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GPs go forth

NICE issues prescribing advice for dermatology patients with Covid-19

GPs should ensure that patients taking oral corticosteroids for dermatological conditions do not ‘suddenly’ stop taking them if they have coronavirus (Covid-19) symptoms, NICE has said.

Patients taking hydroxychloroquine, chloroquine, mepacrine, dapsone and sulfasalazine, as well as any topical treatments, should also continue to take them if they develop symptoms, it added.

However, GPs should consider 'temporarily' stopping 'all other immunosuppressive therapies' and contact the dermatology department for advice on when to restart treatment, NICE added.

The advice comes as part of a new rapid guideline on managing patients undergoing treatments for dermatological conditions with ’drugs affecting the immune response’ during the coronavirus pandemic.

The guideline said: 'In patients known or suspected to have Covid-19: do not suddenly stop oral corticosteroids [and] continue hydroxychloroquine, chloroquine, mepacrine, dapsone and sulfasalazine.'

It added: 'Consider temporarily stopping all other oral immunosuppressive therapies, novel small-molecule immunosuppressants, biological therapies and monoclonal antibodies, and contact the dermatology department for advice on when to restart treatment.'

GPs should tell patients to contract NHS 111 online or by phone if they think they have coronavirus and advise them to prepare a list of their conditions and medicines to give to healthcare staff treating them for Covid-19, NICE said.

It added: 'Be aware that patients taking drugs that affect the immune system may have atypical presentations of Covid‑19. For example, patients taking prednisolone may not develop a fever.'

The guideline added that GPs should be provided with 'acute and emergency dermatology advice' to avoid 'unnecessary' admissions.

It said: 'Provide acute and emergency dermatology advice to GPs to avoid unnecessary emergency department attendances and admissions, using advice and guidance services and teletriage where possible.'

'Some' of these patients will have been notified via a letter that they are at 'high risk of severe illness' from Covid-19 and should be advised to follow shielding guidance, the guideline added.

It comes as NHS England said last week that GPs are 'strongly discouraged' from prescribing antimalarial drugs hydroxychloroquine and chloroquine off licence to treat Covid-19 while clinical trials are ongoing and urged them to help enrol patients into the trials instead.

Highlights from NICE rapid guideline on dermatology and Covid-19

  • Advise patients, or their parents or carers, to write down a list of the medicines they take and the conditions they have, to give to healthcare staff if they need to seek treatment for COVID‑19.
  • Tell patients, or their families and carers, that they should contact the NHS 111 online coronavirus service, or call NHS 111 if they don’t have internet access, if they think they have COVID‑19. In an emergency they should call 999 if they are seriously ill. They should also inform their dermatology team, to get advice about their immunosuppressive therapies.
  • Be aware that patients taking drugs that affect the immune system may have atypical presentations of COVID‑19. For example, patients taking prednisolone may not develop a fever.
  • Provide acute and emergency dermatology advice to GPs to avoid unnecessary emergency department attendances and admissions, using advice and guidance services and teletriage where possible.
  • In patients known or suspected to have COVID‑19:
    • do not suddenly stop oral corticosteroids
    • continue hydroxychloroquine, chloroquine, mepacrine, dapsone and sulfasalazine
    • continue topical treatments
    • think about treating new-onset dermatological conditions with topical treatments rather than new systemic treatments that affect the immune system
    • consider temporarily stopping all other oral immunosuppressive therapies, novel small-molecule immunosuppressants, biological therapies and monoclonal antibodies, and contact the dermatology department for advice on when to restart treatment.
  • When deciding whether to stop treatment, discuss the risks and benefits with the patient, or their parent or carer, and take into account:
    • whether COVID‑19 is confirmed
    • the severity of the COVID‑19
    • the risks and benefits of stopping or continuing treatment
    • the severity of the dermatological condition
    • the effect of stopping treatment on other conditions, for example the effect on asthma of stopping dupilumab
    • other risk factors such as age and comorbidities, for example respiratory or cardiovascular conditions.

Source: NICE

Readers' comments (3)

  • National Hopeless Service

    How about Dermatologist do that? I once heard that Consultants do know how to use the telephone machine to contact patients directly rather than via their Foundation forever Year GPs

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  • Thanks NICE.....you may be interested to know every GP had always done this for any patient with intercurrent illness whether COVID or not. Nothing new here.

    ....And some experts have been paid for this, what a shame!

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  • A waste of time and money publishing this. All GPs have always done that. We know our job of risk management.

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