Although the dermatology practice mainly depends on the outpatient clinics, several systemic diseases, infections and medications may present with skin manifestations. Dermatology consultations have a large impact on the management of these disorders. Since the COVID-19 (severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ) first appeared in December been reported, some of which were also linked to the disease prognosis. (1,2) Dermatology consultations have a great importance especially during this pandemic period regarding to the wide spectrum of cutaneous findings of COVID infection. During COVID pandemic our hospital provided health care services both in routine hospital wards and seperatedly in the COVID services. In this study we want to investigate the dermatology consultations both in the hospital wards and the COVID services during the pandemic, retrospectively.
This study was conducted in the dermatology clinic of Istanbul Univesrsity Cerrahpasa Medical Faculty and approved by the local Institutional Review Board. The inpatient dermatology consult database was reviewed retrospectively. In this study of both pediatric and adult dermatology inpatient consultations were evaluated for the last two months starting after the first case of COVID infection was reported in Turkey. For both groups we reviewed patient demographic characteristics of the patients including age, sex, consult requesting service and reason for dermatology consultation from March 10 to May 10, 2020. Patients who have more than one consultation or admission for different indications, were conducted for a seperate diagnosis.
Diseases were classified into 7 groups according to etiology including cutaneous infections (viral eruption, cellulitis, herpes zoster, tinea pedis), urticaria, inflammatory disorders ( dermatitis, psoriasis, rosacea), drug eruptions, wounds and ulcers, benign tumors, malignant This article is protected by copyright. All rights reserved.
tumors. Purpuric-petechial eruption which is thought be related to COVID-19 infection was classified in the cutaneous infection subgroup.
Departments were classified into 13 groups including emergency, internal medicine, intensive care, pediatrics, infectious disease, physical medicine and rehabilition, cardiology, neurology, COVID wards, COVID intensive care unit, surgery and surgical subspecialties and psychiatry.
In this study only face-to-face, standart consultations were included, teleconsultations were excluded.
Data analysis was performed using the NCSS statistical package (Number Cruncher Statistical System) 2007 (Kaysville, Utah, USA). The results were analyzed by using mean± standart deviation, percentile values and Chi-square tests. Statistical significance was set at the 0.5% level.
A total of 166 consultations were reviewed between March -May 2020. Of these patients, 57%
(n=94) were male. The mean age of the patients was 53,12 (range:1-89 years) ( Table 1) Among these consultations requested by subspecialities and services, 46 requests (27,7%) from internal medicine, 41 requests (24,9%) from COVID wards, 22(13,2%) from surgery and surgical subspecialties,13 (7,8%) COVID intensive care unit, 11 (6,6%) pediatrics, 9 (5,4%) emergency room, 7 (4,2%) from infectious disease, 4 (2,4%) from intensive care unit, 4 (2,4%) from cardiology,4 (2,4%) from neurology, 3 (1,8%) from physical medicine and rehabilition, 2(1,2%) from psychiatry. (Table 2) This article is protected by copyright. All rights reserved.
The most common indications seen by the dermatology consulting services were cutaneous infections (n=61, 36%), followed by inflammatory skin disorders (n=53, 32%), urticaria (n=18, 11%), wound and ulcers (n=15, 9%) drug eruptions (n=13, 8%), malignant tumors (n=5,3%), benign tumor (n=1,1%). In infection group maculopapular viral eruption (n=13,21%) was the most common cutaneous finding followed by herpes zoster infection (n=8,13%). (Table 2 )
In the present study, the indications for dermatology consultation requests and the distribution of consult requesting services at a tertiary referral center during COVID pandemic were reviewed. The most common conditions seen by our dermatology consulting services were cutaneous infections (n=61, 36,7%), inflammatory skin disorders (n=53, 31,9 %), urticaria (n=18, 10,8%), and drug eruptions (n=13, 7,8%). Almost all of these indications were common skin disorders, none of them were rare diagnosis. The inflammatory skin disorders and cutaneous infections have been reported to be most common clinical diagnoses in dermatology consultations in most of the large hospital series before COVID pandemic similar with our study. (3) The role of dermatology consultations have been reviewed in many large hospital centers either in different departments such as emergency, hematology and transplantation units or in different indications selecting only one category such as inflammatory disorders or cutaneous infections (3-6) In our study skin disorders were classified into several subgroups according to their etiology and it was seen that the most common consultation requests were made by COVID services including wards and intensive care unit (N=54, 32,5%).
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The second most common department requested consultation from dermatology was internal medicine (n=46, 27,7%) reflecting the high volume of patients cared for by this department.
The most common indications of the consultations were inflammatory skin disorders, cutaneous infections and drug eruptions for both sex (37%, 28,3% and 13%) compatibly with the previous studies in the literature. (2, 4) Dermatology consultations from pediatrics were reported to be the 11-33% of the all consultations in pre-pandemic period in previous studies. (7) Temiz et al. reported that almost 19,7% of the dermatology consultations were requested from pediatric patients during COVID-19 pandemic.(7) In our study 6.6% (n=11) of the dermatology consultations were requested from the department of pediatrics which is most probably related to quarantine, reflecting the change in patient profile during pandemic. Infections (n=6, 54%) were similarly the most common indication in dermatology consultations requested from pediatric patient group.
Limitations of our study include its retrospective nature and the fact that in many cases, primary teams do not accurately record a preliminary diagnosis, skin physical exam findings or a treatment plan once a consultation to dermatology has been placed.
We would like to thank our department of statistics, in particular Özden CALAY, MD.
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During COVID-19 pandemic, the majority of dermatology consultations were requested from COVID wards and COVID intensive care unit in our hospital. These results support that dermatology consultations may have an essential role in the early diagnosis and differential diagnosis of cutaneous manifestations of COVID-19 which may also affect the risk stratification of patients with COVID-19. Further training of ward clinicians on common dermatologic conditions and cutaneous manifestation of COVID-19 will improve the management of skin disorders, hospitalization duration and life quality of the hospitalized patients.
The study was carried out in accordance with the World Medical Association Declaration of 
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