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

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