World Congress of Dermatology

Dr John’s Daily Blog

Wake to sounds of thunder and realise that this is the last day. Boo and hurray in equal measures. Yesterday was a long day with three symposia under the belt and suffering a surfeit of knowledge and sore feet.

The crowds at last seem to be thinning out in the Exhibition Hall. All agree that surviving a convention of this length requires stamina equivalent to climbing the north face of the Eiger. Notice younger ones not faring so well as we old-timers.

Attend the morning session of P&Gs Symposium – Skin and Anti-aging Research Update. Once again they seem to have assembled a cracking faculty chaired by Alexa Kimball from Harvard, no less, who opens with a review of the prevalence of common skin disorders. All good, solid stuff.

Paul Matts from P&G Beauty gives a fascinating talk on technologies used by cosmetic scientists to assess skin physiology changes resulting from applied moisturisers and the like. Most naïve attendees could not fail to be impressed with how much kit these boys have to play with.

Skin pigmentation heavyweight Jean Paul Ortonne does an overview of ingredients currently under review for alleviation of what is an interestingly common problem. Interestingly niacinamide, which is a vitamin B derivative, keeps popping into these talks. Promise self to get some of their Regenerist product – in my case it will need to be good.

Kevin Cooper, another one with a stunning IQ, reviews the role of innate and adaptive immunity, inflammatory mechanisms of the skin and the immune effects of UV in relation to the aging process. Apparently, it is the immunocellular-mediated oxidation, proteolysis and cellular changes in skin that may lead to wrinkles and texture modifications. Never realized getting sun-burnt was so complicated.

Professor Zhu from China talks on the myths and facts regarding botanical ingredients and reviews the use of botanicals for the treatment of aging and skin disorders very much from a different cultural perspective than most of the audience are used to.

Zoe Draelos closes with some practical stuff on moisturizers and tips for dermatologists.

These symposia are amongst the best of the stuff on offer as they are SO professional, whereas badly-chaired sessions are the bane of a delegate’s life.

After the obligatory and stunningly good pizza for lunch (lots of them in BA), attend packed cosmetic dermatology session. Learn lots of stuff on fillers from professors of cosmetic dermatology (good grief) who all hail from big cities in the USA. Very obvious that lots of derms have been practicing on themselves. Presumably a bit like me in my trichology session – if you don’t have a good head of hair, the punter is not going to be impressed.

Attend P&Gs Cosmeceutical Symposium late in afternoon. Again packed house obviously attracted by the free coffee and chockie- bickies.

Zoe Draelos, who is obviously cloning herself to be in so many places, gives concise review of cosmeceuticals which apparently provide a new therapeutic frontier for anti-aging in dermatology. She reviews the ingredients which are currently being incorporated into carefully constructed formulations designed to deliver scientifically measurable and visibly noticeable improvement. Topical niacinamide comes up again as do retinoids (such as retinyl propionate), N-acetyl glucosamine and UVA photo-protective ingredients as the sort of ingredients to look for.

Jay Nash, who is P&G Beauty’s sunscreen expert, gives concise overview of photoaging and ingredients to combat our self-inflicted worst excesses whilst Tom Dawson follows with review of hair care for those who missed the hair symposium. Jim Schwartz, one of the bevy of super bright scientists these companies have the clout to hire, gives the fungus story on dandruff and seb. derm.

Lovely Pat Engasser does a splendid and balanced review of risk assessment for cosmetic products. Reminds the cynical that regulatory bodies around the world have set rigorous standards for product safety, while improved technology has made testing more efficient. Nice to know that we are being looked after. Some of this stuff is really complicated but reassuring.

P&G Beauty’s Harald Schlatter draws the graveyard slot but the room is still full for a review of hair dye safety. Probably the last major allergen which gets the contact dermatitis boys in a job and this is a genuinely important talk so bear with me if this section is less than trite.

He admits that due to their basic reactive chemistry, the safety evaluation of hair dyes has always been a major consideration. Hair dyes are apparently one of the most studied and regulated consumer products on the market with an overwhelming amount of safety data. Yet, hair dyes continue to come under scrutiny, primarily regarding two safety concerns: First, a potential link to increased cancer risk and second, skin allergy.

Seems lots of epidemiological studies have been conducted, evaluating a potential correlation between hair dye use and an increased risk for any possible cancer type. Taking all currently available epidemiology studies and state-of-the-art safety data into account, it is concluded that hair dyes do not pose an increased cancer risk, either for consumers and clients, or for professional hair dressers.

Like other products such as certain foods or drugs, hair dyes can cause allergic reactions in a few sensitive individuals. The vast majority of hair dyes allergies are delayed hypersensitivity or type IV reactions. Allergic reactions to hair dyes are rare when compared to their widespread use and occur at a rate of approximately 1 per one million products sold. To further minimize the risk of hair dye allergies, the cosmetic industry has voluntarily implemented risk management measures. For example, all oxidative hair dye products bear allergy warning labels on pack, making consumers and hairdressers aware of a potential allergy risk. In addition, hair coloring products are equipped with clear use instructions and majority of brands recommend conducting a skin sensitivity test 48 hours before the hair coloration. Professional hairdressers are advised to apply appropriate occupational safety measures (like wearing gloves). In collaboration with dermatologists, P&G Beauty underscored it will continue its education efforts targeting consumers, clients and hairdressers in order to further minimize any potential allergy risk and improve compliance with risk management measures.

After all this lot – sink exhausted into a vodka tonic and scrub up for the final event – the Gala Dinner – which isn’t. 2500 people at a stand up nosh is not my cuppa, but meet lots of friends which is what it is all about. Stagger of to nurse even sorer feet after a couple of hours and pass out relatively early.

Flying out tomorrow for week long recovery in Las Vegas.

Overall how was it for me?

FINAL IMPRESSION

The local organization has done a fantastic job in getting it all together and lots and lots for every one with big attendances at the cosmetic stuff.

The venue creaked a bit, not least that it was SO noisy and the transport to and from brought out the forager in me in finding new and novel was to steal taxis from the unsuspecting.

Overwhelmed at times by hoards of local regional delegates. The queuing became one of the enduring memories and the Exhibitors will need admitting to intensive care units to recover.

Had interesting talk with some of P&G Beauty’s scientists on their stuff and overall their exhibit booth, with their cinema-style presentation, exuded a steady flow and became a haven.

Well organized satellite symposia with strong faculties were better value than some of the more ad hoc sessions.

All in all, an enjoyable but utterly draining week – I know… don’t cry for me Argentina, at least I had a week away from sore throats and hemorrhoids and ate more cow in a week than I usually do in a month.

To cap it all, the next World Congress will be in Seoul in 2011 – after much Machiavellian politics, they beat Rome by a mile with poor old London a long way off third. Much grief in the Pontine after such a heavy defeat. An industry colleague who works in Asia contemplating suicide when he realized that the entire organization will be coming his way.

On the assumption that we all live that long – hopefully see you there.
Chau,

John Gray

World Congress of Dermatology

Dr John Gray’s Daily Blog

Wednesday morning dawns grey and damp but the spirit is unquenched. Late in last night after mandatory visit to famous tango club (which was excellent) but continued Atkins diet like fare beginning to take its toll.

Today’s highlight is the P&G Beauty Satellite symposium – Hair & Scalp Science Breakthroughs.

A very strong faculty lead by Rod Sinclair who describes the importance to us all of healthy hair. Give thanks that I chose my parents wisely and still have a full head of beautiful hair with only distinguished streaks of grey. Apparently we have, like sheep, a protective f-layer on our hair which helps it look shiny and beautiful – transpires that most of womanhood seems determined to strip this by means of sundry which is why we need conditioners.

Amy McMichael from the USA, describes how hair breakage and fragility are large problem for many African-American ladies. The hair shaft being flatter is more vulnerable to the various hair care practices and abuses the wearer inflicts. A combination of chemical relaxing and straightening (which is rampant in the USA) weakens the hair shaft. In one reported incident 95% of interviewees had hair breakage, before the ever vigilant FDA had the product removed. The habit of tight braiding from childhood and continuous wearing of extensions can lead to irreversible alopecia. P&G Beauty’s conditioners really help!

Ramon Grimalt from Barcelona gives splendid practical guide to scalp disorders – did not know scaly scalp could be so exiting. Good old fashioned dandruff (which was, from memory, epidemic amongst the academics at my medical school) has now assumed a new status. Massive amounts of research now lining it up at the start of the queue of seb.derm and psoriasis – transpires that a fungus called malassezia lurks in the hair infundibulum and gorges on the hormone driven grease until the immune system gets fed up and responds. Probably explains cradle cap – gorging fungi on our babies head until mother’s hormones wear off. That recent study clearly shows that there is no resistance to good old head and shoulders shampoo which I always recommend. As usual, looks like people just don’t stick to using it daily like I do.

Tom Dawson from P&G proudly announces his Appalachian heritage and describes the incredible genomic work he and a host of others have pursued over 5 years to unravel the mysteries of said above fungus. This little critter (his words not mine) which apparently leapt from corn pods on to our scalps back in the dawn of human evolution is so specialised that it can only live in niches on our body where it feeds by vomiting enzymes all over us. It now transpires that these fungi are having sex to keep themselves super fit. Realise that I am inadvertently scratching my head at the thought of it. I continue to be staggered at the quality of research that this company puts into fundamental research. Quite awesome.

Ralf Paus from Germany and who clearly has an IQ off the scale gives amazing dissertation “deep down in the follicle” in his own words. The hair follicle is a unique mini-organ capable of life long cycles of massive growth. Recent work has identified an unbelievably complex localised signalling mechanism between the skin neuro-ectoderm and mesoderm which drives the cyclic organ transformations. Transpires the follicle can manufacture almost all the enzymes we posses including oestrogen and prolactin, ACTH. Bottom line is that this cross talk may revolutionise our approach to the treatment of skin diseases by targeted pharmacological or biophysical manipulation of intracutaneous neruoendrocine regulatory loops. All this would be hard to take in if not for the fact that it is delivered with incredible energy and belief. Were all lecturers this good!

Antonella Tosti from Bologna, a much loved speaker at these events – gives practical guide to the office physician on how to manage the patient with hair loss. Most helpful since these patients are invariably horrendously difficult to manage, with great expectations of a miracle cure and frank disbelief that anything we offer will take a year to show. Much better to become an expert in hair growth inhibition where after 6 weeks the patient thinks you are a genius. Smart alek question from the floor on what hair is for receives standard reply that we really don’t know but those of us lucky enough to hang on to it this far don’t care. Overall – a really excellent session and highlights that if the faculty is really top notch, even only incremental increase in knowledge which can be retained leaves one feeling inspired to learn more.

Attended cocktail reception and then to the President’s dinner sponsored by P&G Beauty. Sumptuous affair amongst the dermatological glitterati, with black tie and posh frocks in profusion (some of the women look beautiful too). Mercifully brief speeches and presentations followed by excellent sing-along opera style show where we all get to sing nessun dorma and o sole mio. Invited to dance Viennese waltz with charming Venetian-masked damsel and impressed by being able to reverse. More dancing and new knee holds out well but come the dawn.

Chau,
John Gray

World Congress of Dermatology

Dr John Gray’s Daily Blog

The rains have cleared but we are left with a tropical mugginess and nasty niffs from the drains.

I have realised that I have no hope of describing even a fraction of the hundreds of talks going on throughout the week.

So today, instead of describing the continued assault on the exhibitors, now reminiscent of the Alamo, I thought I would offer a few personal highlights of talks in a specific area important to us all – UV and its interaction with human skin.

Of the major areas of activity there is no doubt that skin cancers and their distant relatives, skin ageing, are attracting huge efforts from academics and industry. Throughout the week, both plenary and sponsored sessions have focused on basic research and treatment modalities (new posh word).

In Meeting of Minds on Monday, David Hill outlined a global strategy for skin cancer prevention. Recent public statements on the potential benefits of UV (vitamin D) have further hampered public health policies for an already sceptical populace. Evidence suggests that the key target group, teenagers, have little or no belief in the need for effective UV avoidance. This is a critical issue, as up to 80% of UV exposure occurs before age 18. Other areas included a discussion of the relevance of genetic screening for melanomata and the publishing of a UV index.

The old chestnut of whether the use of UV screens made cancers worse surfaced. You should sit in any GP practice with an ageing population (mine) handing out creams or sachets for the old soldiers AKs to know that ANY strategy (big hats and creams) would have helped this a lot – but men were men then!

From a personal perspective – I would love to have the time to do all this as would, I am sure, our local dermatologist. In an economic climate when there is no funding for any research at all in our health care system – this remains a pipe dream. Thank heavens that the cosmetic companies have pushed the use of sunscreens in their daily care ranges. At least if mothers teach their daughters to cleanse and moisturise with products containing these effective systems – by subterfuge protection is gained. Shoving it down a population’s throat will not work and unlike banning smoking in public places (hurray) forced application seems a might totalitarian.

I personally use Olay Total Effects as part of my pledge to take better care, and I have become quite fanatical about it – you can never beat a convert!,

On Monday in Photoprotection and Sunscreens, Professor Anthony Young (UK) gave his usual superb review of the pathogenesis of cutaneous tumors. The suspicion that UVA may have a greater role in all such lesions has been raised but at present no model can reproduce markers suggestive that UVB is not the more important. However, there is accumulating evidence that UVA is a major component of skin ageing with hitherto unexpected effects on collagen. Although the escalation of skin cancer is potentially a major public health issue, for most women the preservation of youth (sounds better than reversal of ageing) is a constant worry. New ingredients, such as niacinamide, in conjunction with effective moisturisers and a full range of screens in a formulation which encourages compliance, have been shown to be of significant use.

In the interactive session on ageing Bob Binder from P&G presented his highly commended presentation on epidermal barrier and differentiation markers. This sophisticated study set out in lucid detail the key regulators in skin which are down-regulated in old skin affecting epidermal differentiation and lipid biosynthesis leading to decreased barrier function. This occurs in both intrinsic and extrinsically aged skin but profoundly more so in sun damaged skin. This type of detailed work will lead to even more targeted cosmetic products.

In What’s New, Gillian Murphy (Ireland) described recent interesting developments in the genetics of photodynamic therapy for cutaneous cancers and rejuvenation. These are clearly on the horizon. This does raise the dilemma of developing clear public messages on where we stand on the management of the interaction of human skin and light.
The legions of ladies in their 50s who turn up each year with skin wrecked by a combination of holidays in Spain, weekly trips to the sun-parlour and smoking, and wish to line my pockets with gold in return for botox, bears testimony to our failure so far.

In the Meeting of the Minds session on antioxidants and their efficacy in dermatology, the presentation by Professor Jean Paul Ortonne addressed the issue of oxidative stress in skin disorders. The role of antioxidants is a hot topic but as yet he stressed, the efficacy of topical dietary treatments is not proven.

I hope this has offered a flavour of what went on.

Tomorrow is the first of the major P&G Satellite Symposia – Hair & Scalp Research Breakthroughs.
Chau,
John Gray

World Congress of Dermatology

Dr John Gray’s Daily Blog

The real thing – and after the gentle start, thousands of delegates expected with the prediction that most of Latin America will be there. Indeed they were!
This may be a World Congress (and there are the good and the great from most countries) but it seems that the whole of the Latin American derms have come on a coach- indeed, this is a pilgrimage. Having presumably been denied previous attendance by sheer distance, they are determined to make it to this one – the female to male ratio seems about 10 to 1 and all of them apparently determined to see and enjoy everything.

After two days of blue skies, woken by tropical storm – remember I said pack a raincoat?
Combination of torrential rain and rush hour denies taxi driver credible attempt at Lewis Hamilton impersonation but narrowly avoid monumental puddle at Convention Centre due to the ubiquitous holes in the road.

Morning sessions are underway after protracted journey and hop between sessions “speaker picking.”

Tip of the day

Always highlight the speakers you wish to hear the night before and get familiar with the various halls which are spread about. Saves a lot of time and ensures you see all you possibly can.

The coffee break unleashes seemingly endless hordes into the Exhibition Hall. Queues form which would rival the crossing of the dead sea. Some exhibitors seem to relish sheer volume: with the holy grail of the (often indiscernible) freebie attained by patience. Others adopt a more – see a video, meet the expert, learn some “stuff” and then quietly pick up the goodies.

P&G ran a continuous video highlighting skin, hair and scalp scientists and some core information on technologies. Gradually, over the morning, their cinema-style format works as people can sit and watch. Eventually, this seems an increasingly-preferred option to standing in line.

For the first time ever, hair dye technology is on show. Not one the contact allergists would expect, but obvious from observation that 70% of the females delegates appearing on stand seem to use this type of technology (and probably, some of the men).

After this onslaught, the plenary session is packed. Genomic is the subject and some fascinating information is shared, particularly on cancer. The debate on seed v. soil for predicting prognosis of metastases is fascinating, with recent work highlighting the importance of soil (the local metastatic environment). Seems that metastases DO behave differently from the primary lesion due to local signalling pathways and growth factors. Treatments will, in the future, be modelled on the need to differentiate primary and secondary blocks for these pathways. Each patient will need an individual plan rather than a blanket approach.

The histo-pathologist may be required to predict much more accurately the prognosis of individual cases by histolog, image analysis and gene profiling and help to individualise management. I wonder if our health authorities will relish this, as it sounds expensive.

Lunch brings an even greater onslaught on the stands and queues snaking for miles (kilometres) – the fortitude of all is taxed almost to endurance as the humidity from the storm challenges the air conditioning. However, most seem happy to wait for their eventual prize. Speak to charming but exhausted conference director as P&G Beauty is sponsoring the President’s dinner on Wednesday – as usual, all seems to be well under control. She confesses that the Congress has attracted many more than expected and the breakout sessions are bursting.

Attend contact allergy session – seems allergy to plastic is more common that thought (hmmm…) but presentation by Donald Belsito on new allergens is fascinating and informative. Admits that the fragrance industry is “doing a good job” at reducing incidence of allergies, but watch out for temporary tattooing fallout in kids. Textile dyes from cheap imports are also an increasing issue. Totally agree – unlicensed and unregulated tattooing of children is a real problem, with some as young as eight having the ad hoc holiday tattoo doctored with sensitising dyes to which they are subsequently exposed from other sources.

Sink exhausted into bath tub and scrub up for Distinguished Dermatologist dinner hosted by P&G Beauty. Exit hotel to be faced by serried ranks of paparazzi – sense slight disappointment when discover that they are waiting for Prince amongst others. Give passable Becks wave, but no flashlight disturbs the still storm-drenched night.
Whisked off to amazing private house stuffed full of antiques and paintings of former heroes looking noble but tough. On loan from the army apparently – beats the RAC club by a mile.

Host of genuine thought-leading dermatologists turn up and lots of interesting stuff on the state of the profession and where it is all going. General agreement that skin cancer and photobiology are big stuff. Convincing the public to protect themselves and their kids is maybe getting through. Obvious that without the big cosmetic manufacturers like P&G Beauty, progress would be much slower. The next three hours is passed with magnificent food and a spectacular finale with Eva/Madonna lookalike on balcony – inevitable “don’t cry for me Argentina” brings tear to eye and lump to throat (finale photo 1, 2, 3).
We troop off into the night with many exchanges of cards and hopes of intellectual advances in the future. Cannot beat socialising for fertilising.

Late to bed, but happy.

Chau,

John Gray

Well – here we are at last. Buenos Aires is a LONG way to come – we Europeans don’t realise just how big the world is. Lovely spring weather and the hotel come up trumps with the transport. Clearly the driver was a descendant of Juan Fangio (old time Argentinian formula 1 world champion). Subsequent exposure confirms that they all must be.

Climatise the first day by eating huge amounts of meat and shopping at great exchange rates.
And so to bed…

Sunday 30th September

Wake to more glorious weather and a completely shut city – bit like Europe used to be. Leisurely breakfast , stroll to see the sites along deserted boulevards but find portneos are as mad on dogs as me and get to play with at least 10 labradors. More (much more) meat for lunch

And so to the business in hand – the 21st World Congress of Dermatology

Tip of the day

Too far to walk to convention – and taxis are so cheap. Bit of a culture shock for those of us in the Atlantic alliance who assume every taxi driver speaks English (apart from New York and Shanghai) – finally address written on bit of paper and pointing at map helps. Trick for those reading this- ordering “to and from” radio taxis via the hotel really works, particularly (see below) if you are stuck on the street – take the hotel number with you.

Fortunate to have pass to circumvent inevitable dragons at the door and spend the afternoon watching the Exhibitors putting the finishing touches to their stands and inducting the ubiquitous “hostesses.” Human nature being what it is, there is nothing like a pretty face to pull in jaded dermatologists – other, perhaps, than the promise of a freebie which costs nothing but promotes an evolutionary desire to queue!

Some of the stands are just mind blowing – the P&G Beauty exhibit stand is round and svelte with lots of toys to play with a theatre and afterwards the promise of goodies to take away (starts Monday 1st October). Others stands have hectares of space with nothing much on them other than what look like mars bars(?). An air of “approach if you dare” pervades on others. Find book I wrote on publishing stand (gratifying but no fortunes to be made there).

P&G Beauty personnel include real scientists as well as bevy of multi-lingual, affable and articulate hostesses (who number undergraduates and trainee doctors amongst them).

Quite the reverse from long experience, to those who view your approach as a personal intrusion and delight in making you queue.

Spent time having P&G Beauty scientists analyse my skin – the depths of my appalling lifetime sun habits emerge. Promise to faithfully use their skin care products which seem to have ingredients to counter all my sins and protect me in the future. Amazing, when I was a lad we gave our grandmother a bottle of the famous pink liquid. How far has cosmetic science come.

Fare better on the hair and scalp analysis – no dandruff and my luxuriant and only marginally greying hair is in pretty good shape. Apparently we now even know the gene sequence of the putative yeasts causing common scaling diseases occur. More to come during the week at the P&G Hair & Scalp Symposium.

Admire amazing packaging and just the sheer breadth of product range. Dermatology wasn’t like this when I was a lad.

Do a tour of the exhibition hall- cosmetic companies seem to dominate : further sign of the times.

Decide to brave the registration hall. Amazingly, magnificently efficient registration and bag swap with happy smiling young people – makes a pleasant change from the bad tempered maelstrom endured at previous similar events. Venture to the main hall for the… The Opening Ceremony.

Love them or loathe them – every major such event has to have an opening ceremony. Worst one ever consisted of 20 speeches by all the local dermato-politicians: meeting running 4 hours late before it got started, made worse by the first 92 short presentations elucidating archaic treatments for syphilis (honest).
Manage to employ usual tactic learned at dad’s knee of getting right up the front (thanks dad) and hear admirably short and concise welcome by Congress Secretary, Adrian Pierini, who has to be congratulated on level of organisation and technical delivery, so far.
Robin Marks,wielding designer silver gavel as President of the International League of Dermatological Societies gives an honest, impassioned but overly long review of world dermatology. Presents well deserved prizes to Professors Henning Grossmann and Terence Ryan for outstanding work in rural Africa. Makes you realise how much we (and how little they), have. Humbling!

Some lascivious tango by famous argentine troupe (who overmilk the applause) is followed by more very well deserved prizes to real unsung heroes – but sense audience starting to feel a bit disconnected at this point. Gentle and humorous address by Congress President Gallimberti on “global dermatology for a globalized world” is followed by prolonged diatribe for Spanish speakers only by Argentine Vice President and a further burst of ballet. Enough being enough - depart to discover the more experienced hands are already in the exhibition hall waiting for the free food and (more importantly) drink which is eventually and gratifyingly, in profusion.

Delegates and their retinues eat, drink and cruise the stands, sizing up where to go when the goodies come. A gentle evening, getting to meet old friends and make some new ones.

Usual scrum for taxis made worse by tyrannical dispatcher, but beat them all by dint of phoning hotel who sent taxi with name all over it - much to ire of above. Must write book on how to survive conferences!

Tomorrow it all starts in earnest: fall asleep reading incredibly comprehensive Final Program (more congratulations) and realise will have to be time and space traveller to get to cover it all. Look for best speakers as well as subject matter.

Ethnic hair & skin physiology and disease meets personal interests despite looking like a covert sponsored symposium. Planning the day essential and making sure the suit pressed for attendance at P&G’s distinguished dermatology dinner tonight.

Get up at 5a.m. to write blog.

Tomorrow will bring you as much of the highlights as possible with more pictures to come.

Best,

John Gray

Today is a busy day – all the last minute things before the off for Buenos Aires early tomorrow.

I have said enough about what to expect and who to go and see – so here’s a few practical and light-hearted tips gleaned years of travel and from disasters, potential disasters and disasters.

Flights

• Save time and check-in on line. Don’t forget if you are travelling via the US (even in transit) passport details are needed. Use the Bag Drop – much quicker (some anglo-saxon airline excepted !!)
• Check the luggage allowance – I found that transatlantic flights can be surprisingly generous. My flight allows three pieces of luggage each up to 32 kg. More than enough for the wife’s jewellery !
• If you have time – buy a “suiter” – so much better for the posh frocks and suits. Avoids looking like you travelled in the hold when you arrive at the Opening reception.

Hotels

• Check that you DO have a reservation. You should have a reference number from your agent. My reservation was a potential disaster – no bed for the day I arrive. Thanks to P&G’s splendid administrators – sleeping on the streets was averted.
• Be nice to the concierge and he or she will take good care of you

Taxi from the Airport

• The taxi company number for the Remises (located just beyond Customs) did not have anyone who spoke English (or presumably any other language – American, Australian etc)
• Phone your hotel and/or e-mail them asking them to arrange a taxi. Don’t forget the return. Tip the driver about 10%
• If you don’t manage to do this – outside the airport go to the Taxi Stand and wait for a black and yellow “Radio Taxi” – make sure it has a meter.

Money

• Get local currency when you arrive for best rates. However , apparently ATMs are NOT everywhere but there is bound to be one near your hotel
• Have a few dollars with you and use your credit card to pay for the reserved taxi
• Only about 75% of restaurants take credit cards but most shops do
• US dollars are acceptable as tips

Language

• For first time visitors to Argentina – this is not a country in which English is widely spoken – as I found out to my cost. Learn some key words – and remember that the language is influenced by the large Italian population – don’t say gracias : its Chau (like ciao).
• Buy a local Spanish/English dictionary and learn to smile and point.

Cultural Sensitivity

• Read “A short history of the Argentines” by Felix Luna to understand more and avoid putting your foot in it.

This week, a few further thoughts on how far dermatology has come in the past two decades and what we supplicants can look forward to at the World Congress of Dermatology in Buenos Aires.

What will the presiding themes be? What (and who) should we go to hear? How has the World Congress evolved over the last decade?

Personal View

While many of us have state-of-the-art facilities and resources at our finger tips, we should not forget the millions who do not have access to pharmaceuticals or specialized medicine, let alone the fundamental nursing infrastructure which is the bed-rock of practical dermatology. Infectious skin diseases are conquered in the first world: they are not in the third. As I prepare for my trip I am constantly reminded of just how fortunate I have been throughout my medical career, and that developing nations need the support of the international medical community now, more than ever.

So how far have we actually come in the past 20 years? Two decades ago as a keen young(ish) general practitioner with the secret desire to be a dermatologist, I simply observed, excised or curetted the various lesions occurring in patients who presented more in hope than expectation. I did not think of skin as a contiguous organ or wonder what biochemical wonders lay beneath the surface. Skins appendages were distained or ignored. Cosmetic products although with an historical mandate, were part of a demi-monde.

I adhered to the old mantra: when it’s dry, wet it and when it’s wet, dry it.
Now, thanks to exposure to the global world of dermatology and the scientists of the cosmetic industry, I think in terms of cytokine cascades, immunological self tolerance and stem cells. One of the most poisonous substance on the planet, botox, has become my therapeutic best friend, but I use it in combination with highly effective and affordable cosmetic products.

Finally, I am humbled by the efforts of those working in the developing world to help people who depend on our support and assistance.

World Congresses

I went to my first World Congress in Sydney in 1977, when we, not surprisingly, reflected on the perils pale peoples face in a light-filled world. Professor Robin Marks, Congress President and now President of the International League of Dermatological Societies (ILDS), was instrumental, amongst others, in highlighting to the wider world the perils of skin cancer. This, in my view, was comparable to the work of Richard Doll and immeasurably raised the profile of dermatology.

I am hopeful that this academic profile can be sustained in the light of relentless governmental pressures to reduce the status of the discipline.

I was privileged to participate in a round table discussion on “The Benefits of Lifetime Photo-Protection” subsequently published in the Royal Society of Medicine International Congress and Symposium series. Did it help? How far have we come since then?
Sadly it continues to amaze me that legions of these pale-skinned individuals inflict deliberate and serious cutaneous damage in a way that would have Health & Safety in apoplexy, were it in the workplace. Photobiology has come a long way since then. Academics, health gurus and industry formulators continue to cry out in anguish as sufferers expect miracle cures for their badly damaged skin.

Some of the leading academics and industry researchers will be showcasing findings next week. Look out for some outstanding presentations and posters. (See below)

At the Paris World Congress in 2002, the buzz was all the new biologicals: how psoriasis would be conquered, and how blistering diseases would be a thing of the past. Little did we realize that the astronomical costs of these treatments would be a difficult burden to bear for health care systems and individual patients. Look out for keynote presentations on where the world now stands in this area. (See below)

We also witnessed major cosmetic companies beginning to rival the pharmaceutical giants in the scope and scale of their satellite symposia. The depth of research being carried out in the R&D centres came as a surprise to many seasoned and cynical onlookers. We began to understand the assiduous application of risk assessment models for potential allergens by collaboration between regulators and industry.
This year, the level of oral presentations and posters on fundamental research into disorders of ageing reaches new heights. Do attend the P&G Satellite symposia and visit the poster hall. (See below)

So - what to look out for/what to do (For full details consult the official program)

• Look through the program and plan your day/week to avoid disappointment
• Be sure to choose lectures/workshops or symposia which meet your needs and interests but also – go to something different
• Choose a lecture that may have no immediate relevance but looks inspirational
• Consider what may be important for your practice over the next five years
• Do take some time out to avoid battle fatigue

I plan to attend the following sessions, which reflect my interests (trichology, cosmetic dermatology, office-based primary care dermatology).

Try and compose your own agenda:

Special lectures, advances and hot-spot sections

• “Quo vadis- A focus on wellness or disease?” – Klaus Wolff, October 3 – as per the road to Damascus?
• Stem cells- dreams and reality – Otmar Wiestler, October 5 – should interest the scientists looking to make a fortune

Symposia

Psoriasis/Eczema

• Psoriasis – Chris Griffiths, October 5 – world authority on difficult and quality of life affecting disease
• Occupational dermatoses – Torkil Menee (chairs top class faculty), October 4 – for those involved in public health affairs

Phlebology

• Phelbology and management of leg ulcers – H. Neumann, October 5 – outstanding speaker on an unglamorous but increasingly important subject which will affect all of us with ageing populations

Skin Ageing/Pigmentation

• Pigmentary disorders – Jean Bolognia (great speaker), October 4 – important topic to the office dermatologist
• Antioxidants – Jean Paul Ortonne, October 4 – world authority on coming area in cosmeceuticals
• UV skin damage, in search of light – Anthony Young, October 5 – world authority, peerless
• Gene expression profiles associated with intrinsic and extrinsic ageing –Robert Binder, October 2 – important ageing research
• Skin of color around the world – Susan Taylor, October 3 – fascinating on-going debate with charismatic faculty
• New insights into skin appearance and measurement – Paul Matts, October 4 – reviews the latest skin measurement technologies, always well worth a listen

Satellite symposia

Cosmetic Dermatology

• The Real Benefits of Cosmetics – Florence Poli, October 3 – chairs faculty on subject increasingly important in daily practice

Hair & Nails

• P&G Sponsored Symposium – Hair & Scalp Science Breakthroughs – Rod Sinclair (chairs world class faculty), October 3 – fundamental science to practical tips for the office physician, Do not miss!
• Breakthrough understanding of dandruff and seborrhoeic dermatitis through whole-genome analysis – Tom Dawson, October 3 – P&G sponsored symposium, outstanding beauty science research presented by a unique speaker.
• Treatment of seborrhoeic dermatitis of the scalp – Jim Schwartz (top scientist), October 4 – P&G Satellite Symposium includes new clinical data on the question of tachyphylaxis
• Nails – Antonella Tosti, October 5 – world class authority and always a hit!
• Trichology – Juan Ferrando, includes David Whiting, October 2 – top dermatopathologist

This week, a few practical tips for the delegate and his or her entourage, on how to survive the 21st World Congress of Dermatology to be held at the La Rural Convention Center, Buenos Aires September 30th – October 5th.

In order to make the best of such an intellectual and social maelstrom, planning and tenacity are essential. Activities fall into work, official functions and play.

WORK

More details in the coming blogs on which are the talks not to miss but DO go on line NOW to program@dermato2007.org to make sure you work out what you want to see and hear during the week. Planning now can avert disappointment later.

Make sure you put the P&G Beauty Satellite Symposia in your diary, blackberry or iPod.

OFFICIAL FUNCTIONS

See and be seen at the following:

Opening Ceremony (included in the registration fee):

The Opening Ceremony will be held at the Convention Centre, on Sunday, September 30, 2007 at 18.30. Delegates accompanying persons and exhibitors are welcome.

Welcoming Reception (included in the registration fee):

Following the Opening Ceremony, the Welcoming Reception will be held at the Exhibition area of the Convention Centre, on Sunday, September 30, 2007.
Delegates accompanying registered persons and exhibitors are welcome.
Return transfers will be provided by coach.

**A good chance to get stuck into the atmosphere and to arrange to meet with old friends.

Congress Closing Party: Registered delegates and accompanying persons may also participate in what is described as “a unique party” on Thursday, October 4, 2007, from 20.00 to midnight. According to the organisers, “Refreshments, music and dance are scheduled. Wander, relax, be entertained, dance and look out for a few surprises through the night.” – the mind boggles!

Tickets are required; limited attendance. It is advisable to purchase tickets in advance. Fee: US $95

PLAY (SOCIALISING)

One should never underestimate the impact of socialising during these major events.

Getting together in the evening with professional colleagues and friends is often as important as set lectures and workshops. Certainly for the Exhibitors this is a key part of the week.

Never deride the importance of industry at such events; without them, barely any progress would ever happen; without their products or surgical provisions, we could be mere observers of cutaneous disease.

In 20 years, the most obvious change has been the emergence of major cosmetic manufacturers as equals to the traditional pharmaceutical houses. For instance, this year the cosmetic powerhouse that is P&G Beauty will offer a series of symposia bringing some of the world’s experts in the science of skin, hair and cosmeceuticals to the podium. In the exhibition hall, the latest technologies in hair, hair colour and skin care will be displayed – AND for the delegates – those quality products to take home to the loved ones! In the poster hall, scientific quality undreamed of a decade ago will be on display for the inquisitive mind.

The Gala Dinner is a great opportunity for “networking” (apologies to aficionados of the Queen’s English) in a homogeneous atmosphere and for some “surprises throughout the night”.

The President’s Dinner, hosted by P&G Beauty, welcomes leaders of the global, regional and local organisations in their increasingly global quest to promote training, safety and efficacy standards, and in some cases, defend the speciality against cost-containing bureaucrats and professional interlopers.

Having penciled in your week, following are some valuable logistics and recommendations for dining and getting out and about…

BUENOS AIRES: USEFUL TIPS FOR DELEGATES

CLIMATE & DRESS

Spring begins in September and visitors can expect a temperate climate with average temperatures in the afternoon around 22°C (~72°F) with occasional rain, so pack light and you’d be prudent to bring an umbrella.

Comfortable cloths for lectures, sightseeing and shopping but ladies, don’t forget posh-frocks for the Gala Dinner and gentlemen will need to sport or hire a tuxedo if invited to the President’s Dinner, sponsored by P&G Beauty.

Smart casual is de-rigueur if out in the better restaurants.

AIRPORTS

The two runway Ministro Pistarini International Airport is located in the suburb of Ezeiza, about 35 km (40 minutes’ drive) from the centre of Buenos Aires city. It is also the hub of international routes of Aerolíneas Argentinas.

The airport has two terminals: International airlines arrive and depart from Terminal A which can be very busy, so arrive in plenty of time for your flight home.

The Aeroparque Jorge Newbery airport, located in the Palermo neighborhood next to the riverbank, serves mostly domestic traffic.

TRANSPORTATION

Taxis in Buenos Aires are distinguishable by their standard black and yellow exterior. They are available 24 hours a day, either by flagging or reservation. Payment is per meter reading and not by district. Available taxis are marked LIBRE.

Buses or Colectivos
Buenos Aires has a large network of buses, locally called “Colectivos”. There are 144 lines, each identified with a number and different colors. You purchase your ticket on the bus with coins only. Once on board, you must tell the driver your destination and he/she will enter the amount on the ticket machine. The machine prints a receipt as proof of payment and it is advised that you do not discard the receipt until exiting the bus. If you do not have exact fare, wait until the machine gives you change. Most lines operate 24 hours a day, 7 days a week. Late night services are less frequent. At your stop, go towards the back of the bus and ring the bell on top of the back door.

Car Service or Remises
Remises can be secured by telephone or in person at the “Remiserias”. The price of the trip is arranged at the time of reservation. This form of transportation is very safe, cheaper than taxis and will always take the fastest route. The “remiserias” or “agencias de remise” are small offices or store fronts located throughout the city.

Subway
The subway system is very reliable and it covers the city centre and outskirts of the city. There are five lines identified with letters A, B, C, D and E, which undoubtedly provide the fastest way to move around the city. The subway system runs Monday – Friday from 6am to 10pm, Saturdays, Sundays and holidays from 6am to 8pm.

ATTRACTIONS
Luckily for Congress participants, the La Rural Convention Center is in an excellent location, accessible from anywhere in the city. In anticipation of a “balanced” visit I offer some places of interest.

Teatro Colon
One of the world’s finest opera houses, the Teatro Colon is a site not to miss while in Buenos Aires. Located at 9 de Julio Avenue, in the heart of the city and on a site once occupied by Ferrocarril Oeste’s El Parque station, the building has its main entrance on Libertad Street. For show or tour times, please visit http://www.teatrocolon.org.ar/inicio.htm.

La Boca
La Boca embodies the varied architecture of the city’s multinational heritage. With Spanish Colonial design, Italian detailing and graceful French Classicism. Muralists have turned this area of the city into colorful avenues and a delight for tourists.

Plaza de Mayo
The Plaza de Mayo is the city center (the city, in fact, was literally built around it), and some of Argentina’s most important historical events took place here. Surrounding it is the Government House, the Metropolitan Cathedral and the Cabildo (town hall).

…and last but not least:

TANGO

Tango music was born in the suburbs, notably in the houses of ill repute of the Junín y Lavalle district and in the arrabales. Its sensual dance moves were not seen as respectable until adopted by the Parisian high society in the 1920s, and then all over the world. Tango enjoyed a resurgence in global popularity later in the 20th century due almost exclusively to Astor Piazzolla and his development of the tango nuevo style. In San Telmo, Sundays are devoted to tango shows on the streets and antiques trade in the bazaars around Dorrego Square. Tango shows can be found in establishments such as Rivero’s El Viejo Almacén.

DINING

If in doubt, be generous to the Concierge in the hotel to get you prime restaurants as well as shows and tours. Never underestimate the power these powerful allies wield.

The dining options in Buenos Aires are infinite. Argentinean culture emphasizes its multinational cuisine and gathering people to enjoy it. In-line with the social norm, most restaurants do not serve dinner until 9pm. Main courses usually consist of Asado, a barbecue of outstanding quality beef, which not surprisingly is the dominant protein source. Bife de Chorizo (sirloin steak) or Empanadas (meat pies) are excellent and will do absolutely nothing for the waist line. Some of the local red wine is an excellent accompaniment. Also, try the Yerba Mate–the traditional gaucho drink made with herbal tea, which claims to have multiple medicinal and healthful properties (placebo not included). Last but not least, you must try the national deserts: Dulce de Leche, a milk jelly, and Alfajores, Argentine sweets made from Dulce de Leche.

Here are a few options to consider for Argentinean cuisine:

Madrigales
With cross-cultural flare, Madrigales serves a fusion of Mediterranean and Argentine dishes in a serene atmosphere with modern oriental décor.

Address: Av. Callao 181, Buenos Aires C1022, Telephone: 11-4370 8007

Golden Tulip Savoy Hotel, MON-SUN 7:00 am-12:00 am

Cost: Inexpensive

Restaurant Pigalle
This restaurant is a hit with travelers - live local entertainment and a traditional Argentinean menu.

Address: President M. Ortiz 1835, Peatonal de Recoleta, Buenos Aires 1113, Telephone: 11-4311-6676, Etoile Hotel

Cost: Moderate

Tago Mago
Dancers and acrobats wait tables while singers, jugglers, dancers and trapeze artists entertain diners during the evening hours.

Address: R Obligado & J Salguero, Costanera Norte, Buenos Aires, Telephone: 11-4312-7291

Cost: Expensive

To finish this week’s blog here are some useful Web sites

About the Congress: www.dermato2007.org

Information: info@dermato2007.org

Scientific Program:program@dermato2007.org

Abstracts: abstracts@dermato2007.org

Registration: registration@dermato2007.org

Exhibition: exhibition@dermato2007.org

Hotels: travel@dermato2007.org

Scholarships: scholarship@dermato2007.org

Press: press@dermato2007.org

Thoughts turn to spring in Buenos Aires and less than a month to go before the start of the great jamboree that will be the World Congress of Dermatology. The citizens of this proud and independent city, the Porteños, will welcome an anticipated 12,000 delegates on the 30th of September for the 21st edition of this celebration of skin, its appendages, and its disorders. Over five days, the cream of academia, pharmaceutical experts and cosmetic scientists will forgather in the 91,000 square meters of the La Rural Convention and Exhibition Center situated in the Palermo neighborhood, close to downtown Buenos Aires. Lectures, workshops and symposia on every conceivable aspect of this, the largest and most visible organ of the human body, will vie with the technical exhibition where all major pharmaceutical and cosmetic manufacturers have the opportunity to display and give away their wares.

A Personal View

So why am I excited and why might you want to go?
A variety of reasons – some facile and some important.

• Learn some really important “stuff” from the world’s experts
• Meet old friends and acquire some new ones
• Acquire those CME points
• Experience a fascinating vibrant society with unquenchable night life
• Bring lots of presents for the folks at home

World Congresses tend to be like the Olympics – you can see all of the elements in other places but not all together and not with such enervating excitement that you go away feeling like YOU can take on the world.

As with any Congress, location is important – Buenos Aires certainly fits the bill, although I am not sure my new total knee replacement will quite cope with the Tango.

So is the energy of the organisers and the type of people who will be there. Under the guidance of Congress President Galimberti and Congress Secretary Adrian Pierini, the event will definitely be highly exciting – an element too often lacking when trying to refresh flagging skills, learning new ones and merely survive the five days.

Seriously, the bottom line is this – Why is dermatology important? Why do you need a World Congress, and why do YOU need to be there?

Personally, as a physician trained at time when the art of observation, communication and practical management were keystones – dermatology has it all! It is a specialty in which the physician “sees” the problem and the patient can rewardingly “see” rapid benefits from your intervention. At this World Congress, the role of skin in defining our health, wealth, age and identity comes under as much scrutiny as the traditional diseases have over the previous 20 years.

As a 20-year vicarious observer of “global” dermatology – it is manifestly clear that doctors are facing the stark reality of social, governmental and consumer pressure which may affect and change their professional life.

In many developing countries whilst the “old diseases” linger, the cutaneous manifestations of HIV/AIDS represent a major medical and social challenge. The expansion of dermatology services is vital to these societies.

On the other hand, socialised medicine in Europe is pressuring dermatology services to be more cost effective, potentially at the expense of patient specialist care. Other specialities and alternative practitioners are intruding into what was once purely a professional dermatological domain. At the same time, academic dermatologists reluctantly have to face up to a world in which dealing with the “well” patient’s desire to preserve youth will have to be a core function. Already the burgeoning public demand for cosmetic procedures in the USA and other highly developed systems has produced the specialist “cosmetic dermatologist.” Here, association with the cosmetic scientist presents opportunities for development and public service.

Ultimately, it is in the fight against the tide of global skin cancer and by extension, the place of derm-surgery, that the profession has a critical role to play.

Enough of the diatribe…

So, what does a “World Congress” offer? In fact, this 21st World Congress of Dermatology offers something for everybody – the best speakers, the most important topics in disease management, and the best training for this and the generation to come. More importantly, it gives us and physicians dealing directly with patients the opportunity to meet old and hopefully new colleagues, exchange ideas and make new contacts.

SO – if you are already going – see you there!
Don’t forget to visit the P&G Beauty stand and DO attend the P&G Sponsored Symposia (links below).

If you have nothing better to do in the first week of October – could do worse than a week in the sun in vibrant Buenos Aires.

THINGS NOT TO MISS:

Opening Day, Monday, October 1, 2007

• Workshop: “Genomics and proteomics: a link to practical dermatology,” Giovanna Zambruno (Italy), Nelida Davalos (Paraguay), Junh-Mo Yang (Korea) and Ervin Epstein (United States) – 8:15 to 10:15.
• Symposium: “Ethnic hair and skin physiology,” Victoria Holloway (United States), Xue Min Wang (China), Sergio Talarico (Brazil), Adama Traore (Burkina Faso – 8:30 to 10:30.
• Symposium: “UVA and the skin,” Andre Rougier (France), Franklin Madero (Ecuador), Yoon Kee Park (Korea), Irene Stefanaki (Greece) – 8:30 to 10:30.

Day Two, Tuesday, October 2, 2007

• Workshop: “Photoprotection and Sunscreens,” John Hawk (United Kingdom), Zhigang Bi (China), Alejandro Ruiz Lascano (Argentina), Peter Wolf (Austria) – 8:15 to 10:15.
• Plenary: “Toll-Like Receptors: Role in Skin Inflammation,” Philippe Musette (France) – 11:34 to 11:54.
• Workshop: “Understanding and Governing Cell Migration,” Bernhard Homey (Germany), Jorge Laffargue (Argentina), Jean Francois Nicolas (France), Wolfgang Weninger (United States) – 13:45 to 15:45.

Day Three, Wednesday, October 3, 2007

• Sponsored Symposium: P&G Beauty “Hair and Scalp Science Breakthroughs,” Prof. Rodney Sinclair (Australia), Amy McMichael (United States), Ramon Grimalt (Spain), Tom Dawson (United States), Prof. Ralf Paus (Germany), Prof. Antonella Tosti (Italy) – 14.00 – 16.00, Room B
• Workshop: “Skin Barrier: Mechanism and Repair,” Enzo Berardesca (Italy), Peter Elias (United States), Genji Imokawa (Japan), Cristina Pascutto (Argentina) – 8:15 to 10:15.
• Workshop: “Skin of Color Around the World,” Susan Taylor (United States), Martha Minino (Dominican Republic), Jean-Jacques Morand (France), Edith Nkechi Nnoruka (Nigeria) – 13:45 to 15:45.
• The real benefits of cosmetics – Prof. Zoe Diana Draelos (United States), 14:00 – 16:00
• Alopecia Areata – Prof. Jerry Shapiro (Canada), 13:45 – 15:45

Day Four, Thursday, October 4, 2007

• Sponsored Symposium: P&G Beauty “Skin Health and Anti-Aging Research Update,” Alexa Boer Kimball (Chair, United States), Paul Matts (United Kingdom), Jean-Paul Ortonne (France), Kevin D. Cooper (United States), Wenyuan Zhu (China), Zoe Diana Draelos (United States) – 8.45 to 10.45, Room B
• Satellite Symposia: P&G Beauty “Cosmeceuticals: Practical Solutions for Common Problems,” Zoe Diana Draelos, MD (Chair, United States), Steven Shiel (United Kingdom), James R. Schwartz (United States), J Frank Nash (United States), Patricia Engasser (United States), Harald Schlatter, PhD (Germany) – 16:30 to 18:30, Room D
• Workshop: “Antioxidants and the skin,” Unandar Budimulia (Indonesia), Graciela Cuomo (Argentina), Sheldon Pinnell (United States) – 8:15 to 10:15
• Antioxidants – their efficacy in dermatology – Prof J.P. Ortonne October 4th 13:15- 14:15

Day Five Friday, 5th October 2007

• Nails – Prof Antonella Tosti – October 5th 14:00 – 16:00
• Hair diseases – Prof Blume – Petayvi and Professor David Whiting , October 5th 8:30 – 10:30