key: cord-0834961-jtz0j5bd authors: Cengiz, Fatma Pelin; Emiroglu, Nazan; Bahali, Anil Gulsel; Dizman, Didem; Taslidere, Nazan; Akarslan, Tahsin Cagdas; Gunes, Begum; Mert, Omer; Kucuk, Ozlem Su; Onsun, Nahide title: Which dermatology patients attend to Dermatology Outpatient Clinics during the SARS‐CoV‐2 outbreak in Turkey and what happened to them? date: 2020-05-11 journal: Dermatol Ther DOI: 10.1111/dth.13470 sha: f60da34f23a757526b133716b9e79378b8cb0daa doc_id: 834961 cord_uid: jtz0j5bd Coronavirus disease, first emerged in Wuhan, rapidly spread all over the world since December 2019. There are concerns about elective dermatology appointments and its results. Herein, we aimed to find out which type of dermatologic patients attended to dermatology outpatient clinic. The patients visiting the clinics for elective dermatologic diseases between March 11 and 18, 2020, were included in this study. Their age, sex, diagnosis of disease, requirement for emergent intervention, and their medical records about COVID‐19 were obtained. There were 390 patients attending to the dermatology outpatient clinic in this period. The most common disease was acne (N: 94, 24%), only 19% of patients need emergent interventions or dose adjustment. There were 40 (10%) patients over the age of 65. After their visits, five patients were diagnosed as COVID‐19 in 2weeks. Dermatologic examinations may be a vector for severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) transmission since being closed to the patient. Five of our patients were diagnosed as COVID‐19 after their elective visit to hospital. Since the asymptomatic course of some young patients, most of our patients were not screened for COVID‐19. Our findings support the concerns of elective physician examinations. In December 2019, several cases with unexplained viral pneumonia were reported in Wuhan, China. A novel coronavirus was identified as the pathogen severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the disease was named as COVID-19 (ie coronavirus disease 2019). 1 By February 2020, COVID-19 has spread throughout China and across the world. As of March 11, 2020, the first case of SARS-CoV-2 infection has been confirmed in Turkey. Recent reports demonstrate that the COVID-19 pandemic is set for exponential growth in Turkey. The Turkish government imposed a partial curfew for citizens over the age of 65 and those with chronic diseases, on March 21, 2020. The government had also banned flights with suspicious countries, closed schools, cafes and bars, mass prayers, and indefinitely postponed matches in its main sports leagues. However, outpatient clinics did not completely halt the services to some patients who need to visit during the SARS-CoV-2 outbreak. As reported before, dermatology practices may be a vector for SARS-CoV-2 transmission. 2 In this study, we summarized our patients profile and possible risk factors for transmission. This study was conducted at Bezmialem Vakif University, Dermatology Outpatient Clinics, a major tertiary hospital in Istanbul, with all major medical and surgical specialties and sees over 500000 patients per year. The patients admitted to the dermatology outpatient clinic of Bezmialem Vakif University between March 11 and 18, 2020, were included in this study. The patients who had made online and telephone consultations, and the patients who had visited another doctor for any reason, the patients who did not pay attention to social distancing in their daily life were excluded from the study. The age, sex, diagnosis of patients, their medical history, and urgency of cases were recorded. Then, these patients were followed up from their medical records and checked for SARS-CoV-2 positivity at this incubation period. Kwatra et al reported their concern about dermatology practices as vectors for COVID-19 transmission. 2 As their suggestion, the majority of our outpatient visits were nonemergent. Similar to their suggestion, only 19% of patients need emergent dermatologic intervention, or dose adjustment for their immunosuppresant drugs, The diseases of patients attended to dermatology outpatient clinic Therefore, we cannot predict their risk for transmission. By the way, 40 of patients were over age 65, they were at high risk and severe illness for infection. It was observed that the patients being age 65 and older did not pay attention to the outbreak of COVID-19. After the partial curfew, they did not come to outpatient clinics. After the investigation of their SARS-CoV-2 status, it was seen that five of these patients were diagnosed as COVID-19 later. These individuals may be considered to have been exposed after their hospital visit. In contrast with partial curfew, calls for staying at home, the importance of social distancing, these nonemergent patients carried on to visit the dermatology outpatient clinic. The greatest majority of diagnoses of these patients were acne vulgaris, types of dermatitis, and common superficial tineal infections. It has been reported that more than one-third of dermatology patients have some level of psychiatric or psychologic problem, complicating their skin disease. 4 Acne is one of the most common dermatological diagnoses with psychiatric involvement, 5 and anxiety associated with skin disease was common. In addition, acne is a wellknown stress responsive condition and has known psychological percussion in the causation and in the course of the disease. 5, 6 This may be clarified with their anxiety that their symptoms will get worse if they do not visit their physician and take their treatment immediately. These patients frequently consider that they will not have COVID-19 infection due to their young age, even though they are exposed to will end, and how the outbreak will affect Turkey. This study was an observation of our dermatology clinic, when the outbreak of COVID-19 occurred in Istanbul, Turkey. We will figure out the results of noncancellation of the nonemergent appointments following the end of the COVID-19 outbreak. Genomic characterisation and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding Dermatology practices as vectors for COVID-19 transmission: a call for immediate cessation of nonemergent dermatology visits Aerosol and surface stability of HCoV-19 (SARS-CoV-2) compared to SARS-CoV-1 Psychiatric illness in patients referred to dermatology-psychiatry clinic The frequency of body dysmorphic disorder in dermatology and cosmetic dermatology clinics: a study from Turkey A screening questionnaire for body dysmorphic disorder in a cosmetic dermatologic surgery practice Clinical characteristics of 24 asymptomatic infections with COVID-19 screened among close contacts in Nanjing. Sci China Life Sci: China; 2020. How to cite this article The authors declare no potential conflict of interest. https://orcid.org/0000-0003-0669-6232Nazan Emiroglu https://orcid.org/0000-0002-5575-6484