Looking out for the community: Dermatologists need to recognize threats to public health

Outbreak! Public Health Threats in Clinical Dermatology (S005)

Physicians are trained to treat the patients in their offices, but they also need to recognize when a patient has a condition that could spread in a community. Indications of those danger signs and how to deal with them will be examined Friday in “Outbreak! Public Health Threats in Clinical Dermatology.”

“The idea of this session is to give dermatologists an opportunity to think about where and how that patient’s illness fits into the broader community health context and whether the condition we are seeing in one person might be something that has been influenced by, or is part of, a larger scale community outbreak,” said the symposium director, Wingfield Ellis Rehmus, MD, MPH.

Seven presentations during the session will explore the threat of climate change, flooding, syphilis, risky fads, and contact dermatitis, as well as how to recognize when a condition is a danger to a community and how to deal with the threat.

“This session is titled ‘Outbreak,’ and clearly there is an infectious disease focus, but not all of the presentations are about infectious diseases,” said Dr. Rehmus, clinical assistant professor at the University of British Columbia, Vancouver, Canada.

The first presentation will provide an overview to the topic and a framework for thinking about public health issues in a clinical setting. It will address what might trigger a dermatologist to recognize an individual case or group of cases that is part of a larger outbreak. For example, one group of dermatologists recognized a change in the presentation of hand, foot, and mouth disease and was able to uncover changes in the strains of coxsackie virus that lead to the new presentation.

Another presentation will look at climate change and its impact on skin disease. It is anticipated that the incidence of skin cancer could rise with a greater exposure to ultraviolet light, and changing climate can expand the habitat of disease vectors.

Climate change is also linked to an increase in extreme weather events that can trigger flooding. Another speaker will discuss the dermatologic consequences of flooding, such as the flooding that followed the 2004 Asian tsunami. Indonesian hospital reports on dermatologic disorders in that period showed that 32 percent of cases were infections, with eczemas and traumatic wounds each making up 30 percent of cases.

Also discussed will be the syphilis epidemic among men who have sex with men and the work of public health workers to deal with the ongoing outbreak among gay men in the United States.

Another threat is how to deal with fads that can go viral among social media users. An example is the recent salt ice challenge in which people put salt on their skin and held ice on top of it to simulate localized frostbite, causing many injuries.

When new chemicals are used in consumer products, outbreaks of contact dermatitis can arise. Another topic to be discussed is methylisothiazolinone, a chemical that was used in baby wipes but led to an increase in contact dermatitis reactions. A presentation will look at the threat of chemicals used in cosmetics that can lead to outbreaks of allergic contact dermatitis.

The session’s final presentation will discuss how to approach the media in situations that could be a danger to the public health. The presentation will look at what to take to the media, how to answer questions, and how to maintain confidentiality while sharing important information so people who are at risk know what is going on, Dr. Rehmus said.

“We want useful information provided, but confidentiality should be maintained and we do not want to sensationalize the problem,” she said. “Dermatologists need to remember to keep a public health lens on as they go about their day seeing individual patients and then know what to do if an outbreak that might impact the larger community occurs.”

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