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Dermatology and coronavirus: frequently asked questions

Information for patients

Dermatology

Please see some answers to common questions we have received during the coronavirus (COVID-19) pandemic.

  • I have been referred to the service but I have not heard anything

    We have received your referral and are currently scheduling patients based on the date we received the referral or clinical urgency. You will be on our waiting list and we will be in touch with you in due course. Please contact the doctor who referred you to us if you need any treatment or advice whilst waiting for your appointment.

  • I have an appointment soon and have not heard if I need to come to the hospital

    We are attempting to contact all patients in advance of your appointment. If you haven't heard from us and your appointment is less than three days away, please contact us as detailed on our dermatology page.

    Many of our appointments are by telephone rather than face-to-face, you will be advised how your appointment will take place before the appointment date.

  • I normally have my blood tests at my review appointment. How will this be done if it is a telephone/video appointment?

    Many outpatient services are arranging for patients to be reviewed by telephone or online. Review and frequency of routine blood tests may become less often during this time but we have made arrangements for easy access to bloods tests in our two hospitals daily, or we will ask your GP by letter if they can arrange the tests for you.

  • How will I get my medicine if I have a telephone/video appointment?

    Patients on biologics or subcutaneous methotrexate will continue to receive their medicine via homecare delivery companies. We are not aware of any current stock or delivery issues. It takes two to three weeks for delivery following your appointment, so please inform us in advance if you will run out of medicine.

    Each service and GP practice will make its own arrangements for arranging repeat prescriptions of other medicines. 'Hospital only' medicines, such as isotretinoin, will either need to be collected or, in some circumstances, can be posted to patients.

  • I have been asked to come to the hospital for a face-to-face appointment and am worried about catching coronavirus (COVID-19). Is it safe to come?

    The number of people coming to the hospital for face-to-face appointments is low. This is to avoid the hospital becoming too busy. We have security teams managing the hospital entrances. Everyone entering the hospital is required to use supplied hand gel on arrival. 

    We are keeping the number of patients in the clinic low to allow social distancing in waiting areas. You are asked to come into the hospital alone unless there is a very good reason to be accompanied.

    We ask you come to your appointment no earlier than 15 minutes before the scheduled time. We will try to undertake all the investigations required at your visit in our clinic area where possible, reducing the need for you to move around the hospital

  • I am worried that I might have coronavirus (COVID-19)

    Please use NHS 111 online or call NHS 111 for advice.

  • Can I and/or my family get tested for coronavirus (COVID-19)?

    If you think you may currently have coronavirus (COVID-19), you can be tested to confirm this. The NHS website has further advice on how to arrange this.

  • I am on medication prescribed by your team and I am not sure if I should stop them

    Do not stop any medication unless specifically told to do so by your clinical team.

  • I have symptoms that I am worried about

    If the symptoms are related to the condition for which we are seeing you for and you need specific clinical advice from our team please contact us as detailed on our dermatology page.

  • My medication is running out and I need a prescription

    If the medication is usually prescribed by your GP, contact the surgery. If we usually prescribe your medication, please contact us as detailed on our dermatology page (please use email unless your request is urgent). 

 Immunosuppressants and medication

  • I am on a medicine for my skin problem: what should I do?

    If you are taking a medicine that targets your immune system, coronavirus (COVID-19) may pose a higher risk to you and therefore specific measures are advised.

  • What are the specific measures?

    There are two categories of measures: shielding and very careful social distancing.

  • Shielding for extremely vulnerable people

    Shielding is a measure to protect people who are at very high risk of severe illness from coronavirus (COVID-19) by minimising all face-to-face interaction between those who are extremely vulnerable and others. Shielding is a step up from very careful social distancing.

    Read the shielding guidance on the GOV.UK website.

  • Which category applies to me if I’m on a systemic immunosuppressant (tablet or injection) medicine for my skin condition?

    This depends on the medicine (s) you are taking, your age and what other medical problems you have. You will be advised by your doctors prescribing your
    drug whether you are an 'extremely vulnerable' person needing to shield. Assess your risk using our calculator.

  • I’ve received a letter from Public Health England (or my specialist
    team) giving me a risk categorisation which I don’t think is correct –
    how can I check this?

    If you think there may be an error and you do not meet the criteria for the risk level you've been allocated, you can do two things:

    1. use table two in these FAQs to assess your risk
    2. contact your specialist team for further discussion and confirmation.
  • I have been told to shield but I am a key worker – what should I do?

    Shielding is for your personal protection and it is strongly advised. You should not feel pressured to continue working if your job means you are coming into contact with people. For some people working from home may be an option, so discuss with your employer.

    Read the shielding guidance on the GOV.UK website.

  • How can I get help if I am shielding?

    If you are in the 'extremely vulnerable' group and are required to 'shield' you will be able to ask for help getting deliveries of essential supplies like food and medicine. In England you can register for this help on the gov.uk website. There is separate advice for Northern Ireland, Scotland and Wales.

  • The medicine I’m on is not listed in table 1 – do I need to do anything?

    Unless you also have another medical condition that makes you more vulnerable, you do not need to undertake any more stringent social distancing measures than the general population, provided you are not taking immunosuppressant and biologic medicines. The following medicines are used to treat dermatological conditions but they are not immunosuppressant medicines: hydroxychloroquine, acitretin (neotigason), alitretinoin (toctino), isotretinoin, dapsone, chloroquine, 5-ASA medications (e.g. mesalazine), sulphasalazine, antibiotics, topical skin treatments (e.g. steroid creams), inhaled or rectal administered medicines e.g. steroid inhalers.

  • Should I stop my medicine?

    We do not advise you stop your medicine without prior discussion with your specialist doctor. Stopping your treatment could worsen your skin condition resulting in need for hospital treatment.

  • Can I stop my medicine if I want to?

    If you feel strongly that you no longer want to take your prescribed treatment we recommend you discuss this option with your specialist doctor to consider the risk of stopping and discuss alternative treatments options.

  • Can I administer my medicine if I am self-isolating because I have symptoms of coronavirus (COVID-19) or a member of my household has symptoms for (COVID-19)?

    People self-isolating for two weeks should not administer any doses of biologics/immunosuppressant during this period until it is clear you are well. The exception to this is if you are taking corticosteroids (prednisolone or hydrocortisone tablets) as this should not be stopped abruptly.

  • I've been advised I'm 'moderate risk' for coronavirus (COVID-19) infection and should be undertaking very careful social distancing. Can I return to work?

    There is no single answer to this, it depends on the type of work you do and your personal circumstances. For example, can you maintain reasonable social distancing whilst working? We recommend you discuss with your employer and/or occupational health department.

    Read the advice on working safely during coronavirus (COVID-19) on the GOV.UK website.

  • I am in the 'extremely vulnerable' group (shielding) and would like to know what to do about returning to work?

    You should make every effort to work from home and your employer is expected to help you to do this.

    Read the shielding guidance on the GOV.UK website.

  • I am in the 'extremely vulnerable' group (shielding). Is it safe for me if my child returns to school?

    If a child/young person lives in a household with someone who is extremely clinically vulnerable, as set out in the Government's guidance on shielding, it is advised they only attend an education or childcare setting if stringent social distancing can be met and, in the case of children, if they are able to understand and follow those instructions.

    This may not be possible for very young children and older children who are unable to understand the instructions on social distancing. If stringent social distancing cannot be met, children should not attend and they should be supported to learn at home.

    Read the guidance on implementing protective measures in education and childcare settings on the GOV.UK website.

 

 

Table 1: Immunosuppressant and biologic medicines prescribed for people with dermatological conditions

Immunosuppressive medicines / Small molecule immunosuppressive (tablets or injection)

Brand names 

Biologic medicines 

Brand names 

 Methotrexate*

 

Etanercept 

Enbrel, Benepali,
Erelzi

 Azathioprine*

 

Adalimumab

Humira, Amgevita,
Hulio, Hyrimoz, Imraldi

 Mycophenolate mofetil
or mycophenolic acid*

 

Infliximab

Remicade, Remsima,
Flixabi, Inflectra, Zessly

 Ciclosporin*

 

Golimumab

Simponi

 Fumaric acid esters

Skilarence, Fumaderm

Certolizumab

 Cimzia

 Hydroxycarbamide*

 

Secukinumab

Cosentyx

 6 mercaptourine*

 

Ixekizumab

Taltz

 Leflunomide*

 

Brodalumab

Kyntheum

 Cyclophosphamide*

 

Ustekinumab

Stelara

 Tacrolimus* (tablet only, not ointment)

 

Guselkumab

Tremfya

 Sirolimus

Rapamune

Tildrakizumab

Illumetri

 Apremilast

Otezla

Risankizumab

Skyrizi

 Baricitinib

Olumiant

Rituximab (in last 12
months)

Mabthera, Truxima,
Rixathon

 Tofacitinib

Xeljanz

Belimumab

Benlysta

Thalidomide

     

 

 

Sarilumab

Kevzara

 

 

Tocilzumab

RoActemra

 

 

Abatacept

Orencia

 

 

Canakinumab

Ilaris

 

 

Anakinra

Kineret

 

 

Dupilumab

Dupixent

 * For these medicines there are multiple branded and generic products available.

More information about my risk from COVID-19 and my medicines

Very careful social distancing for vulnerable people (moderate risk)

If you have no other significant medical problem and are taking:

  • only one immunosuppressive or biologic medicine or
  • a biologic combined with methotrexate, hydroxychloroquine or sulphasalazine

you will fall into the category of moderate risk and should take social distancing measures very carefully.

Shielding for extremely vulnerable people (high risk)

Some people with dermatological conditions will be categorised as extremely vulnerable and should adopt the requirements of not leaving home for 12 weeks. People in this category include:

  • Dermatology patients who are taking two or more immunosuppressive or biologic medicines for their condition (except the combination of a biologic with methotrexate, hydroxychloroquine or sulphasalazine)
  • People on a systemic corticosteroid (called prednisolone if taken orally) of 20mgs or more each day for more than 4 weeks
  • People who take a corticosteroid dose of more than 5mg (or prednisolone equivalent e.g. hydrocortisone tablets) each day for more than 4 weeks plus at least one other immunosuppressive or biologic medication
  • People who take cyclophosphamide (not to be confused with ciclosporin, which is a different medicine), rituximab or infliximab for their skin condition
  • Also people on a single immunosuppressive or biologic medicine (or a biologic combined with methotrexate, Hydroxychloroquine or sulphasalazine) who are over the age of 70, or are pregnant or have another medical problem

You will be advised by your specialist doctor if you fit into this category.

Table 2: self-assessment risk calculator
Questions If answer 'yes', note the score 
Have you had cyclophosphamide tablets and/or infusions in the last six months?  3
Have you been taking prednisolone 20mg (or more) daily for more than four weeks?  3
Have you received rituximab (in the last 12 months)?  3
Do you receive infliximab infusions?  3
Do you take prednisolone 5mg (or more) daily as well as one or more immunosuppressive or biologic medication?  3

Do you have any of the following problems:  lung disease, heart disease, high blood pressure, kidney or liver disease, chronic neurological conditions, diabetes, are very overweight or any other medical condition requiring specialist treatment

or even if you do not have any of these problems, are you over 70 years old?

or you are pregnant

 1
Are you on just one immunosuppressive or biologic medicine?  2
Are you on two or more immunosuppressive or biologic medicines (other than sulfasalazine or hydroxychloroquine OR a combination of a biologic with methotrexate)?  3
Add up the numbers above, to make your total:  
  • If you score of 3 or more: you are 'extremely vulnerable' and probably need to shield yourself. If you will need help at home to enable shielding you can register for help.
  • If you score 2: you are unlikely to need to shield yourself. You should practice very careful social distancing. If you are unsure whether you fall in this category, you can contact your dermatology department.

  • Score of 0 or 1: the treatments taken for your skin condition alone will not increase your COVID-19 risk. Please follow the GOV.UK advice given to the general public. If, however, you have concerns about other medical conditions, seek
    advice from your GP or other specialist.