Dermatology and skin diseases at the heart of the Midi Libre Health Lab

Stéphanie Merhand, Charlotte Pernet and Michael Chekroun, the three speakers this Wednesday at the Midi Libre headquarters. Midi Libre – MICHAEL ESDOURRUBAILH

The Midi Libre Health Lab, with the institutional support of Sanofi & Regeneron and the French Eczema Association, looked at the multiple questions surrounding dermatology on Wednesday. And since skin diseases affect millions of French people, there was no shortage of topics during this round table organized at the Midi Libre headquarters in Saint-Jean-de-Védas.

Today, 16 million French people suffer from one of the 6,500 skin diseases listed by the French Society of Dermatology. A majority of French people say they are concerned about protecting their skin and taking care of it.

“For example, eczema affects two thirds of women and one third of men,” introduces Stéphanie Merhand, founder and director of the French Eczema Association. Skin diseases are a big problem. This is also the case for access to dermatologists. You have to know how to take care of your skin throughout your life. Skin diseases are often obvious. Since 2018, new treatments have been available to treat eczema, also called atopic dermatitis, and we see that patients are returning to the care pathway.”

Charlotte Pernet, a dermatologist at the Eureka dermatology center in Castelnau-le-Lez (Hérault), notes an awareness among the population: “For a long time, we thought that there was nothing that could be done about certain skin diseases. They affect the entire population, from babies to the elderly, men and women alike. It is necessary to contact a specialist as soon as the skin problem is a concern for the patient. You should first go and see your GP who can solve the problem or refer you to a dermatologist.”

As with acne in teenagers. “A very common disease, notes Charlotte Pernet. It affects about 60% of adolescents and 40% of adults. Minimal acne is physiological, it is part of the development of puberty. The dermatologist treats more severe acne that resists initial treatments.”

The difficulty of making an appointment with a dermatologist

One of the main problems with skin diseases in France is the long waits to get an appointment with a dermatologist. 73% of French people find it difficult to access dermatologists. On average, it takes three months to get an appointment with a specialist. Around 46% of patients have given up on having a skin problem treated. “The number of dermatologists is decreasing,” emphasizes Stéphanie Merhand. There are 3,000 of them in the country, the average age is 58. The specialty is in danger. In Occitanie, three departments do not have a dermatologist.”

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A solution to overcome this lack is tele-expertise, a system that has been in place for two years at the Eureka Dermatology Center in Castelnau-le-Lez. “This is a method that allows the general practitioner to ask a specialist for advice,” explains Charlotte Pernet. This lends itself well to dermatology because we can be sent photos, the clinical history, the evolution of the disease, etc. We then respond on photo, without seeing the patient first. Either we can solve the problem, or, in 30% of cases, we need to see the patient. So we commit to freeing up emergency slots during the day, week or month. The results are positive, general practitioners are very satisfied with this method of consultation. And we have the impression that we are not missing out on potentially serious cases.”

Innovations and prevention at the heart of the subject

For the past ten years, there have been major innovations in dermatology based on the fact that specialists have better understood the immune mechanisms of the inflammatory response. These treatments for chronic diseases are essentially based on biotherapies, treatments that modulate the immune response and block an inflammation pathway to limit flare-ups.

“We are also seeing major therapeutic progress in melanoma with the arrival of targeted therapies that block cancer cells, but also immunotherapy in melanoma that stimulates the immune response, develops Charlotte Pernet. All this has completely changed the management of these pathologies.”

Beyond innovations, prevention is a major topic to counter the arrival of certain skin diseases. “We can talk about the prevention and screening of skin cancers, it is important that this education is done from a young age, believes Michael Chekroun, director of MedVallée, the global center of excellence in global health in Montpellier. There is the role of parents but also that of the school which can raise awareness on the use of sun creams or protective clothing. I note the therapeutic progress but there is a need for prevention, knowledge of good practices in terms of hygiene and diet. As for chronic diseases, beyond treatment, education on patient support is needed. Eczema and psoriasis are visible diseases that can have an impact on patients' daily lives from a very young age.”

The importance of good care

The shortage of dermatologists means that patients are tempted to find solutions elsewhere, whether on the Internet or in memories of grandmother's remedies. From the moment a redness, a spot or a lesion on the skin is detected, it is important not to self-medicate but rather to turn to a specialist. “We absolutely must fight against this and trust professionals,” says dermatologist Charlotte Pernet. When it comes to atopic dermatitis, the important thing is to moisturize your skin with emollients.”

“Social networks don't always help even if positive things happen, adds Stéphanie Merhand. Skin is so different that we can't have a single solution for everyone. But some patient testimonials give hope and can help isolated people.”