Indian Dermatology Online Journal

PRACTICE RECOMMENDATIONS
Year
: 2020  |  Volume : 11  |  Issue : 3  |  Page : 343--344

Dermoscopy practice during COVID-19 pandemic: Recommendations by SIG Dermoscopy (IADVL academy)


Deepak Jakhar1, Yasmeen J Bhat2, Manas Chatterjee3, Vinay Keshavmurthy4, Balachandra S Ankad5, Abhijeet K Jha6, Puravoor Jayasree7, Sushrut Save8, Samipa S Mukherjee9, Hita Mehta10, Satish Udare11, Savitha Beergouder12,  
1 Department of Dermatology, North Delhi Municipal Corporation Medical College and Hindu Rao Hospital, New Delhi, India
2 Department of Dermatology, Venereology and Leprosy, GMC, Jammu and Kashmir, India
3 Department of Dermatology, Command Hospital (Eastern Command), Kolkata, West Bengal, India
4 Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
5 Department of Dermatology, S Nijaligappa Medical College, Bengaluru, Karnataka, India
6 Department of Skin and VD, Patna Medical College, Patna, Bihar, India
7 Medical Trust Hospital, Cochin, Kerala, Mumbai, India
8 Dr. Save's Clinic, Mumbai, India
9 Consultant Pediatric Dermatologist and Dermatologist, Department of Dermatology, Cloudine Hospitals, Bengaluru, Karnataka, India
10 Department of Dermatology, Government Medical College, Bhavnagar, Gujrat, India
11 Dr Udare Skin Clinic, Navi Mumbai, Maharashtra, India
12 Consultant Dermatologist, Anagha Skin Care Clinic, Bagalkot, Karnataka, India

Correspondence Address:
Yasmeen J Bhat
Postgraduate Department of Dermatology, Venereology and Leprosy, Government Medical College, Srinagar, Jammu and Kashmir - 190 010
India




How to cite this article:
Jakhar D, Bhat YJ, Chatterjee M, Keshavmurthy V, Ankad BS, Jha AK, Jayasree P, Save S, Mukherjee SS, Mehta H, Udare S, Beergouder S. Dermoscopy practice during COVID-19 pandemic: Recommendations by SIG Dermoscopy (IADVL academy).Indian Dermatol Online J 2020;11:343-344


How to cite this URL:
Jakhar D, Bhat YJ, Chatterjee M, Keshavmurthy V, Ankad BS, Jha AK, Jayasree P, Save S, Mukherjee SS, Mehta H, Udare S, Beergouder S. Dermoscopy practice during COVID-19 pandemic: Recommendations by SIG Dermoscopy (IADVL academy). Indian Dermatol Online J [serial online] 2020 [cited 2020 Oct 24 ];11:343-344
Available from: https://www.idoj.in/text.asp?2020/11/3/343/284093


Full Text



Coronavirus disease (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The disease originated in China in December 2019 and has now been declared pandemic by the world health organization (WHO).[1] The studies on the human-to-human and fomite-to-human transmission of SARS-CoV-2 suggest that the virus can stay on the surface of plastics, cardboard, stainless steel, copper, door handles, mobile phones, and other daily routine commodities.[2],[3] These findings are important keeping in mind that dermatologists also use certain instruments in daily clinical practice, which can potentially act as a source of nosocomial spread of COVID-19.

It is important to note that dermatology outpatient clinics are running in many countries even at these times of pandemic.[4],[5] Aggravation of previous skin diseases such as rosacea, eczema, atopic dermatitis, and neurodermatitis has been seen in Covid-19 patients.[4],[5] In addition, urticarial lesions, chicken-pox like vesicles, livedoid, and erythematous rash has also been noticed.[6] However, the most common scenario in the coming days would be asymptomatic shedders visiting dermatology clinics for a preexisting dermatosis and dermatology practice may act as a vector for COVID-19 transmission.[7] Over past few years, dermoscopy using a dermatoscope, has become one of the most frequently performed examination procedures in dermatology clinics. Existing literature suggests that a dermatoscope can act as a possible source of nosocomial spread of infections and may also act as a potential source of SARS-CoV-2.[8] Therefore it is important that we remain vigilant while performing dermoscopy. Nevertheless, it may also serve as an important investigative tool in such times when invasive procedures like skin biopsy are best avoided.

In view of COVID-19, it is only wise to avoid or postpone doing dermoscopy on COVID-19 positive cases; patients showing signs and symptoms related to COVID-19; patients with history of travel in the past 2 weeks, especially to high risk countries; patients from red zones or high risk areas; and patients with family history/close contact history of COVID-19. Dermoscopy may be better avoided wherever clinical examination is sufficient to reach a diagnosis or other modalities (with lesser risk of transmission) can be used. The importance of social distancing to minimize the transmission of COVID-19, should be kept in mind during clinical as well as dermoscopic evaluation. Wherever possible, for COVID-19 suspected patients, standardized protocol of wearing personalized protective equipments (PPE) and examination in negative pressure rooms should be followed.[9] In the coming months, after the nationwide lockdown is over, the risk of random patient with asymptomatic COVID-19 infection may still prevail, therefore we recommend certain precautions in the dermatology OPDs and clinics to be followed.

It is important to make sure that dermatoscope should be wiped with 70% isopropyl alcohol wipes for at least 1 min. The dermatologist performing dermoscopy should follow all universal precautions advised by WHO[1] and wear gloves before performing dermoscopy. Patient should be advised to wear a facemask and clean the hands (with soap and water for at least 20 s or sanitization with 60-90% isopropyl alcohol).[1]

Various methods have been described in literature to decrease the chances of nosocomial spread through a dermatoscope:

Disposable dermoscopic lens cover: provided with most dermatoscopes now-a-daysPlastic bottle cap: a disposable plastic bottle cap fitting the size of the dermatoscope may be used[10]Polyvinyl chloride (PVC) food wrap: a PVC film is placed (with or without mineral oil on both sides of it) between the dermatoscope lens and the lesion[11]Transparent adhesive tape: after placing the immersion fluid, a transparent adhesive tape is applied to assist contact dermoscopy[10]Microscopic glass slide: a glass slide can be placed over the lesion in front of the dermatoscope[8]Polyethylene tube for mucoscopy: a disposable polyethylene tube can be used with a USB dermatoscope for performing mucoscopy[12]Car phone holder for oculoscopy.[13]

The dermatologist while performing dermoscopy may use these methods. The lesion to be scoped should be cleaned with alcohol swabs (60-90% isopropyl alcohol) and alcohol-containing solutions should be used as interface medium. Noncontact dermoscopy is preferable over contact dermoscopy and use of a video dermatoscope or universal serial bus (USB) dermatoscope may be preferred over hand-held dermatoscope. Dermoscopy of mucosal lesions and oozy/fissured lesions is better avoided. The patient should be made to turn his head to the other side and adequate distance to be maintained so that there is minimal chance of spread through aerosol.

Postdermoscopy, especially in COVID-19 suspected cases, the dermatoscope and all other surfaces exposed to the patients should be cleaned with 60-90% isopropyl alcohol. It is advisable to clean the mobile phone, if used for the visualization of the images using the dermatoscope. As a paperless approach is better, a digital dermoscopy report is preferable. All materials used for dermoscopic examination should be disposed as per biomedical waste guidelines.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1World Health Organization. Critical preparedness, readiness and response actions for COVID-19-7 March 2020. Available from: https://www.who.int/publications-detail/criti cal-preparedness-readiness-and-response-actions-for-covid-19.
2Kampf G, Todt D, Pfaender S, S teinmann E. Persistence of coronaviruses on inanimate surfaces and its inactivation with biocidal agents. J Hosp Infect 2020;104:246-51.
3Van Doremalen N, Bushmaker T, Morris DH, Hoolbrook GM, Gamble A, Williamson NB, et al. Aerosol and surface stability of SARS-CoV-2 as compared with SARS-CoV-1. N Engl J Med 2020;382:1564-7.
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8Mun JH, Park SM, Ko HC, Kim BS, Kim MB. Prevention of possible cross-infection among patients by dermoscopy: Abrief review of the literature and our suggestion. Dermatol Pract Concept 2013;3:33-4.
9Chen X, Tian J, Li G, Li G. Initiation of a new infection control system for the COVID-19 outbreak. Lancet Infect Dis2020;20:397-8.
10Kaliyadan F, Jayshree P. Preventing cross-infection during polarized dermoscopy using hand held dermatoscope. Indian Dermatol Online J 2020;11:282-3.
11Zampino MR, Borghi A, Caselli E, Galvan M, Corraza M, Cassai E, et al. Virologic safety of polyvinyl chloride film in dermoscopic analysis of mucosal areas. Arch Dermatol 2007;143:945-6.
12Jakhar D, Grover C. Innovative modification of the USB dermatoscope for mucoscopy. J Am Acad Dermatol 2018;78:e3-4.
13Jakhar D, Grover C. Using a car phone holder for performing oculoscopy with auniversal serial bus dermatoscope. J Am Acad Dermatol 2019;80:e1-2.