key: cord-0788749-jpzevtw1 authors: Carrascosa, J. M.; Pastor-Nieto, M. A.; Ruiz-González, I.; Silvestre, J. F.; Borrego, L.; Gatica-Ortega, M. E.; Giménez-Arnau, A. M.; Armario Hita, José Carlos; Borrego Hernando, Leopoldo; Carrascosa Carrillo, José Manuel; Córdoba Guijarro, Susana; Curto, Laia; Fernández Redondo, Virginia; Figueras Nart, Ignasi; García Gavín, Juan; Elena Gatica Ortega, María; Giménez Arnau, Anna; Giménez Arnau, Elena; Gómez de la Fuente, Enrique; González Pérez, Ricardo; Heras Mendaza, Felipe; Hervella Garcés, Marcos; Manrique Martínez, Pilar; Mercader García, Pedro; Javier Ortiz de Frutos, Francisco; Miquel Miquel, Javier; Antonia Pastor Nieto, María; Rodríguez Serna, Mercedes; Ruíz González, Inmaculada; Sánchez Gilo, Araceli; Sánchez-Pedreño Guillén, Paloma; Sánchez Pérez, Javier; Sanz Sánchez, Tatiana; Serra-Baldrich, Esther; Silvestre Salvador, Juan Francisco; Zaragoza Ninet, Violeta title: Patch Testing During the COVID-19 Pandemic: Recommendations of the AEDV's Spanish Contact Dermatitis and Skin Allergy Research Group (GEIDAC) date: 2020-09-18 journal: Actas Dermosifiliogr DOI: 10.1016/j.adengl.2020.06.003 sha: 5d5e0545ef22ded5c294fc8d0bdd2b57c860211c doc_id: 788749 cord_uid: jpzevtw1 As the COVID-19 pandemic gradually comes under control, the members of the Spanish Contact Dermatitis and Skin Allergy Research Group (GEIDAC) have drawn up a proposed list of the requirements, limitations, and conditioning factors affecting the resumption of work in contact dermatitis units. The assumption is that the severe acute respiratory syndrome coronavirus 2 is still circulating and that occasional or seasonal outbreaks will occur. They recommend that the first step should be to assess how many patch tests each clinic can handle and review the waiting list to prioritize cases according to disease severity and urgency. Digital technologies can, where possible, be used to send and receive the documentation necessary for the patch test (information, instructions, informed consent, etc.). If the necessary infrastructure is available, patients can be offered the option of a remote initial consultation. Likewise, in selected cases, the patch test results can be read in a virtual visit using photographs taken by the patient or a video visit can be scheduled to allow the physician to evaluate the site of application remotely. These measures will reduce the number of face-to-face visits required, but will not affect the time spent on each case, which must be scheduled in the normal manner. All of these recommendations are suggestions and should be adapted to the needs and possibilities of each health centre. 1 Refers to AD_2406 Documento de consenso Recomendaciones del Grupo Español de Investigación en Dermatitis de Contacto y Alergia Cutánea (GEIDAC) de la AEDV en relación con la realización de pruebas epicutáneas durante la pandemia por SARS- Patch Autor para correspondencia: Jose-Manuel Carrascosa Email: jmcarrascosac@hotmail.com ◊En el anexo se detallan todos los componentes del Grupo Español de Investigación en Dermatitis de Contacto y Alergia Cutánea (GEIDAC) Resumen -Con el progresivo control de la pandemia por SARS-CoV-2, los miembros del Grupo Español de Investigación en Dermatitis de Contacto y Alergia Cutánea (GEIDAC) realizan una propuesta sobre cuáles van a ser los requisitos, limitaciones y condicionantes para reanudar el servicio en las unidades de dermatitis de contacto en un escenario en el que se presume la persistencia del virus, con episodios ocasionales o estacionales de exacerbación. Se aconseja ajustar el número de pruebas epicutáneas ( PE) a las posibilidades de cada centro y la revisión de los casos en lista de espera para priorizar a los pacientes en función de la gravedad y la urgencia. Se ofrecerán, si es factible, métodos telemáticos para los documentos relativos a las PE (información, pautas, documentos de consentimiento informado). De estar disponible, puede ofrecerse la opción de realizar una primera visita telemática. Igualmente, en pacientes seleccionados, puede llevarse a cabo una televisita en las visitas de lectura a través de imágenes realizadas por el paciente o a mediante una videovisita que permita visualizar el resultado de la exploración. Estas acciones permitirán reducir el número de visitas presenciales, aunque no el tiempo dedicado y asignado al facultativo para los actos médicos. Todas estas recomendaciones son sugerencias y se adaptarán a los requisitos y a las posibilidades de cada centro sanitario Dermatitis, COVID-19, epicutáneas, telemedicina, contacto As the COVID-19 pandemic gradually comes under control, the members of the Spanish Contact Dermatitis and Skin Allergy Research Group (GEIDAC) have drawn up a proposed list of the requirements, limitations, and conditioning factors affecting the resumption of work in contact dermatitis units. The assumption is that the severe acute respiratory syndrome coronavirus 2 is still circulating and that occasional or seasonal outbreaks will occur. They recommend that the first step should be to assess how many patch tests each clinic can handle and review the waiting list to prioritize cases according to disease severity and urgency. Digital technologies can, where possible, be used to send and receive the documentation necessary for the patch test (information, instructions, informed consent, etc.). If the necessary infrastructure is available, patients can be offered the option of a remote initial consultation. Likewise, in selected cases, the patch test results can be read in a virtual visit using photographs taken by the patient or a video visit can be scheduled to allow the physician to evaluate the site of application remotely. These measures will reduce the number of face-to-face visits required, but will not affect the time spent on each case, which must be scheduled in the normal manner. All of these recommendations are suggestions and should be adapted to the needs and possibilities of each health centre. The SARS-CoV-2 pandemic has led to the suspension of most contact dermatitis units and patch testing services because of the need for hospitals to prioritize treatment of COVID-19. 2, 3 As the pandemic is gradually coming under control, we must now consider the requirements, preferably before patch testing (Appendix D).  The procedures followed for patch testing should be adapted to appropriate safety requirements for the SARS-CoV-2 pandemic (Appendix E).  Visit for reading/interpretation of patch test results (48-96░h). The first reading should be taken immediately after removal of the patches. In equivocal cases, we should wait half an hour following the previously established safety recommendations. In specific cases, we can turn to teledermatology, which enables patients to send images they themselves have taken. Similarly, a video consultation will enable us to visualize the outcome of the examination, provide an interpretation, and record results in the clinical history, with recommendations for the patient. At this visit, we should calculate the time necessary to resolve doubts and send all the documentation (e.g., report, avoidance measures, treatment, and new appointments).  These actions will make it possible to reduce the number of in-person visits, although not the time taken by and assigned to the physician for medical procedures. This may be even longer, given the need for a strict protocol and additional requirements. In other words, quality and detail should be preferred over quantity.  These procedures should be based on circuits that guarantee the confidentiality and reliability of digitally transmitted data. Prioritized  Occupational eczema.  Severe eczema.  Eczema of the face or hands and widespread eczema that does not respond to appropriate treatment or protection measures.  Acute recurrent eczema of unknown origin.  Patients in whom dermatitis progresses with a high impact on quality-of-life.  Patients who are to undergo a surgical or therapeutic intervention that cannot be delayed and for which the results of patch testing are essential (drugs, medical devices, glucose sensors/insulin pumps, dental intervention, orthopedic intervention, patients who are atopic before systemic therapy). During the last 14 days, have you experienced any of the following symptoms? J o u r n a l P r e -p r o o f  Fever.  Cough.  Difficulty breathing.  Muscle pain.  Tiredness.  Impairment or loss of sense of taste or a bitter taste with food and water.  Reduced sense of smell or loss of sense of smell.  Diarrhea. If you notice any of the symptoms, please call us and we will decide what to do. However, in principle, it would be best if you did not come to the hospital. During the week you undergo testing, you should take your temperature every day and ensure that you do not have any of the symptoms mentioned above. Please contact us if you notice any symptoms. 1. Before coming to the center, please re-read the information on tests that we gave you when you came to your first visit or that you were sent by e-mail. 2. Please keep to the time of your appointment. If you arrive early, please wait in the car. YOU MUST NOT ARRIVE LATE. We are trying to avoid crowding in the waiting rooms. We would be grateful if you would help by arriving at the allotted time. 3. Do not forget to bring your own products (shower gel, creams, and products for your skin condition). Please bring these in their original container. 4. Your own products will be placed in a clean bag and can be left in the hospital until the until testing is complete. You can also bring them and take them home again, although they must be here at each visit. 5. You are recommended to bring the signed informed consent document (you can send this by e-mail as a scanned document if this option is available at your center). Alternatively, you can sign the informed consent document during your first visit. J o u r n a l P r e -p r o o f 6. Please go to the toilet before leaving home so that you do not to have to do so in the hospital. 7. Please try to bring as few personal objects as possible (bag, fan, umbrella 10. You must enter the hospital unaccompanied unless you need help. Only minors or people with special needs (elderly and dependent persons) can be accompanied. Persons accompanying patients to the hospital must remain outside or in the car. 11. You must follow the recommendations of the staff at the center and maintain the recommended safe distance (1.5-2░m) . 12. While in the hospital DO NOT TOUCH ANYTHING (E.G., DOORS, HANDLES) and maintain a safe distance from other people. Avoid crowding. 13. In the clinic, we will try to speak as little as necessary. Where possible, every effort will be made to send notifications and information by e-mail so that you do not have to take papers from the hospital to your home. If this is not possible, you will have to disinfect the papers when you arrive home or leave them in a safe place where they will not contaminate other objects. 14. Your belongings (e.g., clothing, bag) will be placed on the stretcher (clean sheets for each patient) or hung up in the consulting room. For your safety, please take care NOT TO TOUCH ANYTHING. You will have to strip to the waist. The required test patches and your own products will be applied to your back. 15. We will give you the information about your next appointment by telephone or by email. Wherever possible, we will try to keep your appointment at the same time throughout the week of patch testing. 16. WHEN YOU RETURN HOME from hospital on the days of your tests you must take the following precautions (and in the following order): a. Leave items such as bags and papers at the entrance.  There should be a clean, well signposted circuit, as well as staff who can inform patients and facilitate access to the clinic in order to prevent them from walking around the highest-risk areas.  If a patient has to partially undress, then he/she should have access, where possible, to an individual consulting room or stretcher where clothes can be left. Clothes will be kept in a disposable bag. It is important to ensure appropriate disinfection of surfaces and of other areas such as chairs and door handles between one patient and the next.  Gloves and mask should be worn when receiving patients, during the visit, and during the patch tests. The use of safety glasses or a face shield and an impermeable gown will be evaluated in specific cases (possible risk of aerosol transport).  Apply hand antiseptic (gel/water-alcohol solution) before and after each patient. J o u r n a l P r e -p r o o f  Collect the informed consent document in a plastic sheath supplied by the hospital (standard).  Apply tests using gloves that can be discarded after each patient.  Patch tests can be marked using adhesive material (preferably surgical steri-strip), individual acetate sheets, or 1 marker per patient. Disinfect the area to be marked with water-alcohol solution.  In the case of patients who bring their own products, these should be provided in individual bags and handled while wearing gloves  Establish appropriate ventilation of areas between one patient and the next.  During the removal of patches and the first reading, follow the procedures and recommendations indicated for application of the patch test.  During the week, give patients the option to store their own products in clean bags that can remain in the hospital until the tests are complete. J o u r n a l P r e -p r o o f Exploring the Impact of COVID-19 on progress towards achieving global surgery goals Dermatologists and SARS-CoV-2: The impact of the pandemic on daily practice Impact of COVID-19 outbreak on dermatology services: Dermatology in isolation