key: cord-0021997-boytxsn4
authors: Schwarzenberger, Kathryn
title: First, and foremost, a physician
date: 2021-09-10
journal: J Am Acad Dermatol
DOI: 10.1016/j.jaad.2021.09.009
sha: 3cc3178d37a129eb1565d606db751bfe60f9d9a1
doc_id: 21997
cord_uid: boytxsn4

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I n August of this year, the Advisory Committee on Immunization Practices, which provides guidance to the Centers for Disease Control and Prevention regarding use of vaccines and related agents for control of vaccine-preventable diseases, published recommendations regarding immunocompromised patients who should be considered for an additional dose of mRNA COVID-19 vaccine. 1 The US Food and Drug Administration modified the emergency use authorizations for both the Pfizer-BioNTech and Moderna COVID-19 vaccines to allow for this additional, or third, dose to be given. Drs Waldman and Grant-Kels responded quickly to these changes and provided us with a synopsis of these recommendations, along with their thoughtful analysis as to how they believe we can most appropriately apply these recommendations to our patients on immunosuppressive medications and biologics. 2 Many of our patients will likely qualify for an additional dose, and hopefully, this information will help us help our patients. However, I was rather surprised to note that the list of patients considered to be immunosuppressed in the article did not match that provided by the Advisory Committee on Immunization Practices, and, upon closer reading, I realized that the authors had included only patient groups that they deemed to be ''primarily managed by a dermatologist.'' Several important categories of patients, including those with advanced or untreated HIV infection, those undergoing treatment for hematologic malignancies, recent recipients of chimeric antigen receptor T cell or hematopoietic stem cell transplant, and patients with immunodeficiency syndromes, such as Wiskott-Aldrich syndrome, were left off the list.

Perhaps rumination is the privilege of being an older doctor, but I have been thinking about this ever since. Many of us do provide care for patients with immunosuppressed conditions listed above. Should we, as dermatologists, limit our consideration for this issuedas well as others that might arisedonly to patients with diagnoses that we primarily manage? In this scenario, we lose the opportunity to advise patients who may benefit from a third vaccine to receive what could potentially be a life-saving preventative measure. We hope and assume that they will get this information from other providers, but what if they do not?

As specialists, we have spent years acquiring expertise that enables us to manage even the sickest of patients with any number of different dermatologic diseases. Limiting our care to ''just dermatology'' would, at face value, seem to allow us to do what we do best; it is also comfortable and familiar. However, we may want to consider the potential harm, both at the individual level and beyond, that could result if we narrow our focus too much. Dermatology has an image problem, with a significant percentage of the public believing that we primarily perform cosmetic procedures and some not even realizing we are doctors. 3 This may be a great opportunity to remind ourselves that while we are all committed dermatologists, we are also, first and foremost, physicians.

Considerations for use of an additional mRNA COVID-19 vaccine dose after an initial 2-dose COVID-19 mRNA vaccine series for immunocompromised people

Dermatology patients on biologics and certain other systemic therapies should receive a ''booster'' mRNA COVID-19 vaccine dose: a critical appraisal of recent FDA and ACIP recommendations

Public perception of dermatologists and comparison with other medical specialties: results from a national survey

None disclosed.