• Ivan Bristow

What has been happening in dermatology during lockdown?

For the last few months, we have experienced something unique, with many podiatry and other health clinics closing and hospitals running minimal services during the COVID-19 pandemic. The situation has been worrying for many patients but as people were effectively confined to their homes what has happened in dermatology? In this article, I would like to provide a brief roundup of what research has been reported during this time in dermatology. Some of it is surprising, some of it not.




Firstly, dermatology is a very visual subject and potentially can lend itself to online consultations (or teledermatology [TD]). At the end of last year, data from the British Association of Dermatologists reported about a quarter of dermatology departments were engaging in some form of online consultation. This can be triaging patient referrals or consulting online with referring colleagues. Its probably no surprise to learn that by 2020, 100% of departments were undertaking some form of teledermatology with many face-to-face outpatient clinics being closed across the UK. This has been a major turn of events in a short period of time and as research has shown junior doctors in the speciality have had little or no training in this technology (1). However, in a wider survey of 216 dermatologists, 88% of them were engaged in some form of teledermatology during the pandemic. In the study, 71% felt TD was more difficult than face-to-face and time consuming (2). Ultimately, TD is here to stay but in what capacity is unclear at this stage. Certain issues need to be addressed around training and the most effective use of the resources but there is little doubt they have been well utilised and to good effect during the pandemic.

The emergence of COVID toes – chilblain lesions in children and young adults has been widely reported in the media and on every podiatrist’s radar. Over the last few months, I have provided information as part of the College of Podiatry’s COVID-19 group. The story so far can be found in these blogs as the mystery continues to unfold. (LINK to TWO articles).

In addition, there have been published articles examining what has been happening with the public during lockdown. One tool which has been successfully used is Google Trends, an inquiry-based search which allows researchers to find out what search terms have been entered into the world’s most popular search engine. Earlier work showed that interest and enquiries regarding chilblains increased dramatically during the pandemic compared with other years, even before it was reported in the media suggesting that this phenomenon was going on before it hit the news (3). Another survey suggested that general dermatological searches were stable or slightly reduced during the lockdown period in the USA as people’s attention was focussed elsewhere (4). Another study looked at the UK public’s search habits for dermatology related information. They broadly concurred with the American study although “cosmetic” dermatology enquiries reduced. However, the relative number of searches for the terms “wart,” and “hand eczema” rose over the period January to May 2020 both qualitatively and in percentage terms. The 25% increased interest during this period may reflect the public desire to self-treat these non-urgent, but life-impacting conditions, during a period of lockdown. The 16% increase in searches for hand eczema reflects greater emphasis (and public health campaigns) regarding hand hygiene, which has led to an increased incidence of hand eczema, for which patients are seeking online advice (5).

Finally, another study from a London hospital has been published which looked to compare the diagnosis of melanoma during two periods pre-lockdown (27th January to 17th March) and during lockdown (18th March to 18th May). The results showed that during lockdown, despite their being fewer referrals (481 versus 157) detection rates were higher (1.7% versus 5.73%) – perhaps surprising but a further analysis post-lockdown should be able to confirm this finding. What it shows is that even at a time of health crisis a significant number of MM were found, which may have been missed or delayed if the service had been unavailable (6).

References

1. Lowe A, Pararajasingam A, Goodwin R. A UK-wide survey looking at teaching and trainee confidence in teledermatology: A vital gap in a Covid-19 induced era of rapid digital transformation? Clin Exp Dermatol. 2020.

2. Sharma A, Jindal V, Singla P, Goldust M, Mhatre M. Will teledermatology be the silver lining during and after COVID-19? Dermatol Ther. 2020:e13643.

3. Kluger N, Scrivener Y. The use of Google trends for acral symptoms during COVID-19 outbreak in France. J Eur Acad Dermatol Venereol. 2020

4. Guzman AK, Barbieri JS. Analysis of dermatology-related search engine trends during the COVID-19 pandemic: implications for patient demand for outpatient services and telehealth. J Am Acad Dermatol. 2020.

5. Searle T, Al-Niaimi F, Ali FR. Dermatological insights from Google Trends: what does the public think is important during COVID-19 lockdown? Clin Exp Dermatol. 2020

6. Schauer AA, Kulakov EL, Martyn-Simmons CL, Bunker CB, Edmonds E. Melanoma defies ‘lockdown’: ongoing detection during Covid-19 in central London. Clin Exp Dermatol. 2020