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.
The PASSION project
Dr. Christophe Hsu
Founder, Global Dermatology
WCD 2023 AMBASSADOR FROM SWITZERLAND, EUROPE
The number of dermatologists worldwide is already quite low, one in 60000 globally on average. In rural India, the number falls to one in a million. However in Sub-Saharan Africa, the number of specialists is close to nil, with for example 13 dermatologists in the whole of Madagascar (population 26 million).
Combine it with a large population group of children and adolescents, which already represents the majority of the population, and what you get a is recipe for a health crisis. Indeed while there are healthcare providers, let alone medical officers and general practitioners, their attention is aimed at dealing with more pressing problems such as infectious diseases and non-communicable diseases (NCDs). It is part of the World Health Organization’s (WHO) sustainable development goals (SDG), to find a solution (see below for exact goals).
When you take into account these two parameters, it is easy to forgive that the inability to train dermatologists and enough medical officers will bring dermatological expertise to a halt…or will it not ?
Luckily the number of skin diseases in the pediatric population group which amounts to 80% of all of them comes down to five: eczema, impetigo, tinea, scabies and insect bites. And these conditions are treatable on the ground; even scabies medication ivermectin is now on the World Health Organization (WHO) Essential Drug list.
Even if these diseases were not priority health concerns, they are a social time bomb, with consequences on the whole population. Inability to go to school, overburdened carers and reduced opportunities (marriage, work) are the consequences of becoming a Social Leper.
The data explosion has kicked in, more data has been produced in the last 2 years than in the history of humanity. This enables to use Artificial Intelligence Intelligence (AI; Augmented Intelligence is a better term), more precisely a part of it called Machine Learning (ML). Mathematical equations, called algorithms are the resulting solutions and are coded as a computer program.
Since the pandemic began, it becomes imaginable that solutions using Digital Health will remain with us. Teledermatology has been around for quite a while, and in the United States almost 70% of in person visits were replaced with telemedicine in skin diseases. Moving forward Teledermatology, as well as AI and Data science, will become common vocabulary in medicine. To read more on digital health in Dermatology, please visit www.telemedskin.com
This is the beginning of a long journey; the PASSION project is funded by Fondation Botnar. Even if AI is applied to Dermatology there will be a lot of emotion in its development. Expect support and resistance (minor, moderate, strong and key) as well as pivot points which will be reached when concrete hurdles arise…but we know where the trend is heading !
Follow us for updates on this project at www.telederm.ai
Sustainable Development Goals of WHO covered by the project
SDG 3: Good Health and Well being: https://www.un.org/sustainabledevelopment/health/
-3.3 end the epidemics of other communicable diseases….Communicable diseases concerns two of our disease foci (infected eczema, impetigo and scabies)
-3.8 Achieve universal health coverage…access to quality essential health- care services…Specifically to the field of Dermatology, we intend to use AI for five skin diseases to begin with.
SDG 10: Reduce inequalities https://www.un.org/sustainabledevelopment/inequality
Prof. Stefania Jablonska – the first woman in the board of the ILDS
Prof. Lidia Rudnicka
Polish Dermatological Society
WCD 2023 AMBASSADOR FROM POLAND, EUROPE
Stefania Jablonska (1920 –2017), was one of the worlds best known dermatologists of her time. She was valued by many dermatology experts for her intelligence, her research achievements, broad clinical knowledge and willingness to help young dermatologists in achieving their goals.
She was the first woman and the first dermatologist from eastern Europe elected to serve in the board of the International League of Dermatological Societies. In 2000 she was awarded by the ILDS with the certificate in appreciation for her lifetime achievements and contributions to international dermatology and for her impact upon European dermatological education.
For a transient moment, professor Stefania Jablonska shared her life story via the Internet:
Her father Emil Emanuel Ginzburg, PhD in economics, graduated from the University of Dorpat (Estonia) and her mother Bella Krasucka, was a dermatologist, educated in Berlin.
Stafania Jablonska (born was brought up by a German woman, She knew German well, and wrote in Gothic. As a child she was browsing through her mother’s dermatology atlases and medical books, both German and French.
She went to School in Warsaw, Poland. About her education Stefania Jablonska wrote “My whole life was a pursuit of learning, in which I resembled the heroine of I. B. Singer’s book – Jentl, famous for the wonderful role of Barbara Streisand. As a girl, Jentl could not be admitted to school, so she decided to study disguised as a boy, renouncing her personal life and her own happiness.” Prof. Jablonska was the first woman to achieve several significant positions in dermatology. She was perceived by many as a feminist role model. However she herself was not a feminist. She admired and promoted intelligent, hardworking scientists, regardless of gender.
She studied medicine in Warsaw, Poland. After the outbreak of the war and the occupation of Warsaw (1939), the University of Warsaw was closed. She moved to Lviv, where the University was active until the German Nazi army entered (June 30, 1941), and on July 4, eminent Lviv professors were summoned to a meeting at which they were murdered (Massacre of Lwow professors). She then moved to the University of Frunze, where she completed medical studies with honors in 1942.
About her first marriage she wrote: “From 1936 I was associated with the Jablonski family after my engagement with Pawel, the relationship with him became the most durable in my life. The biggest tragedy was that he died before our official wedding. Regardless of my fate, this relationship remained the only true one for the rest of my life. I only use the surname Jablonska and all my scientific papers are signed with this surname”
In 1946 she started working at the Department of Dermatology, University of Warsaw in Warsaw, Poland. This building in the Koszykowa Street in Warsaw became her second home for live. Here she received her PhD, her professorship and became chairman of the department. She was the head of Warsaw and Polish Dermatology for many years and was considered a highest authority in dermatology long after she has retired.
She was an exceptionally active dermatologist and researcher both in Poland and internationally. She was the author of over 1000 publications with significant achievements in investigating the pathogenesis and new diagnostic techniques in autoimmune bullous diseases, connective tissue diseases and HPV-induced oncogenesis.
For her work and achievements she was awarded with several national and international awards, including the Robert Koch International Award (1985), Rose Hirschler Award for Women (1992), Alfred Marchionini Gold Medal (1992), Gold Medal of the Austrian Dermatological Association (1999) and EADV Award for Scientific Achievements EADV (2007). She was the honorary member of multiple dermatological societies and honorary president of the Polish Dermatological Society.
In everyday live she was a minimalist. Living in a small apartment full of books, medical journals, articles and typed sheets of scientific work in progress. She had a small house at the lake in Skepe village in Poland, where she was working on publications during vacation time.
She will be remembered as an exceptionally intelligent women with a concrete personality, dedication to education and promotion of young dermatologists, who never refused to help others.
To celebrate the memory of this exceptional dermatologist, The Stefania Jablonska Medal was established as highest award of the Polish Dermatological Society for outstanding achievements in dermatology. On the occasion of its 100-th anniversary the Polish Dermatological Society awarded with the Medal to Jean Bologna (USA), Henry Lim (Canada) and Suzanne M. Olbricht (USA), Marek Haftek (France/Poland), Andrzej Kaszuba (Poland), Andrzej Langner (Poland) and Anna Sysa-Jedrzejowska (Poland). The Award Ceremony, planned for May 2020, was postponed until after the pandemic.
Prof Stefania Jablonska (1920 –2017)
Prof Stefania Jablonska was a dedicated promotor of young dermatologists. Here, celebrating the PhD degree of Lidia Rudnicka in 1992 in Warsaw, Poland.
Planning for the World Congress of Dermatology in Munich, 1967. Seated, left to right: Wermer Jadassohn, Jose Gay Prieto, Stephanie Jablonska, Robert Degos, Marcial L. Quiroga, and Sven Hellerström. Standing, left to right: Louis Brunsting, Felix Sagher, Marion B. Sulzberger, Franco Flarer, Spartacus Lapière, J. Ramos e Silva, Gordon MitchellHeggs, Clarence Linvingood, Carl G. Schirren (President of the Organizing Committee), and Donald M. Pillsburry (image from Ossama Abbas and Abdul-Ghani Kibbi: International League of Dermatological Societies 2013; published online https://ilds.org/wp-content/uploads/2018/03/ILDS-A-History.pdf)
The Professor Stefania Jablonska Medal
A First-hand experience in the time of Covid-19 in the Philippines
Evangeline B. Handog, MD, FPDS, FAAD
First Woman President of the International Society of Dermatology
WCD 2023 AMBASSADOR FROM PHILIPPINES, ASIA
The magnitude of this Covid-19 pandemic is preposterous! It took me sometime to realize that our world could literally come to a halt, turn our schedules upside down, change our lifestyle and routines drastically and come to one’s senses that everyone, yes, all of humanity will be affected. Our immediate plans, our foresight, even our dreams will have to wait.
The difficulty of the times – the pandemic is real…but living optimistic creatures that we are, resiliency and patience are the order of the day! Waking up to the scenario that we are in, helping people with dermatological concerns kept nagging me. What can we do during long months of lockdown? The government kept reminding everyone to be safe and to stay home!
Firstly, we have a residency training program to continue. As consultants of the Dermatology Department of the Research Institute for Tropical Medicine, we ensured that knowledge via grand rounds, case conferences, didactics and even quizzes be given importance and regularity. Outpatient face to face consultations were replaced by teledermatology. And as we, doctor and patient, got accustomed to this method, trust and rapport recovered, increasing back the number of consults. Phototherapy sessions for needy patients have resumed just recently. However, elective dermatological procedures are still deferred.
Continuing medical education seminars provided by the Philippine Dermatological Society, post-graduate conferences, scientific webinars, and small round table discussions are the orders of the day. Reaching up to four or five weekly, what may appear as information overload were actually diverting our attention and easing our anxieties towards the pandemic.
Secondly, on the global perspective, the mentorship committee of the International Society of Dermatology (ISD) went virtual. The fellowship program continues to provide opportunities to ISD members to enhance dermatological knowledge and skills. Many of the accepted mentees for the 2019-2020 agreed to virtual meetings with volunteer mentors. As of this writing, I have a Mexican, a Georgian, and a Russian under this virtual ISD mentorship program. Miles apart, technology brings us together. It may take much time to prepare powerpoint lectures for these activities but it gives me great pleasure and satisfaction to see the enthusiasm on the faces of these young dermatologists.
Finally, one outstanding event that we can look forward to is the World Congress of Dermatology 2023, which hopefully is a face-to-face affair, in the highly-spirited Singapore! I am certain that the scientific program will not only be comprehensive but perfect and suitable to the times we are in. We are very supportive! Time to see each other!