The annual meeting of the American Academy of Dermatology was held from March 16 to 20 in San Diego, and attracted approximately 17,000 participants from around the world, including clinicians, academicians, allied health professionals, and others interested in dermatology. The conference highlighted recent advances in the diagnosis and management of dermatologic conditions, with presentations mainly focused on acne, vitiligo, psoriasis, melanoma, and contact dermatitis.
During one presentation, Anthony F. Fransway, M.D., a dermatologist in private practice in Fort Myers, Fla., discussed how musicians are at an elevated risk for contact dermatitis.
"Contact dermatitis depends upon the musical instrument played and the sensitivity potential of the individual, but common allergens include metals (almost all media), exotic woods, cane reed (woodwind players), rosin (stringed instruments), shellac, paraphenylenediamine (staining agent for woods), and other unusual allergens," Fransway said. "These occurrences are not very common but common enough that the practicing dermatologist and the expert in contact dermatitis need to be aware of the possible sources of problems, and the way to manage, evaluate, and treat."
According to Fransway, awareness of the problem along with appropriate evaluation and intervention can allow musicians affected -- and even debilitated -- to continue in their chosen medium, using a combination of avoidance, substitution. and treatment.
In another presentation, Rebat M. Halder, M.D., of the Howard University College of Medicine in Washington D.C., outlined new surgical techniques for treating vitiligo.
"In the future, the treatment of stable vitiligo will be more focused on surgical options, as opposed to medical therapies, which vary in efficacy and safety. Individuals with stable disease -- disease that does not involve the development of new lesions or expansion of lesions over a 12-month period -- would be considered excellent candidates for surgery, especially those with segmental vitiligo," Halder said.
Skin grafting is the most common surgical option for stable vitiligo, including techniques such as miniature punch grafting and suction blister grafting. Melanocyte transplantation for stable vitiligo using non-cultured suspensions of epidermal melanocytes has recently been developed.
"These types of surgical options will likely replace standard medical therapies for stable cases of vitiligo," Halder said. "Surgical therapies for vitiligo can give good cosmetic results, with a high level of repigmentation within treated lesions. However, patient selection is of utmost importance, with stability of disease being the most important parameter to consider."
Darrell S. Rigel, M.D., of the New York University Langone Medical Center in New York City, presented information on new therapies for the management of patients with advanced melanoma.
"Within the last year, two drugs have been approved for the treatment of advanced melanoma. These approaches are more targeted in nature and do not just shut down the entire immune system. The first drug is called vemurafenib (Zelboraf), and the other drug is called ipilimumab (Yervoy)," Rigel said.
Vemurafenib is a drug that stops melanoma cells from growing by inhibiting the serine/threonine-protein kinase pathway.
"Patients with a BRAF mutation continue to stimulate the growth of melanoma cells. However, the use of this drug inhibits the pathway from being turned on and stops the melanoma cells from growing. Studies to date have demonstrated a survival improvement of 10 to 15 months," Rigel said. "There are a number of side effects associated with vemurafenib, including fatigue, weight loss, and hair thinning. However, the largest concern is the risk of squamous cell carcinoma within the first six to eight weeks of treatment."
Ipilimumab is an anti-CTLA-4 antibody that prevents antigen-presenting cells from binding to T-lymphocytes, which prevents melanoma cell growth.
"Although studies to date have shown a survival improvement of up to 15 months, not everyone responds. The downside to the drug is the risk of immunological side effects," Rigel said. "Although there is no cure for melanoma at this point, the benefits of these targeted therapies are that they could be used after [other treatments] fail and provide a more targeted approach to treatment."
Joel M. Gelfand, M.D., of the University of Pennsylvania Perelman School of Medicine in Philadelphia, discussed the potential link between psoriasis and other serious medical conditions.
According to Gelfand, individuals with psoriasis, especially severe psoriasis, are at an increased risk of stroke, myocardial infarction, and cardiovascular mortality. This risk is independent of common cardiovascular risk factors such as smoking, increased blood pressure, high cholesterol, diabetes, and obesity. In addition, psoriasis has also been found to be associated with hyperglycemia and hypertriglyceridemia, independent of the most common risk factors for these conditions, including obesity.
"Future research is necessary to better determine how skin disease severity affects the risk of developing insulin resistance, obesity, abnormal cholesterol levels, and cardiovascular disease, and whether successful treatment of psoriasis alters these risks," Gelfand said in a statement.
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