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Interview past EADV President Prof. Carle Paul

Prof. Carle Paul
EADV 2020

Dermatology in Times of COVID-19

Interview with Prof. Carle Paul, past President of the European Academy of Dermatology and Venereology (EADV) and Chair of the Department of Dermatology at Paul Sabatier University in Toulouse, France.

Prof. Carle Paul, MD, PhD

How has the pandemic influenced the field of dermatology?

In many dramatic ways. Of course, COVID-19 has influenced the work of everybody. Survey data about the impact of COVID-19 in Europe has shown that one-third of dermatologists had to work in a COVID unit, and most dermatologists had to cancel many appointments in spring. There was an increase in tele-dermatology consultation. This was prevalent until the summer when people started to come into the practice again. Most dermatologists, including myself, feel that tele-dermatology does not have all the advantages of face-to-face consultations.

During the pandemic, we observed that many patients delayed treatment and consultations or even stopped their treatment. Many patients with inflammatory skin diseases stopped their immune modulators because they feared this medication would render them more susceptible to a COVID-19 infection. Now we have evidence that some of these patients relapsed.

Are there skin manifestations of COVID-19 that dermatologists need to know about?

The most familiar manifestation of COVID-19 is what we call pernio, the pernio-like eruptions that show on hands and feet. They usually manifest a few weeks after the COVID-19 infection and can last for several months. Data was presented in the late-breaking session by a US colleague, Prof. Esther Freeman from Harvard. She did excellent work on analysing an international COVID-19 registry from 39 countries and showed that these dermatologic manifestations can sometimes persist for several months. There are also less specific dermatologic manifestations like morbilliform rashes, urticaria, and purpura.

This is the first year the EADV goes virtual. What are the highlights of the congress?

It was back in May when we first realised that we had to do a virtual meeting due to the pandemic. The EADV office led by Martine de Sutter with the expertise of Kimberly Zimmerman, head of the congress, selected the best providers of virtual event platforms and paved the way for a successful experience. The scientific committee, led by Prof. Brigitte Dréno, put together a massive amount of new data presented by over 550 speakers in over 700 lectures. We selected 1,600 abstracts that describe the most significant advances in our specialty.

There are vast amounts of new data and innovation with a lot of progress in the treatment of psoriasis. You will also find presentations on novel, breakthrough therapy in atopic dermatitis, not only with systemic but also with novel topical drugs; this is a quickly evolving field. We also see novel treatment possibilities in alopecia areata, which has been a neglected indication, and now we have both oral and topical novel drugs.

Last but not least, tremendous progress has been made in rare diseases like epidermolysis bullosa (EB). A novel compound was presented that allows the lesions to heal more rapidly. Usually, blisters in EB can take months or years to heal. So, taken together, I think this year was a very interesting rich congress with a lot of innovation.

Which sessions are not-to-be-missed?

Of course, this primarily depends on one’s interest, e.g. psoriasis or sexually transmittable disease or skin oncology. We have several interesting plenary sessions with excellent speakers, e.g. a talk from the general director of the World Health Organisation.

We also must learn how to cope with the current difficulties due to the pandemic. A survey performed by the EADV communication committee has shown that the pandemic has a huge impact on the general population: about 50% of patients report anxiety but also anger and a feeling of uselessness. This also impacts the doctor because these emotions of our patients are contagious. It is a real challenge, but there is a way to learn how to cope with this difficult situation. There is a fascinating talk by Ms Michele Nevarez, the CEO of the emotional intelligence coaching company Goleman EI, who together with the EADV executive committee developed a leader-level emotional intelligence training and certification programme for European dermatologists. In her presentation, she explained how physicians can reduce the impact of these negative developments on their own situation and how we can best cope with the COVID-19 pandemic.

How will the congress landscape develop? Will virtual conferences replace in-person conventions or will there be dual events?

Experience shows that it is more difficult to engage virtually than face-to-face. I think the future will be a dual approach with a physical congress once we can control the pandemic, probably after the first semester of 2021. We simply cannot replace an in-person congress. But alongside the physical meeting will be a virtual component for the people that cannot travel or those with a limited amount of time. I am a strong believer in this dual approach. It will expand the reach of the congress and by now we have the tools to increase the quality of virtual meetings. But nothing can replace the face-to-face contact

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