Lluís Puig, MD, PhD
Hospital de la Santa Creu i Sant Pau
The COVID-19 pandemic has disrupted many aspects of social behavior and medical practice. The flow of information on the different manifestations of the disease is bewildering, with more than 9,500 publications in just four months, many of them freely available.
The dermatological aspects of the disease (apart from occupational dermatitis) were revealed when dermatologists became involved in care of COVID patients, and soon cases pervaded social media.
The pandemic, which at the time of this writing has affected close to 250,000 in Spain, causing close to 26,000 deaths, struck Madrid first and then Barcelona in full force on early March. A “state of alarm” was declared in Spain on March 14. In both cities, dermatological consultations in most hospitals were shut down. All the available dermatology residents and most staff below age 60 were redeployed to COVID wards, which made up 80% of the available beds. The ICUs tripled their capacities and field hospitals were set up, including a 1500-bed facility in Madrid Exhibition Halls.
At that time, Dr. Alba Català (a dermatologist at Hospital Plató, serving a population of 135,000 in uptown Barcelona) and Dr. Cristina Galván Casas (working at Hospital Universitario de Móstoles, serving a population of 168,000 in the periphery of Madrid) were attending to COVID-19 patients full time. The two were struck by the dermatological manifestations which were starting to be noted in COVID-19 cases. Since no publications on skin symptoms in COVID-19 were available, Català and Galván Casas joined an online dermatology chat group to understand the issue better. From there, they decided to launch a survey, designing the protocol, and navigating the red tape, with the help of Dr. Gregorio Carretero (Hospital Universitario de Gran Canaria, which serves a population of 350,000).
With the support of the Spanish Academy of Dermatology and Venereology (AEDV), an amazing feat of collaboration started: in the first 2 weeks of April, 100 dermatologists working on the front line of COVID care contributed 430 documented cases of dermatological manifestations, of which 375 with confirmed or suspected COVID-19 made the cut. With the support of the Research Unit of the AEDV, a consensus was reached, and a landmark paper with a comprehensive clinical categorization of the skin manifestations of COVID was published in the British Journal of Dermatology, with an exhaustive companion atlas as an online supplement.
This is an exhilarating example of teamwork and generous collaboration of dermatologists from all ranks who worked long shifts at COVID-19 wards, switching PASI for PAFI. Busy days with varying supplies of personal protective equipment, phones in polyethylene bags, sleepless nights, and perhaps some contagion were perhaps worth the effort. Kudos and thank you.
Disclaimer: Views expressed in this commentary are those of the author and do not necessarily represent the position of the International Psoriasis Council or its Board of Directors.