АКЦЕНТИ ОТ 1-ВИ ДЕН

ESMS: EUROPEAN SOCIETY FOR MICROGRAPHIC SURGERY

Report by Dr. Adrian ALEGRE SÁNCHEZ (Dermatologist, Spain)

ESMS: EUROPEAN SOCIETY FOR MICROGRAPHIC SURGERY
SURGERY TIPS AND TRICKS

According to the oral communication of Prof. Dr. Ally-Khan SOMANI (Dermatologist, United States)

INK THE LAYER BEFORE REMOVING IT

When removing layers of skin during Mohs surgery, the first few layers are very easy because the tissue is very thick. However, after the first few, it gets harder because the layers are thinner and it is easy to break one and not remove the whole layer. In response to this, Prof. SOMANI proposes using a surgical marker to ink the zone to be removed and then to completely remove the layer, verifying that no inked skin remains in the surgical field. That way, if you have left some ink in the surgical field, you will know that you made a hole in the piece being removed and you will have to redo the layer.

THE PAPER CUT TECHNIQUE

For very small, thin layers being removed, Prof. SOMANI proposes a technique that helps avoid excessive contraction or folding of the piece of skin before it is processed. First, he proposes performing hydrodissection with anaesthesia or a saline drip before removal. As the layer is very thin, it is to be immediately placed on filter paper, which prevents movement and excessive contraction. Furthermore, Prof. SOMANI even proposes freezing the tumour with the paper before cutting the layers for histological mapping. When analysing the piece of skin, the paper will be present at the edges of the piece, preventing loss of tissue at the edges. In this way, you can ensure totally free edges. The paper used is normal filter paper.

CALCULATING ANGLES IN Z-PLASTY

Prof. Dr. Ally-Khan SOMANI proposes using a ruler and intersections with a surgical pen to easily calculate the angles for a Z-plasty.

SUBCUTANEOUS LOOPED INVERTED HORIZONTAL MATTRESS STITCH

This suture is made like an inverted horizontal mattress stitch, but with the second stitch looped beneath. This allows the stitch to withstand high tension with good aesthetics.

TITANIUM MESHES FOR NASAL RECONSTRUCTION

According to the oral communication of MD Paula FERNÁNDEZ CANGA (Dermatologist, Spain)

MD Paula FERNÁNDEZ CANGA, from León, Spain, talked about the experience in her hospital performing reconstruction of total nasal structural defects. She emphasised that one should always start by considering the alignment of the nose, then the structural support, and finally the outermost covering. The structural support is made up of bones and cartilage (upper and lower lateral cartilage, septal cartilage). When these fail, there are several options for reconstruction, but the most common tends to be to select autologous cartilage from other parts of the body (ribs, ears, etc.).

When using autologous cartilage, different complications can occur, including haematomas, infections, chondritis in the donor area, deformation in the donor area, extrusion of the graft, or necrosis. Furthermore, in such cases, the surgery takes more time. For these reasons, her group proposes using an allogenic titanium mesh as an alternative material to autologous cartilage. This type of mesh has 0.1 mm pores that allow for the passage of new vascularisation and encourage adhesion of progenitor cells.

The titanium mesh is about 0.2 mm thick, but is rigid enough to maintain the shape. It is also flexible enough to reduce the possible dehiscence of tissues. This makes it an ideal material given that it can be moulded and cut with surgical scissors, but is still rigid enough to support the weight of the rest of the nasal tissues.

This type of material has previously been used in eye sockets, the abdominal area, and other places. It is an easy-to-use material, is non-allergenic, and is resistant to corrosion. Furthermore, it has not been shown to stimulate tumorigenesis. The only complications to look out for are the risk of infection and interference with magnetic resonance.

They propose reconstruction with this titanium mesh for structural defects (cartilage or bone of > 2 cm diameter), with a proper external and internal covering. The reconstruction of the external covering can be done with flaps of skin, direct closure, or skin grafts.

MOHS SURGERY INDICATIONS AND GUIDELINES ACCORDING TO THE EUROPEAN SOCIETY FOR MICROGRAPHIC SURGERY

According to the oral communication of Prof. John PAOLI (Dermatologist, Sweden)

The situation of Mohs micrographic surgery in Europe is radically different from the situation in the United States. To date, there has never been a consensus document regarding the indications for Mohs surgery. The European Society for Mohs Surgery (ESMS) document is intended to fill the void that has existed to this point. This document would be analogous to one that the American Academy of Dermatology has, which can be read in the Journal of the American Academy of Dermatology, October 2012Volume 67, Issue 4, Pages 531–550.

The European consensus document can be read online: esms-mohs.eu/resources/. In the presentation by Dr John Paoli, he mainly reviewed the indications for Mohs micrographic surgery, which are as follows:

BASAL CELL CARCINOMA (BCC)

This is the most typical indication for Mohs micrographic surgery. The indication for the types of basal cell carcinoma that should be operated on with Mohs surgery tends to be more restrictive. Its main indication tends to be for high-risk BCCs on the head and neck, particularly if they are in the following situations:

Centre of the face, around the eyes, nose, lips, etc.
Poor definition at the margins
Recurrence or incomplete excision
Aggressive histopathology (e.g. morpheaform, infiltrative, micronodular, basosquamous)
More than 2 cm
When you have to save as much tissue as possible

The number of passes required depends on the indications applied at the time the treatment is selected. Authors from Rotterdam explained that BCCs located in the facial H-zone, recurring tumours, aggressive subtypes, and tumours > 10 mm are significantly associated with requiring two or more passes. According to various studies, tumours located in extrafacial areas require, on average, fewer passes than facial tumours.

In regards to recurrences, it was reported that for Mohs micrographic surgery in facial areas, the rate was around 4.4%, whereas for conventional excision it would be 12.2%. For recurring BCCs, 10 years out, this difference would result in recurrence rates of 3.9% and 13.5% respectively.

SPINOCELLULAR CARCINOMA (SCC)

The main difference with basal cell carcinoma is its ability to metastasise. In the case of spinocellular carcinoma, the incidence is estimated to be 2% to 5%. According to the latest European guidelines, the most appropriate treatment for spinocellular carcinoma is total excision, adapting the surgical margins to each situation of clinical and histopathological risk. Exact criteria have not been established to distinguish between situations in which one should choose conventional excision or Mohs surgery, but in general, Mohs is preferred for high-risk carcinomas, those with the possibility of metastasis, or areas with particular aesthetic considerations (tumours on the eyelids, lips, outer ear, face, or nails). With Mohs surgery, recurrence is reduced by 0-8%, compared to 47.2%.

MALIGNANT MELANOMA (MM)

Generally, Mohs surgery is recommended for cases of melanoma with imprecise clinical margins. This is often the case with lentigo maligna melanoma and acral lentiginous melanoma. In regards to surgical margins, there is controversy due to the fact that in the case of Mohs micrographic surgery, the margins are minimal. In studies comparing recurrence rates for malignant melanoma on the face, nose, or ears, as well as for lentiginous subtypes, the minimal surgical margins from Mohs surgery were not associated with higher recurrence rates.

OTHER SPECIAL INDICATIONS: EXTRAMAMMARY PAGET’S DISEASE AND ADNEXAL TUMOURS:

With Mohs surgery, the recurrence rates are around 10%. Even so, these rates are lower than those for wide excision with surgical margins.

LASERS IN SCARS TREATMENT, WHERE ARE WE STANDING?

Report by Dr. Laura BOUCHARD (Dermatologist, Finland)

ESLD – European Society for Lasers and Energy Based Devices

LASERS IN SCARS TREATMENT, WHERE ARE WE STANDING?

According to the oral communication of Prof. Keyvan NOURI (Dermatologist, United States)

Prof. NOURI from the United States presented split-scar studies from his own study group of surgical scars treated starting at suture removal day. Only patients with skin type I-IV were treated as darker skin types may be problematic to treat. Results were assessed using the Vancouver scar scale (VSS: vascularity, pigmentation, pliability, height).

11 patients with 12 scars completed 3 treatments at 4 week intervals with 585 nm pulse-dyed laser (PDL). 1 month after the last treatment revealed:

54% improvement in pulse-dyed laser treated group vs 10% in untreated controls
Significantly better cosmetic appearance scale for treated scars at 7.3 vs 5.2 for controls

The results were confirmed by histology, where less scar tissue and more elastin was observed in the treated side vs control.

Two subsequent comparisons were completed with the same regimen:

585 nm pulse-dyed laser was compared to 595 nm in 14 patients with 19 scars
- both groups showed significant improvement vs non-treated control with a trend towards better result in 585 nm vs 595 nm in vascularity and scar height and no difference in pigmentation or pliability.

Short pulse (450 μm) pulse-dyed laser was compared to long pulse (1.5 ms) pulse-dyed laser in 20 patients with 20 scars
– both short-pulse and long-pulse 585 nm pulse-dyed laser groups significantly improved VSS (92% and 89% respectively compared to untreated controls (67%) (p<0.05) - there was a trend towards better improvement in the short-pulse group Prof. NOURI’s suggestion for pulse-dyed laser treatment of surgery scars at suture removal: Wavelength 585 nm, pulse-duration 0.4-0.45 ms, fluence 3.5-4 J avoiding a lot of purpura and no cooling.

THIN NODULAR MELANOMA VS OTHER NODULAR TUMORS

Report by Dr. Laura BOUCHARD (Dermatologist, Finland)

IDS – International Dermoscopy Society

THIN NODULAR MELANOMA VS OTHER NODULAR TUMORS

According to the oral communication of Dr. Dimitris SGOUROS (Dermatologist, Greece)

Dr. Dimitris SGOUROS from Greece presented an unpublished multicenter study on dermoscopic features that differentiate thin nodular melanomas (NM) from thicker ones with 2 mm being the cutoff for thin vs thick nodular melanomas.

19 centers from 13 countries participated to the study between 2016-2018 in a retrospective morphological case-control study comparing clinical-dermoscopic images of thin (≤ 2.0 mm) and thick (>2.0 mm) nodular melanomas. 69 cases of thin and 96 cases of thick nodular melanomas were included in the study. The control group consisted of 89 cases of non-melanoma nodular tumors (e.g. BCC, SK, nevi etc). A randomized analysis of dermoscopic features was performed by a 5-member independent expert review panel.

Four dermoscopic features were used in the analysis being

Overall architecture and colors
Pigmented structures
Non-pigmented structures
Vascular structures

The goal of the study was to find dermoscopic features specific for thin nodular melanomas, dermoscopic features of thin nodular melanomas as compared to other non-melanoma nodular tumors, and subgroup analysis between pigmented and non-pigmented thin and thick nodular melanomas.

There was no significant difference in asymmetry of structures or colors between the groups. However light brown color was more prevalent in the thin nodular melanomas, whereas blue color was expectedly observed more frequently in thick nodular melanomas. Non-pigmented thin nodular melanomas were less irregular in structure and constituted a source of diagnostic pitfalls for nodular melanomas diagnostics noting that 30% of nodular melanomas are non-pigmented.

Dotted and serpentine vessels were present in both thin and thick nodular melanomas, but serpentine vessels were more common in thick (43.7 %) vs thin (18.8 %) nodular melanomas. Corkscrew vessels were observed only in thick nodular melanomas in this material (17.8 %). Light brown color was a predictor of thin nodular melanomas with an odds ratio (OR) of 1.8 and serpentine vessels with an OR of 0.3. Ulceration was more common in thick pigmented nodular melanomas (73.4 %) vs thin nodular melanomas (26.3 %), whereas there was less difference in ulceration prevalence in non-pigmented nodular melanomas: thick non-pigmented nodular melanomas (51.3 %) vs thin non-pigmented nodular melanomas (41.7 %).

When comparing thin nodular melanomas to non-melanoma nodular tumors, irregular blue structureless areas (OR 2.4), white shiny lines (OR 2.9) and dotted vessels (OR 3.4) were the best predictors of nodular melanoma and so, dotted vessels in a nodular lesion is always a sign of possible nodular melanoma.

WAS HIPPOCRATES THE FIRST DERMATOLOGIST?

Report by Dr. Nicolas KLUGER (Dermatologist, Finland)

WAS HIPPOCRATES THE FIRST DERMATOLOGIST?

According to the oral communication of Prof. Alexey TAGANOV (Dermatologist, Russian Federation)

Dermatology as we know it as a modern independent discipline dates back to the late 18th century. However, there are dermatological descriptions from more than 2000 years ago via Hippocrates, whose writings described several dermatoses (among other things) such as acne, scabies, onychopathies, mouth ulcers, erysipelas, alopecia, etc.

Hippocrates thought that diseases were the result of an imbalance between bodily fluids. He made a distinction between infections and dermatoses. Hippocrates observed that lichen and vitiligo developed slowly. He recommended vinegar-based solutions and lotions for lichen and warts. Lemon and concentrated vinegar were used for vitiligo, leprosy and psoriasis. Baths in hot springs were recommended for pruritic dermatoses as well as for psoriasis. Baths in salted seawater and steam baths were proposed for severe cases of pruritus. In the event of intolerance to seawater, oily topical agents were applied. For infectious eczema, other oozing lesions and intertrigo, he proposed copper oxide and myrrh oil.
Hippocrates was thus a precursor, laying some therapeutic foundations still applied today, such as balneotherapy as well as the application of fatty substances in the event of dry lesions and drying topical agents in the event of oozing lesions.

HIDRADENITIS SUPPURATIVA

Report by Dr. Nicolas KLUGER (Dermatologist, Finland) and Dr. Adrian ALEGRE SÁNCHEZ (Dermatologist, Spain)

HIDRADENITIS SUPPURATIVA

COMPLEMENTARY AND ALTERNATIVE MEDICINE USE IN HIDRADENITIS SUPPURATIVA

According to the oral communication of Dr. Niamh KEARNEY (Dermatologist, Ireland)

Hidradenitis suppurativa (HS) is a chronic inflammatory disease of apocrine-rich areas with recurrent boils and scarring. Treatment include long sequence of antibiotherapies, biologics and surgical procedure. This condition is however difficult to treated and patients may be attempted to look for alternative solution. An anonymous survey performed among 107 patients attending hidradenitis suppurativa clinics in Dublin explored the use of complementary and alternative medicine (CAMs).
Twenty percent had previously used complementary and alternative medicine, mostly tumeric (33%), Reiki (28,9%), acupuncture (19%) and then aromatherapy; use of nutritional supplements and herbal ointment (14,3%). Eight patients (38,1%) reported a reduction in symptoms and improved quality of life. The costs of complementary and alternative medicine ranged from 0 to 5200€ (mean 413€).
In this study, bearing in mind the small number of patients and bias of selection in a tertiary center, according to the authors, the use of complementary and alternative medicine was lower than in the general population. As often, patients reported dissatisfaction with conventional treatment as a reason for using complementary and alternative medicine in hidradenitis suppurativa; and curiosity as well. No patient here reported side events in relation to use of complementary and alternative medicine. The main issue is the extra expenses that represent complementary and alternative medicine while efficacy in hidradenitis suppurativa has not been shown. In some cases, patients may feel benefits on the quality of life. It is important that dermatologists inquire about complementary and alternative medicine use during the consultation in hidradenitis suppurativa patients.

VITAMIN D LEVEL IN SERUM AND IST GENDER-SPECIFIC DIFFERENCIES IN PATIENTS WITH HIDRADENITIS SUPPURATIVA

According to the oral communication of Dr. Natalie KIRSTEN (Dermatologist, Germany)

PATIENTS WITH HIDRADENITIS SUPPURATIVA TEND TO HAVE LOWER LEVELS OF VITAMIN D

In a s german monocentric cross section study on the nutritional status of patients hidradenitis suppurativa, serum D vitamin levels was measured . This study is still ongoing as the authors intend to include 100 patients. This poster report about 34 patients.

The average age is 37,5 years and almost 72% are women. The mean BMI is 29.7 mg/m2. 15% have a Hurley III and 38.5 a Hurley II.
61.8% of the patients explored had a serum vitamin D deficiency (<20 ng/mL) and 23.5% an insufficiency (20-29 ng/mL). BMI and age were not associated with deficiency, only a slight trend toward men is noted with a p=0.048. The study is still on going but serum D vitamin may need to be monitored in patients with hidradenitis suppurativa.

HIDRADENITIS SUPPURATIVA ASSOCIATED WITH DOWLING DEGOS DISEASE

According to the oral communication of Dr. Simone GARCOVICH (Dermatologist, Italy)

A NOVEL STOP-GAIN NICASTRIN MUTATION CAUSES HIDRADENITIS SUPPURATIVA ASSOCIATED WITH DOWLING DEGOS DISEASE: IS NOTCH SIGNALLING PATHWAY GUILTY?

Both hidradenitis suppurativa and Dowling Degos disease (DDD, OMIM 179850) share common features such as autosomal dominant transmission, clinical and genetical heterogeneity and flexural and follicular involvement. The association between both conditions has been observed in the 90s and currently 35 cases have been reported in the litterature. Various mutations have been described within affected offsprings in families such as PSENEN, POFUT1, or nicastrin gene NCSTN.

Thus, preliminary data supports abnormal NOTCH signalling in hidradenitis suppurativa – DDD phenotype.

NEW APPROACH IN THE COMBINED CONSERVATIVE TREATMENT OF HIDRADENITIS SUPPURATIVA

According to the oral communication of Prof. Evgenyia HRISTAKIEVA (Dermatologist, Bulgaria)

A TRIPLE COMBINATION BY COLCHICINE, METRONIDAZOLE AND KETOTIFEN IN HIDRADENITIS SUPPURATIVA?

Dr. Evegenyia HRISTAKIEVA reported here experience with the following combination of treatment in case of pyoderma gangrenosum – like hidradenitis suppurativa lesions: Colchicine 1 mg, metronidazole 500 mg x 2, and ketotifen 2 x 1 mg for four months. It was an open observational single center study with no control group, no placebo, and no randomization no. According to the authors, out of the 47 patients treated with this protocol, 94% were respondents with a good tolerance of the treatment.
The rationale is based on the various pharmacological effect of each drugs : neutrophils inhibition (colchine), antimicrobial (metronidazol) and anti fibrosis (ketotifene). However, the results as they were presented that day do not allow to draw any firm conclusion. Further studies would be necessary to evaluate the interest of this combination.

OF THE BENEFITS OF ULTRASOUND IMAGING BEFORE SURGERY IN HIDRADENITIS SUPPURATIVA

According to the oral communication of Dr. MOLINA LEVYA (Dermatologist)

SURGICAL MANAGEMENT OF HIDRADENITIS SUPPURATIVA: IMPLICATIONS OF ULTRASONOGRAPHIC PLANNING AND CONCOMITANT BIOLOGIC TREATMENT
Dr. MOLINA LEVYA showed very nicely that the use of soft tissue ultrasound image before surgery is hidradenitis suppurativa was modifying considerably the area to excise compared to a simple clinical approach. The difference of excised area was of + 3,67 cmz (22,62 cm2clinically vs 26,29 cm2 after ultrasound imaging. The factors involved with inaccurate clinical surgical delimitation of the projected site included high BMI and Hurley II stage lesions.

Besides, patients under biologics did not more post-operative infection compared to patients without biologics after such surgery.

THE SIGNIFICANCE OF TOUGH LEVEL AND AAA IN PATIENTS WITH HIDRADENITIS SUPPURATIVA

According to the oral communication of Dr. Afsaneh ALAVI (Dermatologist, Canada)

MONITORING SERUM LEVELS OF ADALIMUMAB AND AUTOANTIBODIES AGAINST ADALIMUMAB IS OF INTEREST IN HIDRADENITIS SUPPURATIVA

Dr. Afsaneh ALAVI from Toronto, Canada showed in her presentation that this effect of anti -TNF alpha inhibitor adalimumab is dose dependant in hidradenitis suppurativa. Serum level monitoring of the drug is of interest to offer a personalized approach. Systematic dose escalation is not always appropriate in patients who are poorly responding to treatment!

To illustrate this, adalimumab circulating level were monitored in a series of 38 psoriatic patients with partial response to adalimumab.

Among them,

42% of them disclosed sub-therapeutic levels of adalimumab <6 microgr/mL: 24% had circulating antibodies against adalimumab. A switch to another biologic is therefore recommended. The remaining 18% had no antibodies, so an increase dose to 80 mg weekly can be tried. · 11% had supra-therapeutic levels (> 20 microg/mL): a switch to another biologic is advisable as well
47% were in the therapeutic range (6-20 microg/mL): various strategies are possible such as combination or adding an other immunosuprressive treatment; dose optimisation; surgery; or switch to another biologic.

EFFECTIVENESS AND SAFETY OF ADALIMUMAB INTENSIFICATION IN RESISTANT HIDRADENITIS SUPPURATIVA PATIENTS

According to the oral communication of Dr. Fernando ALFAGEME (Dermatologist, Spain)

ADALIMUMAB DOSE INTENSIFICATION IN RECALCITRANT HIDRADENITIS SUPPURATIVA

Dr. Fernando ALFAGEME from Madrid presented the results of a retrospective multicentric study evaluating the efficacy of a compassionate intensified regimen of adalimumab at the dose of 80 mg weekly in hidradenitis suppurativa.
It was a small series of 14 patients (mean age 40.5 y, duration of disease 19 y, smokers 64% BMI 29.0 Family history 28.6% Comorbidity 78.6%). The use of adalimumab at 80 mg weekly was associated with a diminution of the IHS4 score and less pain. The results of this study are of course limited by the small number of cases and its retrospective nature. More studies are needed, but it is interesting to that we can increase the dosage of adalimumab in case of inefficacy or progressive efficacy loss after initial response. Of course this result echoes back to the previous presentation by Afasaneh ALAVI about monitoring the level of adalimumab and circulating antibodies.

COMBINED STRATEGIES FOR HIDRADENITIS SUPPURATIVA?

According to the oral communication of Dr. Antonio MARTORELL CALATAYUD (Dermatologist, Spain)

Hidradenitis suppurativa (HS) is a disease with devastating psychological effects. Its prevalence appears to be higher than previously estimated, reaching up to 4% in some countries. We should remember that the disease does not only affect the skin. It comes with a generalized pro-inflammatory state that favours the appearance of multiple comorbidities, particularly a higher risk of cardiovascular events (e.g. peripheral artery disease, coronary artery disease). In regards to treatment of HS, Dr. Antonio MARTORELL of the Hospital de Manises in Valencia, Spain, talked about the importance of the ‘window of opportunity’: this is the initial phase of the disease, during which the main lesions are inflammatory, but permanent damage has not yet accumulated in the form of sequelae. The window of opportunity offers the best possible results for treatment, with the possibility of achieving prolonged periods of remission and real improvement in the lives of patients. In regards to management of the disease, Dr. MARTORELL proposed following three steps:

Defining objectives according to the phenotypes of the disease and risk factors for progression. There are different clinical types of HS with different prognoses (e.g. follicular, axillary-mammary, gluteal, flares, etc.). Patients with a more follicular pattern are different from those with an inflammatory pattern in that the former start earlier and progress less quickly than the latter. The inflammatory pattern can cause tunnels, sustained inflammation, and scarring.
Determining the severity in my patient: There are different severity scales (HS4, HiSCR, Hurley, etc.). You have to remember that if you simply look at the affected area, you may make errors in determining the status. For this reason, it is essential to use methods like Doppler ultrasonography, as well as MRI for cases such as occurrence in the perianal area. Sonography is particularly useful in cases of tunnelling given that, depending on the type of tunnel, it will require intralesional or surgical treatment.
Selecting the best treatment: Dr. MARTORELL always recommends starting with laser depilation given that HS is really a disease of the pilosebaceous unit. In regards to treatments, in mild cases, doctors typically use topical clindamycin, tetracycline, zinc gluconate, acitretin, or alternatives like colchicine. In a recent study, the combination of minocycline 100 mg daily with colchicine 0.5 mg twice daily for six months resulted in sustained remission. In moderate to severe cases, combinations of antibiotics (clindamycin/rifampicin 300 mg twice daily for 10 weeks) should be the first line of treatment. For second-line treatment, there are biologics: adalidumab, infliximab, anakinra, and ustekinumab. Also, we should not forget that corticosteroids can be used both intralesionally and orally in low doses for occasional control of flare-ups.

We should not forget to control comorbidities like hyperandrogenism, obesity/insulin resistance, tobacco usage, polycystic ovary syndrome, etc., which can lead to a worsening of the disease.

PROSPECTIVE STUDY OF HLA-B*58:01 SCREENING TO AVOID ALLOPURINOL-INDUCED SEVERE CUTANEOUS ADVERSE REACTIONS IN CHINESE PATIENTS WITH CHRONIC KIDNEY DISEASE

Report by Dr. Nicolas KLUGER (Dermatologist, Finland)

PROSPECTIVE STUDY OF HLA-B*58:01 SCREENING TO AVOID ALLOPURINOL-INDUCED SEVERE CUTANEOUS ADVERSE REACTIONS IN CHINESE PATIENTS WITH CHRONIC KIDNEY DISEASE

According to the oral communication of Dr. Sze-man Christina WONG (Dermatologist, Hong Kong)

UTILITY OF HLA-B*5801 SCREENING TO PREVENT CUTANEOUS SIDE EFFECTS WITH ALLOPURINOL IN CHINESE PATIENTS

Allopurinol is known to be one of the main cause of severe cutaneous adverse event (SCAR) with a high mortality rate (26%). However, this treatment may be needed by patients for gout. A recent study in Taiwan showed that HLA B*58:10, Cw*03:02 and DRB1*03:01.

A multi-disciplinary team in Hong-Kong performed a prospective study by screening systematically patients with chronic kidney disease who may need allopurinol for HLA B*58:10 before allopurinol initiation. In case of positivity, the patient was commenced an alternative treatment. Those who were negative received allopurinol. Follow-up after initiation was 2 months. Between 2011 and 2015, 192 patients were included and analysed: 28 patients were HLA B*58:01 positive (15%). No patient who received febuxostat in replacement for allopurinol had cutaneous adverse event. Amont the 118 patients (72% of the HLA negative), none developped toxic epidermal necrolysis or Stevens Johnson syndrome, but 6 patients had mild cutaneous rashes that subsided with drug withdrawal.

The incidence of SCARs with allopurinol in Hong-Kong is 0.39%. The cost of HLA B*58 typing is 90 USD. According to the authors, the use of HLA typing may save 1 patient from developing SCARs out of 257 typing with notable cost savings compared to SCAR management.

This study illustrates the interest of specific HLA screening before initating a drug at risk of cutaneous side effects.

SKIN DISEASES AMONG DERMATOLOGISTS

Report by Dr. Nicolas KLUGER (Dermatologist, Finland)

SKIN DISEASES AMONG DERMATOLOGISTS

According to the oral communication of MD Caner DEMIRCAN (Dermatologist,Turkey)

DERMATOLOGIC DISEASES AMONG DERMATOLOGISTS AND IT’S IMPACT ON CHOOSING SPECIALITY: A QUESTIONNAIRE OF 184 DERMATOLOGISTS

Demircan and al from Ankara, Turkey explored an interesting question: what is the frequency of dermatoses among dermatologists and have they got any impact on the choice of the speciality.

The study included 184 dermatologists (including 60.8% of dermatology specialists, 28.2% of residents and 10.8% of attending dermatologists).

Out of those 184, 101 (54.8%) respondents and 49.4% of the relatives respondents had a dermatologic condition. The number of conditions was rather extensive and wide (309 !): the most common dermatoses among dermatologists were acne, contact dermatitis (13% each), seborrheic dermatitis (10%), urticaria (6.5%), pityriasis rosea (5.4%), atopic dermatitis (3.8%). 8.7% of the respondents claimed that having a dermatologic condition in self or in a relative had ana effect in choosing dermatology as a speciality. Acne in self (28.6%) and alopecia areata in a relative (22.2%) were those with the highest impact in choosing the speciality.

The factors influencing medical speciality selection include duration of residency, patient load, working hour, familial advice, flexible working conditions, role model and income level. Here interestingly 8.7% of the dermatologists claimed that existing dermatological disease had an impact in their choice. It would have been of interest to have a control group among another speciality. Besides, is this trend reproductible in other countries?

ESDAP: EUROPEAN SOCIETY OF DERMATOLOGY AND PSYCHIATRY

Report by Prof. Anna ZALEWSKA JANOWSKA (Dermatologist, Poland)

ESDAP: EUROPEAN SOCIETY OF DERMATOLOGY AND PSYCHIATRY
TRICHOTILLOMANIA: PSYCHOPATHOLOGICAL PERSPECTIVES AND PSYCHIATRIC COMORBIDITY

According to the oral communication of Prof. Mohammad JAFFERANY (Dermatologist, United States)

Prof. Mohammad JAFFERANY from the USA gave in-depth overview of trichotillomania pointing out at the importance of childhood trauma and violence experienced by 76-91% of trichotillomania patients. Of importance trichotillomania could be regarded as a “form” of negative coping mechanism with past traumas. In the treatment the following drugs and methods are of use: tricyclic anti-depressants, SSRI, mood stabilizers, N-acetylocysteine, habit reversal therapy, acceptance and commitment therapy, awareness-enhancing monitoring devices, response inhibition training. The speaker invited the audience to the next american Psychodermatology meeting (APMNA – Association for Psychoneurocutaneous Medicine of North America, the 19.03.2020 in Colorado).

PSYCHOLOGICAL IMPAIRMENT IN ATOPIC DERMATITIS

According to the oral communication of Dr. Sandra ROS (Dermatologist, Spain)

Dr. Sandra ROS from Barcelona, delivered a talk on psychological impairment in atopic dermatitis, pointing out at the importance of holistic approach to atopic dermatitis patients delivered by multidisciplinary team composed of dermatologists, nurses and psychologists operating at the same place. The speaker underlined that atopic dermatitis patients very often feel stigmatized when referral to psychiatry department based psychologist or psychiatrist is offered. During the discussion the chairs of the session suggested regular visit executed by every clinician to the very useful webside Atopic Skin Disease.

DISSATISFACTION WITH CUTANEOUS BODY IMAGE: DISTINGUISHING AND MEDIATING MENTAL HEALTH COMPLAINS IN DERMATOLOGICAL DISORDERS

According to the oral communication of Prof. Dmitry ROMANOV (Dermatologist, Russian Federation)

Speakers from Russian Federation led by Prof. Dmitry ROMANOV presented body image concept pointing at the body image as 3-dimensional schema everyone has about own appearance in mind (irrespective how the own body looks like). Distortion in body image can affect all spheres of one’ life. It was pointed out that body dysmorphic disease is of high concern because its point prevalence is 9-15% of dermatology patients vs 2,9-3,2 in general population.

PSORIASIS: DOCTOR PATIENT RELATIONSHIP AS AN ART OF PATIENT CARE

According to the oral communication of Dr. Francoise POOT (Dermatologist, Belgium)

Dr. Francoise POOT delivered a talk on extremely useful issue for clinicians namely proper communication with the patients. She stressed that the interviews should be structured according to the Calgary-Cambridge guide of the consultation, where both medical structure and building relationship with the patients go together. Of importance 80% of what the doctor’s says is forgotten when the patient leaves the consultation room and the patient satisfaction with care in dermatology is 60%. Dr Poot invited the audience to take part in the training course on communication skills improvement. Such courses are being organized by ESDaP and EADV since 2007 in Brussels (program).