A window to the world... of dermatology
Positively international, Saturday's programme focused on dermatological practices in various regions of the world, both in European countries and in far-away lands. The meetings, as usual, were fascinating.
Innovation in all its forms was also covered in various sessions, with regards to paediatric dermatology, recent therapeutic technologies and new diagnostic challenges. But it was just not possible to attend all the sessions of this rich event! Therefore, here are the themes that our special reporters in Austria, Dr. Chaussade and Professor Caux, decided to follow on Saturday. We hope you will enjoy their reports, which will allow you to experience EADV from a distance without leaving your home.
Dr Véronique Chaussade
Atopic dermatitis (AD) was clearly in the spotlight during this EADV 2016 congress: it was the topic of many sessions, papers and symposia. Emma Guttman reviewed its physiopathology, knowledge of which is lagging far behind that of psoriasis, undoubtedly because it is more complex. Here are some notes to supplement the comments made by Frédéric Caux. AD phenotypes in Asians may be different from those of Europeans and Americans. Asians have clearer and more limited erythematous patches than Europeans and Americans. The prevalence of AD is higher in Asia (7-10% in Asia/3-7% in Europe and America). The histological features are more "psoriasiform" in Asians.
Several molecules are currently being studied and will undoubtedly lead to a better understanding of the various pathways involved. Dirk Hijnen reported that the initial results regarding nemolizumab, an anti-IL-31 antibody, were encouraging. Pruritus was reduced by 50% after four weeks of treatment. Biomarkers (as those for asthma) will be necessary to better undertake studies. A. Wollenberg pointed out the advantages of preventive proactive treatment with dermocorticoids or tacrolimus in cases of severe, recurring AD. Patients maintain treatment twice a week on treated zones "in remission" (they clinically appear to be healthy but are in fact histologically impaired), in addition to the emollients they apply on a chronic basis. Relapses are thus less frequent than with traditional "reactive" application during flare-ups.
In a small-scale study dealing with 30 cases of squamous cell carcinoma of the anal mucosa (20 HIV+ cases and 10 HIV- cases), the authors tested for HPV and sought to determine the type. The virus was found in 9/10 sero-negative subjects (HPV16 = 100%) and 18/20 sero-positive subjects (HPV16 = 40%). They recommend a multivalent HPV vaccine for at-risk subjects (Anal squamous cell cancer in HIV+ and HIV- patients; which HPV genotype causes the lesion? K. Gosen. The Netherlands).
One of the congress's last sessions was extremely moving. It dealt with diseases "imported by migrants". Aldo Morrone considers that the current migratory movements are the most significant since WWII. These migrants account for 8.4% of the European population and mostly come from countries at war. According to Valeska Padovese, they mainly bring in non-contagious diseases that are difficult to treat since they are usually impossible to monitor. They are above all cutaneous diseases associated with poverty: scabies, bacterial, fungal and viral infections, irritative dermatitis, etc. Burns on the palms of hands are not rare (to try to erase fingerprints and no longer be identifiable). Such diseases can be very advanced, due to the lack of access to healthcare in these migrants' countries of origin. Cutaneous leishmaniasis of the face for example can resemble leprosy. Resistance to treatment is more common, particularly in Africans. In HIV+ patients, all these diseases are exacerbated. Torture scars are difficult to diagnose but need to be diagnosed because psychological support is necessary to treat post-traumatic stress syndrome.
Pr Frédéric Caux
One speaker described the off-label use of ingenol mebutate gel 0.05% (P2292). This local treatment was offered to treat anal or genital venereal warts. This exploratory monocentric trial included 40 patients including 83% males with an average of ten lesions, which had been progressing for approximately four years and had already been treated several times. The gel was applied for three days in a row with a new course of treatment two weeks later. A decrease in the number of venereal warts was observed for 81% of the patients. There was complete remission in 44% of cases but 57% of the patients had a relapse after three months. Local side effects were observed for 85% of the patients, leading to stoppage of treatment in 35% of cases. The high frequency of irritation could be related to the formulation of a gel that is locally dispersed. The results on the use of ingenol mebutate to treat venereal warts should be confirmed with a larger series of patients.
Janus kinase (JAK) inhibitors used in haematology seem to be indicated for a wide range of dermatological diseases. For example, tofacitinib is currently being developed for psoriasis. A recent article also reported the efficacy of this molecule in treating alopecia areata for a patient. This therapeutic effect was observed by chance in a patient having both psoriasis and alopecia areata who was in a clinical trial testing tofacitinib. During this EADV congress, a poster from Zurich reported the use of tofacitinib for a 51-year-old patient with alopecia areata and retinal vasculitis treated with methotrexate (P1213). Treatment with tofacitinib 5 mg twice a day led to partial regrowth after three months of treatment. However, this patient's hair remained for only one month despite the continuation of tofacitinib. This unexpected response brings to mind an article published in JAAD in February 2016 in which a patient with alopecia areata and vitiligo was treated with another Janus kinase inhibitor, ruxolitinib, which did not improve alopecia areata but led to the partial and temporary repigmentation of his vitiligo. During the plenary session, Martin Steinhoff affirmed that oclacitinib, a JAK1 inhibitor, could be offered to treat atopic dermatitis in humans. In fact, in 2014 it was demonstrated that this molecule is just as effective as oral corticoids in the control of itching for dogs with atopic dermatitis. Therefore, there are still a lot of avenues to be explored and mechanisms to be understood regarding the use of these new molecules in dermatology.
A study was undertaken in Australia on the current attitude of Australians towards tanning. In this country that has one of the highest incidences of skin cancers, several prevention campaigns were carried out by the public authorities between 1980 and 2000 to raise awareness of the risks of sun exposure and explain the importance of sun protection. A questionnaire was distributed to 884 adults with an average age of 36 who were consulting for mole screening. This population had a phototype of II or III in 82% of cases and had a personal or family history of skin cancer in respectively 8% and 40% of cases. Sunburn in the previous year was found for 57% of the patients. The questionnaire showed that 60% considered that tanned skin is more attractive than pale skin, 47% that tanning boosts self-confidence, and 21% that tanning is a way to be more socially integrated. Young patients were more likely than older patients to consider that tanned skin is more attractive than white skin (21-30 years, 69% versus >41 years, 49%; p=0.0009). The fact of having a dermatologist or having already had skin cancer screening did not change patient attitudes towards the sun. This study shows that skin cancer prevention campaigns have not changed the attitudes of Australians. Skin cancer prevention should now target cultural perceptions of tanning and the ideals associated with this aspect of the skin.