key: cord-0833992-rjc99fyk authors: Turkmen, Dursun; Altunisik, Nihal; Mantar, Irem; Durmaz, Imge; Sener, Serpil; Colak, Cemil title: Comparison of patients’ diagnoses in a dermatology outpatient clinic during the COVID‐19 pandemic period and pre‐pandemic period date: 2020-12-26 journal: Int J Clin Pract DOI: 10.1111/ijcp.13948 sha: c7166b6f058ee38b9d76f565c637a39a4846f487 doc_id: 833992 cord_uid: rjc99fyk AIM: In this study, we compared the current diagnoses of patients admitted to the dermatology outpatient clinic with the diagnoses during the non‐pandemic period, and we examined the effect of COVID‐19 on the patient profile. METHODS: Diagnoses were compared by examining the patient files of the 3‐month period when the pandemic was influential in our country and the 2‐week non‐pandemic period corresponding to the same season a year ago. The outpatient diagnoses in the first month and the last month of the 3‐month pandemic period were also compared. RESULTS: During the 3‐month pandemic process, the most common reasons for applying to the outpatient clinic were acne, urticaria, psoriasis, and allergic/irritant contact dermatitis. Urticaria, psoriasis, allergic/irritant contact dermatitis, scabies, liken planus, mycosis fungoides, zona zoster, recurrent aphthous stomatitis and polymorph light eruption were statistically more common in the pandemic period. Moreover, acne, other eczematous dermatities, verruca, androgenic alopecia, and melanocytic nevus diagnoses were found to decrease statistically during the pandemic period when compared with the non‐pandemic period. CONCLUSION: Unlike other studies, the present study evaluated the patient diagnoses during the pandemic period and the period a year before and discussed the possible reasons for the changes in patient profiles. The minimum sample size required to detect a significant difference between the pandemic and non-pandemic periods was calculated to be at least 473 in each period (946 in total), taking into account type I error (alpha) of 0.05, power (1-beta) of 0.8, an effect size of 0.18 for Urticaria and the two-sided alternative hypothesis (H 1 ). Data were summarised by median (interquartile range) or number and percentage. The suitability of quantitative data for normal distribution was examined with the Shapiro-Wilk test. In statistical analyses, the Pearson Chi-Square, Mann-Whitney U, and Fisher-exact tests were used in the appropriate situations. Values of P < .05 were found statistically important. All the analyses were performed with the IBM SPSS Statistics 26.0 programme. In a 3-month period between March 16, 2020 and June 15, 2020, 1286 patients were admitted to the İnönü University dermatology outpatient clinic. Of these patients, 142 were admitted between April 9 and 22, which is the period when COVID-19 patient numbers peaked in Turkey. During the 2-week period of the previous year, which corresponds to this year's peak period, the number of admissions to the outpatient clinic was 1403. While 718 (55.8%) of the patients who were admitted during the 3-month coronavirus period were female and 568 (44.2) were male, 884 (63%) of the patients who were admitted in the non-pandemic period a year ago were female, and 519 (37%) were male. Statistically, a significant difference was found in the comparison of pandemic and non-pandemic period What's known • There are limited numbers of studies examining admission diagnoses to dermatology outpatient clinics during the COVİD-19 pandemic. • In studies conducted during the COVID-19 pandemic, an increase has been reported in the incidence of diseases such as psoriasis and urticaria. • Unlike other studies, our study evaluated the diagnoses of current patients with those admitted in the same season of the previous year, the changes in patient profiles were emphasised, and the possible reasons were discussed. • Urticaria, psoriasis, allergic/irritant contact dermatitis, scabies, liken planus, mycosis fungoides, zona zoster, recurrent aphthous stomatitis, and polymorph light eruption had a statistical increase in the pandemic period when compared with the non-pandemic period. • In the comparison of the peak period and non-pandemic period, urticaria, psoriasis, scabies, zona, drug reactions, and ichthyosis diagnoses were found to increase statistically. • We also compared the diagnoses in the first and third months of the pandemic period. While urticaria was found to be statistically high in the first period, nail dystrophy was found to be high in the third period. patients in terms of age and gender (P = .001, P < .001, respectively) ( Table 1) . During the 3-month pandemic period, the most common causes of admission to the outpatient clinic were acne, urticaria, psoriasis, and allergic/irritant contact dermatitis. During the non-pandemic period, the most common causes of admission to the outpatient clinic were acne and other eczematous dermatities. Table 2 shows the diagnoses of the patients who were admitted during the 3-month pandemic period, peak period, and the previous year, in order of frequency. Urticaria, psoriasis, allergic/irritant contact dermatitis, scabies, liken planus, mycosis fungoides, zona zoster, recurrent aphthous stomatitis, and polymorph light eruption had a statistical increase in the pandemic period when compared with the non-pandemic period (P < .001, P < .001, P = .0074, P < .001, P = .0129, P = .0028, respectively). Moreover, acne, other eczematous dermatities, verruca, androgenic alopecia, and melanocytic nevus diagnoses were found to decrease statistically in the pandemic period when compared with the non-pandemic period (P < .001, P < .001, P = .221, P = .0174, P = .174, respectively). In the comparison of the peak period and non-pandemic period, urticaria, psoriasis, scabies, zona, drug reactions, and ichthyosis diagnoses were found to increase statistically (P = .002, P = .0008, P = .0004, P = .0235, P = .051, P = .0143, respectively). Moreover, other eczematous dermatitis diagnoses were found to decrease in the peak period when compared with the non-pandemic period (P = .163) ( Table 2 ). The diagnoses in the first and third months of the pandemic period were also compared. While urticaria was found to be statistically high in the first period (P = .0426), nail dystrophy was found to be high in the second period (P = .0120), and these are shown in Table 3 . Statistically significant p values (P < .05) in the tables were shown with bold letters. The present study compares the patient profiles during the 3-month pandemic period in which the COVID-19 pandemic was effective and in which staying home was encouraged, and during the non-pandemic period that corresponds to the same season as the pandemic period a year ago. In our study, in general, the rate of female patients and the average age during the pandemic period were lower than the non-pandemic period. This may be because of female patients being more concerned and more careful about the pandemic, and parents may have been hesitant about taking their children out and going to the hospital. The percentage of diseases such as urticaria, psoriasis, allergic/irritant contact dermatitis, scabies, liken planus, mycosis fungoides, zona zoster, recurrent aphthous stomatitis, and polymorph light eruption was found to increase during the pandemic period. Moreover, the percentage of diseases such as acne, other eczematous dermatities, verruca, androgenic alopecia, and melanocytic nevus was found to decrease. In studies conducted during the COVID-19 pandemic, an increase has been reported in the incidence of diseases such as psoriasis and urticaria, and it has been stated that the increase in the adverse effects of the epidemic on the quality of life as well as social anxiety and stress may have caused the increase in these diseases. 4, [7] [8] [9] [10] The results obtained in our study and the fact that these rates were increased during the period when the pandemic peaked in our country also support this. However, we believe that the decrease in the non-emergency admissions to outpatient clinics during the pandemic period when there were curfews, and the relative increase in admissions to outpatient clinics with diseases such as urticaria and psoriasis, which may cause emergency or stress, may have contributed to these changes. Indeed, the decrease in the non-emergent diagnoses in our study, such as verruca, androgenic alopecia, and melanocytic nevus during the pandemic period also supports our thought. Consistent with other studies conducted in our country, acne was the most common disease in both the pandemic period and non-pandemic period in the present study. 4, 5, 11 The reason for this may be the fact that acne is a widespread disease amongst adolescents and young individuals and that a large number of patients receive isotretinoin treatment, which requires continuity. Furthermore, acne is a disease that is mostly seen on the face and which is essential for cosmetic appearance. Acne also has an important psychosocial effect on patients. For these reasons, a significant number of acne patients may have continued their outpatient clinic visits even when the curfews were intense. The majority of our society can directly apply to the tertiary level hospitals without referral within the scope of general health insurance. There is no secondary healthcare facility in our city, and this may have caused a high number of acne patients in both pandemic and non-pandemic periods in our study. In our study, the percentage of visits related to scabies was found to increase during the COVID-19 pandemic. The incubation period is reported as approximately 2-3 weeks in scabies. Sarcoptes that can 15 We assume that a large proportion of the patients involved in our study were healthcare workers and may have contributed to the increase in the diagnosis of allergic/irritant contact dermatitis during the pandemic period. In another study, we evaluated hair diseases such as telogen effluvium, alopecia areata, and seborrheic dermatitis during the pandemic; we reported that a significant part of the patients did not go to the hospital during the pandemic period and preferred not to receive treatment. 16 The fact that there were no increases in admissions related to these diseases during the pandemic can be interpreted as patients' preferring not to go to the hospital because of concerns about the transmission of COVID-19. In conclusion, there are limited numbers of studies examining admission diagnoses to dermatology outpatient clinics during the COVİD-19 pandemic. Unlike other studies, our study evaluated the diagnoses of current patients with those admitted in the same season of the previous year, the changes in patient profiles were emphasised, and the possible reasons were discussed. We assume that, during this time, when the pandemic is still ongoing, the data obtained from this study will contribute to the literature. The authors have declared no conflicts of interest for this article. https://orcid.org/0000-0001-9076-4669 Nihal Altunisik https://orcid.org/0000-0001-6844-1097 The origin, transmission and clinical therapies on coronavirus disease 2019 (COVID-19) outbreakan update on the status A review of coronavirus disease-2019 (COVID-19) General Directorate of Public Health. COVID-19 (SARS-CoV2 Infection) Guide (Science Board Study): General information, epidemiology and diagnosis. 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