanding of the disease and finding newer ways to tackle the problems. Use of technology like Teledermatology and related modalities are the new ray of hope and will offer better treatment options in present circumstances as well as in future.
( views are personal)
*Dr. Praveen Bhardwaj is a Dermatologist at Manipal Hospitals, Whitefield, Bangalore