Dear editor,

Since December 2019, a new coronavirus (COVID-19) was recognized as a cause of pneumonia and death in Wuhan, China. It has become the most serious medical crisis that occurs in the human society in the twenty-first century. In few weeks after China, Japan, South Korea, Iran and Italy were severely affected. The recent virus quickly becomes a worldwide health challenge due to rapid human to human transmission. Contact transmission and respiratory droplets are two main routs of COVID-19 spread and physical distancing is considered an effective measure to disrupt the chain of transmission (1).

After the first case announcement by Ministry of Health and Education in Iran, measures were taken by the referral center of Dermatology, Razi Hospital, Tehran, including closure of non-emergent clinics and canceling the elective and cosmetic surgeries. During the outbreak progression, some dermatologists have temporarily closed their private clinics to reduce the risk of transmission. However, strategies were taken for delivering limited care in special and emergency situations. From the very first days of infection in Iran, outpatient 24 h urgent consultations were provided by Razi hospital exclusively for patients with complicated skin problems, skin rash due to COVID-19, and drug reactions, by ensuring self-protection for health workers and triage of patients before dermatology consultation by monitoring the body temperature and getting history of fever and respiratory symptoms. If the high body temperature was detected, the patient was referred to the infectious clinic for further evaluation. Moreover, faculty members and residents pf dermatology, voluntarily relocated for visiting patients infected by COVID-19 in assigned hospitals for coronavirus management (2).

The out-patients clinics reduced from 9 to 3 clinics and visited about 300 patients daily (form nearly 1500 visit each day). Laser clinic was completely closed and some other clinics like tumor, alopecia areata, psoriasis, and pemphigus, were joined to general clinics with limited number of patients. Patients with scheduled appointment for cosmetic procedures, were contacted by cell phone and the appointments have postponed (2,3). The waiting room designed carefully to isolate patients from each other. All the equipment and surfaces that have contact with patients, sterilized immediately after the visit and procedure. All staffs were checked routinely at the beginning and end of daily work and our infectious disease specialist was in access to evaluate the staff for any hidden or proved COVID-19 infection. The dermatology residents, attending, and hospital staff in direct contact with patients wore protective clothes and gloves, protective mask, and face shield or protective glasses. It was recommended for patients to wear protective masks and clean their hands with water and soap or by hand rub products in the entry part of the surgery rooms for the emergency procedures.

During pandemic, teledermatology as a precious rout of consultation without the risk of infection, provides an opportunity for not only dermatology patients’ management, but also for education purpose for undergraduate and postgraduate students (4). Dermatology residents made calls to patients with critical skin disease and whom were candidate for inpatient biologic injection to change and postpone the already planned treatment. All the attending professors were actually on-call and dermatology residents took their opinion for the patients plan considering the risk of infection and severity of dermatology problems. For any unexpected situation and questions a 24 h responsive phone number and e-mail address were assigned, respectively.

In the context of COVID-19, a clinic for infectious and respiratory disease was established to handle suspected cases of COVID-19 in an attempt to have a role in fight against the pandemic. An infectious disease specialist and a dermatology resident were active in this clinic. Dermatology residents were trained how to approach the patients with suspicious presentations due to developed protocols. All patients with COVID-19 high suspicion were referred to special corona centers in the city. Patients with mild disease were educated how to manage the disease in their home. Moreover, an isolated inpatient ward was set in the case of need for hospitalization of COVID-19 positive Dermatology patients during the emergency. Psychologic training materials were prepared by psychiatrist of the hospital, and the clinic was active for psychologic consultation for the staff and patients.

The faculty members and residents of dermatology were actively involved in giving consultation to the health staffs of other hospitals in case of cutaneous difficulties due to protective instruments and hand dermatitis of frequent hand washing. Multidisciplinary consultations for admitted patients in other hospitals were provided firstly by sending pictures and onsite visit in case of unclear diagnosis distantly (5,6).

Information about COVID-19 pandemics protocols were provided in WhatsApp groups for faculty members and residents. This social media was a good platform for sharing the experiences, news, asking questions about complicated patients, and even minor conferences for educational purposes. The education of dermatology residents and undergraduate students was continued during pandemic by the facilities available for distance learning such as journal clubs, CPC, case presentation, and dermatology procedures using online platforms, as the traineeship of dermatology for medical students was suspended and the number of dermatology residents and attending reduced significantly to ensure reducing the risk of contamination. We used a virtual platform provided from Virtual faculty of TUMS, for uploading PowerPoints with voice recorded on them for dermatology students. Activities and examinations were also provided in this platform.

Some research proposals were designed and accepted for evaluating the dermatologic patients in COVID-19 pandemics, using remote tools. Some scientific papers were accepted for publication affiliated to our hospital, which were about the best approach for different dermatologic diseases and also dermatologic procedure considerations in this pandemic (7–10).

Strategies by reducing office based services and increasing the teledermatology facilities is a precious potential to provide effective dermatology services without endangering health staff and society. This can keep dermatology patients away from the emergency clinics that the risk of COVID-19 transmission is high.