Neue Formen der Zusammenarbeit zwischen Praxis und Klinik

Preventive measures in occupational dermatology have proven to be very effective in recent years, especially measures of primary and secondary prevention as components of a complex hierarchical prevention concept. For those cases of occupational dermatoses in which these outpatient prevention measures are not successful, interdisciplinary inpatient rehabilitation measures have been developed (“tertiary individual prevention” [TIP]). TIP comprises 3 weeks inpatient treatment including intensive disease-oriented teaching and psychological counseling, followed by outpatient treatment by the local dermatologist. In 2005, a German prospective cohort multicenter study (?Medizinisch-Berufliches Rehabilitationsverfahren Haut – Optimierung und Qualitätssicherung des Heilverfahrens” [ROQ]) started which will further standardize TIP and evaluate long-term success and scientific sustainability in depth. This integrated concept of an inpatient/outpatient disease management reveals remarkable pertinent options for patients with severe occupational dermatoses in all high-risk professions.     

Optimierte Versorgung von Patienten mit berufsbedingten Handekzemen

Occupational dermatoses (OD) have been at the top of all occupational diseases in Germany for years (>25% of all occupational diseases officially reported annually to the public statutory employers' liability insurance bodies). More than 90% of OD-cases are hand eczema. Several pilot initiatives to improve prevention of occupational skin diseases have been developed and funded since 2005 by the statutory employers' liability insurance schemes. The concept underpinning these initiatives is a nationwide multi-step intervention approach recently implemented by the public statutory insurance system administration ("step- wise procedure") which aims at offering quick and specific preventive help at all levels of severity of OD. The dermatologist has a pivotal function in this concept; for early secondary prevention, the so-called dermatologist's procedure was recently updated in order to provide more rapid and concise dermatological consultations and care. Additionally, combined outpatient dermatological and educational intervention seminars ("secondary individual prevention", SIP) and interdisciplinary inpatient prevention measures have been developed ("tertiary individual prevention", [TIP]) and are currently being further evaluated in multicenter studies.     

10 years quality assurance of the dermatologist's procedure. ABD review board part II: 2003–2009

Background: The dermatologist's procedure (“procedure for early detection of occupational skin diseases”) enables dermatologists to conduct the relevant diagnostics at the expenses of the statutory employers’ liability insurance funds (UVT) if there is a possibility of a work‐related skin disorder in an employee. Acceptance of this most relevant tool for secondary prevention in occupational dermatology in Germany is high and most dermatologists make careful use of this unparalleled privilege. However, there have been occasional complaints by the UVT, concerning overly extensive diagnostics. Consequently, the Task Force on Occupational and Environmental Dermatology (ABD) of the German Society of Dermatology set up a review board in May 1999. Results: Dermatologists’ reports in question were submitted by the UVT to the review board and reviewed separately by two experienced occupational dermatologists both in the 1^st period (1999–2003) and now in the second period (June 2003 – November 2009). The criticism of the reviewers was mostly directed towards the number of tests and an insufficient documentation in the dermatologist's report. There were 69 dermatologists’ reports submitted to the review board (as compared to 155 in the 1^st period). Conclusions: The decreased number of dermatologists’ reports submitted could be a result of the review process itself. Other factors may include the optimization of the dermatologist's report with a better reimbursement as well as the recent publication of guidelines and continuous education in occupational dermatology with certification of more than 700 dermatologists. These measures of quality assurance are aimed to further optimize the dermatologist's procedure and to allow for improved and more rapid care for patients with occupational dermatoses by dermatologists.     

First results from the multicentre study rehabilitation of occupational skin diseases--optimization and quality assurance of inpatient management (ROQ)

Background and objectives. The German stepwise procedure of handling occupational skin diseases (OSDs) offers interdisciplinary integrated (inpatient/outpatient) rehabilitation measures [tertiary individual prevention (TIP)] for severe OSD. In 2005, a prospective cohort multicentre study was started in order to evaluate TIP. Methods. One thousand seven hundred and eighty‐eight patients with severe OSD were treated and educated in five clinics with follow‐up before and 4 weeks after return to work. Results. During the inpatient phase, there was a significant improvement in the severity of OSD (Osnabrueck Hand Eczema Severity Index, p < 0.001) and in the quality of life (Dermatology Life Quality Index, p < 0.001). These effects were largely sustained during the outpatient follow‐up phase and in the 4 weeks after return to work. Among all patients, 89.4% used topical steroids before TIP, including 52.5% using high‐grade topical steroids; 93.2% of the patients were able to refrain from using topical steroids before returning to work. As a result of TIP, return to work was possible for 1587 patients (88.8%). Conclusions. The primary objectives of TIP (return to work, improvement of OSD, enhancement of quality of life, and reduction in the use of topical steroids) were successfully met. The long‐term follow‐up (1 and 3 years after TIP) will examine whether these favourable outcomes can be sustained.     

Occupational skin diseases

Occupational skin diseases are the most commonly reported notifiable occupational diseases. In Germany, 23 596 out of a total of 71 263 reported occupational diseases in 2010 were classified as occupational skin diseases (BK No. 5101: “severe or recurrent skin diseases which have forced the person to discontinue all occupational activities that caused or could cause the development, worsening, or recurrence of the disease”). Contact dermatitis (allergic, irritant) of the hands is the most common skin disease and atopic skin diathesis is often an important co‐factor. The number of work‐related skin diseases is many times higher than the number of notified occupational dermatoses. This CME article explains the legal framework of occupational diseases, the tasks and obligations of the legal statutory work insurance. Typical allergens and irritants of high risk professions are also presented as are the important steps from diagnosis to compensation. Early prevention of occupational skin diseases is very important to avoid severe chronic hand eczema. Therefore the “dermatologist's report” is crucial. Other occupational dermatoses (outside of BK 5101) are briefly mentioned. In recent years the number of notifications of occupational skin cancer due to occupational UV‐irradiation has increased. According to recent epidemiological findings, there is a significant and consistent positive association between occupational UV‐irradiation and squamous cell carcinoma. Therefore, an important criterion for a new occupational disease is fulfilled.     

UV‐induced occupational skin cancer: possibilities of secondary individual prevention in the “Dermatologist's Procedure”

Invasive squamous cell carcinoma (SCC) as a “quasi occupational disease” according to §9 Section 2 of the German Social Code Book (SGB) VII typically develops on chronically UV‐damaged skin from actinic keratoses. After the Medical Scientific Committee of the Federal Ministry of Labor and Social Affairs has confirmed the legal criteria for acknowledging UV‐induced SCC as an occupational disease, it is expected that the condition will be added to the official list of occupational diseases issued by the Federal Government in the near future. The Social Accident Insurance is required by law (§3 Occupational Disease Regulation) to prevent these tumors by “ all appropriate means“. There are excellent therapeutic and preventive measures for the management of actinic keratoses to avoid the development of SCC. The “ Dermatologist's Procedure“ according to §§ 41–43 of the agreement between the Social Accident Insurance and the Federal Medical Association was established in Germany in 1972 to take preventive measures in insured persons with skin lesions possibly developing into an occupational disease, or worsening it, or leading to a recurrence of it This procedure proved to be very successful in the prevention of severe and/or recurring skin diseases forcing a worker to leave his job. On the basis of this agreement, the Social Accident Insurance has the instruments to independently provide preventive measures for the new occupational skin disease SCC induced by natural UV light according to §9 Section 2 of the German Social Code Book (SGB) VII.     

Skin cancer induced by natural UV‐radiation as an occupational disease – Requirements for its notification and recognition

In Germany over 2.5 million employees have an increased risk of skin cancer due to their occupational exposure to natural UV‐irradiation. The medical consultation board “Occupational diseases” of the Ministry of Labor and Social affairs has investigated the association between occupational UV‐irradiation and skin cancer risk and recommends to add the following new occupational disease into the appendix1 of the German ordinance on occupational diseases: “Squamous cell carcinoma and multiple actinic keratosis due to natural UV‐irradiation”. In this article we report in the view of the German Society of Occupational and Environmental Dermatology (ABD) and the German Statutory accident insurance (DGUV), whose criteria have to be fulfilled for the notification and recognition of an occupational skin cancer due to natural UV‐irradiation.     

Optimiertes Hautarztverfahren und Stufenverfahren Haut

Parallel to the introduction of the optimized dermatologist’s report in 2006, a hierarchical multi-step intervention approach to occupational dermatitis (OD) was launched within the statutory accident insurance bodies. It is aimed at ensuring that OD patients can be allocated to dermatological consultations and preventive measures quickly and in a manner appropriate to the severity of their OD. At present, a study (“EVA Haut”) is being conducted at the University of Osnabrueck in which about 10% of the annually reported cases in Germany with suspected OD in 2007 have been selected at random (N=1,600). All randomized notifications are reviewed by occupational dermatologists; in parallel, the implementation of the hierarchical multi-step intervention scheme by the insurance-administrations is evaluated. Main criteria are the course of OD, job loss and costs of the procedures (follow-up 1 year). The random quota sample reveals the number of cases in which dermatological and/or preventive intervention were initiated by the administrations (“dermatologist’s procedure”; N=995), in these cases patients and dermatologists involved are interviewed by a standardized questionnaire. In the remaining N=556 cases, no intervention has taken place so far; these cases are also analyzed. The study offers the unique opportunity to analyze the quality and interaction of dermatological and administrative procedures in the management of occupational dermatoses in Germany and to define criteria for further improvement.     

Multicentre study ‘rehabilitation of occupational skin diseases –optimization and quality assurance of inpatient management (ROQ)’–results from 12‐month follow‐up

Background. Occupational skin disease (OSD) is common, and imposes a considerable personal and public burden. To tackle OSD, the German stepwise procedure of handling OSD was set up. It contains an interdisciplinary, integrated inpatient rehabilitation measure [tertiary individual prevention (TIP)] [dermatological treatment and diagnostic procedures, and patient education (health and psychological)]. The primary aims of the TIP are reduction of the severity of OSD, reduction in the use of corticosteroids, facilitation of return to work, decreased absence from work, and enhanced quality of life (QoL). It was positively evaluated for a period of 4 weeks after return to work. Objectives. To investigate whether the observed short‐term effects remain significant and meaningful over a period of 12 months after discharge from the TIP. Methods. A prospective design was used to compare clinical and patient‐reported outcome data between admission to a 3‐week inpatient TIP and 12 months after discharge (12‐month follow‐up). Results. Of 1788 individuals admitted to the TIP, data from 1617 individuals were available for analysis. We observed a significant reduction in the severity of OSD, the use of topical corticosteroids, and days of absence from work because of OSD. QoL was significantly improved, and 87.4% were able to return to work and remain in the workforce. Conclusions. A randomized controlled trial would have been desirable, but was not possible, for legal and other reasons. However, the long‐term 12‐month follow‐up shows that the TIP is associated with sustained improvements in terms of ability to work, QoL, and prognosis, and reductions in days of absence from work because of skin conditions and topical corticosteroid application. These results indicate that the TIP provided a reduction in the personal and public burden of OSD.     

Long-term effectiveness of secondary prevention in geriatric nurses with occupational hand eczema: the challenge of a controlled study design

Background. The high prevalence of occupational dermatoses indicates the need for effective and sustainable prevention strategies. Objectives. To evaluate the long‐term effectiveness of secondary prevention in geriatric nurses. Patients/Methods. One hundred and two geriatric nurses with occupational hand eczema participated in an interdisciplinary prevention programme [intervention group (IG)]. Members of the control group (CG) (n = 107) were medically treated by local dermatologists. Six years after intervention (T2), data on job continuation, skin lesions and skin protection behaviour were obtained by standardized questionnaires and compared with baseline values (T0) and data from a 3‐month follow‐up (T1). Results. At T2, 65.3% of the IG and 56.8% of the CG still worked as geriatric nurses; 6.9% of the IG and 13.6% of the CG had given up work because of occupational hand eczema. The skin status improved in both cohorts. The data indicated a lower frequency of skin lesions and morphological signs in the IG, for example vesicles (IG, 12.8%; CG, 40.0%; χ² = 7.00, degrees of freedom = 1, p = 0.008). Conclusions. The results indicate long‐term effects regarding job continuation and disease severity, although few results showed statistical significance. It is outlined that controlled long‐term studies aiming at proving the general effectiveness of secondary prevention are no longer feasible in Germany, as the statutory accident insurance has led to a legal entitlement of all patients affected by occupational hand eczema to immediate preventive intervention.     

“Slime” dermatitis,a fad‐associated chronic hand dermatitis

“Slime” is the colloquial name for a non‐Newtonian viscoelastic putty‐like substance that is currently a popular plaything among pre‐teens and adolescents. Several ingredients in homemade slime recipes may cause irritant or allergic contact dermatitis. We report two children who developed slime‐associated chronic hand dermatitis, more prominently on their dominant hand. We review the potential for irritant and allergic contact dermatoses as the causes of dermatitis associated with homemade slime.     

Supportive Immunglobulingabe beim metastasierten Melanom unter Polychemoimmuntherapie nach dem „Legha‐Protokoll”

Summary: Background and Objective: Metastatic malignant melanoma as one of the most aggressive tumors has got a new and promising therapy option with the polychemoimmunotherapy according to “Legha's protocol” (5 – 7). Facing the relatively high toxicity of this therapy, especially the high rate of infections of 49 % ( 8 ), we decided to perform a supportive treatment with intravenous IgM‐enriched immunoglobulins in order to avoid infections.
Patients/Methods: From 1998 to 2002 we treated 34 patients with metastatic malignant melanoma with the polychemoimmunotherapy according to “Legha's protocol”. Four days after each course (except the first one) patients intravenously got IgM‐enriched immunoglobulins (5 ml/kg, i. e. 250 mg /kg).
Results: Out of 34 patients three patients suffered from different infections during the polychemoimmunotherapy: One patient developed a labial herpes infection after each course, another one a subcutaneous abscess on her forearm after the third course and the third patient had a gluteal abscess after the first course, that means before getting immunoglobulins. In comparison with the infection rate of 49 % given in the literature our observed infection rate as a side effect of Legha's therapy is very low (8,8 %) when combined with supportive immunoglobulins.
Conclusions: The supportive treatment with IgM‐enriched immunoglobulins during the polychemoimmunotherapy according to “Legha's protocol” can significantly reduce the rate of opportunistic infections in these secundarily immunosuppressed patients.     

A 7‐step consultation plan for health care workers and hairdressers

Background: Skin diseases are among the most common occupational disor‐ders in health care workers and hairdressers. Optimal prevention methods make it possible for more individuals to remain active in their profession. We devised a 7‐step consultation plan which was employed in a standard fashion and then evaluated. Patients and Methods: 264 employes were evaluated in the Education and Support Center of the German Accident Prevention and Insurance Association in the Health and Welfare Services (BGW schu.ber.z Berlin) from 2003 to 2005 in a standardized manner. Included were detailed history, physical examination, skin physiology measurements (transepidermal water loss, corneometry, sebumetry) and then making a diagnosis and therapeutic recommendations. Results: Within the study group of 264 employes the most frequent diagnosis were toxic‐irritant hand eczema (28.4%), allergic contact eczema (19.7%), atopic eczema (15.5%) and irritant contact eczema with atopic diathesis (13.6%). The frequency of contact sensitivity was high in the study group (80.7%). The skin physiological parameters were not remarkably altered and did not differ between individuals with an atopic diathesis versus without an atopic diathesis. Conclusion: This standardized protocol for a “7‐step consultation plan”when applied in a standardized manner offers quality‐controlled but also individually‐adapted support considering dermatological, educational and occupational aspects. Skin physiology parameters did not provide any further information indicating the need of the development of novel techniques to measure skin barrier function.     

Quality‐of‐life in wasp venom allergy – validation of the German version of the “Vespid Allergy Quality of Life Questionnaire” (VQLQ‐d)

Background: Little is known about the quality of life of patients who are allergic to insect venom. This fact is due to the lack of specific instruments assessing the interaction of type 1 allergy and its psychological burden. Patients and methods: The only established questionnaire on health‐related quality‐of‐life in patients with wasp venom allergies is the “Vespid Allergy Quality of Life Questionnaire” (VQLQ). This questionnaire was translated from Dutch into German and validated with 79 patients with wasp venom allergy, including the use of the well‐established general quality‐of‐life questionnaire WHOQOL‐BREF. Results: In the German version VQLQ‐d we could reproduce the validity and reliability of the original Dutch version. Cronbach's alpha of the VQLQ‐d was α= 0.95. The results of the VQLQ‐d corresponded to the total score of the WHOQOL‐BREF. Conclusion: The VQLQ‐d enables measurement of quality‐of‐life in patients with wasp venom allergy in the German‐speaking population. This economic tool makes it possible to better describe and treat affected patients. Furthermore, it can be used to advance research in this field.     

Multidisciplinary long‐term care and modern surgical treatment of congenital melanocytic nevi – recommendations by the CMN surgery network

In recent years, our knowledge of congenital melanocytic nevi (CMN) has greatly expanded. This has led to a paradigm shift. The present article represents a commentary by an interdisciplinary group of physicians from German‐speaking countries with extensive experience in long‐term care and surgical treatment of children and adults with CMN (CMN surgery network, “Netzwerk Nävuschirurgie”, NNC). The authors address aspects such as the indication for treatment as well as treatment planning and implementation under these new premises. Adequate counseling of parents on conservative and/or surgical management requires an interdisciplinary exchange among physicians and individualized planning of the intervention, which frequently involves a multi‐stage procedure. Today, the long‐term aesthetic outcome is at the center of any therapeutic endeavor, whereas melanoma prevention plays only a minor role. The premise of “removal at any cost” no longer holds. Potential treatment‐related adverse effects (hospitalization, wound healing disorders, and others) must be carefully weighed against the prospects of a beneficial outcome. In this context, the use of dermabrasion in particular must be critically evaluated. At a meeting of the NNC in September 2018, its members agreed on a consensus‐based position on dermabrasion, stating that the procedure frequently leads to impaired wound healing and cosmetically unfavorable or hypertrophic scarring. Moreover, dermabrasion is considered to be commonly associated with considerable repigmentation that usually occurs a number of years after the procedure. In addition, the NNC members saw no benefit in terms of melanoma prevention. In the future, physicians should therefore thoroughly caution about the potential risks and often limited cosmetic benefits of dermabrasion.     

S1 guideline on occupational skin products: protective creams,skin cleansers,skin care products (ICD 10: L23, L24) – short version

Job‐related hand dermatitis heads up the list of reported occupational diseases. So‐called skin products – understood to mean protective creams, skin cleansers and skin care products – are used for the primary and secondary prevention of job‐ related hand dermatitis. In the interests of evidence‐based medicine, the only preventive measures and/or occupational skin products that should be used are those whose potential uses and efficacy are underpinned by scientific research. To this end, the Arbeitsgemeinschaft für Berufs‐ und Umweltdermatologie e.V. (Working Group for Occupational and Environmental Dermatology, ABD) of the DDG (German Dermatological Society) and the Deutsche Gesellschaft für Arbeits‐ und Umweltmedizin (German Society for Occupational and Environmental Medicine, DGAUM) have summed up the latest scientific findings and recommendations in the updated guideline. The benefit of the combined application of protective creams and skin care products in the primary and secondary prevention of work‐related contact dermatitis has been widely confirmed by recent clinical‐epidemiological studies. The guideline clearly explains the necessity of demonstrating the efficacy of protective creams and cleansing products by means of in vivo methods in the sense of repetitive applications. Transferable standardised testing systems designed to examine the irritation potential and thus the compatibility of occupational skin cleansers and the reduction of irritation by protective skin creams have now been developed and validated by multicentre studies for skin protection creams and cleansers. The status of the current assessment of the safety of occupational skin products is also summarised.     

T‐Zellplastizität bei entzündlichen Hauterkrankungen – die Guten,die Schlechten und die Chamäleons

Nach dem Konzept der T‐Zellplastizität können periphere T‐Zellen – sobald sie sich in eine spezifische T‐Zell‐Untergruppe differenziert haben – in Reaktion auf neue Umweltfaktoren oder veränderte Signale den Phänotyp einer anderen Helferzell‐Untergruppe in Bezug auf Zytokinproduktion und regulatorische Funktionen annehmen. Die T‐Zellplastizität – besonders die Umwandlung regulatorischer T‐Zellen (Tregs) zu IL‐17‐produzierenden Entzündungszellen – wurde in jüngster Zeit bei verschiedenen T‐Zell‐vermittelten entzündlichen Erkrankungen wie rheumatoider Arthritis, Multipler Sklerose, entzündlichen Darmerkrankungen und Psoriasis als wichtiger Pathomechanismus, der an der Verschlimmerung von Entzündungssymptomen und der Chronifizierung der Krankheit beteiligt ist, beschrieben. Neben Psoriasis kann das Phänomen der Immunzellplastizität auch bei anderen entzündlichen Hauterkrankungen mit T‐Zell‐Komponente und/oder einer IL‐17‐vermittelten Symptomatik eine Rolle spielen, wie beispielsweise bei Lichen ruber, Lupus erythematodes, blasenbildenden Erkrankungen, allergischen Erkrankungen sowie anderen. Diese Übersichtsarbeit fasst die grundlegenden molekularen Mechanismen zusammen, welche über das Schicksal von T‐Zellen und ihre Plastizität in entzündeter Haut und anderen lymphatischen Organen entscheiden. Außerdem umreißt sie die Wirkung etablierter zielgerichteter Therapien sowie alternativer Konzepte daraufhin, wie sich die ungewollte Umwandlung “hilfreicher” T‐Zellen und anderer nützlicher Immunzellen in pathologische entzündliche „Schädlinge“ vermeiden lässt.     

Health education about occupational allergies and dermatoses for adolescents

Background: Occupational dermatoses and allergies are frequent and often affect individuals with atopic dermatitis. Our aim was to inform adolescents about potentially dangerous occupations, risk groups and preventive measures before they started apprenticeships in order to minimize the risk of occupational allergies or skin diseases. Methods: 1015 high‐school students were instructed by two dermatologists/ allergists (Heidelberg) and a teacher (Potsdam) in a 90‐minute instructional unit.This included the exemplification of occupational skin hazards and allergies, the identification of at‐risk persons, and application of preventive measures. A questionnaire was filled in by the students prior to and at least two weeks after the training. Results: In both regions, the students showed an increase in knowledge after the training, which was statistically significant higher in the Heidelberg region (6.6 points on average vs.4.4 points). 76% of students termed the subject matter as “important”, and 67% rated the teaching unit as “very good” or “good”. Conclusions: We demonstrate that students who have not yet chosen a career are highly interested in this subject, that the developed instructional unit is widely accepted, and that it leads to an increase in knowledge. Therefore we suggest nation‐wide implementation of this primary prevention measure in high‐schools.     

Tertiäre Prävention von Berufsdermatosen

Background: Inpatient tertiary prevention of occupational skin diseases is indicated when the employee is threatened with loosing their job. Earlier studies have shown that with intensive tertiary preventive measures, 2/3 of such individuals can continue their jobs long‐term. Data on the effectiveness of tertiary prevention for various occupational groups has not been previously available. Patients and Methods: The outcome of all participants treated in the year 2002 was analyzed according to occupational groups with respect to diagnosis, medical intervention prior and during the inpatient period. Results: In 91 % of 296 cases contact dermatitis of the hands was diagnosed (75 % primary irritant contact dermatitis (37 % chronic irritant contact dermatitis, 38 % irritated atopic hand eczema, 16 % allergic contact dermatitis). Clinically relevant Type IV‐delayed hypersensitivity (allergic contact dermatitis) reactions were identified in 42 % of cases; in most cases, the delayed hypersensitivity followed irritant contact dermatitis. In more than 83 % of cases, a complete or nearly complete remission was achieved. Clinical relevant Type IV sensitization was most frequent in hairdressers (66 %). Cleaning and housekeeping personnel most frequently used corticosteroids on a regular basis (60 %) and most often experienced corticosteroid withdrawal (53 %) and atrophy of the skin of the hands (23 %). Conclusion: The data from studies on the tertiary prevention of occupational skin diseases reveal strategies for the optimization of outpatient care indicate specific occupational risk factors. The variance between professions may reflect differing approaches to secondary prevention.     

The effect of the “stay‐at‐home” policy on requests for dermatology outpatient clinic visits after the COVID‐19 outbreak

The Coronavirus Disease 2019 (COVID‐19) emerged late in Turkey but it showed a rapid progression later. We aimed to investigate the changes in the number of patients who requested a dermatology outpatient clinic visit due to the increased social and medical burden caused by COVID‐19 in Turkey during the first days of the pandemic. We also examined the most common dermatologic diseases diagnosed during the COVID‐19 outbreak. A statistically significant negative correlation was found between the number of COVID‐19 patients in the country and the number of patients requesting a dermatology outpatient clinic visit in the secondary and tertiary care hospitals during self‐quarantine. In the first 10 days after the COVID‐19 outbreak, acne (28.2%), urticaria (12.8%), scabies (12.8%), irritant contact dermatitis (10.3%), and xerosis cutis (10.2%) were the most common diseases seen in the dermatology clinic at the secondary care hospital, while acne (23.3%), warts (5.4%), seborrheic dermatitis (4.5%), urticaria (3.8%), and psoriasis (3.32%) were the most common diseases seen in the dermatology clinic at the tertiary care hospital. This is our first study on the frequency and nature of outpatient dermatology visits during this novel coronavirus pandemic. Understanding the trends and impacts of dermatologic diseases on patients and health systems during this pandemic will allow for better preparation of dermatologists in the future.