10.5826/dpc.1301a112
Introduction: Due to the increase in COVID-19 patients during the pandemic, the workload of emergency departments has increased. The  profile of the patients  seeking non-COVID medical care has changed significantly because of the pandemic including the dermatological emergencies.
Objective: The aim was to evaluate and compare adult dermatological emergency consultations during the COVID-19 period with pre-pandemic period.
Methods:Consulted patients from ED to dermatology between March 11, 2019, and March 11, 2021 were  included (Pre-pandemic and pandemic) Age, gender, zone of triage, consultation hour,  consultation date, consultation response time, ICD-10 codes were recorded.
Results: The total number of consultations were 639. The mean age of the patients in the pre-pandemic  period was 44.4 and 46.1 in the pandemic period. The mean consultation response time in the  pre-pandemic period was 44.4 minutes and 60.3 minutes in the pandemic. In the pre-pandemic period, the most common consulted diseases were herpes zoster, urticaria, and allergic contact dermatitis. In the pandemic, the most common  consulted diseases were herpes zoster, dermatitis other, and urticaria.There was a statistically significant difference of the incidence of other dermatitis, impetigo/folliculitis, cutaneous vasculitis, and pruritus (p&lt;0.05)
Conclusions: Emergency departments are the busiest and fastest areas of the hospital. Pandemics such as COVID-19 may also occur in the coming years. Informing the society about dermatological emergencies and adding adequate dermatology training to the training of emergency physicians  will facilitate appropriate patient management in emergency departments.
text/xml
2160-9381
2605
en
Nermin Karaosmanoglu
https://creativecommons.org/licenses/by-nc/4.0
Dermatology Practical & Conceptual
dermatology
Comparative Evaluation Of Dermatological Emergency Consultations In The Coronavirus  Pandemic Era: Tertiary Clinic Experience
Text.Serial.Journal
https://dpcj.org/index.php/dpc
Original Article
2023-01-31
2022-05-21
2023-01-31
2023-02-27
e2023112
Dermatol Pract Concept
Introduction: Due to the increase in COVID-19 patients during the pandemic, the workload of emergency departments has increased. The  profile of the patients  seeking non-COVID medical care has changed significantly because of the pandemic including the dermatological emergencies.
Objective: The aim was to evaluate and compare adult dermatological emergency consultations during the COVID-19 period with pre-pandemic period.
Methods:Consulted patients from ED to dermatology between March 11, 2019, and March 11, 2021 were  included (Pre-pandemic and pandemic) Age, gender, zone of triage, consultation hour,  consultation date, consultation response time, ICD-10 codes were recorded.
Results: The total number of consultations were 639. The mean age of the patients in the pre-pandemic  period was 44.4 and 46.1 in the pandemic period. The mean consultation response time in the  pre-pandemic period was 44.4 minutes and 60.3 minutes in the pandemic. In the pre-pandemic period, the most common consulted diseases were herpes zoster, urticaria, and allergic contact dermatitis. In the pandemic, the most common  consulted diseases were herpes zoster, dermatitis other, and urticaria.There was a statistically significant difference of the incidence of other dermatitis, impetigo/folliculitis, cutaneous vasculitis, and pruritus (p&lt;0.05)
Conclusions: Emergency departments are the busiest and fastest areas of the hospital. Pandemics such as COVID-19 may also occur in the coming years. Informing the society about dermatological emergencies and adding adequate dermatology training to the training of emergency physicians  will facilitate appropriate patient management in emergency departments.
Nermin Karaosmanoglu
2023/01/31
10.5826/dpc.1301a112
e2023112
Department of Dermatology, Ministry of Health, Ankara Training and Research Hospital, Ankara, Turkey
2160-9381
dermatology
en
e2023112
Weyrich P, Christ M, Celebi N, Riessen R. Triagesysteme in der Notaufnahme [Triage systems in the emergency department]. Med Klin Intensivmed Notfmed. 2012;107(1):67- 78. 18. Smith M. Rise in violence against doctors in Turkey, elsewhere. CMAJ. 2015;187(9):643. 4- 8.
Comparative Evaluation Of Dermatological Emergency Consultations In The Coronavirus  Pandemic Era: Tertiary Clinic Experience
https://dpcj.org/index.php/dpc/article/download/2605/1960
           Comparative Evaluation of Dermatological
          Emergency Consultations in the Coronavirus
            Pandemic Era: Tertiary Clinic Experience
                       Berkay Temel1, Ozge Mine Orenay1, Nermin Karaosmanoglu1


1 Department of Dermatology, Ministry of Health, Ankara Training and Research Hospital, Ankara, Turkey



Key words: covid, consultation, emergency, dermatology
Citation: Temel B, Orenay OM, Karaosmanoglu N. Comparative evaluation of dermatological emergency consultations in the coronavirus
pandemic era: Tertiary clinic experience. Dermatol Pract Concept. 2023;13(1):e20230112. DOI: https://doi.org/10.5826/dpc.1301a112
Accepted: June 16, 2022; Published: January 2023
Copyright: ©2023 Temel et al. This is an open-access article distributed under the terms of the Creative Commons Attribution-
NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use,
distribution, and reproduction in any medium, provided the original authors and source are credited.
Funding: None.
Competing Interests: None.
Authorship: All authors have contributed significantly to this publication.
Corresponding Author: Berkay Temel, MD, Adress: Department of Dermatology, Ministry of Health, Ankara Training and Research,
Hospital. Sakarya Mahallesi, 89, Ulucanlar Caddesi, 06230, Altındağ/ Ankara, Turkey. Phone number: +905058190789
E-mail: berkaytemel42@gmail.com




  ABSTRACT             Introduction: Due to the increase in COVID-19 patients during the pandemic, the workload of
                       ­emergency departments has increased. The profile of patients seeking non-COVID medical care has
                        changed significantly because of the pandemic; this includes dermatological emergencies.
                       Objective: The aim was to evaluate and compare adult dermatological emergency consultations
                       during the COVID-19 period with the pre-pandemic period.
                       Methods: Consulted patients from ED to dermatology between March 11, 2019, and March 11, 2021
                       were included (Pre-pandemic and pandemic). Age, gender, zone of triage, consultation hour, consulta-
                       tion date, consultation response time, ICD-10 codes were recorded.
                       Results: The total number of consultations was 639. The mean age of the patients was 44.4 in the
                       pre-pandemic period and 46.1 in the pandemic period. The mean consultation response time was
                       44.4 minutes in the pre-pandemic period and 60.3 minutes in the pandemic. In the pre-pandemic
                       ­period, the most common consulted diseases were herpes zoster, urticaria, and allergic contact derma-
                        titis. During the pandemic, the most common consulted diseases were herpes zoster, other dermatitis,
                        and urticaria. There was a statistically significant difference in the incidence of other dermatitis, impe-
                        tigo/folliculitis, cutaneous vasculitis, and pruritus (p<0.05)
                       Conclusions: Emergency departments are the busiest and fastest areas of the hospital. Pandemics
                       such as COVID-19 may also occur in the coming years. Informing society about dermatological
                       ­emergencies and adding adequate dermatology training to the training of emergency physicians will
                        facilitate a­ ppropriate patient management in emergency departments.




Original Article | Dermatol Pract Concept. 2023;13(1):e20230112                                                                       1
Introduction                                                        Zone of triage was determined as green (simple health con-
                                                                    ditions that present as an outpatient, are stable in general
On March 11, 2020, the World Health Organization de-                condition and can be treated on an outpatient basis), yel-
clared the Coronavirus disease 19 (COVID-19) outbreak as            low (conditions with potentially life-threatening, risk of
a pandemic, reporting more than 118,000 cases and 4,291             limb loss and significant morbidity) red (conditions that are
deaths in 114 countries [1]. The rapid spread of COVID-19           life-threatening and require a rapid aggressive approach and
all over the world hit health systems hard and prompted             urgent simultaneous evaluation and treatment). In our center,
many countries to take various measures that aimed to limit         consultations requested from the adult emergency between
the spread of the virus and reduce the number of patients           08:00 and 16:00 are evaluated in outpatient clinics. Between
and deaths [2]. The health system, which was rebuilt under          16.00-08.00, a doctor is assigned to the inpatient clinic
the influence of the pandemic, affected every medical depart-       for consultation. Consultation time was divided into three
ment including the dermatology and emergency departments            time periods 08.00-16.00, 16.00-00.00, and 00.00-08.00.
(ED). Almost most of the dermatology inpatient services             The consulted diseases were classified according to ICD-10
were reserved for COVID-19 patients, and the number of              codes. These were dermatitis, infection diseases, hypersensi-
patients in dermatology outpatient clinics was restricted           tivity diseases, inflammatory diseases, autoimmune bullous
by health authorities to reduce the spread of the virus [3].        disease, and others. The subgroup disease profile was also
Therefore, the number of dermatologic patients who applied          determined under these headings one by one. Bullous disor-
to clinics during the pandemic period decreased, and in ad-         ders with extensive involvement, angioedema, erythroderma,
dition to this decrease, fear of contracting COVID-19 and           toxic epidermal necrolysis, Steven Johnson’s syndrome, pus-
skin conditions related to COVID-19 (vesicular eruptions,           tular psoriasis with metabolic complications were accepted
petechial/purpuric rashes, acral lesions, livedoid lesions, urti-   as true dermatological emergencies [10]. These data were
carial rash, and maculopapular-erythematous rash) changed           evaluated and compared according to pre-pandemic and
the profile of faced dermatological diseases [3-5].                 pandemic periods retrospectively.
    During the pandemic, many COVID-19 patients were
first evaluated in hospital EDs. Because of this, the workload      Statistical Analysis
in ED increased significantly. There have been many studies         Research data was evaluated via Statistical Package for the
investigating the impact of the pandemic on the ED. These           Social Sciences (SPSS.22, IBM SPSS Statistics for Windows,
studies showed that the number of non-COVID-19 patients             Version 22.0. Armonk, New York: IBM Corp.). Descriptive
admitted to the ED decreased and their disease profiles             statistics were recorded as mean (±) standard deviation, fre-
changed [6,7]. Despite these studies, studies on dermatolog-        quency distribution, and percentage. Normality analyses of
ical diseases consulted from emergency services were limited        the data were carried out with the Shapiro-Wilk test. For cat-
[8,9]. This study aimed to evaluate adult dermatological            egorical variables, whether there is a difference in frequency
emergency consultations during the COVID-19 period and              between groups was compared using Pearson chi-square.
to compare them with the pre-pandemic period.                       The t-test was used to evaluate normally distributed means.
                                                                    Mann-Whitney U test was used to evaluate not normally
Material and Methods                                                distributed means. The statistical significance value of this
                                                                    study was accepted as p<0.05.
Study Design, Patient Selection and Variables
Patients who were consulted to the dermatology clinic by            Results
the adult emergency department between March 11, 2020,
and March 11, 2021 (pandemic period) and the same dates             Main Characteristics of Pre-Pandemic and
of the previous year (pre-pandemic period) were included in         Pandemic Period Consultations
this study. The dividing point for the pre-pandemic and pan-        The total number of consultations during the pre-pandemic
demic period was chosen on March 11, 2020, the day when             and pandemic period was 639. It was determined that 467
COVID-19 was declared as a pandemic all over the world.             consultations were requested in the pre-pandemic 1-year
This study was conducted in the Dermatology Clinic of An-           period, while 172 consultations were requested in the pan-
kara Training and Research Hospital, which is a tertiary            demic 1-year period. It was found that consultations de-
clinic in Turkey. Local ethical approval was obtained for this      creased by 63.1% during the pandemic period. The mean
study. Age, gender, zone of triage, consultation hour, consul-      age of the patients in the pre-pandemic period was calculated
tation date, consultation response time, and I­nternational         as 44.4±18.6. In the pandemic period, the mean age was cal-
Classification of Diseases, Tenth Revision (ICD-10) codes           culated as 46.1±18.2. There was no statistically significant
were recorded from hospital electronic medical records.             difference between the periods in terms of mean age (p=0.31)



2                                                                      Original Article | Dermatol Pract Concept. 2023;13(1):e20230112
(Table 1). 47.3% (n=221) of the patients evaluated in the              in August 2019 (n=55) and least in September 2019 (n=25).
pre-pandemic period were male and 52.7% (n=246) were fe-               During the pandemic period, consultation was most re-
male. During the pandemic period, 51.2% (n=88) were men                quested in July 2020 (n=35) and least in January 2021
and 48.8% (n=84) were women. There was no statistically                (n=2) (Figure 1).
significant difference in terms of gender (p=0.38) (Table 1).
In the pre-pandemic period, 40.3% (n=18) of the consulta-              Comparison of Pre-Pandemic and Pandemic Period
tions were requested from the green zone, 50.7% (n=237)                Disease Profiles
from the yellow zone and 9% (n=42) from the red zone. In               In the pre-pandemic period, the three most commonly con-
the pandemic period, 25% (n=43) were requested from the                sulted diseases were herpes zoster, urticaria, and allergic
green zone, 64.5% (n=111) from the yellow zone and 10.5%               contact dermatitis. In the pandemic period, the three most
(n=18) from the red zone. There was a statistically significant        consulted diseases were herpes zoster, other dermatitis,
difference between the periods in terms of green and yellow            and urticaria. There was a statistically significant differ-
triage zones (p=0.01) (Table 1).                                       ence between the periods in terms of the incidence of other
    In the pre-pandemic period, 40% (n=187) of the con-                dermatitis, impetigo/folliculitis, cutaneous vasculitis, and
sultations were requested between 08.00- 16.00, 51.2%                  pruritus (p=0.01, 0.02, 0.03, 0.01) (Table 2). True dermato-
(n=239) between 16.00-00.00 and 8.8% (n=41) between                    logical emergencies were detected in 37 (7.9%) patients in
00.00-08.00. In the pandemic period, 45.9% (n=79) of the               the pre-pandemic period and 13 (7.6%) patients in the pan-
consultations were requested between 08.00-16.00, 41.3%                demic period. There was no statistically significant difference
(n=71) between 16.00-00.00 and 12.8% (n=22) between                    between the periods in terms of dermatological emergencies
00.00-08.00. There was a statistically significant difference          (p=0.86) (Table 1).
between the periods in terms of 16.00-00.00 consultation
time (p=0.04) (Table 1). The mean consultation response
                                                                       Discussion
time in the pre-pandemic period was 44.4 minutes. It was
60.3 minutes during the pandemic period. There was no sta-             The COVID-19 pandemic has deeply affected the health sys-
tistically significant difference between the periods in terms         tem of every country. During the pandemic period, emergency
of consultation response time (p=0.52) (Table 1). 6 (1.3%)             departments became the first points of contact for COVID-19
of the patients in the pre-pandemic period and 1 (0.6%) of             patients. Therefore, the number and profile of non-COVID-19
the patients in the pandemic period were hospitalized. There           patients admitted to the emergency department changed. In
was no statistically significant difference between the peri-          this study, the dermatology consultations requested from the
ods in terms of hospitalization rates (p=0.34) (Table 1). In           adult emergency department during the pandemic period
the pre-pandemic period, consultation was most requested               were examined and compared with the pre-pandemic period.


                                              Table 1. Characteristics of study.
                                                                  Pre-Pandemic (n=467)             Pandemic (n=172)            pvalue
 Age, mean ±Std                                                          44.4±18.6                      46.1±18.2              0.31*
 Gender, n (%)                                                                                                                 0.38**
 Male Female                                                             221 (47.3)                      88 (51.2)
                                                                         246 (52.7)                      84 (48.8)
 Triage Zones, n (%)                                                                                                          0.01**
 Green Yellow Red                                                       118 (40.3)a                      43 (25)b            <0.05
                                                                        237 (50.7)a                    111 (64.5)b           <0.05
                                                                          42 (9)a                       18 (10.5)a           >0.05
 Consultation time                                                                                                            0.04**
 08.00-16.00                                                             187 (40)a                      79 (45.9)a           >0.05
 16.00-00.00                                                            239 (51.2)a                     71 (41.3)b           <0.05
 00.00-08.00                                                             41 (8.8)a                      22 (12.8)a           >0.05
 Consultation response time, min                                            44.4                           60.3                0.52***
 Hospitalization, n(%)                                                     6 (1.3)                        1 (0.6)              0.34*
 True Dermatological                                                      37 (7.9)                        13 (7.6)             0.86*
 Emergency,n (%)

Std: Standart Deviation, min: minute, *: T-test, **: Chi-square test, ***: Mann Whitney Utesta,b: Each subscript letter denotes a subset of
pandemic status categories whose column proportions do not differ significantly from each other at the 0.5 levels.



Original Article | Dermatol Pract Concept. 2023;13(1):e20230112                                                                          3
                                                                                                                        Number of Patients
    60

    50

    40

    30

    20

    10

     0
                                                          July 2019




                                                                                                                                                                                                                                    July 2020
                                                                                                                    November 2019
                                                                                                                                    December 2019




                                                                                                                                                                                                                                                                                              November 2020
                                                                                                                                                                                                                                                                                                              December 2020
         March 2019




                                                                                    September 2019




                                                                                                                                                    January 2020


                                                                                                                                                                                   March 2020




                                                                                                                                                                                                                                                              September 2020




                                                                                                                                                                                                                                                                                                                              January 2021


                                                                                                                                                                                                                                                                                                                                                             March 2021
                      April 2019


                                              June 2019


                                                                      August 2019




                                                                                                                                                                                                April 2020


                                                                                                                                                                                                                        June 2020


                                                                                                                                                                                                                                                August 2020
                                   May.2019




                                                                                                     October 2019




                                                                                                                                                                   February 2020




                                                                                                                                                                                                             May.2020




                                                                                                                                                                                                                                                                               October 2020




                                                                                                                                                                                                                                                                                                                                             February 2021
Figure 1. Distribution of the Number of Patients by Month.


                                                                                             Table 2. Comparison of Diseases Profile.
                                                                          Diseases, n (%)                                                                                                                                              Pre-Pandemic                                              Pandemic                                       P-value*
 Dermatitis                                                                                                                                                                                                                                 73 (15.6)                                             35 (20.3)                                        0.3
 Irrıtant contact dermatitis Allergic contact dermatitis Dermatitis, others                                                                                                                                                                  13 (2.8)                                              4 (2.3)                                        0.96
                                                                                                                                                                                                                                             39 (8.4)                                              8 (4.7)                                        0.11
                                                                                                                                                                                                                                             21 (4.5)                                             23 (13.4)                                       0.01
 Infection Diseases Impetigo/folliculitis Cellulitis Dermatophytosis Herpes                                                                                                                                                                 223 (47.7)                                            84 (48.8)                                       0.96
 Simplex Herpes Zoster Leishmaniasis Scabies                                                                                                                                                                                                   28 (6)                                              3 (1.7)                                        0.02
 Syphilis                                                                                                                                                                                                                                    25 (5.4)                                              13 (7.6)                                       0.29
                                                                                                                                                                                                                                             12 (2.6)                                               5 (2.9)                                       0.81
                                                                                                                                                                                                                                              8 (1.7)                                                0 (0)                                        0.08
                                                                                                                                                                                                                                            125 (20.8)                                            50 (29.1)                                       0.56
                                                                                                                                                                                                                                              1 (0.2)                                               1 (0.6)                                       0.46
                                                                                                                                                                                                                                             22 (4.7)                                               12 (7)                                        0.25
                                                                                                                                                                                                                                              2 (0.4)                                                0 (0)                                        0.39
 Hypersensitivity Diseases                                                                                                                                                                                                                  115 (24.6)                                            42 (24.4)                                        0.9
 Urticaria Angioedema Insect Bite                                                                                                                                                                                                            53 (11.3)                                             16 (9.3)                                       0.46
 Maculopapular Drug Eruption Erythema Multiforme                                                                                                                                                                                              29 (6.2)                                             13 (7.6)                                       0.54
                                                                                                                                                                                                                                              11 (2.4)                                              7 (4.1)                                       0.24
                                                                                                                                                                                                                                               14 (3)                                               6 (3.5)                                        0.5
                                                                                                                                                                                                                                               8 (1.7)                                               0 (0)                                        0.08
 Inflammatory Diseases                                                                                                                                                                                                                        25 (5.3)                                              8 (4.6)                                       0.87
 Psoriasis Pityriasis Rosea                                                                                                                                                                                                                    8 (1.7)                                              1 (0.6)                                       0.28
 Cutaneous Vasculitis Behcet Disease                                                                                                                                                                                                          10 (2.1)                                              1 (0.6)                                       0.17
                                                                                                                                                                                                                                               5 (1.1)                                              6 (3.5)                                       0.03
                                                                                                                                                                                                                                               2 (0.4)                                               0 (0)                                        0.54
 Autoimmune Bullous Disease                                                                                                                                                                                                                    8 (1.7)                                               0 (0)                                        0.08
 Others                                                                                                                                                                                                                                       23 (4.9)                                              2 (1.2)                                       0.32
 Leg Ulcer Alopecia Areata Acne Vulgaris Pruritus                                                                                                                                                                                              1 (0.2)                                              2 (1.2)                                       0.12
                                                                                                                                                                                                                                               2 (0.4)                                               0 (0)                                        0.39
                                                                                                                                                                                                                                               3 (0.6)                                               0 (0)                                      0.290.01
                                                                                                                                                                                                                                              17 (3.6)                                               0 (0)
 Total                                                                                                                                                                                                                                      467 (100)                                             172 (100)

*: Chi-squaretest



4                                                                                                                                                                                               Original Article | Dermatol Pract Concept. 2023;13(1):e20230112
    There were numerous published studies evaluating der-          compared to the pre-pandemic period. Similar results were
matologic emergency consultations in the pre-pandemic pe-          obtained by Neslihan Ogut et al. [8]. During the COVID-19
riod. The mean age of the patients included in these studies       pandemic, countries started to take measures quickly, the
was between 43-51. The rate of male patients was between           most important of which was the curfew. The curfew was im-
47-62% [11-15]. As expected, similar findings were found in        posed on all weekends and weekdays between 21.00-05.00
the pre-pandemic period of our study.                              in our country. We thought that this situation caused a
    In pre-pandemic period studies, the most frequently con-       change in consultation hours.
sulted diseases were non-specific dermatitis, scabies, con-           Emergency departments are one of the most crowded
tact dermatitis, herpes zoster, superficial fungal infections,     places in hospitals that work 7 days and 24 hours. Turkey
maculopapular drug eruptions, urticaria, erysipelas/cellulitis     has the world’s highest number of emergency department
and cutaneous vasculitis [11-15]. However, the incidence of        visits annually: some 100 million. The high number of pa-
the aforementioned diseases varied in these studies. Similar       tients, especially in our country, is one of the risk factors
diseases were also consulted in the pre-pandemic period of         for transmission during the COVID-19 pandemic. In our
our study.                                                         study, it was found that consultation response time increased
    Bullous disorders with extensive involvement, an-              during the pandemic period compared to the pre-pandemic
gioedema, erythroderma, toxic epidermal necrolysis, Steven         period (44.4 minutes vs 60.3 minutes). Both the working of
Johnson’s syndrome, pustular psoriasis with metabolic com-         dermatology physicians in the COVID departments and the
plications were defined as a true dermatological emergency         increase of COVID patient load on emergency departments
in Gupta et al’s study [10]. On the other hand, Murr et al.        should have increased the consultation response time. The
defined diseases that started or flared up for 5 days as der-      prolongation of the consultation response time increased the
matological emergencies [16]. In pre-pandemic period stud-         length of stay of the patients in emergency departments and
ies, similar to our results, true dermatological emergencies       this situation could have increased the non-COVID patient
were between 6-24.7% of the consulted diseases [11,12,15].         burden on emergency departments.
It was clearly seen that the rate of real dermatological emer-        Along with the pandemic, the distribution of the number
gencies among the diseases consulted from the emergency            of patients by month also changed. Demirel Ogut et al. [8]
department to dermatology was quite low. We thought that           reported that the number of patients decreased in March
this situation was caused by the fact that public and emer-        2020, April 2020, and May 2020 compared to 2019, and
gency physicians did not know which dermatological disease         the number of patients started to increase as of June 2020.
was a true emergency.                                              A similar trend was obtained in our study. Interestingly, in
    There were few studies investigating the impact of the         our study, the number of patients decreased as of July 2020,
COVID-19 pandemic on dermatology consultations re-                 and the number of patients in 2019 could never be reached.
quested from emergency departments [8,9]. These studies            In our country, full or partial curfews were implemented to
showed that the number and mean age of consulted patients          coincide with the periods when the number of patients de-
decreased and the rate of male patients increased during the       creased. We thought that this result was caused by the cur-
pandemic period [8,9]. However, our study showed that the          fews and travel bans during the pandemic period
mean age of the patients during the pandemic period was               Pandemic period studies showed that the profile of
higher. On the other hand, Demirel Ogut et al. [8] reported        the disease consulted from emergency departments has
that the rate of hospitalizations and true dermatological          changed [8,9]. In Isoletta et al.’s study, although urticaria,
emergencies decreased during the pandemic period. Similar          atopic eczema and acute onset infections were reported to
results were obtained in our study. Emergency department           be the most frequently consulted diseases during the pan-
triage systems facilitate the categorization of emergency pa-      demic period, urticaria, vasculopathic lesions and scabies
tients according to their disease severity and determine both      were found to be statistically significantly higher compared
treatment priority and treatment location [17]. In our study,      to the pre-pandemic period [9]. In Demirel Ogut et al’s study,
while the rate of patients consulted from the yellow zone          although contact dermatitis, scabies and urticaria were re-
increased during the pandemic period, the rate of patients         ported to be the most frequently consulted diseases during
consulted from the green zone decreased. This showed that          the pandemic period, scabies and pityriasis rosea were found
the number of unnecessary consultations decreased during           to be statistically significantly higher and herpes zoster
the pandemic period. We thought that these situations were         was found statistically significantly lower compared to the
caused by the fear of infection and the curfews.                   pre-pandemic period [8]. In addition to obtaining similar re-
    In   this   study,    consultations    requested     between   sults, the rate of pruritus and impetigo/folliculitis was statis-
08.00-16.00 increased and the consultations requested be-          tically significantly lower in our study. These results showed
tween 16.00-00.00 decreased during the pandemic period             that non-urgent situations decreased during the pandemic



Original Article | Dermatol Pract Concept. 2023;13(1):e20230112                                                                   5
period. In our study, as in other studies [8, 9], diseases previ-         Dermatology Practice in 1 Year Around the World: Perspectives
ously associated with COVID-19 disease and vaccines such                  from 11 Countries. Dermatol Clin. 2021;39(4):639-651.
                                                                       5. Çaytemel C, Erdem O, Ağırgöl Ş, Türkoğlu Z. Dermatology out-
as herpes zoster, cutaneous vasculitis and urticaria were
                                                                            patient clinic outcomes after COVID-19 outbreak: What is new
listed. Emergency department physicians should be careful
                                                                            normal? Dermatol Ther. 2021 May;34(3):e14950.
about these diseases and COVID-19 should be investigated.              6.   Hartnett KP, Kite-Powell A, DeVies J, et al. Impact of the
                                                                            COVID-19 Pandemic on Emergency Department Visits - United
Limitations                                                                 States, January 1, 2019-May 30, 2020. MMWR Morb Mortal
                                                                            Wkly Rep. 2020;69(23):699-704.
This study had some limitations. The study was retrospec-
                                                                       7.   Santi L, Golinelli D, Tampieri A, et al. Non-COVID-19 patients
tively planned from a single care center. The diagnoses of
                                                                            in times of pandemic: Emergency department visits, hospitaliza-
the patients were made according to ICD-10 codes. There                     tions and cause-specific mortality in Northern Italy. PLoS One.
may have been person-based errors in adding the diagnostic                  2021;16(3):e0248995.
codes to the system. More than one doctor was evaluating               8.   Demirel Öğüt N, Tabak GH, Gülseren D, Yalıcı-Armağan B,
the consultations. In this case, there may be conflicts about               ­Akdoğan N, Doğan S, Elçin G, Karaduman A, Ersoy Evans S. The
                                                                             effect of the COVID-19 pandemic on dermatology ­consultation
the accuracy of the diagnoses. However, to correct this situa-
                                                                             requests from adult and paediatric emergency departments. Int
tion, the diagnosis is confirmed by a second doctor.
                                                                             J Clin Pract. 2021;75(12):e14906.
                                                                       9.    Isoletta E, Vassallo C, Brazzelli V, Giorgini C, Tomasini CF,

Conclusion                                                                   Sabena A, Perlini S, De Silvestri A, Barruscotti S. Emergency
                                                                             accesses in Dermatology Department during the Covid-19 pan-
                                                                             demic in a referral third level center in the north of Italy. Derma-
This study showed that the prolongation of the consultation
                                                                             tol Ther. 2020;33(6):e14027.
response time increased during the COVID-19 pandemic pe-
                                                                      10.    Gupta S, Sandhu K, Kumar B. Evaluation of emergency derma-
riod. The distribution of the number of patients by month                   tological consultations in a tertiary care centre in North India.
changed, and the number of patients decreased as of July                    J Eur Acad Dermatol Venereol. 2003;17:303–5.
2020. The profile of dermatological diseases consulted from           11.   Jack AR, Spence AA, Nichols BJ, et al. Cutaneous conditions
the emergency department also has changed. During the pan-                  leading to dermatology consultations in the emergency depart-
                                                                            ment. West J Emerg Med. 2011;12(4):551-555.
demic period, non-urgent conditions such as impetigo/fol-
                                                                      12.   Ozkur E, Altunay I, Sekerlisoy G, Erdem Y. Evaluation of Der-
liculitis and pruritus decreased. Emergency departments are
                                                                            matology Consultations in a Tertiary Care Centre Emergency
the busiest and fastest areas of the hospital. Pandemics such               Service. Sisli Etfal Hastan Tip Bul. 2020;54(2):197- 200.
as COVID-19 may also occur in the coming years. Inform-               13.   Drago F, Gasparini G, Signori A, Campisi C, Cozzani E, Parodi
ing the public about dermatological emergencies and adding                  A. Dermatological consultations in an observation unit of an
adequate dermatology training to the training of emergency                  emergency department in Italy. J Eur Acad Dermatol Venereol.
                                                                            2015;29:973–80.
physicians will facilitate appropriate patient management in
                                                                      14.   Rubegni P, Cevenini G, Lamberti A, Bruni F, Tiezzi R, Verzuri
emergency departments.
                                                                            A, Barbini P, Manzi P, Fimiani M. Dermatological conditions
                                                                            presenting at the Emergency Department in Siena University
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6                                                                           Original Article | Dermatol Pract Concept. 2023;13(1):e20230112
