Indian Journal of Dermatology
: 2021  |  Volume : 66  |  Issue : 3  |  Page : 324--325

Keep in touch; Improve the Outcome of Patients during COVID-19 pandemic

Shilpa Jithendran, Betsy Ambooken, Kidangazhiathmana Ajithkumar, Neelakandhan Asokan 
 From the Department of Dermatology and Venereology, Government Medical College, Thrissur, Kerala, India

Correspondence Address:
Neelakandhan Asokan
From the Department of Dermatology and Venereology, Government Medical College, Thrissur, Kerala

How to cite this article:
Jithendran S, Ambooken B, Ajithkumar K, Asokan N. Keep in touch; Improve the Outcome of Patients during COVID-19 pandemic.Indian J Dermatol 2021;66:324-325

How to cite this URL:
Jithendran S, Ambooken B, Ajithkumar K, Asokan N. Keep in touch; Improve the Outcome of Patients during COVID-19 pandemic. Indian J Dermatol [serial online] 2021 [cited 2022 May 25 ];66:324-325
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The unexpected emergence of the COVID-19 pandemic imposed a huge strain on the healthcare sector, worldwide.[1],[2] Imposition of lockdown and suspension of public transport in several countries reduced access to health care facilities. Re-visits and medication refills became difficult for many patients with chronic noncommunicable diseases, including autoimmune vesiculobullous diseases. Such a situation can be dangerous in pemphigus vulgaris, in which risk of relapse on discontinuation of treatment is estimated to be 44%.[3]

Our institution, a tertiary care teaching hospital in Kerala, conducts a vesiculobullous disease clinic, once a week, for streamlining the care of such patients. We have been doing a study from January 2020 to estimate the adherence to treatment of patients attending this clinic, with the approval of institutional review board. Once the lockdown was clamped in Kerala from 24th March 2020, the attendance in outpatient department dropped sharply. Fearing that it could lead to irregular therapy and increased chance of relapse, we started to contact as many patients as possible over telephone, enquired about availability of medicines and provided them with necessary instructions to continue treatment without break.

There were 59 patients on regular follow up during the two months preceding the lockdown (21st January to 17th March 2020) and due for next visit between 24th March to 14th April [Table 1]. We assessed their rate of adherence to treatment during the week from 15th to 21st April 2020. Twelve (20.34%) among them could attend our clinic during the lockdown period on their appointed date. They included a patient whose treatment regimen included corticosteroids and azathioprine. She could not get azathioprine from the local hospital or pharmacy and came to our clinic with relapse of pemphigus and was hospitalized. Among the 47 patients who had to miss the scheduled follow up visit, we could speak to 35 persons (pemphigus vulgaris = 31, pemphigus foliaceous = 1, bullous pemphigoid = 3) over the telephone. One patient who missed the drugs reported increased activity (new lesions, extension of existing lesions) of disease. We could make the drugs available at her home through the district health system and control the relapse. All others (n = 34; 97.14%) got their regular medications, including systemic corticosteroids and azathioprine, from the nearby medical store or hospital. In all, we could ensure that appropriate treatment was available to 47 (79.66%) of our patients—including 12 persons who came on their own to the clinic and 35 persons whom we could talk over telephone. We could prevent or control relapse in all, except one patient.{Table 1}

Our experience shows that keeping in touch with patients during COVID-19 pandemic and lockdown period can prevent bad outcomes to a large extent. The generally higher educational level and health care seeking behavior of the people of Kerala could have contributed to a better adherence in our study. With improved guidelines, telemedicine would help to keep in touch with patients with chronic illnesses more effectively. This would make the renewal of prescriptions easier and safer for both the patients and doctors.

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Conflicts of interest

There are no conflicts of interest.


1Legido-Quigley H, Asgari N, Teo YY, Leung GM, Oshitani H, Fukuda K, et al. Are high-performing health systems resilient against the COVID-19 epidemic? Lancet. 2020;395:848-50.
2Rukmini S. How covid-19 response disrupted health services in rural India [Internet] Available from: [Last accessed on 2020 May 27].
3Balighi K, Taheri A, Mansoori P, Chams C. Value of direct immunofluorescence in predicting remission in pemphigus vulgaris. Int J Dermatol 2006;45:1308-11.