Covid-19 developments: US dermatologists at the forefront
Mark Lebwohl, MD
Professor and Chairman of the Dermatology Department
Chairman Emeritus of the Medical Board
WCD 2023 AMBASSADOR FROM USA, NORTH AMERICA
The past year has been a difficult one because of the COVID-19 pandemic, and dermatology has been disproportionately affected. Many of us had to close our practices, and many others shifted to teledermatology to see our patients. When our practices reopened, we often dealt with facial lesions that required us to unmask our patients, and when we examined them, we were often only a few centimeters away from patients who were potentially contagious. Like everyone else, we had to fight for personal protective equipment and had to convince hospital bureaucrats that we indeed were putting ourselves at risk more than many other specialists.
In the first days of the pandemic, I was receiving more than 600 daily calls and emails from colleagues and patients asking what they should do with their patients on biologics. We quickly published a letter in the Journal of the American Academy of Dermatology pointing out the rates of viral infections in pivotal trials of biologic therapies for psoriasis. As data emerged, it was clear that treatment with biologic therapies did not have a negative impact on susceptibility to, or outcome of COVID-19 infection. In fact, there were suggestions of a protective effect against bad outcomes to the infection. Many of our national and international organizations, including the National Psoriasis Foundation, the International Eczema Council, and the American Academy of Dermatology recommended continuing biologic therapies in the absence of active infection.
Because of all the questions that came up about COVID-19, how to deal with psoriasis therapies, and how to deal with COVID-19-related questions, the Foundation for Research & Education in Dermatology held a virtual Grand Rounds that was announced within days of the pandemic hitting New York City. Nearly 5000 mostly American dermatologists viewed that session. That led to an online weekly virtual Grand Rounds that is open to anyone (Fall Clinical Virtual Grand Rounds) which has persisted to this day.
When the vaccines became available in the US, we again had to make the case that dermatologists were on the frontline and should be among the first vaccinated. Questions were then raised regarding the impact of biologic therapies and oral therapies on the response to vaccination. Again, our organizations, including the National Psoriasis Foundation, the International Eczema Council, the American College of Rheumatology, and Skin Inflammation & Psoriasis International Network (SPIN) weighed in. The recommendations differed only slightly with the National Psoriasis Foundation recommending no (or minor) changes in therapy regimen at the time of vaccinations. Other organizations recommended delays of up to 2 weeks in therapies targeting the immune system following vaccination or suggested obtaining the vaccine at the midpoint between injection of biologic therapies. The pandemic is not yet over, but with more and more of the population vaccinated, it appears to be abating in the US, although third waves are hitting Europe. One thing is clear: all of us miss seeing our colleagues and are tired of virtual meetings. By the time the World Congress of Dermatology is scheduled to start in Singapore, I would expect an enormous number of dermatologists to participate.