EADV News 82 Spring 2022

WINTER 2015–2016 SPRING 2022

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P4 Making our voice heard Building inroads to the European institution s >

News The leading European professional organisation for Dermatology and Venereology

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Tuning into your patients’ rhythm An introduction to the “Optimising Patient Treatment” webcast series > Symposium Programme Finally, we can meet again in person! >

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Focusing on the young, investing in the future

Already registered? 17 th EADV Spring Symposium Ljubljana, 12–14 May 2022

Technology and innovation have transformed the speed at which we learn, interact and exchange knowledge. Our Academy has kept up with all these advances and has a vast array of offerings specifically designed for residents and junior colleagues to support their education and professional development. First, EADV provides a membership status for Junior Members (Junior Fellows, Junior Residents, Junior Scientists) with reduced registration fees for our world-class events, the annual EADV Congress and Symposium. Young dermato-venereologists and colleagues-in-training can apply for EADV scholarships covering free registration to EADV Congresses and Symposia, with a travel stipend and free membership for the following year. Travel grants are also available to attend important international scientific events of dermato-venereology and national dermatology congresses in the UK, France and the USA. Recipients of an EADV scholarship become part of

At our strategy alignment workshop with EADV last November , our discussion focused on how to generate added value for members and how to create a membership experience that spans the entire professional career of our colleagues, starting from residency and specialty training. As we listed EADV’s many offers and resources, my mind travelled back 30 years to the time when I was a dermatology trainee, and I compared the availability of resources now and then. Textbooks and classroom notes, the basic learning resource back then, have been replaced by online resources, notepads and PubMed ® . Email exchange was in its infancy and access to journals meant a visit to the hospital library and an intense search for a specific journal’s issue. Participation in congresses and courses is today enriched by online and hybrid events, webinars and webcasts that provide accessibility to an endless base of educational resources and expertise. It is all just a click away.

Xxxxxx

“By focusing on the youth, we invest in the future of our Academy and our discipline.”

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organisational work by joining an EADV Committee as a Junior Co-opted Member and/or our task forces. We seek to complement the training and skills of young dermato-venereologists with state-of-the-art knowledge and expertise that will help them embark on a successful professional path. And above all, help them integrate in the unique professional community of

for residents. The one on skin cancer is already scheduled for the Spring Symposium in Ljubljana, Slovenia. A number of fellowships supported by EADV are also available, including a six- month fellowship in Mohs' surgery and a recently initiated Clinical Fellowship for recently qualified dermatologists- venereologists to support short- term (2-3 months) clinical training at

Prof Alexander Stratigos

a renowned centre abroad. For those wishing to follow a more research track or a physician-scientist career, an EADV Research Fellowship is

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the prestigious EADV Alumni Club, a network of peers with long-lasting relations and fruitful exchange. EADV also offers on-site resident courses led by outstanding experts to help attendees sharpen their clinical expertise and build scientific collaborations and networks. Our recently restructured Learning Platform is a unique educational resource that makes all digital courses and webinars available online. Members can navigate through the entire education catalogue and register for in-person courses. As we expand our educational programme to create distinct learning paths on different topics, from basic to advanced level, the offering is also enriched by masterclasses

EADV, with shared values and a deep commitment to making a difference for our patients and our societies.

EADV strives to be next to our members at all stages of their career ”

As a life-long companion, EADV strives to be next to our members at all stages of their career, starting from the very beginning. This is just a glimpse of the opportunities EADV offers to young dermato- venereologists. For all details, please visit www.eadv.org . l

a wonderful opportunity to do basic or clinical research at a high-profile research centre in a country other than their own. The EADV website provides access to infinite reading resources: clinical guidelines, classic books, such as Rook’s Textbook of Dermatology , and prominent journals, including our EADV Journals ( JEADV and the JEACP ), the British Journal of Dermatology, JAMA Dermatology and Paediatric Dermatology , among many others. Younger members

Alexander J. Stratigos EADV President (2020-2022)

can also play a more active role in our

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Editorial WINTER 2015–2016 SPRING 2022 82

What is there to say?

I In the Editorial of the 77 th issue of EADV News , I reported on functional impairment associated with winter-seasonal depression. It might be comparable to the current seasonal feeling, but we have not had the masses of snow and ice in southern Europe that we did last year and levels of COVID-19 pandemic-associated social isolation have somehow improved, from this time last year. Over the years, we have sought to offer optimistic, thematically dedicated EADV News Editorials; always looking for light at the end of the tunnel. Physicians are used to the daily fight against disease and death, they try to remain optimistic about outcomes, respecting each human life. When the young Swiss humanitarian Henry Dunant organised local people to support the wounded on 24 June 1859 during the battle of Solferino (Italy), he was thinking of the value of each human life. Dunant called for the creation of national relief societies to assist those wounded in war, paving the way for the future Geneva Convention. When, on 8 March 2022, Sascha Siwzowa wrote his essay in the Decoder newsletter entitled, “ You have the feeling that a person's life is worth nothing ”, we get the impression that we are back in pre- Solferino times. Prof Christos Zouboulis

I know that there have been several similar situations in the last decades, in Afghanistan, several African countries, the Balkans, Iraq and Syria. And I am by no means suggesting that the current humanitarian catastrophe is worse than those, but large numbers of unjustifiable deaths are currently being reported in many locations by the media. Where is the new Henry Dunant to take care of the daily somatically and mentally wounded? We read about heroes who go to war, but we see pictures of bodies strewn around cities, of soldiers and civilians who may not even have known what they were dying for. Have we really returned to a point where a person's life is worth nothing? Is this what we call a civilized world? Excuse me for leaving you with such a difficult question and trust me that it is not winter-seasonal depression that is making me so pessimistic. However, to end on a slightly brighter note, it is heartening to see so many people coming to the aid of others of all nationalities, again reported by various media outlets, to offer support where they can. l Christos C. Zouboulis MD PhD Editor

In this issue

Focusing on the young ________________________________________ 1 Editorial ____________________________________________________________________ 3 Making our voice heard ____________________________________ 4 Chronic and acute exposome factors ______________ 6 Mohs' Fellowship in times of COVID-19 _________ 8 Non-laser and non-surgical removal methods of tattoos _____________________________________________ 10 Supporting dermatological education in Sri Lanka ___________________________________________________________ 12 Patient Working Group: Personalised Care _______________________________________________ 14 Creating a harmonised catalogue of undergraduate training in Europe __________________ 16 SPC Introduction to the Symposium Programme ___________________________________________________________ 18 Discover Slovenia during our EADV Spring Symposium _________________________________ 19 EADV’s Dermatology for Cancer Patients Task Force ____________________________________________ 20 Nurses in Dermatology Practice ____________________ 22 EADV courses _____________________________________________________ 24 JEADV Editor-in-Chief-Elect: Call for Nominations _______________________________________ 29 Calendar of Events ____________________________________________ 30

In response to the ongoing war and humanitarian crisis in Ukraine, we draw your attention to this dedicated webpage . EADV seeks to mobilise our far-reaching community to help with efforts in meeting the substantial needs of those impacted.

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Advocacy Working Group

Building

D Despite the high burden of skin and venereal disease in Europe , this group of diseases has long been underrepresented, and even absent, at the level of policymaking. It was with this lacuna in mind that in 2020, EADV decided to embark on our advocacy journey, with the aim of putting dermato-venereology firmly on the European Union (EU) health policy agenda and ensuring dermatologists have a seat at the decision-making table.

Dr Myrto Trakatelli

the autumn, targeting key policymakers with specific policy recommendations. Our advocacy activities in 2020 and 2021 have helped EADV build inroads to the EU policy-making machinery. Encouragingly, our work on skin cancer in the context of EU’s Beating Cancer Plan has already delivered tangible outcomes. Members of our working group have been taking time out of their busy agendas to hold calls with key Members of the European Parliament to explain the importance of strengthened sunbed legislation, recognition of skin cancer as an occupational disease and improved registration of skin cancer (among other measures), and we are delighted that these efforts have led to a substantially strengthened paragraph on ultraviolet (UV) radiation and skin cancer in the report ‘ Strengthening Europe in the fight against cancer – towards a comprehensive and coordinated strategy ’ of the European Parliament’s Special Committee on Beating Cancer. This success is an important first step in ensuring Europe’s Beating Cancer Plan delivers impactful change in the field of skin cancer prevention. But we are not stopping there. On World Cancer Day 2022, we were proud to have mobilised Europe’s multi-stakeholder community of dermatologists, oncologists,

Anna Rouillard

Advocacy is the act of arguing or pleading in favour of someone or a cause. For EADV, advocacy means arguing in favour of both the dermato-venereology profession and the patients we serve.

The impact of life- threatening diseases such as malignant melanoma is well known, but much more needs to be done to raise awareness about the severe impact of chronic conditions

“ Our work on skin cancer in the context of EU’s Beating Cancer Plan has already delivered tangible outcomes ”

like psoriasis and atopic dermatitis on patients’ quality of life and psychological wellbeing. Armed with the results of EADV’s Burden of Skin Disease survey, our Advocacy Working Group is developing a programme of activities to help raise awareness of the need for concerted policy attention to this neglected group of diseases. A series of scientific publications will provide the basis for a multi-stakeholder Policy Roundtable discussion at our Congress in Milan (Italy), ahead of the launch of an EADV Call to Action in Brussels (Belgium), in

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Making our voice heard : inroads to the European institutions

We will continue to nurture our relationships with stakeholder organisations who share EADV’s goals. We believe that together we are

organ transplant specialists, patient organisations, public health organisations and trade unions around EADV’s Joint Statement on skin cancer prevention. Co-signed by 58 organisations, including 35 national societies of dermatology and three prominent Members of the European Parliament, the statement is a powerful call to action addressed to policymakers. Further to the launch of the Joint Statement, the European Commissioner for Health, Stella Kyriakides, herself a cancer survivor, has invited EADV to speak with her and her colleagues in the Spring. We look forward to discussing the policy and funding needs for skin cancer as well as for dermato-venereology more broadly. Next on our skin cancer agenda ist the development of a statement on the early detection of skin cancer. The time is ripe for EADV to be vocal on this issue, as the European Commission is in the process of revising the 2003 Council Recommendations on cancer screening. The paper will form the basis for multi- stakeholder discussion at our upcoming virtual Policy Roundtable in connection with EADV’s Spring Symposium in Ljubljana (Slovenia). EADV has been appointed to provide input to the European Commission on the implementation of Europe’s Beating Cancer Plan via participation in three thematic groups: 1) cancer prevention, 2) early detection, diagnosis and treatment of cancer and 3) research, innovation and digitalisation

EADV’s advocacy programme is well underway and our ongoing activities have been given fresh propulsion by the elaboration of a multi-dimensional strategy and roadmap. Strategically positioning the dermato-venereology profession is a transversal objective running through all our activities, and one which we believe is crucial to ensure we can advocate optimally in favour of our specialty and ultimately our patients. l

Myrto Trakatelli, Advocacy Working Group Chair Anna Rouillard Senior Public Affairs Manager,

stronger to push for the changes we seek. It is in this spirit that EADV has applied to become a member of the European Cancer Organisation and we look forward to fruitful collaboration with this network of cancer professional and patient organisations in the months and years to come.

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Skin

Chronic and acute exposome factors impact skin physiology and dermatoses

T The skin exposome refers to the totality of exposures to non-genetic factors encountered by an individual over their lifetime . The clinical and biological impact of chronic exposome aggressions on skin functions play a critical role on skin aging, skin cancers and many chronic dermatoses 1,2 . Skin is exposed to environmental stressors; meteorological factors (extreme heat, cold, humidity), solar radiation (including ultraviolet radiation (UVR)), visible light, short infrared radiations, pollution and tobacco smoke. The skin is also affected by internal stressors; an unhealthy diet, hormonal variations, lack of sleep and psychosocial stress. The impact of chronic exposome on skin is well understood, but additional research is warranted on the combined action of these factors. There is a paucity of information on the immediate effects of short-term acute exposure. As a group of international experts, we recently reviewed existing information on the role of acute stressors on skin functions and dermatoses 3 . Prof Thierry Passeron

reactivate skin infectious diseases (i.e. herpes zoster or herpes labialis). Lack of sleep impacts the immune system and could manifest as autoimmune diseases. Signs of skin aging are more pronounced after an acute lack of sleep. Acute change in diet or acute hormonal variations can promote flares of some dermatoses (e.g. acne). Acute exposure to some medications, procedures and acute stress challenges also impact skin functions and are shown to trigger flares or worsen dermatoses (e.g. rosacea, acne and atopic dermatitis). Further research is required to better understand the biological and clinical impact of acute stressors on the skin to develop effective prevention measures. l Thierry Passeron , MD, PhD, University Côte d’Azur, Nice, France. Department of Dermatology, CHU Nice, Nice, France 1 Krutmann J, Bouloc A, Sore G, Bernard BA, Passeron T. The skin agingexposome. J Dermatol Sci 2017;85(3): 152–161. 2 Passeron T, Krutmann J, Andersen ML, Katta R, Zouboulis CC. Clinicaland biological impact of the exposome on the skin. J Eur Acad DermatolVenereol 2020; 34 (Suppl 4): 4–25. 3 Passeron T, Zouboulis CC, Tan J, Andersen ML, Katta R, Lyu X, et al. Adult skin acute stress responses to short-term environmental and internal aggression from exposome factors. J Eur Acad Dermatol Venereol. 2021;35; 1963-1975.

acute disturbance to homeostasis after environmental and/or internal exposure. Acute stress, which would typically last minutes to hours (generally no more than a week in humans) provokes a transient yet robust response. Our investigation provided an overview of the biological effects of a frequent acute stressor on six key skin functions (see image). Acute exposure to the sun can induce sunburn as well as flushes and immunosuppression (promoting skin infections) and may trigger pigmentary disorders and photodermatoses. It has beneficial effects too; synthesis of vitamin D, release of opioid factors, less pain and lower blood pressure. Short-term pollutant exposure has been linked to xerosis, itching and exacerbation of atopic dermatitis and acne symptoms. Acute exposure to heat can cause erythema ab igne . Exposure to cold and dry air may lead to a reduction in skin hydration and promote atopic dermatitis flares. Autoimmune diseases (e.g. alopecia areata and vitiligo) may be triggered by acute stress with altered innate and adaptive responses and increased oxidative stress. Acute psychosocial stress may also Skin functions affected by acute stressors

Exposome factors that lead to acutely stressed skin can be defined as any

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EADV Mohs Micrographic Surgery’ Fellowship

Applications for the EADV Mohs’ Fellowship closes on 31 May 2022 Mohs Micrographic surgery (MMS) is not widely available in Europe. EADV offers a six-month MMS fellowship to eligible EADV specialist members to help expand the number of European Mohs surgeons able to offer the best possible care for skin cancer patients.

For more information:

> Apply online

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EADV Fellowships

Mohs' Fellowship

I

Dr Johan Chanal

and analysts, all people I would be working with for the next six months. They were all very welcoming and straightforward in what they expected of me. At the beginning, I admittedly found it challenging to hold my scalpel at 45° and, yes, I messed up the colouring three or four times and, yes, at first, for me all hair follicles were tumours under the microscope. But my mistakes were lessons to be learned and allowed me to progress with the supervisors’ help. Hands-on learning I find Dutch patients to be quite understanding, trusting a non-Dutch speaking doctor with a strong French accent (I spoke to them in English). A supervisor was always on hand to teach

I am very grateful to EADV for accepting me for the Mohs' Fellowship at Erasmus MC Rotterdam, Netherlands. On 4 January 2021, in the midst of the COVID-19 pandemic, I packed my luggage to begin my adventure. I was both excited and trepidatious when I waved goodbye to my husband from the train pulling out of Paris Gare du Nord. I arrived in Rotterdam at 18:00. Everything was closed, the streets empty, with people staying home to keep away from the virus. I took ownership of the key to my flat and unpacked, anxious for the days ahead. I again looked over the different steps of Mohs (watch your 45°, don't mess up the colouring and work your pathology). The first day turned out to be a no-Mohs day, rather a standard surgery, as the analyst was off. My first learning point; surgeons and nurses are disposable, a good analyst isn’t. In my team, I met dermatologic surgeons, residents, nurses

“ It is important that when you learn something this important, you share the knowledge with others ”

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in times of COVID-19

live in? For example, in France, there is only one centre that does Mohs frozen section, whereas in the Netherlands every hospital with a dermatology department has a Mohs clinic. It has been shown in numerous publications and recommendations, and I have seen it myself during my fellowship, that the Mohs technique reduces the size of the surgical defect, assesses one hundred percent of the margins (lateral and deep), enables you to operate more precisely to reduce scarring and, ultimately, reduces the risk of tumour recurrences. In terms of COVID-19 and Mohs surgery, it is clear how important, on local and European levels, healthcare policies are for patients. Preparing my future surgery By June, when my fellowship was almost over, I had made real progress in surgery and pathology – there is of course always more to learn. I emailed my managers and made a list of the machines (cryostat, microscope, stainer, etc) and people that I would need to begin offering Mohs surgery. It usually takes months for administration to fund requests, but I was so eager to begin. I know how important it is for my patients that I am able to operate on them using this technique. I just needed to pass my test to be officially appointed a Mohs surgeon. Before returning home, I also emailed my colleagues in dermatologic surgery in France about Mohs. It is important that when you learn something this important, you share the knowledge with others. Thank you to Prof Nijsten and all the Mohs team at Erasmus MC Rotterdam

me how handle a Mohs case and to listen to the patients, explaining the steps of a Mohs surgery: Remove the tumour with minimal margins and give it to an analyst for processing. Check the slides and perform a second round if needed. Visiting France was getting more and more difficult due to COVID-19 and the required PCR tests and need to quarantine, although my husband and I managed a few trips to see each other. Except for with the people at work, it was impossible to build relationships or participate in any social events. At first, I would get home and have no other distraction than television or books. The lack of stimulation numbed my mind (a feeling I believe many people had during the pandemic). At work, people tried to cheer me up. They were all very concerned about my wellbeing and even invited me to their homes, when allowed. One nurse was so kind she brought me a quiche Lorraine and a supervisor shared her relaxation tips with me. Slowly, I was able to create a new routine and make new connections and friends. I learned how to deal with the loneliness of being so close (2 hours 40 minutes by train) to Paris, yet so far away due to COVID-19. Comparing COVID-19 and Mohs I can’t help but make a parallel between the COVID-19 situation and Mohs surgery in Europe. Why do different European countries deal with the pandemic in such different ways in terms of public health (including rollout policies for the vaccine) and why does access to Mohs surgery depend on the country you

for their kindness, patience and professionalism. Thank you EADV for this great opportunity. Thank you to my bosses Prof Aractingo and Prof Dupin for letting me leave for six months (sorry for the extra work). And of course, thank you to all the patients I saw (dank je wel!). l Johan Chanal MD, AP-HP, Dermatology Department, Hôpital Cochin-Port Royal, APHP, Paris, France

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Tattoos and Body Art Task Force

Non-laser and methods

T

The tattoo removal industry has seen tremendous growth over the past years as a natural consequence of the increased popularity of tattoos . Current treatments include surgical removal of the tattooed skin or laser removal by ablative CO 2 , Q-switched or picoseconds lasers. Each method has its benefits and drawbacks. However, individuals may seek easier, cheaper and faster methods 1 . At the beginning of the 2000s, a “new” technique, which consisted of puncturing the tattoo and introducing various chemical products into the dermis, leading to the expulsion of the pigments via the formation of scabs, appeared on the market 2 . On the internet, these methods are presented as fast, safe, effective alternatives to laser removal. They are said to be “natural”, “cruelty free” and, by their nature, capable of removing all colour (unlike laser). An additional, often-used marketing argument is the alleged hazardous nature of laser removal which may drive pigment particles deeper or

mean that ink remains in the body 3 . Except for a limited study of one of these methods, there are no comprehensive clinical studies for such methods of tattoo removal. Pictures available online are usually not taken in a standardised fashion and are often of poor quality. Companies do acknowledge the risk of scarring and dyspigmentation with their procedure, but usually fail to provide any data. Knowledge and mastering of this tattooing technique are usually cited as a prerequisite for its use 4 , and that it should be used by a medical professional, cosmetologist or tattooist 5 . Aesthetic complications with hypertrophic scars and dyschromia have been reported 1,6,7 . You could consider these “new” methods to be old wine in new bottles. In 1888, Gustave Variot, a French physician, published a new method of tattoo removal 8,9 . He conducted a study on six French prisoners willing to get rid of their tattoos. After various unsuccessful attempts, he finally developed an efficient method that carries his name. The tannic acid method of Variot consisted of inducing escharotic necrosis of the epidermis and dermis by puncturing the skin with needles and applying a solution of tannic acid and silver nitrate. According to Variot, he obtained a very good result with few side effects 8,9 . Following Variot, different physicians developed their own methods by (mainly) changing the formulation of the chemical ingredients, while maintaining the same procedure 10 . Variot's method had its place when

Dr Nicolas Kluger

Dr Hugues Cartier

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non-surgical removal of tattoos: A call to action

“ Products comprising this method should be evaluated by proper studies, with strict rules established for their use ” References 1. Kluger N. The risks of do-it-yourself and over-the-counter devices for tattoo removal. Int J Dermatol. 2015 Jan;54(1):13-8. 2. Cheng W. A non-laser method to reverse permanent makeup and tattoos. Cosmet Dermatol 2001;14:47–50

laser therapy was not available, for small amateur tattoos and when performed by someone with experience. Professional tattoos display a compact distribution of pigments in the dermis, that has nothing to with what Variot attempted to remove in the 19 th century. Even if trained, laymen, tattooists and beauticians have no experience in dealing with potential healing issues that could occur after the procedure. Because of the risk of necrosis, possible secondary infection and scarring, as well as the improper use of the method by non-medical laypeople, and the existence of lasers, we, as a task force, believe that the use of this method for tattoo removal should be discouraged. Products comprising this method are neither tattoo pigments nor medical devices, and should be evaluated by proper studies, with strict rules established for their use. l Nicolas Kluger MD, PhD Tattoo consultation, Hôpital Bichat – Claude Bernard, Paris, France, and Department of dermatology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland Hugues Cartier MD, Department of dermatology and wound healing, Centre Hospitalier d’Arras, Arras, France

3. https://tatt2away.com/pages/tatt2away-vs-laser [accessed 21 Jan 2022]

4. Cheng W. Chemical extraction technique for tattoo removal. Br J Dermatol 2004;151: 1282–1283

5. http://www.e-raze.com/ [accessed 21 Jan 2022]

6. Hutton Carlsen K, Serup J. Sequels to tattoo removal by caustic products. Skin Res Technol. 2018 Nov;24(4):636-641. 7. Wollina U. Depigmentation and hypertrophic scars after application of a fluid lactic acid tattoo eraser. Wien Med Wochenschr. 2015 May;165(9-10):195-8. 8. Kluger N. Tattoo removal at the start of the 20 th century. Ann Dermatol Venereol. 2010 Aug-Sep;137(8-9):582-4. French. doi: 9. Variot G. Nouveau procédé de destruction des tatouages. Bull Mem Soc Anthropol Paris1888;11: 480–483.

10.Bruno C. Tatoués, qui êtes-vous...?. Editions de Feynerolles, Bruxelles, Belgium, 1974

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Tropical Dermatology Task Force

Supporting dermatologi

T The EADV Task Force for Tropical Dermatology supports dermatological education in many ways and is encouraged by the interest of enthusiastic and eager young doctors across the world . COVID-19 temporarily decelerated and even stopped many projects that foster the international exchange of dermatological experience and ideas. However, in October 2021, I had a great opportunity to combine the enjoyment of my membership of this task force with my responsibilities as a deputy liaison officer between the German Dermatological Association and the Sri Lanka College of Dermatologists (SLCD). I am sharing my experiences to encourage others to follow suit.

Panzer, Consultant Dermatologist, Department of Dermatology, University Hospital, Rostock, Germany, it was my pleasure, last autumn, to lecture on relevant dermatological fields to young dermatological house officers from hospitals all over Sri Lanka - Jaffna, Colombo, Galle and Kandy. Due to the pandemic, these lectures took place via Zoom. I covered four main dermatological subjects: lymphoedema/lipoedema, diabetes-associated dermatological diseases, laser therapy in dermatology and skin and starvation. Dr Reinel delivered one lecture on cutaneous fungal infections and Dr Panzer three lectures: skin barrier, photobiology and clinicopathological approach to granulomatous skin disease. Each lecture was followed by an enriching discussion with participants, sharing experiences of our cultures, different systems of medical education and local needs, and finding we have differing lists of leading local diagnoses in each of our countries. If there had been a choice, everyone would have preferred to hold the lectures

Dr med Andreas Montag

Together with Dr Reinel, German dermatologist and liaison officer, and the much-appreciated support of Dr Ruediger

The National Hospital of Sri Lanka

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ical education in Sri Lanka

had named 70 dermatologists as Board Certified Consultant Dermatologists in Sri Lanka. Since then, the number of dermatologists in Sri Lanka has doubled. Collaborations like these are part of the soul of tropical dermatology, known also now as global health dermatology. They open minds, enrich our dermatological everyday life and create enduring friendships. Bonds between cultures are one of the most important principles of forging our success as tropical dermatologists. My Sri Lankan colleagues can count on me as a lifelong friend. l Andreas Montag , MD, Consultant Dermatologist, private practice, Germany. Dr med Andreas Montag and his team in Hamburg with a Sri Lankan colleague

physically at the Post Graduate Institute of Medicine, University of Colombo, as we usually do. Colombo is a prosperous city in a country that is rapidly growing, now that things are stable following the civil war. No wonder. The meaning of ‘Sri Lanka’, formerly Ceylon, is “bright blooming country”. Sri Lankan and German dermatologists have enjoyed a close relationship for some time. SLCD was founded in 2005, having begun life as the Sri Lanka Association of Dermatologists (SLAD) in 1985, with 15 dermatologists caring for the whole country. (Sri Lanka 1985: 16.18 million people, Sri Lanka 2020: 22 million people). A Board of Study in Dermatology was established at the Post Graduate Institute of Medicine of the University of Colombo to help train dermatology specialists to work all over Sri Lanka. The first annual academic session was held in 1986 in collaboration with the German Dermatological Society (GDS). Since 1991, academic sessions have been held at least annually. There

have been more than 25 conferences in total, with several international events held in collaboration with dermatologists from all over the globe. Links have also been established with the International League of Dermatological Societies (ILDS). Trainees are offered scholarships and placements in different countries. In 2006, GDS started donating funds to establish an academic unit with a Chair in Dermatology at the Faculty of Medical sciences, University of Sri Jayawardenepura. From 1985 onwards, Dr Guenther Schwenzer, a German dermatologist, became the first liaison officer working for GDS and SLCD. In 2008, Dr Reinel took over from Dr Schwenzer. I have had the privilege of supporting Dr Reinel as his deputy since 2016. In 2017, Prof Dr Peter Elsner, Head of Department of Dermatology, University of Jena, established an ongoing annual internship for young Sri Lankan doctors in the final year of their dermatological education. I contribute to this with an annual two-week training programme in my practice. According to its website, up to August 2014, SLCD

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Patient Working Group

Tuning into An introduction to the “Personalised Care”

T The music starts – you take a step to the side, one step back, to the side again and nowyou are swaying in time to the beat . Most people like to dance, no? To create moments of togetherness with others? The metaphor of dancing works well for medical consultations, for what do we as dermatologists and what our patients need. Everyone should leave the ‘dancefloor’ satisfied with the interaction.

are right for them. It is a collaborative process through which a clinician supports a patient to reach a decision about their treatment. The conversation brings together: The clinician’s expertise, such as treatment options, evidence, risks and benefits. What the patient knows best: their preferences, personal circumstances, goals, values and beliefs ”. 1 Ideally, as Dr Jose Luis Turabian, a family physician in Spain, writes, a doctor adapts during a medical consultation to the rhythm of the patient and detects " what dance the patient dances " and, like a good dancer, “take[s] a step back, another forward, dancing and pacing with the patient ”. 2 Why should we try tomaster this complex dance? Because the challenges shared by patients and dermatologists are numerous. If we can resolve them, better patient care will result. What are these challenges? Firstly, patients often don’t feel heard by their physicians. Secondly, as many as 40% of patients fail to adhere to treatment recommendations. And lastly, nonadherence can be as high as 70% when preventive or treatment regimens are very complex and/ or require lifestyle changes and the modification of existing habits. These challenges impact not only the physician and patient, but also patients’ families, society and healthcare systems. Opinion leaders in this field of research have published the following insights: • The physician–patient relationship is important in determining patient outcomes, including patient adherence

Dr Catherine van Montfrans

In a webcast series starting on 30 March 2022, EADV’s Patient Working Group brings together dermatologists and patient organisation leaders to address six different disease areas (see programme opposite). In each episode, we will look at how to improve quality of care by sharing real-life examples and best practices. Over time, there has been a trend to move away from the “I decide the best treatment for you” approach, also known as the paternalistic decision- making model. We have seen some for you" comes into play. But for many, the deliberative model, "we choose together" or shared-decision-making model is an even more significant step forward. What is shared decision making? The National Health Service (NHS) in the United Kingdom says: “ Shared decision making (SDM) ensures that individuals are supported to make decisions that movement towards a more informative model where, “I give you some information, however I still decide

Jennifer Austin

“ The physician–patient relationship is important in determining patient outcomes, including patient adherence ”

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your patients’ rhythm webcast series

• patients who feel that their physicians communicate well and actively encourage them to be involved in their own care tend to be more motivated to adhere to advice • cohesive partnerships and effective interpersonal communication help support patients to follow mutually agreed-upon recommendations • patients' trust in their physician far exceeds many other variables when it comes to promoting patients' satisfaction with their care With shared decision making, where physicians and patients work together and strive for mutual agreement, compliance improves and satisfaction and recall of physician information increases. Time and resources may also be saved. Today, a patient told me, “ You think from your doctor’s perspective, and you do not see my point of view. You think about the past, about what has happened, and I think about the future and what will

happen ”. Of course, he was right, and only he can shed light on what matters to him, including his preferences, personal circumstances, goals, values and beliefs. It is patients who should be determining the end points that are most meaningful to them and their treatment plans should reflect this.

Patients are a very under-used resource in healthcare, but one that could help make our jobs easier and even more fulfilling. In EADV’s webcast series entitled “ Personalised Care ”, dermatologists and patient leaders will talk about the steps they took to move towards shared decision making and how this made a meaningful difference in their lives. l

Catherine van Montfrans , MD Department of Dermatology, Medical Center, Rotterdam, The Netherlands Jennifer Austin , CEO, International Alliance of Dermatology Patient Organizations (GlobalSkin)

Webcast Series Programme

Cutaneous Oncology

30 March 2022

¹ https://www.england.nhs.uk/publication/ shared-decision-making-summary-guide ² REF Jose Luis Turabian Doctor-Patient Relationship as Dancing a Dance JOURNAL OF FAMILY MEDICINE 2018; 1 (2): 1-6 www. openaccesspub.org JFM CC-license DOI: 10.14302/issn.2640-690X.jfm-18-2485 Vol-1 Issue –2 Pg. no.– 3

Paediatric Dermatology

27 April 2022

Dermatological Surgery

25 May 2022

Inflammatory skin diseases

22 June 2022

Hair and Nail disorders

20 July 2022

Cosmetical Dermatology

17 August 2022

>> YouTube channel

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EADV Education

Creating a harmonised catalogue of undergraduate training in Europe

Dermatology Forum (EDF) took on the challenge to envision a harmonised catalogue of undergraduate learning offerings for our discipline in Europe. Thanks to a three-year grant from the Strategic Partnerships section of the Erasmus Plus programme, supported by both EDF and an unrestricted grant from Viatris, an American global healthcare company, we have developed a comprehensive teaching catalogue. Together, dermato-venereology specialists in Barcelona (Spain), Brussels (Belgium), Dessau (Germany), Helsinki (Finland), Magdeburg (Germany), Paris (France) and Zagreb (Croatia), along with Switzerland as an associate member and the IT team from Swiss4ward, a software consultancy company in Alicante (Spain), have worked out a basic catalogue of more than 140 diagnoses, several chapters on cutaneous symptoms and syndromes and several on basics in dermatology. The results are available now as a more than 500-page pdf webbook. You can also access short

text versions of the materials as a blended e-learning tool via the DOIT cyberderm website. Find out more at hedulearnit. org or cyberderm.net . The project partners have also established recommendations for a minimum obligatory amount (more than 60 hours) of teaching of content and a recommendation for the distribution of lectures, seminars, hands-on workshops and bedside teaching. For teachers, there is also advice with regard to structuring “ Learning and Teaching in the Inverted (Flipped) Classroom ”. Diagnoses are ranked by their impor- tance in terms of what a university med- ical student should be expected to know. The content of diagnoses and other materials was evaluated by students as the programme developed to make sure that it was of an appropriate level and fully understandable by non-English native speakers. It was rated as good or very good by more than 75% of respon- dents who recommended its value to be significant. The COVID-19 pandem- ic underlined the need to have good, blended learning material when access to lecture halls and bedsides was not possible. This project represents a good solution to that. Results of the project are due to be implemented at medical faculties inter- ested in them. EDF takes responsibility for future maintenance, follow-up and updates, as required. l

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Prof Dr Harald Gollnick

Remember your training in dermato- venereology? It must have been good as it led you to select our medical discipline for your professional career. But how does it equate with fellow students training in different regions? For residents in training, a harmonised European Training Recommendation for Dermato-Venereology has already been endorsed by the European Union of Medical Specialists (UEMS), as published in the JEADV in 2019. But what about undergraduate training? Did you know that teaching hours for undergraduate training in Europe for dermato-venereology vary between 15 and 120 hours? To bring more balance, a number of professors from the European

Harald Gollnick , MD, PhD

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UEMS European Board of Dermato-Venereology Diploma (EBDVD) Examination

UEMS EBDVD Examination (in English) assesses the knowledge and clinical skills required to assure delivery of a high standard of dermato-venereological care, both in hospitals and independent clinics. > Date of the next EBDVD (remote online) examination: 14 October 2022 > Deadline for application: 1 May 2022 (deadline for payment: 15 May 2022)

Fee • 550 euros for candidates from a European Union Member State, a signatory country of the European Economic Area Agreement and Switzerland • 750 euros for candidates from other countries Eligibility Only available to candidates who can demonstrate a secure room to take the examination and a reliable authorised person to invigilate (read all requirements). > FIND OUT MORE <

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Symposium

Finally, we can meet again in person !

discussions that will focus on challenging cases encountered in daily practice and provide state-of-the-art guidance for management. The event will also feature one of the audience’s favourite sessions entitled Breaking news at which the latest, cutting-edge developments of our rapidly evolving specialty will be shared. The Plenary lecture will be given by Prof Tatjana Avšič Županc, an acclaimed Slovenian virologist, who will talk about “ Emerging viral infections of the 21 st century ”, a topic of actuality and great interest. On behalf of EADV’s leadership and the Scientific Programming committee, I am excited to welcome you to Ljubljana for this Symposium, a long- overdue face-to-face meeting with the highest quality of scientific content and many opportunities for personal and professional development. l Michel Gilliet , MD Chair of the Scientific Programming Committee

F EADV’s Spring Symposium is our first in-person meeting after two long years of meeting cancellations and virtual conferences . TheSymposiumwill be held in Ljubljana from 12-14 May 2022, an ideal convivial location to celebrate our face-to-face return with great networking

Prof Michel Gilliet

opportunities and possibilities to share our latest experiences and research. The three-day scientific programme will continue a long-established tradition of academic excellence in the fields of dermatology and venereology, featuring over 20 sessions with more than 70 international top-level speakers. The sessions will focus on a selection of hot topics such as skin cancer, psoriasis, atopic dermatitis, sexually transmitted infections (STIs), acne, hair and nail disorders, paediatric dermatology and aesthetic dermatology, among others. These topics will be presented in different formats, ranging from Clinical updates, which will provide the latest news relevant to our clinical practice, to Clinical case

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National Society

Discover Slovenia during our EADV Spring Symposium

Assoc Prof Mateja Dolenc-Voljč

Dermato-venereology, an autonomous medical discipline in Slovenia , dates back to the last century. The Department of Dermatology and Venereal Diseases was established in 1945 within the University of Ljubljana’s Faculty of Medicine. Our predecessorsmade great efforts to keep abreast of developments and practice their profession at a level comparable to other European countries. The most distinguished among them was the internationally recognised Franjo Kogoj, after whom the spongiform pustule of Kogoj was named. He played a notable role in the advancement of dermato- venereology in Slovenia, at both academic and research levels. Today, there are two faculties of medicine with departments of dermatology and venereology in the “ Dermatology is one of the most attractive specialisations in Slovenia ” as

in spolne bolezni (Skin and Venereal Diseases), intended for medical students and family doctors. Slovenia has been represented on the EADV board since 2018. We consistently promote EADV among our colleagues and the number of EADV members from Slovenia has almost doubled. They are also present (especially residents) in greater numbers at educational events, including as presenters. Slovenian dermato-venereologists are eager to foster close international ties. In May 2022, Ljubljana will host the EADV Spring Symposium as a live event. Slovenian dermatologists are very much looking forward to introducing Slovenian dermato-venereology and the Association of Slovenian Dermato-venereologists. We hope you will attend the event, both for the attractive three-day programme of symposium events as well as to visit the stunning capital of Slovenia. Established on the site of the ancient Roman city of Emona, it is adorned by a medieval 11th century hilltop castle. Today, Ljubljana is a green, safe and vibrant city with a wealth of cultural heritage and academic tradition. It has put quality of life at the forefront of its developement and in recognition it was recently awarded European Best Destination 2022. We look forward to welcoming you to Ljubljana. l

country, serving a population of around two million. The Association of Slovenian Dermato- venereologists was founded in 1998 as a continuation of the Dermatology Section that was established by the Slovenian Medical Association in 1978. The association works with leading educational and clinical institutions in Slovenia and has played an important role in making people aware of the dangers of sun exposure and promoting the prevention of malignant skin tumours. The association has 152 members. It publishes the quarterly English-language Acta Dermatovenerologica Alpina, Pannonica et Adriatica , founded in 1992 by Dr Aleksej Kansky. The journal has an international editorial board and is indexed in Medline, Excerpta Medica and the European Science Communication Institute (ESCI). The association has recently published an updated edition of the dermatological textbook Kožne

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Mateja Dolenc-Voljč , Dr Med Assoc Prof University of Ljubljana, Ljubljana, Slovenia

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Dermatology for Cancer Patient Task Force

Supporti introducing EADV’s for Cancer Patie

According to the European Commission's science and knowledge service 1 “ Data suggests that only half of the European population will go through life without developing cancer at some point. However, cancer continues to wreck lives, impact families and put major pressure on our health and social systems and economies ”

Dr Azael Freites- Martinez

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Supportive is about the care of cancer patients with dermatologic toxicities acquired during and after oncologic treatments. It includes the prevention, early recognition and mitigation of the adverse reactions of modern and traditional oncologic therapies on the skin, hair, nails and oral and genital mucosae. While supportive oncodermatology departments have been created in some countries, in Europe, it is still a relatively new concept. Nevertheless, there is an increasing perceived clinical need. The high numbers of people being treated for cancer and cancer survivors are driving some hospitals and healthcare centres to develop specific dermatologic supportive care for oncologic patients. Several scientific societies are dedicated to the research, support and education around all aspects of cancer treatments. However, there was no European group focused on the study and management of dermatologic adverse reactions induced by oncologic therapies (i.e. chemotherapy, targeted therapies, radiation therapy, endocrine agents, immunotherapy, etc.). A collaborative approach of 73 dermatol- ogists, representing 18 European and three oncodermatology

non-European countries (Argentina, Israel, USA) is addressing this unmet need. Our group traces its beginning to the 2019 EADV annual meeting in Madrid. In April 2021, we officially became the EADV Dermatology for Cancer Patients Task Force. Our main objectives are to: • Foster scientific education and establish guidelines on the optimised prevention and management of dermatologic adverse reactions of oncologic therapies, and dermatologic disorders attributed to cancer • Detect and describe via multicentric studies novel dermatologic toxicities induced by oncologic therapies • Improve dermatologic management and quality of life for cancer patients and cancer survivors (with dermatologic sequelae) One of our initials aims was to establish a position statement for the management of dermatologic toxicities of relatively new immune checkpoint inhibitors, which today represent the cornerstone of the management of many cancers. To

Dr Vincent Sibaud

Dr Gabriella Fabbrocini

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