Frequency of skin diseases in Egyptian population during coronavirus disease 2019 pandemic: a hospital-based cross-sectional study

Marwa Mohamed; Nesreen Ali Mohammed; Ramadan Saleh

doi:10.4103/ejdv.ejdv_38_21

ORIGINAL ARTICLE

Year : 2022 | Volume : 42 | Issue : 3 | Page : 167-173

Frequency of skin diseases in Egyptian population during coronavirus disease 2019 pandemic: a hospital-based cross-sectional study

Marwa Mohamed¹, Nesreen Ali Mohammed², Ramadan Saleh¹
¹ Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Sohag University, Sohag, Egypt
² Department of Public Health and Community Medicine, Faculty of Medicine, Sohag University, Sohag, Egypt

Date of Submission	13-Sep-2021
Date of Acceptance	16-Nov-2021
Date of Web Publication	01-Sep-2022

Correspondence Address:
MD Marwa Mohamed
Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Sohag University, Sohag 82524
Egypt

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/ejdv.ejdv_38_21

Abstract

Background Coronavirus disease 2019 (COVID-19) pandemic has resulted in remarkable changes in the profiles of diseases including dermatologic conditions.
Aim To investigate the patterns of skin diseases in Egypt during the COVID-19 pandemic.
Patients and methods In this cross-sectional study, we reviewed the data of patients who visited dermatology clinics between August 2020 and January 2021 and compared them with the data from the same clinics in the previous year.
Results The total number of patients who attended the dermatology clinics between August 2020 and January 2021 was 803 as compared with 1611 patients in the corresponding period of the previous year (49.84% reduction). During the COVID-19 pandemic, there was a significant increase in the frequency of allergic contact dermatitis, irritant contact dermatitis, pityriasis rosea, alopecia areata, erythema multiforme, vasculitis, herpes zoster, and chicken pox (P<0.05). On the contrary, some dermatological conditions such as urticaria and nonscarring hair loss had significantly decreased frequencies during the COVID-19 pandemic (P<0.05). Several skin diseases had unchanged frequencies during the COVID-19 pandemic. These included skin infections (other than viral infections), bullous disorders, some eczematous skin diseases, papulosquamous disorders, and disorders of skin pigmentation.
Conclusion This study indicates a significant reduction in the total number of patients attending dermatology clinics in Egypt during the COVID-19 pandemic. The frequency of some skin diseases increased significantly, whereas other skin diseases decreased significantly or remained unchanged during the pandemic. Periodic evaluation of the epidemiologic characteristics of skin diseases is required at different stages of evolution of the COVID-19 pandemic.

Keywords: coronavirus disease 2019, dermatology, pandemic, skin diseases

How to cite this article:
Mohamed M, Mohammed NA, Saleh R. Frequency of skin diseases in Egyptian population during coronavirus disease 2019 pandemic: a hospital-based cross-sectional study. Egypt J Dermatol Venerol 2022;42:167-73

How to cite this URL:
Mohamed M, Mohammed NA, Saleh R. Frequency of skin diseases in Egyptian population during coronavirus disease 2019 pandemic: a hospital-based cross-sectional study. Egypt J Dermatol Venerol [serial online] 2022 [cited 2023 Mar 22];42:167-73. Available from: http://www.ejdv.eg.net/text.asp?2022/42/3/167/354680

Introduction

In December 2019, a new coronavirus was identified in Wuhan, China, and the associated disease came to be known as coronavirus disease 2019 (COVID-19) [1]. Then, COVID-19 was declared by the WHO as a pandemic on March 11, 2020, with subsequent remarkable changes in different aspects of medical practice including dermatology [2],[3]. With the tremendous increase in the number of COVID-19 cases and deaths, there was a parallel decrease in the number of people who attended hospitals in all branches of medicine [2],[4],[5].

In addition, the profiles of diseases including dermatologic conditions changed in the era of the COVID-19 pandemic [6],[7],[8]. The number of patients who visit dermatology clinics as well as the spectrum of dermatologic diseases was influenced owing to psychological and other complications of the pandemic [9],[10]. On the contrary, recognizing COVID-19-related cutaneous manifestations are thought to assist clinicians in early diagnosis of disease, before the development of respiratory symptoms, and may also be used to identify complications requiring treatment [11].

In the current study, we aimed to explore the patterns of skin diseases during the COVID-19 pandemic in an Egyptian tertiary care medical facility and to compare the findings with a corresponding period of the previous year (before the pandemic).

Patients and methods

The study was approved by the Institutional Ethics and Research Committee of Faculty of Medicine, Sohag University, Egypt. We collect and analyze the data of the patients which is extracted from the database of our dermatology clinic and take the ethical approval of our research ethical committee.

Inclusion criteria

In this cross-sectional study, we analyzed the data of all patients who attended the dermatology outpatient clinics at Sohag University Hospital, Sohag, Egypt, between August 2020 and January 2021 (n=803). Data of patients who attended the same dermatology clinics in the corresponding period of the previous year (between August 2019 and January 2020) were included for comparison (n=1611). Some of the patients were newly diagnosed, whereas others came for follow-up.

Exclusion criteria

Patients with no final accurate diagnosis were excluded from the study.

Dermatological diseases reported in the current study are defined and classified according to International Classification of Diseases (ICD-10) [12].

Most of the skin diseases were diagnosed clinically by more than one expert dermatologist and few of them needed skin biopsy and histopathological evaluation ([Figure 1]).

Figure 1 Flow chart of our study.

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Statistical analysis

Our data were analyzed using IBM SPSS Statistics for Windows (version 20) (SPSS Inc., Chicago, Illinois). Qualitative data are expressed as frequencies and percentages and were compared by χ² test. Binary logistic regression analysis was used to determine the odds ratio for changes in dermatologic disease prevalence during the COVID-19 pandemic. P value less than 0.05 was considered statistically significant.

Results

A total of 803 patients attended the dermatology outpatient clinics in the interval between August 2020 and January 2021 (i.e. during the COVID-19 pandemic) as compared with 1611 patients in the corresponding period of the previous year (49.84% reduction). The sociodemographic characteristics of patients included in the study are reported in [Table 1]. The distribution of dermatologic diseases with significantly increased frequencies during COVID-19 pandemic is shown in [Table 2]. The distribution of dermatologic diseases with significantly decreased frequencies during the COVID-19 pandemic and those with no change in the frequency during the pandemic are shown in [Table 3] and [Table 4], respectively. The odds ratio for diseases that increased during the COVID-19 pandemic is shown in [Table 5].

Table 1 Sociodemographic characteristics of the studied patients

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Table 2 Skin diseases with significantly increased frequencies during the coronavirus disease 2019 pandemic

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Table 3 Skin diseases with significantly decreased frequencies during the coronavirus disease 2019 pandemic

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Table 4 Skin diseases with no change in their frequencies during the coronavirus disease 2019 pandemic

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Table 5 Odds ratio of skin diseases with increased frequencies during coronavirus disease 2019 pandemic

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Discussion

The present study highlights the frequencies and patterns of skin diseases during the COVID-19 pandemic. Approximately 50% reduction of the number of patients who attended dermatology outpatient clinics is noted during the COVID-19 pandemic in comparison with the corresponding period of the previous year. This was anticipated owing to several restrictions that were applied during the pandemic and the fear of acquiring COVID-19 disease.

In this study, some dermatologic diseases showed significant increase in their frequencies during the COVID-19 pandemic including allergic and irritant contact dermatitis, pityriasis rosea, alopecia areata (AA), erythema multiforme, vasculitis, and viral skin infections. A previous study from Turkey reported a significant increase in contact dermatitis 2 months after the COVID-19 pandemic [13]. Increased percentage of contact dermatitis during the pandemic may be explained, at least in part, by the enhanced preventive hygiene measures with antiseptics to halt COVID-19 infection [14],[15]. Moreover, prolonged wearing of protective respirators, as well as medical and fabric masks may lead to skin changes that include impairment of keratinocytes, release of proinflammatory cytokines, cutaneous microbiota disorder, and increased transepidermal water loss and skin pH [16]. In addition, closed and warm environments may increase skin’s permeability and sensitivity to physical or chemical irritants, leading to chronic cumulative irritant contact dermatitis or even allergic contact dermatitis [17].

The results emerging from the current study also indicate an increased proportion of pityriasis rosea during the pandemic of COVID-19 as compared with its frequency in the corresponding period of the previous year. Such observation is in accordance with the results of previous studies [6],[13]. The authors of the latter study speculate that reactivation of human herpes virus-6, owing to new the coronavirus, and psychoemotional factors to be potential factors that may explain the increased percentage of pityriasis rosea [6]. However, it is not clear whether patients with pityriasis rosea are asymptomatic carriers for COVID-19 infection, and further research is warranted.

The finding of increased frequency of AA during the pandemic of COVID-19, in the current study, is in line with a recent report by Kutlu et al. [18]. The authors of the latter study indicate that stress-related autoimmune diseases are likely to increase during the COVID-19 outbreak. AA is known to be a tissue-specific autoimmune disease that develops based on genetic predisposition [19]. In several patients, acute or chronic psychoemotional stress may be causing the initiation and/or progression of AA [20].

The results of the current study also indicate an increased frequency of cutaneous vasculitis during COVID-19 pandemic in comparison with its frequency in the corresponding period of the previous year. Several studies reported the presence of vasculitic lesions as a cutaneous manifestation associated with COVID-19-infected patients [21],[22],[23]. Cutaneous vasculitis in relation to COVID-19 was thought to be the result of direct damage of endothelial cells by the virus or dysregulated host inflammatory responses.

In the current study, an increased frequency of viral skin infections is observed during the COVID-19 pandemic. These included herpes viral vesicular dermatitis, chicken pox, and herpes zoster. Varicella-like exanthem was reported as a rare but specific cutaneous manifestation of COVID-19 in a multicenter series of 22 patients from Italy [24]. Similarly, varicella-like exanthema was considered a COVID-19-associated skin manifestation and a possible diagnostic clue in children [25]. Attenuation of the immune system in COVID-19-infected patients increases the susceptibility to coinfection with other viruses like parvovirus18, herpes simplex virus type 1 and 2, and varicella-zoster virus [26],[27],[28].

On the contrary, some dermatological diseases such as urticaria and nonscarring hair loss had significantly decreased frequencies during the COVID-19 pandemic. Several skin diseases had unchanged frequencies during the COVID-19 pandemic. These included skin infections (other than viral infections), bullous disorders, some eczematous skin diseases, papulosquamous disorders, and disorders of skin pigmentation. In a previous study, the frequency of herpes vesicular dermatitis, herpes zoster, dermatophytosis, warts, anogenital warts, molluscum contagiosum, recurrent aphthous stomatitis, acne, seborrheic dermatitis, urticaria, and psoriasis was reported as significantly decreased/not changed, 1 and 2 months after the occurrence of the COVID-19 pandemic [13]. This may indicate that people postponed dermatology consultation for fear of COVID-19 infection.

Despite the interesting findings of the current study, we note few limitations. First, we included patients from a single tertiary care medical center, and therefore, patients with skin diseases attending primary and secondary health care centers as well as those attending private dermatology clinics are not represented in this sample. Second, the study interval is limited to 6 months, while the COVID-19 pandemic is still ongoing. Therefore, there is a possibility that the pattern of presentation may change as the pandemic lasts for longer intervals.

Third, testing for COVID-19 is not routinely performed in dermatological cases, and the retrospective nature of the current study precluded us from getting information on the results of COVID-19 testing that might have been done for some patients included in this study. As such, it is difficult to find a causal relationship between COVID-19 and some skin diseases with increased frequencies during the pandemic.

Conclusion

The results of the current study indicate a significant reduction of the number of patients attending dermatology clinics during the COVID-19 pandemic. Our results also indicate a significant increase in the frequency of certain dermatological diseases during the COVID-19 pandemic such as allergic and irritant contact dermatitis, pityriasis rosea, AA, erythema multiforme, vasculitis, herpes zoster, and chicken pox. On the contrary, some dermatological diseases such as urticaria and nonscarring hair loss had significantly decreased frequencies during the COVID-19 pandemic. Several skin diseases had unchanged frequencies during the COVID-19 pandemic. These included skin infections (other than viral infections), bullous disorders, some eczematous skin diseases, papulosquamous disorders, and disorders of skin pigmentation. Periodic evaluation of the epidemiologic characteristics of skin diseases is required at different stages of evolution of the COVID-19 pandemic.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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