The effects of the COVID-19 pandemic on outpatients of Dermatology Clinic of Aydin Adnan Menderes University Hospital

Introduction: COVID-19 was declared as a pandemic by WHO on March 11, 2020, the date when the first case was diagnosed in our country. The COVID-19 pandemic has affected the entire health system including dermatology outpatient clinics in many ways. At the beginning of the pandemic, dermatology outpatient clinics were closed in most clinics or the number of appointments were reduced, along with the change in number of patients. The distribution of diagnoses also changed. In our study, we aimed to determine how dermatology outpatient profile was affected by the pandemic, to determine which skin diseases were perceived as an emergency by the patients who were seen at our outpatient clinic during the pandemic, and to determine the level of pandemic awareness. Method: Data of the patients seen at our outpatient clinic within first 60 days prior to start of the pandemic in Turkey and 60 days afterwards were extracted through the digital hospital database. In addition, a questionnaire was applied to adult patients who were asked to fill in a questionarre with 24 questions, 10 of which were about the pandemic. The target sample size for our study was calculated according to the formula (number of questions about the pandemic x 10). A questionnaire was applied to 123 patients (9.3%) out of 1314 patients who applied to our outpatient clinic during the pandemic. SPSS 20 package program was used for statistical analysis. Results: A total of 3202 patients were evaluated. Of these, 1888 (59%) were examined before the pandemic started and 1314 (41%) during the pandemic. A decrease of 30.4% was observed in the number of patients during the pandemic. There was a significant increase in the male to female ratio of patients. Diseases diagnosed with a statistically significant increase in frequency are psoriasis, bullous diseases, melanoma; the diseases whose frequency decreased significantly were acne, xerosis cutis, and nail diseases. Among patients who participated in the survey, the rate of being psychologically affected by the pandemic in female patients (76.1%) was found to be higher than male patients (53.8%) (p=0.017). The mean age of the patients who thought that their psychological impact from the pandemic was related to their dermatological complaints was 51±16.7 years, and the mean age of those who did not was 41±13.7 (p=0.012). Sixty (48.8%) patients had at least one chronic disease, 63 (51.2%) reported none. There were nine (7.3%) patients on immunosuppressive treatment (systemic corticosteroids, biologic agents, chemotherapeutics etc.). 121 (98.4%) of the patients were aware that they needed to quarantine at home unless absolutely necessary during the initial months of the pandemic. Duration of dermatological complaints was shorter than three months in 44 (35.8%) patients, between three to six months in 12 (9.8%) and longer than six months in 67 (54.5%) patients. While 91 (74%) of the patients thought that their reason for seeking an appoinment at the dermatology outpatient clinic was urgent, 32 (26%) did not think so. There was no statistically significant relationship between the patients' opinion of whether their complaints consisted an emergency and the duration of skin disease (p = 0.830). Conclusion: The diagnostic distribution in dermatology practice during the pandemic is the result of several factors such as easy access to specialists in our country, the effect of dermatological diseases on body perception and quality of life, the risk perception that changes according to the individual, and the increased stress load in our country. The finding that the emergency concept of patients does not coincide with the general understanding of medicine is striking. In a period with dramatic changes in the health system such as the pandemic, the use of online applications such as telemedicine, whatsapp may be beneficial for patients to reach healthcare services. A better understanding of patient behaviour and knowledge of the shift in the distribution of diseases in extraordinary times will aid in providing better healthcare. Further research on this subject may contribute to improving patient care and provide better medical practice. Keywords: Covid-19, pandemic, dermatology