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