In-Patient Care Dermatology

During the 2024 EADV congress, Prof Dr Jan Gutermuth, dermatologist at the University Hospital Brussels, chaired an interesting pro-con session in which 2 hot topics in dermatology were discusses.

The first of these debates tackled the question whether patients with bullous pemphigoid (BP) should be routinely screened for cancer. The available data on the association between BP and cancer are contradictory. For example, a large meta-analysis including 16 studies with a total of almost 9.400 BP patients showed a higher overall event rate of malignancy among BP patients than in matched controls (OR[95%CI]: 2.08[1.22-3.55]; p= 0.005). Of note, in this analysis, the risk for malignancy was higher among men and in European BP patients.1 More recently, however, data from a large Mendelian randomization study failed to show an association between BP and an increased risk of developing 13 types of malignant tumors. Given these contradicting data, it is difficult to set out clear guidelines for cancer screening in BP patients. Given the fact that BP is usually seen in older patients, many of these patients are already candidates for existing cancer screening programs. Therefore, Prof Gutermuth argued that it is not necessary to do additional cancer screening in BP patients, but that it is important to adhere closely to the existing screening programs.

During the second debate, the focus was shifted to the need for in-patient beds in dermatology care. The overall conclusion of this lively discussion was that the need for dermatology beds is quite low. In fact, many skin conditions do not require hospitalization. The latter is further reinforced by the availability of a broad range of new medical treatments for major dermatological diseases, such as psoriasis, atopic dermatitis and bullous disorders. In addition to this, advances in surgery have led to a marked decrease in the risk for complications after surgery. Nevertheless, it is important to have a limited number of beds available to guarantee optimal care for the small proportion of patients with complex dermatological disorders that require close monitoring. For Prof Gutermuth, the care for these more complicated cases is preferably organized in dedicated reference centers by experienced teams of well-trained dermatologists and dermatology nurses.