The spectrum and magnitude of changes in dermatology practice induced by the COVID-19 pandemic have not been adequately studied. To assess immediate and long-term effects of the pandemic on dermatology practice on a large scale, including the clinical activity of participant, frequency and types of procedures used, and teledermatology (TD) use. This web-based, global survey included 733 dermatologists. Primary outcomes are percentages of responders providing in-person consultations, hospital service, and TD, and doing procedures. Also, factors in logistic regression models that may influence the Odds Ratio (OR) for TD use during pandemic and for future use. The percentages of responders providing in-person consultations (46.6% vs 100% before), and hospital service (27% vs 52.8% before), and doing procedures (25.6% vs 100% before) decreased while practicing TD increased three-fold (75.2% vs 26.1% before) during pandemic (P < .001 for each). Practice location was associated with TD use during the pandemic and with its expected use in the future (P < .001 for both), with North American responders indicating the highest use. TD use during the pandemic showed a positive correlation with TD use before, performing procedures and, more specifically, with biopsies of suspicious pigmented lesions during pandemic (P < .001 for each). TD use before pandemic was the most powerful predictor of TD use during pandemic (OR, 16.47 [95% CI, 7.12-38.06]). More than two thirds (68.6%) of participants expect to use TD in the future. The factor with the largest increase in OR on the expectation of future TD use was >1,000 COVID-19 cases in the country (OR, 3.80 [95% CI, 2.33-6.21]). This survey indicates a profound immediate effect of the pandemic on dermatology practice. The pandemic appears to have substantially contributed to an increased use of TD in the long-run.
1 June 2020 in International Journal of Women's Dermatology
Subcorneal pustular dermatosis (SPD), also known as Sneddon-Wilkinson disease, is a rare, relapsing, sterile pustular eruption of unknown etiology that develops most commonly in middle-aged or mature women. This article reviews the presentation, associations, and management of the condition and highlights advances in pathophysiology. Onset of SPD during pregnancy has not been reported. Herein, we report a case of SPD that developed during pregnancy. The patient was treated with dapsone without complications for her or the fetus. An association between T helper (Th) 17 and Th2 environments in the development of SPD has been advocated. Pregnancy is characterized by a predominance of Th2 responses and increased interleukin-17 levels and thus may favor the development of the condition