key: cord-319820-eb5y7gxj
authors: Kutlu, Ömer
title: Analysis of dermatologic conditions in Turkey and Italy by using Google Trends analysis in the era of the COVID‐19 pandemic
date: 2020-07-02
journal: Dermatol Ther
DOI: 10.1111/dth.13949
sha: 
doc_id: 319820
cord_uid: eb5y7gxj

Many areas of life including patterns of dermatological diseases that patient attend to the hospital were tremendously affected by implementing stay‐at‐home orders during the COVID‐19 pandemic. We aimed to identify the dermatologic interest of the public during the COVID‐19 pandemic by using Google Trends. The terms “acne”, “hair loss”, “eczema”, “genital warts”, “molluscum contagiosum”, “botox”, “skin cancer”, “sunscreen” were analyzed on first April, first May, first June 2020, and the corresponding period of the previous year in Turkey and Italy by using Google Trends. The searching spectrum was between 3first March 2019‐first June 2020. The relative change of search term “acne” was +10, +29, +13/ ‐1, +17,+33, “hair loss” was +14, +40, +16/+3, +16, +15, and “eczema” was +2, +34, −4/ +3, +25, +18, on the other hand, the relative change of the “genital warts” was −15, −48, +10/ ‐44, −30, +18 and “molluscum contagiosum” was −12, −2, −4/ ‐4, −1, −12 while “botox” was, −10, −43, −8/ ‐41, −31, +4, “skin cancer” was −27, −38, −38/−22,+33, −7 and sunscreen was −6, −25, −71/−13,0,‐45 in Turkey/Italy on 1 st April, 1 st May, and 1 st June, 2020, respectively. A statistically significant positive correlation was found between the number of COVID‐19 cases in Turkey and search terms of the general dermatology group during the COVID‐19 pandemic (P < 0.05). The search terms including “acne”, “eczema”, “hair loss” appears to be increasing while “molluscum contagiosum”, “genital warts” “botox”, “skin cancer”, and “sunscreen” decreasing in the era of the COVID‐19 pandemic. Understanding the trends and impacts of dermatologic diseases on public perceptions during the COVID‐19 pandemic will allow for better preparation of dermatologists. This article is protected by copyright. All rights reserved.

warts", "molluscum contagiosum"), cosmetology and surgery ("botox", "skin cancer", "sunscreen"). These terms were searched in Turkish and Italian languages by using Google Trends in two countries (https://trends.google.com/trends/?geo=TR and https://trends.google.com/trends/?geo=IT). We compared the data of Turkey with Italy which was one of the most affected countries by the COVID-19 pandemic in order to investigate whether these searching terms objective for other communities or not. Although the first case of COVID-19 in Italy appeared earlier than Turkey, similar measures such as the shutdown of all schools and universities, lockdown orders, closure of museums, cultural centers, cinemas, theatres, pubs and suspending of international flights were taken in both countries at approximately the same time. 12, 13 The search terms in three groups were analyzed on 1 st April, 1 st May, 1 st June 2020, and the corresponding period of the previous year in order to rule out seasonal effects. The searching spectrum was between March 31, 2019, and June 1, 2020.

The correlation between diseases in general dermatology groups and the number of COVID-19 cases in Turkey were investigated. The statistical analysis for correlation was performed from 11 March to 1 June 2020 in order to the first case of COVID-19 was appeared on March 11, 2020, in Turkey. The study was approved by the institutional review board.

This article is protected by copyright. All rights reserved.

The data were evaluated in the SPSS 20.0 (SPSS Inc., Chicago, Illinois) program and were considered statistically significant when p<0.05. Shapiro-Wilk test was used for the normal distribution of data. Spearman's rho correlation was used for not normally distributed data in continuous measurement variables.

In Turkey/Italy on 1 st April, 1 st May, and 1 st June, 2020, in the general dermatology group, the relative change of "acne" was +10, +29, +13/ -1, +17,+33 while "hair loss" was +14, +40, +16/+3, +16, +15, and "eczema" was +2, +34, -4/ +3, +25, +18, respectively. In the venereology group, the relative change of the "genital warts" was -15, -48, +10/ -44, -30, +18 while "molluscum contagiosum" was -12, -2, -4/ -4, -1, -12, respectively. In cosmetology and surgery group, the relative change of "botox" was -10, -43, -8/ -41, -31, +4, while "skin cancer" was -27, -38, -38/-22,+33, -7 and sunscreen was -6, -25, -71/-13, 0,-45, respectively ( Figure 1-3) .

The most common search term in the general dermatology group in Turkey was "eczema" followed by "hair loss", and "acne", respectively, whereas it was "acne" followed by "eczema", and "hair loss" in Italy (Figure 4, 5) . In the venereology group, "genital warts" was more common in Turkey, whereas molluscum contagiosum was more common in Italy (Figure 6, 7) .In both countries, cosmetology and surgery groups, botox was the most common search term followed by sunscreen, skin cancer, respectively (Figure 8, 9 ). This article is protected by copyright. All rights reserved.

A statistically significant positive correlation was found between the number of COVID-19 cases in Turkey and search terms of the general dermatology group during the COVID-19 pandemic (Table 1) .

After the COVID-19 pandemic, the number of patients who request dermatology outpatient clinic visits was decreased in many countries because of stay at home policies in order to deal with the global pandemic. 2, 14, 15 Thus, certain diseases that may be increased in number after the COVID-19 pandemic remained concealed.

Dermatology outpatient clinics represent only the tip of the iceberg during the COVID-19 pandemic days. Therefore, it can be expected that using the internet quite increased by the public in order to access their health information during the current pandemic. 16 The investigation of the public trends may give some clues on the frequency of certain diseases in the COVID-19 pandemic. In this context, according to this study, interestingly, relative changes in search terms were similar between Turkey and Italy after the COVID-19 pandemic. We found that "acne", "hair loss", and "eczema" search terms increased after the COVID-19 outbreak both in Turkey and Italy. The relative change in these terms was more prominent in April and May 2020. As compared to each other, the most common search term among general dermatologic diseases was "eczema" followed by "hair loss" in Turkey, whereas "acne" was the most common disease followed by "eczema" in Italy. There are some points that should be addressed in this regard. The enhanced preventive precautions for hand hygiene by using antiseptics, cologne, liquid soap allows patients to deal 

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