AIM: Typical feature of erysipelas, especially on the lower limbs, is the tendency to reoccur. The study aimed to identify clinical and laboratory characteristics of acute and recurrent erysipelas. MATERIAL AND METHODS: We prospectively included patients diagnosed with erysipelas on the lower limbs in the period from January 2016 to December 2017. Patients were divided into two groups: patients with the first episode and recurrent erysipelas. The groups were compared by their demographics, clinical and laboratory characteristics. RESULTS: The study included 187 patients with the first episode of erysipelas and 126 patients with recurrent erysipelas. Both groups were homogeneous in terms of demographic characteristics, gender and age. Mean age of patients with the first episode of erysipelas was 64.18 ± 12.5 years; patients with recurrent erysipelas were inconsiderably mean younger (62.98 ± 12.5 years). Patients in both groups had a significantly different anatomical localisation of skin infection (p = 0.008). Tibial localisation was more frequent in patients with the first episode of erysipelas 77% vs 62.7%, while recurrent erysipelas was more frequent on the foot 36.5% vs 23%. No significant difference was found, about the affected side of the limb (p = 0.95). Patients with recurrent erysipelas had a pronounced inflammatory response, seen through significantly higher values of C reactive protein (p = 0.02), granulocytes (p = 0.03), fibrinogen (p < 0.0001), and higher body temperature, (37.22 ± 0.97 p = 0.006). Length of hospital stay was increased in the recurrent group. CONCLUSION: Erysipelas is more frequent in older people; it has seasonal character and tendency to reoccur. Identifying clinical and laboratories characteristics of those at risk may prevent recurrence and long term comorbidities.
The current pandemic of COVID-19 demanded fast reorganization, as well as the necessity to adapt existing and administered extraordinary working protocols of dermatological services worldwide. 1 We present a unique experience from Republic of Macedonia where an abrupt interruption of the dermatology service on a national level, and the COVID-19 outbreak, occurred simultaneously, with a significant impact on the quality of care.The fourth diagnosed case of COVID-19 in the Republic of Macedonia was a dermatologist employed at the University Clinic for Dermatology in Skopje, the only tertiary care hospital in the country.Prior to being diagnosed, the doctor made direct contact with nearly all medical and non-medical personnel of the Clinic. The doctor also held a previously scheduled seminar, which was attended by an additional 95 dermatologists and dermatology residents from across the country.In the first hours following the diagnosis, rapid action was taken by government officials, and 128 dermatologists and dermatology residents were put in home quarantine for 14 days. Only 9 dermatologists in secondary care could resume practice in the period from 9 March 2020 to 26 March 2020, unevenly distributed geographically and in terms of subspecialty.At the same time, a number of socially restrictive measures were implemented, further reducing the availability of the dermatological services.The Macedonian dermatological body reacted with notable initiative and self-organization. In the absence of an official teledermatology platform, commonly used social media platforms and conventional telecommunications were used to sustain communication with other specialties and patients. As a result, the management of the majority of chronic patients proceeded without interruption.In an effort to discover which of the dermatological conditions demanded immediate attention, we conducted a survey where we asked colleagues about the number and reasons for teledermatological consults.Overall, 77 dermatologists participated in the survey. Ninety-one percent of respondents had received requests for consultations by patients. Eighty-two percent felt that consultation via a communication application was useful for patient follow-up; however, these methods were appropriate in less than 30% of cases for initial consultations.The most common motives for consultations with patients were therapy follow-ups, acute exacerbations of chronic diseases, and deficiencies of certain medications due to difficulties in drug importations.Most frequently, dermatology input was requested from general practitioners (GPs) and pediatrics ( Table 1).The dermatologists, who were not subject to the home isolation measure, held 163 outpatient examinations, in the majority of which pediatric dermatological pathology dominated (Table 2).A total of 11 patients were admitted during this period in a secondary care hospital; the most frequent admissions were for bullous dermatoses and cutaneous infections (Table 2).Korting, Hammerschmidt, and Miovski constituted the ini...
The novel coronavirus (CoV), CoV disease (COVID)-19, and the ongoing pandemic, is changing every aspect of the human life. Furthermore, the COVID-19 pandemic has a profound impact on health-care worldwide, with no exception in dermatology care units. At the time of pandemic, constant fear and stress are present on the surface. Skin diseases are the most common somatic causes of psychological disorders and, conversely. During a stressful situation, the body has power to adjust and to maintain its well-being, but with prolonged exposure to stress, the first negative changes such as fear, anxiety, and depression will eventually lead to chronic fatigue and an increased risk of disease. The proportion of patients reporting emotional triggers varies with the disease, ranging from approximately 50% in acne to 90% in rosacea, alopecia areata, psoriasis, neurotic excoriations, and lichen simplex and may be 100% for patients with hyperhidrosis. In this paper, we will look at the most common psychodermatological disorders and its implication in the era of COVID-19 pandemic. According to all the pathophysiological conditions that indicate the association of skin diseases with stress, it is normal to expect their deterioration and occurrence in this pandemic period. We will be witnessing a growing number in patients’ consultations with chronic urticaria, dermographism, worsening rosacea, generalization, and relapses of psoriasis. It is needed to be prepared for as many cases as possible, because the psychological consequences will still be felt. We encourage more comprehensive studies of the implications of the COVID-19 pandemic in these patients.
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