Commentary: Dermatologists and SARS – CoV – 2: the impact of the pandemic on daily practice

Paolo Gisondi et al.,¹ summarize well the issues faced by many dermatologists during the unprecedented lockdown period in Spring 2020 due to the COVID-19 pandemic. Issues like the sudden cancellation of face-to-face consultations, and the mandatory introduction of telemedicine (after months of a rather optional exercise with this type of caregiving), needed an entrepreneurial approach to manage.

In Belgium, we performed an online survey from March 22 to April 14, 2020, amongst dermatologist-members of the Royal Belgian Society of Dermatologists, letting them describe their needs as a professional during pandemic times. A total of 236 dermatologists replied (36% of members). The majority (43%) worked in a solo dermatology practice, and 28% stated they found it difficult to adapt to the recommended COVID-19 measures. Sixty-three percent continued urgent face-to-face consultations, and 17% fully closed their practice. The concerns of respondents were various: inadequate digital infrastructure; lack of protective and antiseptic materials; the proper use of disinfectants against the virus; lack of a payment system for virtual consultations; and difficulty convincing non-urgent patients to postpone their consultation.

From a medical point of view, many respondents reported having questions about the safety of continuing or starting up immunosuppressant therapy during the pandemic. They also expressed regret having to interrupt ultraviolet light therapy for their patients with certain conditions. Several dermatologists were prepared to help with first-line care and in COVID wards. And, along with the rest of the medical world, survey participants had questions around COVID-19 testing and immunity.

We know so little about COVID-19 and that concerns us all. I applaud initiatives like www.psoprotect.org (Psoriasis Registry for Outcomes, Therapy and Epidemiology of COVID-19 Infection) where we currently collect real-world evidence on infected patients with psoriasis. Recent research explores the concept that treatment with an immunomodulator like an interleukin-23 blocker or interleukin-17 blocker might protect a patient in the second deleterious hyperinflammatory phase of a COVID-19 infection.² As Dr. Gisondi and his Italian colleagues write, we need to learn from experience and merge these insights with novel research data.

When our Belgian government gradually allowed an ‘exit strategy’ to alleviate strict antiviral measures, specialists were asked to make a list of diagnoses that were most urgent to invite back to the limited consultations. Rather than just blindly list conditions, a dermatologist should trust in their deep insight to decide which patients should have a consultation. Apart from the fact that esthetic procedures needed to be postponed, it was our opinion that each dermatologist should decide on a case-by-case level, taking into consideration severity of symptoms such as pain and itch, risk factors such as age, existing comorbidities, and anxiety level, which patients ought to have a face-to-face visit. Only with skin cancer, a guideline for urgency was designed.

More than ever, we position ourselves as a dermatology community within an integrated patient-centric and transdisciplinary approach. Let’s have the courage to reset, restart, readapt and refocus as much as needed!

References

1.  Gisondi P, Piaserico S, Conti A, Naldi L. Dermatologists and SARS-CoV-2: the impact of the pandemic on daily practice. JEADV, 2020, 34: 1196-1201.

2.  Shett G et al. Nature Immunology Reviews, April 2020, doi.org/10.1038/s41577-020-0312-7 Lebwohl M et al. J Am Acad Dermatol, 2020, 82(5): 1217-1218.