Public health

Dermatology consultations down during pandemic, hospital figures show


Australia may have avoided the worst of the COVID-19 but the pandemic still caused a significant downturn in dermatology practice, according to a report from a Sydney tertiary hospital.

Data from the St George Hospital Dermatology Department showed a 16% reduction in consults in the February-November period of 2000 from the like period of 2018 – a drop from a mean of 31.5 per month to 26.5.

Not surprisingly, the sharpest plunge was in March 2000, coinciding with the introduction of isolation rules for returned travellers, curbs on gatherings and activities, and a spike in COVID-19 cases in the state linked to infected passengers from the Ruby Princess cruise ship.

This was followed by a rebound in May and June, but numbers still remained below the levels of two years earlier, according to a research letter published in the Australian Journal of Dermatology.

Referrals from the hospital’s Emergency Department remained relatively strong in the 10-month period, but there was a decline in referrals for non-melanoma skin cancers and a 22% reduction in biopsies.

Most of the hospital’s dermatology referrals in the review period were for drug eruption, unchanged from 2018, followed by atopic dermatitis, contact dermatitis, scabies and acute urticaria.

The study authors, led by Dr Genevieve Ho, noted that acute dermatitis featured more in 2020, similar to findings in other countries, but the hospital also witnessed an unexpected increase in scabies.

“Interestingly, there was a rise in scabies presentations, which was experienced by other local private practices, they wrote.

“This is contrary to the expectation that lockdown and social distancing would reduce opportunities for intimate or close contact.

“Similar observations have been made regarding sexually transmitted diseases, wherein delayed diagnosis can have more serious implications.”

Given the constancy of demand for hospital dermatology services, they said, departments should learn from overseas experiences to prepare for future pandemics, including ready access to PPE.

In the United States, one centre had reported a reduction of 29% in inpatient dermatology consults from March-May 2019 to 2020 and had resorted to teledermatology for 42% of  its services, they noted.

“We used teledermatology at the beginning of April for a select few patients in order to minimise in-person consults due to limitations of personal protective equipment (PPE); however, hospital supplies were subsequently assured and local policies changed,” the authors said.

“Fortunately, we were able to avoid reliance on teledermatology and its associated limitations that may miss important diagnoses.”

“The long-term consequences of potentially delayed diagnosis of sub-acute conditions in Australian dermatology practice need to be further  evaluated, including trends in private and primary care practices,” the authors said.

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