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.

To the Editor: We thank Shaw et al1Shaw K.S. Karagounis T.K. Yin L. et al.Comment on “patient preference for cellulitis treatment: at-home care is preferred to hospital-based treatment.”.J Am Acad Dermatol. 2021; 85: e157-e158Abstract Full Text Full Text PDF Scopus (1) Google Scholar for their comment on our previously published research article titled “Patient Preference for Cellulitis Treatment: At-Home Care Is Preferred to Hospital-Based Treatment.”2Gabel C. Ko L.N. Dobry A.S. et al.Patient preference for cellulitis treatment: at-home care is preferred to hospital-based treatment.J Am Acad Dermatol. 2021; 85: 767-768Abstract Full Text Full Text PDF Scopus (2) Google Scholar Shaw et al examined whether the trend in patients evaluated at an urban tertiary care center in New York City for skin and soft tissue infections (SSTIs) was affected by the COVID-19 pandemic. They found that, relative to the same time period in 2019, there was a decrease in dermatology consults for SSTIs relative to other common inpatient dermatologic consults during the COVID-19 pandemic. Although the underlying reason for this decrease in consults cannot be confirmed, we agree that these results suggest that patients and providers may have avoided pursuing hospital-based care for SSTIs in light of COVID-19. Likewise, we agree that outpatient treatment for cellulitis for patients who may be good candidates for at-home therapy is important for maintaining access to care in the age of COVID-19. Furthermore, given our findings, outpatient care for appropriate patient candidates may yield high patient satisfaction. Expanded use of teledermatology among dermatology practices3Perkins S. Cohen J.M. Nelson C.A. Bunick C.G. Teledermatology in the era of COVID-19: experience of an academic department of dermatology.J Am Acad Dermatol. 2020; 83: e43-e44Abstract Full Text Full Text PDF PubMed Scopus (66) Google Scholar due to COVID-19 may additionally facilitate the outpatient treatment of cellulitis for appropriate patients. Dermatologists may similarly use teledermatology in the evaluation and treatment of inpatients hospitalized for SSTIs.4Gabel C.K. Nguyen E. Karmouta R. et al.Use of teledermatology by dermatology hospitalists is effective in the diagnosis and management of inpatient disease.J Am Acad Dermatol. 2021; 84: 1547-1553Abstract Full Text Full Text PDF PubMed Scopus (19) Google Scholar Shaw et al1Shaw K.S. Karagounis T.K. Yin L. et al.Comment on “patient preference for cellulitis treatment: at-home care is preferred to hospital-based treatment.”.J Am Acad Dermatol. 2021; 85: e157-e158Abstract Full Text Full Text PDF Scopus (1) Google Scholar suggest that patients may avoid hospital-based care for cellulitis because of concerns about COVID-19, and teledermatology may increase access to care for these patients while simultaneously reducing the risk of transmission of infectious diseases. Teledermatology has been recently studied in its utility specific to cellulitis, which may allow for expanded access to care. Korman et al5Korman A.M. Kroshinsky D. Raff A.B. et al.A survey-based study of diagnostic and treatment concordance in standardized cases of cellulitis and pseudocellulitis via teledermatology.J Am Acad Dermatol. 2020; 82: 1221-1223Abstract Full Text Full Text PDF PubMed Scopus (14) Google Scholar conducted a survey study showing the utility of teledermatology in both differentiating pseudocellulitis from cellulitis and in determining subsequent antibiotic treatment. We additionally propose that outpatient parenteral microbial therapy (OPAT) may be an effective option for patients requiring intravenous antibiotics for cellulitis and help prevent unnecessary hospital-based care. In pediatric patients, OPAT has been suggested to be effective for the treatment of moderate to severe cellulitis, with high patient satisfaction.6Gouin S. Chevalier I. Gauthier M. Lamarre V. Prospective evaluation of the management of moderate to severe cellulitis with parenteral antibiotics at a paediatric day treatment centre.J Paediatr Child Health. 2008; 44: 214-218Crossref PubMed Scopus (25) Google Scholar Given the current health care landscape, OPAT may be an increasingly attractive option for appropriate candidates. In conclusion, we thank Shaw et al1Shaw K.S. Karagounis T.K. Yin L. et al.Comment on “patient preference for cellulitis treatment: at-home care is preferred to hospital-based treatment.”.J Am Acad Dermatol. 2021; 85: e157-e158Abstract Full Text Full Text PDF Scopus (1) Google Scholar for their interest in our article and for highlighting the need for expanded outpatient treatment of SSTIs for appropriate patients in the era of the COVID-19 pandemic. Comment on “Patient preference for cellulitis treatment: At-home care is preferred to hospital-based treatment”Journal of the American Academy of DermatologyVol. 85Issue 3PreviewTo the Editor: We read with interest the recent survey study from Gabel et al1 highlighting the preference of patients for at-home treatment of cellulitis rather than hospital-based care. Notably, these results reflected patient preferences well before the onset of the COVID-19 pandemic. In light of recent reports linking patient anxiety over COVID-19 to delayed and decreased hospital presentations for acute medical problems such as myocardial infarction2 and stroke,3 we examined whether a similar trend was observed for patients presenting with skin and soft tissue infections (SSTIs) at an urban tertiary care center at the epicenter of the COVID-19 pandemic. Full-Text PDF