key: cord-0745654-3nqfo3gf
authors: Gabel, Colleen; Ko, Lauren N.; Dobry, Allison S.; Garza-Mayers, Anna Cristina; Milne, Leslie W.; Nguyen, Emily; Parry, Blair Alden; Raff, Adam; Shah, Radhika; St. John, Jessica; Strazzula, Lauren; Vedak, Priyanka; Kroshinsky, Daniela
title: Reply to the Letter to the Editor (MS#JAAD-D-20-02442R2): “Patient preference for cellulitis treatment: at-home care is preferred to hospital-based treatment.”
date: 2020-08-08
journal: J Am Acad Dermatol
DOI: 10.1016/j.jaad.2020.08.007
sha: 81a01ccafc819f9a9e75b9be63e263b1f9f04eb7
doc_id: 745654
cord_uid: 3nqfo3gf

nan

Article type: Notes and comments: REPLY to the Letter to the Editor (MS#JAAD-D-20-1 02442R2) 2 3

Title: Reply to the Letter to the Editor (MS#JAAD-D-20-02442R2): "Patient preference for 4

cellulitis treatment: at-home care is preferred to hospital-based treatment." 5 6

Authors: Colleen Gabel, BS 1 To the editor, "Patient preference for cellulitis treatment: at-home care is preferred to hospital-based 48 treatment."(1) Shaw et al. examined whether the trend in patients evaluated at an urban tertiary 49 care center in New York City for skin and soft tissue infections (SSTIs) was impacted by the 50 COVID-19 pandemic. The authors found that, relative to the same time period in 2019, there was 51 a decrease in dermatology consults for SSTIs relative to other common inpatient dermatologic 52 consults during the COVID-19 pandemic. 53

While the underlying reason for this decrease in consults cannot be confirmed, we agree that 54 these results suggest that patients and providers may have avoided pursuing hospital-based care 55

for SSTIs in light of COVID-19. Likewise, we agree that outpatient treatment for cellulitis for 56 patients whom may be good candidates for at-home therapy is important for maintaining access 57 to care in the age of COVID-19. Furthermore, given our findings, outpatient care for appropriate 58 patient candidates may yield high patient satisfaction. 59

Expanded use of teledermatology among dermatology practices(2) due to COVID-19 may 60 additionally facilitate the outpatient treatment of cellulitis for appropriate patients. 61

Dermatologists may similarly utilize teledermatology in the evaluation and management of 62 inpatients hospitalized for SSTIs.(3) Shaw et al. suggest that patients may avoid hospital-based 63 care for cellulitis due to concerns for COVID-19, and teledermatology may increase access to 64 care for these patients, while simultaneously reducing the risk of transmission of infectious 65

Teledermatology has been recently studied in its utility specific to cellulitis, which may allow for 67 We additionally propose that outpatient parenteral microbial therapy (OPAT) may be an 71 effective option for patients requiring intravenous antibiotics for cellulitis and help prevent 72 unnecessary hospital-based care. In pediatric patients, OPAT has been suggested to be effective 73 for the treatment of moderate to severe cellulitis, with high patient satisfaction.(5) Given the 74 current healthcare landscape, OPAT may be an increasingly attractive option for appropriate 75

In conclusion, we thank Shaw et al. for their interest in our article and for highlighting the need 77 for expanded outpatient treatment of SSTIs for appropriate patients in the era of the COVID-19 78 pandemic. 79 80

Patient 83 preference for cellulitis treatment: at-home care is preferred to hospital-based treatment

Teledermatology in the era of COVID-19: 86 Experience of an academic department of dermatology

Use of teledermatology 89 by dermatology hospitalists is effective in the diagnosis and management of inpatient disease

A 92 survey-based study of diagnostic and treatment concordance in standardized cases of cellulitis 93 and pseudocellulitis via teledermatology

Prospective evaluation of the management 95 of moderate to severe cellulitis with parenteral antibiotics at a paediatric day treatment centre