Impact of COVID-19 pandemic on acute dermatology referrals in a secondary and tertiary care Central London hospital. A retrospective comparison review of pre-COVID-19 era and COVID-19 pandemic.

BACKGROUND: Although Dermatology is largely considered an outpatient specialty, there is an increasing need for Dermatology input in the acute and inpatient setting. During the COVID-19 pandemic, Dermatology services had to be reorganized to facilitate staff redeployment and minimize the risk of exposure to COVID-19 for patients and staff. This led to an unprecedented increase in teleconsultations aided by clinical images. OBJECTIVES: The main aim of our retrospective study was to analyse the acute Dermatology referrals received in the pre-COVID-19 era and during COVID-19 pandemic. METHODS: We retrospectively analysed acute Dermatology referrals using the acute referral log. RESULTS: We retrospectively analysed 500 and 110 acute Dermatology referrals received in the pre-COVID-19 period and during COVID-19 pandemic, respectively. In the pre-COVID-19 era, consultations were most commonly requested by Oncology/Haemato-Oncology, Emergency Departments and General Practice, while during the COVID-19 pandemic General Practice was the most common source of referrals. A wide variety of dermatological conditions were encountered with the most common been eczematous dermatoses. CONCLUSIONS: Although Dermatology is largely an outpatient-based specialty, this study shows the demand for urgent Dermatology input the care of sick patients with severe skin diseases and in the management of skin problems in patients admitted or receiving treatment for other diseases. Re-organization of Dermatology services during the COVID-19 pandemic resulted in a marked increase in teleconsultations (28% versus 84.5%) and highlighted the importance of complete skin-directed physical examination by the referring clinician as well as procurement of good quality clinical images.

Gene expression profiling in male genital lichen sclerosus.

Male genital lichen sclerosus (MGLSc) has a bimodal distribution in boys and men. It is associated with squamous cell carcinoma (SCC). The pathogenesis of MGLSc is unknown. HPV and autoimmune mechanisms have been mooted. Anti extracellular matrix protein (ECM)1 antibodies have been identified in women with GLSc. The gene expression pattern of LSc is unknown. Using DNA microarrays we studied differences in gene expression in healthy and diseased prepuces obtained at circumcision in adult males with MGLSc (n = 4), paediatric LSc (n = 2) and normal healthy paediatric foreskin (n = 4). In adult samples 51 genes with significantly increased expression and 87 genes with significantly reduced expression were identified; paediatric samples revealed 190 genes with significantly increased expression and 148 genes with significantly reduced expression. Concordance of expression profiles between adult and paediatric samples indicates the same disease process. Functional analysis revealed increased expression in the adult and child MGSLc samples in the immune response/cellular defence gene ontology (GO) category and reduced expression in other categories including genes related to squamous cancer. No specific HPV, autoimmune or squamous carcinogenesis-associated gene expression patterns were found. ECM1 and CABLES1 expression were significantly reduced in paediatric and adult samples respectively.

PPE-associated dermatoses: effect on work and wellbeing.

The COVID-19 pandemic has led to more stringent infection control practice within hospitals, with the added requirement of personal protective equipment (PPE). Consequentially, the incidence of PPE-related dermatoses in healthcare workers is increasing. Analysis of staff members seen in a dermatology self-referral service during the first COVID-19 peak revealed a wide range of healthcare professionals being affected, with irritant hand dermatitis and acneiform eruptions being the commonest diagnoses. These PPE-related dermatoses had significant effects on staff members' work and wellbeing, which improved following assessment and treatment by dermatology. Given the change to our behaviour wearing PPE daily, which is likely to continue for the foreseeable future, the consequences will inevitably affect both healthcare workers and the general public, with these common dermatoses presenting in both primary and secondary care. It is therefore imperative to recognise both the physical and emotional impact that COVID-19 PPE has, and initiate prompt treatment to improve wellbeing.