Added March 19, 2021

CDA recommendations regarding COVID-19 Vaccines side effects with Hyaluronic Acid Dermal Filler Use

The CDA has released its recommendations regarding COVID-19 Vaccines side effects with Hyaluronic Acid Dermal Filler Use*

*Based on information available as of 11 March 2021

Added January 20, 2021

CDA Position Statement: SC2 / SARS-2 / SARS-Cov-2 (SC2) vaccination of patients on systemic therapies

As an important issue our members are facing, the CDA has now released its position on SC2 / SARS-2 / SARS-Cov-2 (SC2) vaccination of patients on systemic therapies.

Added June 19, 2020

NOW AVAILABLE!: The international COVID atopic dermatitis registry, AD-SECURE.

The patient-facing site is now open for patients to submit their own information. Check out the links below:

AD patients survey page: https://www.secure-derm.com/secure-pad/
AD patients FAQ-page: https://www.secure-derm.com/secure-pad-faq/

Added June 4, 2020

The ‘New Normal” For Patients

Some patients may have already seen a dermatologist for medically necessary reasons since the COVID-19 pandemic began, but if not, you may be offered an in-person appointment with your dermatologist in the coming weeks and months as Public Health officials slowly ease restrictions on health care. You will no doubt notice a number of things are different than you last saw a dermatologist in person.

You can likely expect that some or all of the following changes have been instituted to help keep you safe:

• You will be screened for symptoms of COVID-19 (this may occur at multiple times during the process including at time of booking, time of appointment reminder and/or time you come to the office)
  • You will likely be asked to reschedule if you do have any of these symptoms
• You will notice that there are measures in place in the office to ensure that people maintain social distancing (there may be less waiting room chairs, there may be markings on the floor for where to stand and there may be a barrier in place by the administrative assistants)
• You will likely not see any magazines, papers or samples in the office
• You may be asked to remain in your vehicle until the dermatologist is ready to see you to decrease the number of people in the waiting room
• The medical team may ask you some of the history questions over the phone before seeing you in person
• You may be asked to come alone or to only bring one support person if necessary
• You may be asked to wear a mask for your appointment
• You will notice that the dermatologist may be wearing a mask/face shield/goggles for the visit
• Your dermatologist may suggest that doors remain slightly opened to decrease high-touch surfaces that can spread the virus

Every dermatologist’s office may have slightly different protocols to keep you safe, but be sure to ask questions if you want to know more about their individual plans.

Updated May 7, 2020

“COVID TOES” & Other Skin Changes of COVID-19

There have been many reports that the COVID-19 virus can have effects on the skin. The first official reports came out of Italy and were published in March 2020 that about 20% of patients with COVID-19 were experiencing skin issues.

The skin changes related to COVID-19 can look many different ways, and we are learning more about this almost on a daily basis.

There have been reports of the following skin changes with COVID-19:

• “Covid toes” (or covid hands) – similar to the type of cold related changes we have seen in the feet of people for many years, but often occurring in places where the conditions are not cold and damp. These seem to happen more commonly in younger patients.
• Rash with our without small blisters
• Widespread hives (urticaria)
• Small bruises and broken blood vessels (petechiae)

Although these skin findings are not currently listed as symptoms to look out for that should make you consider getting tested for COVID-19, you may want to add them to your list of things to look out for.

As time goes on, we will likely have more information about why these skin changes happen with COVID-19 and when in the timing of exposure to the virus do they seem to occur.

Updated May 7, 2020

How to get the most of your virtual appointment with your dermatologist
Practical Tips for Patients

To keep you safe, most medical offices are limiting in-person visits to emergencies only during the current COVID-19 pandemic.

Your doctor may offer you the option of a “virtual” or telemedicine appointment. This may mean a direct internet video connection (for example, Zoom Telehealth) or a telephone consultation (which could include sending photos via the internet). Some skin conditions or problems don’t work well in these formats in which case your appointment may need to be at a later date when public health officials have deemed it safe for you to be seen in person.

How is a virtual appointment different?

• Some parts of a virtual visit can be similar – taking your medical history.
• Some parts will be limited – for example, it would be challenging to do a full skin check on a virtual platform.
• The dermatologist can only “see” what they are shown on the camera or photo and the assessment is limited by the quality of the video image/photo.
• Dermatologists are not able to use their special examination tools during virtual visits or to perform additional diagnostic tests (e.g. swabs, scrapings, Woods lamp, biopsies).

How can I prepare to have a virtual appointment?

• If you need to send photographs, ensure there is enough time for the physician to receive them before your scheduled visit and take multiple photos.
• In general photos tend to come out better if you are able to have someone who you live with to take your photos for you, rather than holding your camera yourself.
• If you are using a video platform that needs you to sign up, try to set this up before the visit to make sure it works on your computer/tablet/smartphone.
• Try to be a private and quiet place for the visit that has good lighting.
• Have a list of your current medicines, allergies and medical or surgical conditions. Ask if your doctor wants you to send this information in advance.
• Remember that your dermatologist will typically give you an allotted time for your virtual appointment and will have to manage their time effectively in order to have the ability to provide services to all those that need them

What if I prefer not to have a virtual appointment?

• You are not required to do a virtual visit – if you would prefer to wait until the dermatologist is able to see you in-person safely it will not affect your care in any way.
• If you feel that your problem is very urgent please communicate this in advance to the office, and they will help determine how to best proceed.

After your virtual visit, your dermatologist may decide that they need to see you in-person in the office and will arrange for that as needed.

Updated April 2, 2020

Hand Care Recommendations

You will hear over and over again the importance of hand hygiene related to COVID-19. The Canadian Dermatology Association completely supports the message to practice excellent hand hygiene which either means washing your hands or using waterless hand cleansers regularly.

Make sure you:

• Wet hands with warm water
• Apply soap
• For at least 20 seconds, make sure to wash:
  • Palm and back of each hand
  • Between fingers
  • Thumbs
  • Under nails
  • Rinse well
• Dry hands well with paper towel

You may also already struggle with dryness or cracking of your hands and are concerned that frequent washing will make it worse. Alternatively, you may only now be experiencing problems with dry or chapped hands due to the frequent hand cleansing.

The key message is to NOT stop washing your hands. We instead recommend ways to minimize more irritation and treat symptoms. You can also:

1. Use gloves for other wet work (for example, washing dishes and while cleaning)
2. Use hand cream following hand hygiene and we recommend options that are emollient (thicker) and fragrance-free
3. Consider wearing cotton gloves at night over top of your moisturizer
4. If these measures do not keep your skin under control, speak to your physician/dermatologist about other options.

Updated March 27, 2020

COVID-19 & Systemics

You may be on a medication your dermatologist has prescribed that has an effect on your immune system and wonder what that means for COVID-19.

If you are currently taking one of these medications and do NOT display signs or symptoms of COVID and have not tested positive:

BIOLOGICS FOR PSORIASIS
At present, there is no evidence that you would be at more risk while taking a biologic medication, and thus we would not recommend that you stop your medication without discussing with your board certified dermatologist. From clinical trial data, it would appear that medications that these medications do not significantly increase the risk of viral and respiratory infections.

BIOLOGICS FOR ECZEMA
Dupilumab is a medication for atopic dermatitis and has not been shown to increase the risk of viral or respiratory infections.

BIOLOGICS FOR HIVES
Medications like Omalizumab do not suppress the immune system and would not increase the risk for viral or respiratory infections.

OTHER BIOLOGICS
Rituximab is a medication that does suppress a part of the immune system and you should speak with your certified dermatologist if you are supposed to receive this medication.

OTHER SYSTEMICS
Apremilast is a medication that has not been shown to increase risk of infections.

Thalidomide also does not appear to increase the risk of infections.

Methotrexate is a medication that has different effects at different doses and for the doses typically used in psoriasis is unlikely to increase the risk of viral infections.

Other medications like systemic steroids (prednisone), azathioprine and cyclosporine do suppress the immune system, but the risks versus the benefits of these treatments should be discussed with your dermatologist. 

If you are on one of these medications and test POSITIVE for COVID-19 you should discuss the need to discontinue or hold your medication with your dermatologist.

This is a new virus and therefore we do not have firm evidence for our recommendations but will continue to monitor the situation closely and update as needed.

It is important to note that other medications your dermatologist may have given you (for example, isotretinoin, acitretin) would not have any impact on the risk of viral infection and do not suppress your immune system.

Some Basic Advice to keep you safe with COVID-19: Do the “5”

WASH YOUR HANDS

• wet hands with warm water
• Apply soap
• For at least 20 seconds, make sure to wash:
  • Palm and back of each hand
  • Between fingers
  • Thumbs
  • Under nails
  • Rinse well
• Dry hands well with paper towel

COUGH ETIQUETTE

• Cough into your elbow

DON’T TOUCH YOUR FACE

STAY APART (at least 2m)

• Do your part and practice social distancing

STAY HOME

• If you have travelled or feel sick
• Also stay home unless you must go out

Updated April 2, 2020

Resources

Centers for Disease Control and Prevention

Handwashing and Hand Sanitizer Use