Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
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Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018

Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."

Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018

Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."

Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018

Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."

Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
On Sep 2018

Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."

Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata

Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
On Aug 2018

Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".

Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
On Aug 2018

Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".

Dr. Mamta Gupta
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018

Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.

Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."

Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
On May 11,2011

Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."

Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
On April 2011

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.

Dr. Anuradha
On Jan 2020

Important Notice

Original article / research
Year : 2022 | Month : July | Volume : 16 | Issue : 7 | Page : WC01 - WC05 Full Version

Assessment of Fear of COVID-19 in Pateints Attending the Dermatology Outpatient Department: A Cross-sectional Study

Published: July 1, 2022 | DOI:
Renu Rattan, Ghansham Kumar Verma, Meena Chauhan, Ajeet Kumar Negi

1. Assistant Professor, Department of Dermatology, Venereology and Leprosy, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India. 2. Professor and Head, Department of Dermatology, Venereology and Leprosy, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India. 3. Assistant Professor, Department of Dermatology, Venereology and Leprosy, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India. 4. Assistant Professor, Department of Dermatology, Venereology and Leprosy, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India.

Correspondence Address :
Renu Rattan,
Set No 63-64, Block 4, U.S. Club, Shimla, Himachal Pradesh, India.


Introduction: The entire world has been affected by Coronavirus disease 2019 (COVID-19) and experts all over the world are working hard to combat this global pandemic. There is a panic among people with resultant psychosocial consequences.

Aim: To evaluate the fear factor of COVID-19 using Fear of COVID-19 Scale (FCV-19S) among two groups of patients, one with dermatological diseases managed with immunomodulators and second with dermatological diseases not requiring immunosuppression and also to counsel both the groups regarding the course of their disease and tailoring their visits to the hospital accordingly.

Materials and Methods: This cross-sectional study was conducted from 16th January 2021 to 30th April 2021 in the Outpatient Department (OPD) of Dermatology of a tertiary care centre, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India. Consecutive 52 patients meeting the inclusion criteria, with dermatological diseases requiring long-term immunosuppressive therapy and 49 patients with dermatological diseases or cosmetic concerns not requiring immunosuppressive treatment were enrolled for the study. The obtained data was analysed using Epi Info software version

Results: A total number of 101 patients were enrolled in the study with a male to female ratio of 1.7:1. Mean age of patients was 41 years (range 18-71 years). Among them, 52 (51.49%) had chronic diseases with relapsing and remitting course requiring immunomodulator drugs and 49 (48.51%) had either cosmetic concerns or diseases not requiring immunomodulation. Seventeen (16.83%) of the total patients had other co-morbidites like diabetes mellitus, hypertension, chronic kidney disease or cardiac diseases. Out of all the study participants, 3 (2.9%) had severe fear, 16 (15.8%) had moderate fear, 36 (35.6%) had mild fear and 46 (45.5%) had no fear of COVID-19.

Conclusion: During this pandemic time, patients need to be counselled regarding the course and management of their diseases and stress factor should also be addressed.


Chronic, Coronavirus disease 2019, Cosmetic, Immunomodulator, Pandemic

Coronavirus disease 2019 (COVID-19) is a contagious disease caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). The first case was identified in Wuhan, China, in December 2019 (1). Since then, it has spread worldwide, leading to an ongoing pandemic. The World Health Organisation declared the outbreak a Public Health Emergency of International Concern in January 2020 and a pandemic in March 2020 (2).

Coronavirus disease of 2019 (COVID-19), even after two years of its emergence continues to spread on a global scale. As of 14th December 2020, in India, more than nine million cases and more than 143,000 deaths had been reported globally since the start of the pandemic (3). After one year, as of 15th December 2021, the number of confirmed cases of COVID-19 increased to more than 34 million and the number of deaths increased by more than three times as compared to the data from previous year (4). As in other pandemics, fear and anxiety have been the major repercussions in COVID-19 pandemic also. Ever since its emergence, COVID-19 has created a fear among the general population. Researchers agree that COVID-19 is an endemic and one will have to live with constant precautions (5).

In such a situation fear may become more pronounced. This fear of COVID-19 pandemic can adversely affect disease management (6). Hence, fear of COVID-19 should be assessed and addressed appropriately. For assessment of the fear COVID-19, the Fear of COVID-19 Scale (FCV-19S) has been developed by the researchers (7). The FCV-19S is associated with anxiety, depression and fear of vulnerability to infection (7).

Autoimmune diseases account for a significant number of Dermatology patients. These patients need to be managed with immunosuppressive drugs and often require a long-term therapy. Administration of immunosuppressive drugs requires regular follow-up and titration of the dose according to the severity of the disease (8). Unchecked intake of immunomodulators may lead to development of side effects whereas their sudden withdrawal may result in acute exacerbation of the disease (9),(10). In the present era of spreading of COVID-19 infection, there is a fear of vulnerability to infection prevailing among the patients. Moreover, stress is a precipitating factor in a number of dermatological diseases (11).

Due to fear of acquiring infection, a number of patients do not come to the hospital for regular follow-up. They either continue with the dose prescribed to them during last visit or leave the medications abruptly. On the other hand, a number of patients with minor diseases or cosmetic issues regularly keep on coming to the OPD. These patients themselves are at risk of acquiring the infection as well as can be a potential source of infection to other patients and healthcare providers. Such patients can visit the hospital at longer intervals (11). Therefore, streamlining of healthcare facilities and empowerment of patients with knowledge regarding the nature of their disease and rationalization of hospital visits is required. To the best of our knowledge, no study addressing these issues in dermatology patients has been done till date.

Keeping in view the above circumstances, the present study was designed to evaluate the fear factor of COVID-19 among Dermatology patients and to counsel and educate the patients regarding the course of their disease and intervals of visit to the hospital for follow-up.

Material and Methods

This cross-sectional study was conducted in the OPD of Dermatology at Indira Gandhi Medical College, Shimla, Himachal Pradesh, India, from 16th January 2021 to 30th April 2021. The study was approved by Institute Ethics Committee and was conducted as per protocol (Registration no. ECR/533/INST/HP/2014/RR-20). Informed written consent/assent was taken from all the participants.

Inclusion criteria: All patients with acute or chronic dermatological diseases, above 12 of age, attending the OPD of Dermatology and willing to participate in the study were included.

Exclusion criteria: Patients aged below 12 years and who were not willing to give consent for the study were excluded.

Sample size: All the patients who presented in the OPD within the study period, meeting the inclusion criteria were enrolled. The study participants were divided in to two groups.

Group 1: Consecutive 52 patients meeting the inclusion criteria, with dermatological diseases that require long-term immunosuppressive therapy and regular follow-up were enrolled.

Group 2: Consecutive 49 patients with dermatological diseases or cosmetic concerns that did not require immunosuppressive treatment were enrolled.


Detailed evaluation of every patient including history and clinical examination was done. Age, sex, marital status, educational qualification, background (rural or urban), history of smoking and alcohol consumption and presence of any co-morbidities (hypertension, diabetes mellitus, chronic renal disease or cardiac issues) of all the participants were recorded. The FCV-19S was used to assess the status of fear among patients. All the participants were given a pre-designed and pre-validated FCV-19 scale questionnaire to answer (Table/Fig 1) (7).

There were total seven questions in the questionnaire. The participants indicated their level of agreement with the statements using a five-item Likert-type scale. Answers included “strongly disagree,” “disagree,” “neither agree nor disagree,” “agree,” and “strongly agree”. The minimum score possible for each question was 1, and the maximum was 5. A total score was calculated by adding up each item score (ranging from 7 to 35). Fear was directly proportional to the score, i.e.,higher score indicated greater fear of COVID-19.

The FCV-19 score for all the participants in both the groups were calculated and evaluated. Score of fear factor between 1-14 was labeled as no fear, 15-21 as mild, 22-28 as moderate and 29-35 as severe fear. Considering the small sample size of study, according to FCV-19 score, participants were divided into two groups.

No /Mild fear- patients with FCV -19 score between 1-21

Moderate- Severe fear - patients with score between 22-35

All the patients were counselled about the nature of their disease and importance of frequency of visits to the hospital for follow-up. Patients on immunosuppressive drugs with FCV-19 score of 21 or more (indicating moderate to severe fear of acquiring COVID 19 infection and thereby not following regular follow up) were counselled regarding the gravity of regular follow-up. Similarly, patients with cosmetic concerns with FCV-19 score less than 21( suggesting no or mild fear) were explained regarding long-term requirement of treatment that can be managed with less frequent visits to the hospital.


Data was collected and entered in Microsoft excel spread sheet, cleaned for errors and analysed using Epi Info software version Descriptive statistics were used to summarise the clinical and demographic data. Frequencies and their percentages were used to describe categorical variables. Comparison of qualitative variables with outcomes was done using Pearson’s Chi-square test. A two-sided p-value of <0.05 was considered as statistically significant. As the study sample size was small, values of all variables, as well as FCV -19 scores were categorised into binomial form.


A total number of 101 patients were recruited in the study. Mean age of patients was 39.34±13.25 in group 1 and 36.48±16.71 in group 2. In group 1, there were 33 (63.46%) males and 19 (36.54%) females, whereas, in group 2 there were 31 (63.27%) males and 18 (36.73%) females. Mean FCV score in group 1 participants was 16.03 and in group 2, it was observed to be 15.7. Clinicoepidemiological profile of study participants in both the groups is described in (Table/Fig 2).

Keeping in view the small sample size, values of all variables as well as FCV-19 scores were categorised into binomial form for descriptive statistical evaluation (Table/Fig 3). On analysis of data obtained from both the groups, it was observed that male patients had more COVID-19 fear as compared to females. No or mild fear was observed in 54 (84.38 %) of male patients whereas moderate to severe fear was found in only 10 (15.63%) of the males. On the other hand, 28 (75.68%) of female patients reported mild fear and 9 (24.32%) had moderate to severe fear. However, this difference in fear between males and females was statistically insignificant (p-value=0.281).

It was seen that 32 (84.21 %) of patients with age more than 40 years showed no or mild fear of COVID-19 and 6 (15.79%) were observed to be having moderate to severe fear. In comparison to this, 50 (79.37%) of participants of less than 40 years of age were found to be having no or mild fear and 13 (20.63%) had moderate to severe fear. This difference of fear in relation to age was statistically not significant (p-value=0.546).

On analysis of fear factor on the basis of educational qualification, we found that among subjects with education below secondary school, 23 (76.67%) patients had either no or mild fear of COVID-19 and 7 (23.33%) had moderate to severe fear. On the other hand, subjects with higher education, 59 (83.10%) were found to be having no or mild fear and 12 (16.90%) had moderate to severe fear. On analysis of difference between the two groups, p-value was 0.449 indicating that the difference was statistically insignificant.

In present study, 84 (83.17%) of the participants had no co-morbidity while 17 (16.83%) had some co-morbidity in the form of diabetes mellitus, hypertension, chronic kidney disease or cardiac disease. We observed that among participants without any co-morbidity, 70 (69.30%) reported no or mild fear and 14 (16.67%) reported moderate to severe fear. On the other hand, among participants with co-morbidity, 12 (70.59%) were found to be having mild or no fear and moderate to severe fear was seen in 5 (29.41%) patients.

Evaluation in difference of COVID-19 fear among patients with acute dermatological diseases or cosmetic problems and those with chronic dermatological diseases who have to visit the hospital repeatedly was done. In study subjects with acute or cosmetic problems, it was found that majority 43 (42.57%) reported mild or no fear and only 6 (5.9%) reported moderate to severe fear. On the contrary, among subjects with chronic dermatological diseases, 39 (75%) were found to be having no or mild fear and only 13 (25%) reported moderate to severe fear (Table/Fig 4). The difference between these two groups was again statistically not significant.

Only 3 (2.9%) of the study participants had severe fear while 16 (15.8%) had moderate fear 36 (35.6%) had mild fear and 46 (45. 5%) had no fear (Table/Fig 5).


In our study, on analysis of data obtained in both the groups, maximum patients had either no or mild fear. Moderate or severe fear was seen only in very few patients and the difference was statistically not significant. Similarly, on analysis of FCV-19 score obtained using all the analysed parameters individually, we did not observe statistically significant fear among study participants.

The pandemic has caused global social and economic disruption. Fear is an adaptive response to the presence of threat and it can become troublesome, if the threat is uncertain and ceaseless (12). Similar is the case with current COVID-19 pandemic. On the contrary, inadequate fear may result in adverse situations for individuals and society, if people ignore measures imposed by the administration to slow the spread of coronavirus. Besides, fear may trigger safety behaviors (e.g., hand washing) that can alleviate certain threats (e.g., contamination), but they may paradoxically also enhance fear, thereby forming a vicious cycle (13).

Ahorsu DK et al., developed the FCV-19S to complement the clinical efforts in preventing the spread and treating the COVID-19 cases (7). FCV-19S is a seven item unidimensional scale with strong psychometric properties.

Authors conducted this study to assess the fear factor of COVID-19 pandemic on dermatological patients and to counsel them according to their requirement for treatment in their OPD setup. As this pandemic is going to stay for long, treatment strategies need to be modified for management of various dermatological conditions.

After emergence of COVID-19 pandemic, various studies from different parts of world showed increased fear and stress among populations. In China and Europe, national polls suggested a considerable increase in fear and concerns relating to coronavirus (14). In April 2020, a survey conducted on 44,000 participants in Belgium revealed that the number of people reporting anxiety or a depressive disorder had increased substantially as compared to a survey conducted in 2018 (i.e., 20% vs 11 % and 16 vs 10 % prevalence, respectively) (12). Khalaf OO et al., did a study to investigate the fear of COVID-19 infection and its relation to depressive and anxiety symptoms among elderly population during COVID-19 outbreak. In contrast to our study, they observed a high average score of fear of COVID-19 (15).

Skin is considered a part of the immune system as it acts as a shield against different environmental stimuli (16). In general, dermatology deals with a number of inflammatory (infectious and non infectious), neoplastic and other diseases. A number of skin diseases follow a chronic course with acute exacerbations and remissions. Similar is the case with lepra reactions. Such diseases require long immunomodulatory treatment and regular follow-up. Likewise, some cosmetic problems follow a long course, requiring long-term treatment.

In present pandemic times, patients with disease like psoriasis may worsen because COVID-19 fear might lead to increased psychological distress, since such patients are already struggling with a chronic psychologically distressing disease (17). Moreover, stopping immunosuppressive or immune modulating treatment in psoriasis could result in development of immunogenicity which in turn, can result in reduced response at retreatment. On the other hand, unchecked continuation of immunomodulatory drugs leads to excessive immunosuppression as well as development of other side effects of drugs.

COVID-19 pandemic has devastated dermatological practices all over the world. Patients with significant acute and chronic dermatological conditions are afraid of COVID-19 infection, hence not coming to OPDs. On the other hand, some patients with minor conditions, cosmetic problems are coming to OPDs frequently. So different people have different responses to this gruesome pandemic. During medical pandemics, protective behaviour needs to be encouraged and fear appeal is important to introduce behavioral changes in order to control health-related pandemics (18).

In January 2021, first wave of COVID-19 had almost ended and things were thought to be under control. In March 2021, second wave emerged and was much more deadly with a significant case fatality rate. One of the important reasons among many others for emergence of second wave was violation of COVID-19 appropriate behavior (19).

More recently, a new variant omicron has been reported (20). This indicates that the pandemic is not yet over. In such an uncertain situation adherence to COVID-19 measures is must.

While protective measures are must, they should not not evoke stress in the patients. Mental stress can be an aggravating factor in a number of dermatological diseases. Such patients pose a challenge to the physicians. This situation can be encountered through effective communication and counselling. Patients need to be thoroughly explained about the nature of their disease and adherence to the therapy. At the same time, need for following protective protocols should be emphasised. In the same way, patients with cosmetological concerns should be addressed. For both groups of patients, in these pandemic times, teledermatology services could be of immense help. Teledermatology offers a method of service delivery which provides improved access to specialised services and at the same time decreases the cost to the patient by eliminating travel charges (21). Also, at the same time, COVID-19 Standard Operating Procedures (SOPs) can be followed along with delivery of specialised tailored treatment. But first and foremost is counselling of the patients.


Small sample size is the limitation of present study.


COVID-19 pandemic has changed the face of Dermatology practices. Dermatology patients pose a challenge to the physician as they require long-term treatment with regular follow-up. Patients need to be coached regarding the remitting and relapsing nature of their diseases thoroughly, adherence to the therapy and avoidance of self medication. Simultaneously, they should be explained about the higher risk of acquisition of COVID-19 if are managed with immunosuppressants. Following of COVID-19 SOPs should be emphasised.


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DOI and Others

DOI: 10.7860/JCDR/2022/55024.16609

Date of Submission: Jan 18, 2022
Date of Peer Review: Feb 15, 2022
Date of Acceptance: Apr 08, 2022
Date of Publishing: Jul 01, 2022

• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA

• Plagiarism X-checker: Jan 19, 2022
• Manual Googling: Mar 09, 2022
• iThenticate Software: May 20, 2022 (14%)

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