ABSTRACT
The COVID-19 pandemic has influenced the way patch testing is carried out at our tertiary centre. From July 2020 we introduced 'semi-virtual patch testing', where suitable patients remove patches at home on day 2 (D2) and take photos, which were reviewed during the D4 face-to-face appointment. Our aim was to assess the continued efficacy and practicality of this service, as well as the photo quality, patient satisfaction and environmental impact of the changes. Data were collected from patients attending patch testing at the Bristol Royal Infirmary from August to December 2021. Patients/carers were asked at their D4 clinic appointment to complete a pre-prepared questionnaire, with their consent, regarding their patch test experience. A clinician (consultant or clinical fellow) concurrently filled out a questionnaire on image quality. These data were collated with data obtained via telephone questionnaires (July-November 2020). Data were available for 181 patients (age range 0-89 years, 74.8% female and 25.2% male). Ninety-seven per cent (n = 135/139) were happy to have patch testing during the pandemic. Ninety-three per cent (n = 130/140) removed their patches at home on D2. Only 3.9% (n = 5/129) would have preferred to attend hospital. Information was provided by multiple sources: verbally by a nurse (95.2%), a doctor (60.7%), a written information sheet (88.1%) and a video (29.8%). Almost all patients (n = 127/ 136) felt confident/fairly confident removing the patches at home, and 85.0% (n = 108/127) reported it saved > 1 h. Seventy-four per cent (n = 95/129) would have had to take time off work/caring commitments to attend. Almost all patients (n = 131/135) reported that their overall experience was good or very good. Seventy per cent (n = 59/84) of patients travelled independently to their appointment, and 79.8% (n = 67/84) came by car/taxi. The mean mileage (one way) to attend the appointment was 13.3 (range 0.2-46.5;n = 98). Ninety-seven percent (n = 89/92) used a smartphone device for D2 photos. The overall presentation of the D2 reading was clear in 91.2% (n = 83/91), adequate in 6.6% (n = 6/91) and inadequate in 2.2% (n = 2/91). Image focus and colour exposure was good/adequate in 97.8% (n = 90/92) and 97.2% (n = 70/72), respectively. Virtual reading negatively affected the final interpretation of the patch test in 2.2% (n = 2/89) of patients and 9.4% (n = 16/170) would have had additional tests added on D2 if they had attended, the results of which were followed-up virtually. Our review of semi-virtual patch testing in our centre demonstrates this method as being an excellent option for most patients, with very limited adverse clinical impact. There were high levels of patient satisfaction, a reduced need for time away from work/home and a reduction in travel required. The vast majority of patients can competently remove their patch tests and produce high-quality images with good focus and colour exposure, mostly using smartphone technology.
ABSTRACT
A 21-year-old woman was admitted with a 3-day history of severe vulval ulceration, oedema and pain. On examination she had large deep necrotic-appearing kissing ulcers on the right and left inner labia minora, with overlying grey eschar and significant surrounding inflammation. The pain was described as agonizing, requiring opioid analgesia and catheterization for micturition. Three weeks prior, she had tested positive for SARS-CoV-2, having had mild symptoms, but her PCR was negative on admission. She had not been sexually active for several months due to dyspareunia. She was initially started on co-amoxiclav and acyclovir due to a raised C-reactive protein of 94, and white cell count of 11. Investigations were negative for Epstein-Barr virus (EBV), HIV and mycoplasma. Bacterial and viral skin swabs were negative. Biopsies were taken under general anaesthesia. Histology revealed ulceration and granulation tissue only. Bacterial and atypical mycobacterial cultures were negative. She was discharged when the ulcers had stabilized and pain was controlled. Follow-up 2 weeks later revealed full healing of the ulceration. Therefore, this is a case of reactive nonsexually acquired acute genital ulceration (AGU), also known as Lipsh€utz ulceration (Sadoghi B, Stary G, Wolf P et al. Ulcus vulvae acutum Lipsch€utz: a systematic literature review and a diagnostic and therapeutic algorithm. J Eur Acad Dermatol Venereol 2020;34 1432-9), which is likely to have developed secondary to COVID -19 in this patient. This rare form of vulval ulceration has been previously linked to infections including EBV, cytomegalovirus and mycoplasma. There have been three case reports of AGU linked to COVID -19 (Krapf JM, Casey RK, Goldstein AT. Reactive non-sexually related acute genital ulcers associated with COVID-19. BMJ Case Rep 2021;14: e242653). This is a rare and dramatic presentation that needs to be recognized by the dermatologist to aid timely diagnosis and treatment.
ABSTRACT
Background: The COVID-19 pandemic has contributed to changes in NHS services. From July 2020 we introduced semi-virtual patch testing, where suitable patients remove patches at home on day 2 (D2) and take photos, which are reviewed during the D4 face to face appointment. Objectives: Our aim was to assess the continued efficacy and practicality of this service, as well as the photo quality, patient satisfaction and environmental impact. Methods: Questionnaire data were collected from 181 patients/ carers attending their patch testing from July 2020 -December 2021. A clinician (consultant/ clinical fellow) concurrently completed a questionnaire on photo quality. Results: Data were available for 181 patients aged 0-89, 74.8% were females and 25.2% were male. 92.9% (130/140) removed patches at home on D2. Only 3.9% (5/129) would have preferred to attend hospital. Almost all patients (127/136) felt fairly confident/ confident removing the patches at home and reported good overall experience (131/135). 85.0% (108/127) reported saving >1 hour. 73.6% (95/129) would have had to take time off work/ caring commitments to attend on D2. 79.8% (67/84) came by car/ taxi. The mean one-way mileage was 13.3 (range 0.2-46.5). 96.7% (89/92) used a smart phone device for D2 photos. Overall presentation of the D2 reading was clear/ adequate in 97.8% (89/91). Conclusions: This method is an excellent option for most patients. There were high levels of patient satisfaction, reduced travel, and reduced work absence. Most patients can produce high quality images with good focus and colour exposure via smart phones.