The impact of COVID-19 on the practice of dermatology in sub-Saharan Africa.

Dear Editor

The COVID‐19 pandemic since its advent has resulted in economic, lifestyle and clinic practice changes. The first case of COVID‐19 in Nigeria was reported in February 2020 with institution of a lockdown 4 weeks later by the government to limit the spread of the disease (NCDC 2020). As of the 25 September 2020, there are 58 062 confirmed COVID‐19 cases in Nigeria. Consequences of the lockdown has included closure of outpatient clinics with only emergency services, postponement of routine surgeries, institution of teledermatology for nonemergent cases as in other countries. , , The most hit of dermatological services have been aesthetic practices.

In African countries, assess to dermatology services is poor. This is for several reasons; few dermatologists to serve the population, lack of insurance with patients paying out of pocket, problems of logistics as the few dermatology clinics are in the urban areas and poor assess to drugs. These problems have been compounded by the COVID‐19 pandemic. The closure of outpatient dermatology clinics during the lockdown resulted in most patients being unable to assess dermatology care.

Teledermatology which was by text messages, phone and video calls was not readily available. Most of the patients did not have smart phones and so could not conduct video calls. Poor internet access also limited teledermatology. In the few patients where teledermatology was successfully conducted, problems of clear images, poor history, issues with payment modalities bedeviled the process. Furthermore, some of the patients were elderly, unable to read and had to depend on their care givers who may not be committed in order to assess their text messages making consultation difficult.

The use of hydroxychloroquine for the treatment of COVID‐19 resulted in decreased availability and increased cost of this drug for the treatment of inflammatory diseases (lupus erythematosus, lichen planus). Aesthetic practices became abysmal due to fear of infection by both the patients and the practitioners. A further confounding problem was poor assess and availability of personal protective equipment (PPE).

As in other climes, clinical training for dermatology residents and students has temporarily been halted and teachings moved on‐line. The down side of this is no access to patients, no clinical assessment of patients, no access to dermatological procedures. This on the long run will affect clinical skills and knowledge.

With the easing of lockdown measures in the last 10 weeks, continued closure of outpatient clinics was no longer sustainable. Re‐opening of the outpatient clinic has necessitated modifications on modalities for safe dermatological consults. As routine screening for COVID‐19 is not done, all patients assessing the clinic are regarded as potential COVID‐19 positive. Clinic days have reduced from four times to once a week and the number of outpatient appointments reduced in order to ensure physical distancing. In the clinic, appropriate PPEs for the doctors (face masks, gloves, aprons, face shields). Leaving windows in consulting rooms open, hand sanitization and wiping of surfaces with bleach and alcohol‐based sanitizers after every consultation and social distancing is the new norm. Temperature checks and wearing of masks by patients all through consultations is ensured. Only one relation is allowed to accompany any patient that needs assistance. Aesthetic procedures have been limited to chemical peels only.

When this pandemic will be over is anybody's guess. We anticipate an increased incidence of contact dermatitis in health care workers as a result of increased use of hand sanitization and face masks.