key: cord-331120-bp1obxd4 authors: Ho, B.; Ray, A. title: A Case for Palliative Dermatology: COVID-19-related Dermatoses()() date: 2020-06-05 journal: Clin Dermatol DOI: 10.1016/j.clindermatol.2020.06.001 sha: doc_id: 331120 cord_uid: bp1obxd4 The unprecendented COVID-19 pandemic has challenged healthcare systems in different ones. In the United Kingdom, various subspecialties were deployed to the wards to help medical workforce in the frontlines, with dermatologists helping with general medical wards and on-calls. We present a case of COVID-19-related urticaria manifesting in a palliative setting and responding well to systemic antihistamine. This pandemic has highlighted a new subspecialty that should be explored and researched – palliative dermatology – bridging elements of dermatology with the concepts of palliative medicine. As dermatologists, we should be in the position to help with the last stages of a patient's journey. The unprecendented COVID-19 pandemic has challenged healthcare systems in different ones. In the United Kingdom, various subspecialties were deployed to the wards to help medical workforce in the frontlines, with dermatologists helping with general medical wards and on-calls. We present a 79-year-old woman who presented to the acute medical ward with a recent fall, cough, fever and shortness of breath. She had a background of chronic heart failure, atrial fibrillation, hypertension and vascular dementia. Viral swab confirmed the presence of CoVID-19. Unfortunately, signs of respiratory failure developed and progressed and due to her frailty and medical co-morbidities, non-invasive ventilation and intubation were not deemed appropriate. After discussion with our local palliative care, it was agreed symptomatic management should be the priority of care, managing the distressful breathlessness with a continuous subcutaneous infusion of morphine. The medical ward team was asked by the nursing team to review her newly developed rash as they were tending her bedside care. In this particular instance, the medical ward was attended by a recently deployed dermatology trainee. Clinical examination suggested new, erythematous urticated plaques limited to her thighs (figure 1) in keeping with urticaria, likely secondary to COVID-19 given the lack of other potential triggers. We were able to manage her symptoms of itch with menthol in aqueous cream and her urticaria with subcutaneous chlorphenamine due to her inability to tolerate oral tablets. Unfortunately, our patient died within a few days of admission, succumbing to the viral infection. A novel member of the human coronavirus, recently identified in Wuhan, China 1 , officially named as SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) can cause COVID-19 (coronavirus disease 2019). COVID-19 has been reported to be associated with many systemic symptoms including dermatological manifestations with urticarial eruptions commonly reported in various papers [2] [3] [4] [5] [6] . As in our case, COVID-19-related urticaria can manifest in a palliative setting and responds well to systemic antihistamine. As dermatology services are returning to a new "normal", this pandemic has highlighted a new subspecialty that should be explored -palliative dermatology -bridging elements of dermatology with the concepts of palliative medicine 7 . Dermatological conditions may often be overlooked in a palliative care setting, and sometimes rightfully so, especially in the last moments of a patient's journey. However, we as dermatologists, can further help our medical and nursing colleagues by providing diagnostic and management advice in helping patients in their terminal hospital or hospice admission which has traditionally been guided solely by the palliative care teams. Clinical features of patients infected with 2019 novel coronavirus in Wuhan Cutaneous manifestations in COVID-19: a first perspective Clinical characteristics of 140 patients infected with SARS-CoV-2 in Wuhan Urticarial eruption in Coronavirus Disease COVID-19) infection: a case report in Tangerang, Indonesia Classification of the cutaneous manifestations of COVID-19: a rapid prospective nationwide consensus study in Spain with 375 cases Urticaria in a patient with COVID-19: Therapeutic and diagnostic difficulties Palliative dermatology -An area of care yet to be explored