Global Dermatology

Contributions from WCD2023 Ambassadors

Collection of articles about dermatology from all over the world. Dermatology beyond borders.

Impact of COVID-19 On Dermatology Services and Training in India

COVID-19 is responsible for changes across every aspect of life worldwide, including dermatology residents and medical professionals in training. India’s burden quickly escalated during the second wave of the pandemic and in India, Maharashtra took the maximum brunt of this biological terrorism. Residents at DY Patil Hospital, Navi Mumbai worked tirelessly around the clock to cater to the COVID warriors, as our hospital was a healing haven for over 10,000 patients. It’s easy to think among all this is negative, from difficulties with education to lower quality care and extended residencies. However, the impact on these areas of study is both negative and positive.

Learning Challenges

Online education has a place in learning. Nevertheless, it hinders more than it helps in some areas, such as the clinical requirements of medical residents. Digital learning doesn’t provide the same atmosphere for medical students. At the height of the pandemic, up to 90% of dermatology training was transitioned to online learning for educational purposes. The most affected in training and service were in dermatopathology and dermatologic surgery.

Lower Quality Patient Care

It’s more than students missing out on learning experiences. Patients are getting less care than they did pre-COVID-19 era. This is true across the board, but especially for acute care and dermatology. Not only is it harder getting to see individuals because of COVID restrictions, the PPE everyone is wearing for protection prevents quality care. Residents and providers need to see and touch patients’ skin. However, the spread of the pandemic prevents a thorough examination.

Health Concerns of Residents

Another challenge that did not get enough press is the health concerns of the residents and others in training as they were exposed maximum to COVID patients and worked relentlessly fighting the virus. During rounds or while working in COVID wards and ICUs, they are regularly exposed to patients with COVID-19 pneumonia, even before they are fully symptomatic. This spread of the virus occurs through blood, saliva, or any other body fluid, making their training dangerous to their health. Moreover, many residents fell prey to the virus and suffered from covid-19 pneumonia.

Improvements In Teledermatology

One positive is follow-up care in dermatology. More patients take advantage of telemedicine for aftercare services, allowing residents and other medical practitioners to further preventative care through quick videos. National Medical council approved tele dermatology as a legal way of treatment.   Studies in India found 85% of patients were following through with virtual consultations to update their physicians on improvements or problems with their current dermatology treatment plan. Additionally, nearly 55% were happy with the high-quality and convenient care, and they wanted to continue with virtual services.

Expanding the horizons

The pandemic created an atmosphere of urgency and required recruitment of residents and health care providers from all specialities. This was an opportunity for dermatology residents to learn other avenues of medicine which would otherwise been buried under the sand. Residents were able to learn and practise various lifesaving procedures like CPR, intubation, correction of electrolytes or sugars or diagnosing medication’s adverse effects. This inducted a sense of responsibility and moreover, improved inter speciality teamwork. Furthermore, it gave a sense of treating patient as a whole, as a life, that the patient is more than one single speciality, and a team of doctors carries a much more successful prognosis for patients than one.

Amid a COVID-19 pandemic, it’s understandable that dermatology residents and medical professionals in training are experiencing many challenges. However, there is more to this story than hardship. Although few, there are some positive impacts on education, patient care quality, and resident health concerns from the perspective of those who have been affected by COVID-19. These benefits may not be enough to make up for all they’re going through but show how life can continue despite significant obstacles like a global epidemic.

Dr. Jai Singh Solanki
(Resident in dermatology)
Dr. Kiran Godse
(Professor in dermatology)

Chronic itch: A public health challenge with new targeted treatments addressing unmet needs.

Itch, or pruritus, affects tens of millions of dermatology patients around the world and it’s the major   feature of the majority of inflammatory skin diseases.  Chronic itch can be conceptualized as a public health challenge for a number of important reasons having to do with seriousness, prevalence, disparities, vulnerable populations. There are substantial disparities in itch prevalence and seriousness and rates of undertreatment across population groups. Inadequately treated itch is more common in vulnerable populations—including the elderly, children racial and ethnic minorities, that are a traditional concern of public health agencies and programs. Chronic itch is costly not in just terms of health care expenditures and disabilities but also in loss of school days, work productivity and quality of life of patients and their care takers.

Fortunately, in the last decade exciting new finds in itch research in both humans and animal models have given us insight into the mechanisms of itch signalling and led to treatments that are targeting specifically itch pathways. We now understand that the neural pathway of itch transmission the cross talk between neural and immune system inducing itch. There are several neural receptors that are itch selective including: G coupled receptors such MRGPRs, Opioid receptors, and Neurokinin 1 as well as Transient receptor channels such as TRPV1, TRPA1, TRPV3. A revolution in the treatment of chronic pruritus is under way.  New Treatments for Prurigo nodularis a severe form of chronic itch have been developed and are under clinical drug trials. Recently, much effort in treating has been placed on targeting the immune system in pruritic diseases.

Agents that target IL-4 and IL-13 and the itchy cytokine IL-31 and drugs targeting IL17 have shown significant anti pruritic effect as well as JAK/Stat inhibitors. Agents targeting the nervous system are also showing promise in clinical trials for itch of different types and some Kappa Opioids have been approved such as Difelkefalin and Nalfurafine or an under clinical trials.

Due to the complexity of the different etymologies, cell types, and mediators involved in chronic itch one type of drug will not cover all types of chronic itch.

I am looking forward to the upcoming WCD, which will be the perfect venue to showcase the many advances in the field of chronic itch in different skin diseases and populations and the existing unmet needs with experts from all over the world attending the Itch sessions.