Surge in calls to Irish Skin Foundation's 'Ask a nurse' helpline during the COVID‐19 pandemic

Dear Editor,

The Irish Skin Foundation (ISF) is a national Irish charity dedicated to improving the quality of life for people living with skin conditions. The ISF offers a unique ‘Ask a Nurse’ helpline service delivered by Dermatology Clinical Nurse Specialists, all of whom work in clinical practice in hospital dermatology units in Ireland, and are up to date with best practice/current treatments. The ISF ‘Ask a nurse’ helpline has provided a valuable service (as evidenced by the 97% user satisfaction rating since the service was set up in 2016) in addressing the concerns of callers and supporting patients, and even more so during the COVID‐19 pandemic. Since the imposition of the initial lockdown and public health restrictions in Ireland in March 2020, we noticed a spike in the number of people contacting the ISF for assistance.

Comparing the first 12 weeks of lockdown to the same 12‐week period in 2019, the helpline recorded a 66% increase in the volume of calls. We attribute this increased activity to the fact that most general practitioners (GPs) were not conducting face‐to‐face consultations, and some dermatology staff in secondary care were redeployed, thus reducing dermatology services and leading to the cancellation of dermatology outpatient appointments. However, the helpline continued operating through lockdown, with increased calls relating to undiagnosed skin conditions, provision of outpatient services and cutaneous presentations of COVID.

The calls received were varied, with 33% of calls being directly related to COVID‐19 concerns. Users sought guidance regarding safety of immunosuppressant medication and COVID‐19, risks associated with autoimmune disease and COVID‐19, and the presence of possible COVID‐19 rashes. Other worries related to hand dermatitis, access to services and management of skin flares due to cancelled treatments during lockdown.

Interestingly, we had a 221% increase in the number of people contacting us who did not have a diagnosis, because although many were anxious that their rash could be linked with COVID‐19, they were also reluctant to visit GP surgeries for fear of exposure to COVID‐19. For those callers with a diagnosis, there was a 61.5% increase in queries relating to dermatitis/eczema, compared with the same time period in 2019. The most common cause for concern was hand dermatitis, attributed to the increased hand hygiene measures; consequently, managing and preventing hand dermatitis was a common query. There was a 22% increase in queries regarding psoriasis compared with the same time period in the previous year, and a 20% increase related to hidradenitis suppurativa. These queries reflected a range of concerns, including possible risks associated with immunosuppressant medication, increased COVID‐19 risk associated with underlying conditions, skin flaring due to stress about COVID‐19, cocooning (shielding), how to manage psoriasis flares due to cancelled phototherapy, and reduced access to a dermatologist or GP. An increase of 175% in queries to the helpline was registered related to acne, and a 43% increase in enquiries regarding sun protection and moles. We could not explain these increases Taking the year 2020 as a whole, we experienced a 55% increase in queries compared to 2019.

The ISF continues to support those people living with skin conditions that contact the service during COVID‐19. The increased use highlights the utility of this service in bridging the unavoidable gaps that emerged during the pandemic. The helpline data highlight the importance of having a reliable source of information for dermatology patients when other services are unavailable.