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COVID-19 and dermatology patients

Author: Yan Ling Apollonia Tay, Medical Student, University of Otago, Wellington, New Zealand. DermNet NZ Editor in Chief: Adjunct A/Prof Amanda Oakley, Dermatologist, Hamilton, New Zealand. Copy edited by Gus Mitchell. March 2020. Latest update 29 March 2020.


What is COVID-19?

COVID-19 (coronavirus disease 2019) is an illness that may lead to serious respiratory disease and may be fatal. It is caused by the virus SARS-CoV-2. The first human cases occurred in China in December 2019 and the infection rapidly spread throughout the world.

  • SARS-CoV-2 belongs to the same family as SARS-CoV, the coronavirus that caused the outbreak of lethal SARS (severe acute respiratory syndrome) in 2003 [1].
  • COVID-19 and SARS are different diseases.
  • Other coronaviruses cause the common cold.

The World Health Organisation declared on 11 March 2020 that the COVID-19 outbreak was an official pandemic, as COVID-19 had spread rapidly worldwide.

There is currently no known vaccine or cure (March 2020).

Electron microscopic views of SARS-CoV-2

For more images of the SARS-CoV-2 virus, see the National Institute of Health's COVID-19 image gallery.

Who gets COVID-19?

COVID-19 affects people of all ages. Older persons, those with underlying chronic medical conditions, and those who are immunosuppressed have a higher risk of developing severe, life-threatening illness [1]. However, young and otherwise healthy people can also become very sick and may die.

The most common underlying chronic medical conditions that are reported to result in more severe disease include:

  • Diabetes
  • Cardiovascular disease
  • Chronic obstructive pulmonary disease.

How is COVID-19 spread?

The SARS-CoV-2 virus is found in droplets spread by an infected individual that has been coughing, sneezing, talking, or touching items. The droplets may land on surfaces such as door handles, computer keyboards, and table-tops. An uninfected individual that has touched an invisible droplet may then touch their face, transmitting the virus through the mucous membranes of their mouth, nose, and eyes, resulting in infection.

The incubation period before the infection is 2–10 days in most people. Patients are infectious for a couple of days before becoming unwell, and for some time after recovery.

What are the symptoms of COVID-19?

The severity of COVID-19 is variable. Some people infected with SARS-CoV-2 do not develop any symptoms. The most common symptoms of COVID-19 are:

  • Fever
  • Cough
  • Shortness of breath
  • Tiredness.

Less common symptoms include:

  • Body aches
  • Runny nose
  • Sore throat
  • Abdominal pain
  • Diarrhoea.

Skin rashes have been uncommonly described in patients with COVID-19. They are reported to be similar to other viral infections: an erythematous exanthem, acute urticaria, or chickenpox-like blisters [2]. 

People with these symptoms should not go to work and should strictly self-isolate, following local guidelines. Those with serious symptoms may need hospitalisation and mechanical ventilation.

How is COVID-19 diagnosed?

COVID-19 is diagnosed using respiratory swabs. These real-time reverse-transcriptase polymerase chain reaction (rRT-PCR) tests detect the SARS-CoV-2 virus. Tests for other respiratory infections such as influenza and respiratory syncytial virus (RSV) may be done at the same time.

  • A positive result means the patient has active COVID-19 (or one of the other infections tested).
  • A negative swab is not reliable — the patient may still have COVID-19.
  • The test may be repeated if symptoms progress or for public health purposes.
  • The test will not be offered to everyone requesting it.

An antibody blood test to test whether someone has previously had COVID-19 is under development.

The diagnosis of COVID-19 may also be made clinically where the patient has been in contact with a COVID-19 patient, where community infection is widespread, or the patient has recently travelled from a country with community infection.

More electron microscopic views of SARS-CoV-2

Note: Electron microscopy is not used as a standard test to identify SARS-Cov-2.

How can COVID-19 be prevented?

COVID-19 can be prevented — this is why many countries have enforced a ‘lockdown’ and are requiring people to stay at home.

The following personal health practices are strongly encouraged to reduce the risk of infection.

Physical distancing

Keeping a minimum distance between yourself and others to prevent physical contact and possible contamination is an essential step in preventing the spread of the virus.

  • Stay at home; do not go out unless absolutely necessary (this can include visiting a supermarket or pharmacy, or physical exercise limited to your neighbourhood; follow your local guidelines).
  • Avoid being closer than 2 metres from others [3].
  • Greet people by waving instead of shaking hands.
  • Keep in touch with family and friends remotely by phone or via the Internet.

Frequent handwashing

Handwashing is the most effective way to prevent infection.

  • Wash your hands frequently with soap and water [4]. 
  • Alternatively, use a hand sanitiser with an alcohol content of at least 60%.
  • Scrub the backs of both hands, between the fingers, and under the nails for at least 20 seconds. If you have sensitive skin, rinse off thoroughly.
  • Dry your hands with a clean cloth or dry paper towels.  the wait 30 minutes.
  • Moisturisers do not kill SARS-CoV-1 virus so you will still need to wash with soap and water or sanitiser if you have previously been given a moisturiser as a soap substitute.
  • Use an oil-based moisturiser such as petroleum jelly to moisturise the hands, preferably about 30 minutes after washing. This will protect the skin from hand dermatitis from over-washing (see compulsive hand washing). Moisturising your hands will not affect the cleansing properties of handwashing. 
  • Do not touch your eyes, nose, or mouth unless your hands are clean.

Good hygiene etiquette

Practice these hygiene measures to prevent the spread of the virus through droplets or physical contact.

  • Cough and sneeze into your inner upper arm to prevent your hands from becoming dirty and spreading an infection to other people or surfaces [5].
  • If tissues are used, throw them away immediately and wash your hands properly.
  • Wipe down surfaces using bleach or antiseptic product.
  • Don’t share food and drink, toothbrushes, clothing, bedding, or towels.

Should my skin medications be continued?

Commonly used systemic medications for severe skin conditions include immunomodulators or immunosuppressive drugs. These may include a biological agent, a disease-modifying anti-rheumatic drug (DMARD), or a systemic steroid. Dermatological medications are not known to increase the risk of acquiring COVID-19.

If you are currently well, and do not have any other chronic medical conditions [6,7]:

  • Continue taking your medications as prescribed
  • Remember that these medications were started to treat a severe, long-term medical condition
  • The skin condition is very likely to deteriorate if the systemic medication is stopped suddenly.

If you have tested positive for COVID-19:

If you have cold or flu-like symptoms [7]:

  • Local guidelines may apply; ask your doctor
  • A dose reduction or treatment interruption for 2 weeks may be considered if you are on an immunomodulator
  • Systemic steroids should be continued; ask your doctor if you should stay on the same dose, increase it, or reduce the dose.

The influenza vaccine intramuscular injection is highly recommended for all patients without contraindications [7]. See immunisation in immunosuppressed dermatology patients.

What is the outlook for patients with COVID-19?

For current statistics, see the WHO's situation reports.

As of 28 March 2020, COVID-19 infection was officially reported for 570,966 patients with 26,487 deaths. On 29 March, there were 514 cases in New Zealand with 1 death.

For more information

In New Zealand, refer to the Government website, https://covid19.govt.nz. 

See smartphone apps to check your skin.
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Related information

 

References

  1. World Health Organisation. Q&A on coronaviruses (COVID-19). March 2020. Available at: www.who.int/news-room/q-a-detail/q-a-coronaviruses (accessed 23 March 2020).
  2. Recalcati, S. Cutaneous manifestations in COVID‐19: a first perspective. March 2020. J Eur Acad Dermatol Venereol. Accepted Author Manuscript. doi:10.1111/jdv.16387
  3. New Zealand Government. Physical distancing. Unite against COVID-19. March 2020. Available at: https://covid19.govt.nz/how-were-uniting/physical-distancing/ (accessed 23 March 2020)
  4. American Academy of Dermatology. American Academy of Dermatology shares hand washing tips amid COVID-19. March 2020. Available at: https://www.aad.org/news/2020-03-10-hand-washing-covid (accessed 23 March 2020)
  5. Centers for Disease Control and Prevention. Coughing & Sneezing. Water, Sanitation & Environmentally-related Hygiene. July 2016. Available at: https://www.cdc.gov/healthywater/hygiene/etiquette/coughing_sneezing.html (accessed 23 March 2020)
  6. American Academy of Dermatology. Guidance on the use of biologic agents during COVID-19 outbreak. March 2020. Available at: https://assets.ctfassets.net/1ny4yoiyrqia/PicgNuD0IpYd9MSOwab47/023ce3cf6eb82cb304b4ad4a8ef50d56/Biologics_and_COVID-19.pdf (accessed 23 March 2020)
  7. Rademaker M, Baker C, Foley P, Sullivan J, Wang, C. Advice regarding COVID-19 and use of immunomodulators, in patients with severe dermatological diseases. Australas J Dermatol 2020. Accepted Author Manuscript. doi:10.1111/ajd.13295. Available at: https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajd.13295 (accessed 29 March 2020)

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