Transcript Report from World Congress of Dermatology

Report for Skin Care Cymru
from World Congress of
Dermatology (WCD)
8-13 June 2015
By Dr Glenda Hill
Associate Specialist in Dermatology
Wrexham Maelor Hospital
Context
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23rd WCD
126 countries
involved
11,000 delegates
Vancouver, Canada
2 main venuesConvention Centre
West & East
Learning opportunities
Numerous
 Multiple parallel sessions-spoilt for
choice!
 Daily plenary session (distinguished
keynote speakers)
 Additionally:
Symposia,workshops,courses,
controversies in dermatology,
Global celebration forum, free
communications, registrar forum,
posters.
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My journey- Sunday 7thJune
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Arrival & familiarisation
Registration & delegate
information
Umbrella supplied in
delegate bag-bad sign.
Actually not required-not
a drop of rain all week!
Exploring venue-an
impressive set-up.
Monday 8th June
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‘Best of British' session
19 speakers at the top
of their game giving a
10minute synopsis of
their careers research.
Phenomenal learning
experience –felt proud
to have a connection
with the distinguished
group.
Snippets of interest 1……
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Future plan to predict individual patients with Psoriasis
response to drugs ,and susceptibility to side effects on
treatment, by evaluating their genetic make-up and
matching the patient to the therapy-stratified medicine.
Development of computerised models to test hypotheses
regarding therapeutic benefit of interventions when
human testing would not be viable/ethical-fascinating
predictions at a cellular level.
Importance of avoiding harsh skin cleaning products/hard
water in children with atopic eczema-felt to have an
equivalent impact on disease severity as genetic
mutations that impair the skin barrier function (Filaggrin
Mutations)
Development of ‘barrier repair moisturisers’ in future.
Vitamin D supplementation can positively impact barrier
repair in atopic eczema cases.
Snippets of interest 2……
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Wart virus remains hidden (latent) in the skin cells of
patients who have had a clinical clearance with
treatment for up to a year, so can recur easily if the
patients immune system falters.
In malignant melanoma patients, smoking is felt to
increase the risk of death from the disease by 15%
Adequate Vitamin D levels in blood predict a better
survival form Melanoma
Being obese increases the chance of a melanoma
ulcerating and therefore has a negative impact on
survival
Male pattern baldness is inherited via the male line,
giving an 80% chance of hair thinning with a balding
father, compared with 20% chance if father is not
susceptible.
The opening ceremony-8 June pm
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Very grand with
plenty of pomp &
ceremony
Thoroughly
impressive
entertainment at the
reception afterwards!
They even re-lit the
2010 Olympic flame!
World class entertainment at
opening reception!
Tuesday 9th June
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Scleroderma & other sclerosing disorders-Workshop- a
very thorough run through the spectrum of disease within
this diagnostic category.
Snippets-1. the ‘goose pimple sign’ of chronic graft vs.
Host disease( GvHD) that represents a lichen planus-like
process that consists of multiple small lumps of similar
size resembling goose pimples. 2.The emerging
therapeutic use of extracorporeal photophoresis (ECP)
,a very specialist form of treatment where the blood cells
are separated out from the circulation and exposed to
radiation , in both acute & chronic GvHD was
discussed.3.The importance of distinguishing Morphoea
during its active vs. burnt out stage was stressed
,highlighting the need for active intervention only when
the disease was still active.
Tuesday 9th June (2)
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The keynote lecture by Prof John McGrath (UK) was
amazing, as expected. He discussed the fascinating
topic of ‘whole exon sequencing’, whereby the entirety of
an individuals genetic make up can be identified. This
allows propensity to disease to be determined, as well as
providing clues to completely new disease entities by
matching abnormal clinical features in patients within
similar as yet unacknowledged gene defects.
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Time was split in the afternoon between the acne free
communications session and the workshop on
pregnancy related skin issues.
Tuesday 9th June (3)
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In the acne/rosacea session I was thrilled to learn of an
effective new topical therapy that is coming to the UK,
but is already in use elsewhere, this being Ivermectin.
This molecule is already used orally for resistant
scabies, but has been modified as a once a day cream
preparation to treat inflammatory rosacea. It is at least as
effective as the currently available gels and is felt to work
by targeting the demodex mite that blocks the skins
pores in this condition.
Also there was a fascinating talk on diet and acne that
provided some good data suggesting that high GI
foodstuffs are implicated in flaring inflammatory acne in a
susceptible subgroup of patients.
Tuesday 9th June (4)
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The pregnancy related disorders workshop was
extremely well attended & provided a whistle
stop tour through a number of issues relevant to
day to day practice. This ranged form : the use
of antibody testing of blood ( indirect
Immunofluorescence ) to distinguish various
blistering disorders in pregnancy ;details of the
risks associated with malignant melanoma in this
group ; common infections in pregnancy ; and
which cosmetic & dermatology interventions are
considered safe-BOTOX is considered best
avoided during pregnancy.
Wednesday 10th June
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My first Global dermatology session (7am start!) related
to contact dermatitis, or allergy to substances contacting
the skin. Discussions surrounded the identification of
may potent allergens in topical toiletries & cosmetics ,
often poorly ingredient labelled. The new craze for
Brazilian hair straightening treatments poses risk of
exposure to formaldehyde related preservatives that
often fail to be acknowledged.
The symposium on Eosinophilic disorders was detailed
and far reaching . I was interested to hear that a rare
severe drug reaction rash, DRESS syndrome, can be
associated with co-infection with Human Herpes virus 6
in childhood cases.
Wednesday 10th June (2)
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The noteworthy keynote speaker today discussed HIV and the
importance of treatment of the virus as soon as it is diagnosed
rather than waiting for it to suppress the immune system to a defined
degree or cause obvious clinical illness. Many countries worldwide
are signed up to this ,but a significant number aren’t. He provided
compelling arguments to suggest it is cost effective to treat early.
The symposium on Hair disorders was very worthwhile. So much
was covered in a short space of time, by world experts, that I was
eager for a pause button to allow time to digest the facts provided.
The top tip taken from this was the fact that it is scientifically proven
that adding in a simple antifungal shampoo, Ketoconazole or
Nizoral, improves the outcome for patients with several hair thinning
disorders including male and female pattern baldness, and alopecia
associated with polycystic ovaries (PCOS). It works best when
included as an ‘add on’ to other more specific treatment modalities.
I was also fascinated to hear that male carriers who pass on the
gene for PCOS to their daughters have a 50% increased risk of
developing prostate cancer.
Thursday 11th June
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The Allergic Contact Dermatitis symposium was highly
relevant to my day to day practice, as I am the lead for
this in our Hospital. Again ingredient labelling of potential
allergens ,or the lack of it, was highlighted. This included
the lack of legislation surrounding the labelling of
impurities in products. The special case of patch testing
in children was expertly run through along with the
difficulties presented by cases of occupational hand
disease.
The plenary lectures were all of excellent quality
including rare auto-inflammatory syndromes, new
surgical techniques, focussing on the cosmetic market
and what is new in Vitiligo.
Thursday 11th June (2)
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The newly described skin disorders session covered 10 areas of
dermatology ,when speakers were given 15 minutes to run through
highlights in their area of expertise. This session was particularly
informative and provided many insights to chew over including
complex disease processes. I was intrigued to hear of a dietary
chlorophyll supplement promoted in Australian lay press as a detox
agent for those who like to indulge in alcohol. It has a chemical
structure similar to the drug Psoralens that is used to photosensitise
in PUVA therapy ,and induces a porphyria like skin complaint with
blistering on the back of the hands. This can be confused with
another form of porphyria that occurs in alcohol users.
The skin signs associated with Cocaine use were new to me.
The co-existence of severe drug rashes with infection by viruses
was again mentioned, along with a different strain of Hand, foot &
mouth disease associated with loss of the fingernails. The
immunological mechanism of this phenomenon was outlined.
Friday 12th June
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The workshop on skin signs of Drug & physical abuse
was not the most well attended session I had been to,
but with so many choices available to delegates this is
not surprising. It was a shame that such impassioned
speakers did not have a larger audience.
I found the talk on elder abuse particularly enlightening,
if not incredibly sad. The fact that 2/3rd of abusers are
partners of the victim or adult offspring was horrific to
consider.
After this session I spent a few hours of the afternoon
sight-seeing and getting some much needed fresh air.
Saturday 13th June
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Another 7am start to compensate for the half day yesterday! The
global celebrations forum on Skin of Colour was brilliant ,highlighting
common pigmentary and hair problems as well as normal variants
within this group.
The panniculitis symposium provided a fantastic algorithm for
defining disease and was very comprehensive. This was quite a
scientific session and will not be further described.
The plenary session on skin cancers associated with viruses was
detailed and compared cancers where viruses are clearly implicated
e.g. Merkel Cell Carcinoma, with those that are not e.g. Breast
cancer. Proposed mechanisms and the possibility of vaccines to
identified viruses were discussed as potential therapeutic measures
for the future.
The final session attended was a symposium updating on medical
therapies.
Thank you Skin Care Cymru!
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The Barry Statham bursary
has provided a fantastic
opportunity to register for the
WCD ,which I will not forget.
I have been inspired and have
many ideas to bring home to
benefit Welsh patients.
The experience & wealth of
topics covered will also provide
endless material for my role as
programme organiser for the
annual National dermatology
conference for SAS doctors in
dermatology in the UK as a
whole.