Contributions from WCD2023 Ambassadors
Collection of articles about dermatology from all over the world. A dermatology beyond borders.
Global Dermatology at The Medical University of South Carolina.
Dirk M. Elston
WCD 2023 AMBASSADOR FROM USA, NORTH AMERICA
The Medical University of South Carolina in beautiful Charleston has a long-standing commitment to global health initiatives and a well-established global health presence. International cooperation has led to many joint research and education initiatives with both basic science and clinical research involving teams from around the world. Fortunately much of this research was able to continue despite the COVID-19 pandemic. Education was affected more heavily. We host many international research fellows at the university and the Department of Dermatology has a growing number of international dermatopathology fellows each year. The pandemic greatly disrupted plans for our international fellows with cancelled flights and ever-changing rules regarding pre-travel testing and post-travel quarantine, not to mention challenges with visas. We had fellows who faced challenges returning home at the end of their fellowships and incoming fellows whose plans were delayed by travel restrictions. Fortunately vaccination has improved the situation and we are once again welcoming international fellows to our department. If COVID-19 has taught us anything, it is that we truly are a global village and we are more successful when we face challenges together as a global community. Welcome back everyone! We look forward to seeing you all in Singapore!
Tropical Dermatology, Travelers’ Dermatology and Aquatic Dermatology.
WCD 2023 AMBASSADOR FROM BRASIL, LATIN AMERICA
Three themes intertwine when we think of animals causing dermatoses: Tropical Dermatology, Travelers’ Dermatology and Aquatic Dermatology. Various skin diseases caused by infections or infestations can be inserted in one, two or even three themes, such as, for example, injuries by jellyfish and venomous fish. These illnesses are manifested primarily on the skin and although they initially deserve attention from the emergency rooms, in the following days they are treated and medicated by dermatologists.
Accidents by wild animals (including venomous ones such as snakes, spiders, catterpillars and scorpions), infections by Leishmania sp. and other protozoa and infestations by larva migrans, scabies, myiasis, fleas, lices, bed bugs and the chigoe Tunga penetrans fit in the Dermatology of Travelers, but also in Tropical Dermatology. Insect and ticks bites can cause important allergic conditions and also transmit serious diseases. They are clearly neglected diseases, which need to be disseminated among dermatologists, both those established in tropical regions and those in other countries, due to the immense international movement for tourism and work reasons nowadays. The Covid-19 epidemic curbed this movement temporarily, but an explosion of international travels is expected when the crisis is overcome, which values carrying out a specific activity on these dermatoses.
The World Congress is a unique and special chance to discuss these topics with participants from around the world. We might be able to transmit and receive knowledge that would otherwise have a slower dissemination. They are far more common diseases that we think …
Gabriel Gontijo & Vidal Haddad jr
Dermatology in Africa, especially in sub-saharian countries and how to help bring dermatology services to these underserved areas.
WCD 2023 AMBASSADOR FROM TUNISIA, AFRICA & MIDDLE EAST
In spite of the high frequency of skin diseases such as leprosy, tuberculosis, deep mycosis and misuse of topical corticosteroids, there is a truly alarming lack of dermatologists.
In North Africa, the ratio of dermatologists ranges from 3 per million population to 49 per million
population. The rest of the continent has a ratio less than 10 per million population, usually less
than 1 per million population.
In order to address this need, many initiatives have been initiated at the international level. I will cite the most important ones:
1. International League of Dermatological Societies (ILDS) and International Foundation of Dermatology (IFD) are developing special programs dedicated especially for areas with a glaring lack of dermatologists. Even sessions are organized to nurses to improve treatment of skin diseases.
2. One of the International Society of Dermatology Committees, Global Outreach Task Force (headed by Dr. Martin KASSIR) is organizing special training for young dermatologists from low income countries and coordinating various societies and industry to work together toward this goal
3. Project Passion : is offering practical solutions for both training of personnel and, for direct patient care by using new communication tools (Telemedicine and Artificial Intelligence in Dermatology). This project has another fantastic goal which is a long term plan for training dermatologists who stay in their countries to serve their native populations.
4. The African Society of Dermatology and Venereology was born in 2015, alongside the World Congress of Dermatology held in Vancouver and its goals are : to advance the specialty of dermatology in Africa, to establish a disease control programs, and to enhance research in dermatology as well as cooperation and policy development in the African region.
5. And we cannot forget the huge project of Dr Aldo Morrone and his team in Ethiopia
Improving health parameters in different parts of the world should be a concern for all of us. The gap in dermatologic care is obvious between the Global North and the South. As people emigrate from poor countries to rich ones, they move with their diseases, most of which are communicable. The burden of this migration on host countries is palpable (emerging diseases, tuberculosis, AIDS…).
Helping populations with limited resources does not require a huge investment in terms of money. It just needs effort, persistence and lots of good willi.
Together we can build a future we believe in- Bernie Sanders
Doss N. Kassir M. Role of National Dermatological societies : a perspective from Tunis. Clinics in Dermatology (article in press).Mosam A. Todd G. Dermatology training in Africa : Successes and Challenges. Dermatol Clin 39 (2021) : 57-71.
WCD 2023: beyond COVID-19, a learning opportunity for African dermatologists
Lidia de Almeida Voumard
WCD 2023 AMBASSADOR FROM ANGOLA, AFRICA
The WCD offers a special opportunity for African dermatologists to share their experience with colleagues from all over the world on the local pattern and clinical features of skin diseases, ongoing public health initiatives, training programs and to create new links and partnerships. The participation in the WCD of the younger generation should thus be encouraged to expand their vision and scope of the discipline at local, regional and global levels.
Besides cosmopolites conditions, African dermatologists face several challenges and priorities, such as neglected tropical skin diseases, HIV/AIDS related cutaneous conditions, albinism linked actinic and tumoral lesions. Greater efforts are required in the continent in order to increase the visibility of the discipline and to promote training programs to reduce the shortage of specialists, especially outside big cities. As an example, Angola had in 2019 only 32 national dermatologists, which is about 1:1,000.000 population. We now have 26 nationals being trained in Luanda, Huambo and Huila, coming from 9 out of the 18 provinces¹.
As in many countries, the COVID pandemic has a great impact on the health system and on the life of the Angolan people, directly and indirectly by exacerbating the current economic crisis, inequities and poverty.
With the early implementation of WHO recommended measures, the number of COVID-19 notified cases and deaths in Angola – a country of 34 M inhabitants – has remained relatively low: 26.652 cases, 596 deaths (2,2%), and 23.876 (89,5%) recovered patients had been registered² up to end of April 2021.
The access to community and outpatient health services has been restricted³ and most meetings have been cancelled or converted to online events. On a positive note, a large number of health professionals, including many young dermatologists, have acquired better digital skills, experience and interest for international learning platforms such as those offered by Pele Digital in Brazil, CILAD, EADV, ILDS and other institutions, another way to promote the « Dermatology beyond borders » theme of the WCD 2023.
Among this year initiatives, the Angolan Society of Dermatology and Venereology (SADV) will be launched, and the Angolan Association of Albinos is looking forward to convening a national meeting to raise public awareness on the condition and needs of this vulnerable group.
The unprecedented number of daily interviews, reports, and briefings on COVID-19 and more generally on health – including skin diseases – in all Angolan media, is emerging as a major progress in public health information and education. It is also hoped that the multisectoral commission, created to monitor and lead the national response against COVID-19, will amplify the integrated approach to better health, and catalyze the allocation of more human and budgetary resources to the health sector, being in a serious need of urgent support and reform.
¹ Dr.Juliano V. Isaiais, HAB Luanda, personal communication
² Angola, Ministry of Health, Boletim informativo 465, 30.04.2021
³ Dr.Clarry N. Luvualu, Community heath services, personal communication
Fig. 1 & 2. Community health services on Neglected Tropical Skin Diseases (Courtesy from Dr. Clarry. N. Luvualu)
The impact of the Pandemic on Brazilian Dermatology
WCD 2023 AMBASSADOR FROM BRASIL, LATIN AMERICA
Brazil was cruelly hit by the pandemic. We are about 200 million inhabitants in an immense territory, with about 8,500,000 km2, with great differences between the various regions.
In the second wave of COVID-19, Brazil is the epicenter of the pandemic in the world, with a very high number of cases and deaths.
We are having specific variants, more contagious, which compromised mainly the north of the country, but at the same time spread quickly throughout the Brazilian territory.
Brazilian and South American dermatologists are having the chance to treat many COVID cases which have caused different skin manifestations.
The most frequent skin lesions in our country have been pseudo-perniosis in children and young people and inflamed lesions, in form of a rash or sometimes vesico-bullosa.
Patients with more severe COVID have had severe urticaria and necrotic vascular lesions in the extremities.
The dermatologist also treats many skin changes correlated with the occurrence of the pandemic and among them we can highlight: contact dermatitis on the hands, perioral dermatitis or acne related to the use of a mask and hair loss due to virus infection or because of the stress caused by the disease.
I feel that the Brazilian and South American dermatologists play an important role in the pandemic, either by the diagnosis of skin diseases, or the support to the self-esteem of patients affected by the context.
The inflammatory characteristic of this disease highlighted all the issues related to inflammation. Obese patients, even the young, have had more complications than elderly with comorbidities such as hypertension and diabetes.
Pharmacodermias have also occurred more frequently due to the indiscriminate use of medications. Inflamed skin lesions such as psoriasis, atopic eczema, acne and rosacea, have been more frequent too. It is also worth mentioning that there are studies correlating severe androgenetic alopecia with more severe disease progression.
All this things results in a new world, where we have a lot to learn about the mechanisms of action of the disease, but also about empathy and human behavior. The World Congress of Dermatology in Singapore 2023 will certainly be a time for the exchange of ideas and discoveries among specialists from all over the world, each one living in their regional reality, with their own problems and demands.