British Association of Dermatologists Annual Meeting 2007

This year’s British Association of Dermatologists (BAD) Annual Meeting took place at the International Convention Center (Birmingham, UK) from July 10th to the 13th, 2007. Attended by 900 dermatologists and 300 nurses from the UK and abroad, the conference was heralded a huge success by its organizers and the attendees.

BAD scientific program

Sessions were held by the British Contact Dermatitis Society, British Society for Dermatopathology, British Society for Dermatological Surgery, British Society for Pediatric Dermatology, British Skin Foundation, British Dermatological Nursing Group, British Photodermatology Group and more. A total of 130 posters were also on display, covering the topics of acne and hair problems, blistering disorders, case studies, education and training, infections, melanoma and skin cancer, psoriasis, psychology and skin, service issues, skin and renal diseases, therapy, eczema and urticaria, alongside historical topics.

Guest speakers included the BAD’s Irene Leigh (London, UK), a world leader in the field of keratinocyte cell biology and genodermatoses, who spoke on ‘Translational Research in Dermatology’. Leigh explained that translational medicine research involves bringing theoretical, laboratory-based science closer to practical applications of direct patient benefit. It is particularly relevant to dermatology, which has seen an enormous flowering of basic research in skin diseases and basic skin biology that, in turn, has created new diagnostic and therapeutic approaches. Examples of this process were highlighted from the cell to the clinic.

Jon Hanifin (Portland, OR, USA) an international authority on atopic dermatitis, was also a guest speaker on atopic dermatitis. For many years, atopic eczema has been assumed to be an allergic problem. Fillagrin is a protein essential to the formation of an effective skin barrier. Most patients with eczema have dry skin (icthyosis) and recent genetic studies by Irvine Maclean (Dundee, UK) have demonstrated that patients with atopic dermatitis have genetic abnormalities of fillagrin production. Therefore, the dry skin and abnormal barrier function may be the primary cause and allergies are secondary, or possibly caused by allergens penetrating the abnormal barrier, hence a whole new direction of research has gained momentum.

Francisco Kerdel (Miami, FL, USA) introduced delegates to the American experience of managing severe dermatoses. Kerdel’s lecture focused on the management of two important diseases, namely toxic epidermal necrolysis and hidradenitis suppurativa. Toxic epidermal necrolysis is characterized by blistering and peeling of the top layer of skin, often caused by an adverse drug reaction, and represents one of the most difficult therapeutic challenges in hospitalized dermatology patients. Kerdel presented a practical and proven approach to this disease. Hidradenitis suppurativa, an inflammatory skin disease that causes abscesses, discharge and open wounds, is also a difficult to manage problem and Kerdel gave preliminary data on a double blind, placebo-controlled trial (single site) using infliximab to treat this disease.

Martin Cook (Guildford, UK), a renowned dermatopathologist specializing in melanoma and sentinel node biopsy, highlighted the importance of changes in the genetics associated with different clinicopathological types of melanoma pathology and how this may change the classification of the disease. He also reviewed his huge experience of sentinel node biopsy for melanoma and updated delegates on how it is best used.

Robin Graham-Brown (Leicester, UK) reported on the latest developments in the UK Department of Health’s program for dermatology. He explained that it is clear from numerous policy documents and ministerial pronouncements that the government intends to move an increasing volume of work traditionally conducted in ‘acute’ or ‘secondary care’ settings to locations deemed more convenient for patients. In doing so, there is also an expectation among politicians and senior Department of Health officials that such moves will increase throughput, productivity and potentially save money. In the spring of 2006, six working parties were established to examine models of care that were deemed to provide examples of what government policy was hoping to see spread across the National Health Service (NHS) in England. These groups represented multiprofessional opinion in key specialties considered to be ‘ahead of the game’: ear nose and throat, orthopedics, gynecology, urology, general surgery, and dermatology. An assessment exercise was set up to evaluate five pilot sites in each specialty. In dermatology, the working party has undertaken some additional audit work. This presentation demonstrated that dermatology departments are already providing much of their care closer to home. It also emphasized that the working group was aware of the importance of maintaining hospital-based centers of excellence, not only for patient care but also for research development and training of future clinicians.

On the same theme, positive and practical help for developing dermatology departments was obtained from Julia Schofield’s (St Albans, UK) focus session ‘Making Opportunities from Threats’ and her high-quality posters and plenary presentation.

Medical dermatology, dermatopathology and translational research also featured strongly in the program. In addition, the BAD responded to feedback from the successful 2006 meeting, to include a trainee afternoon that involved areas such as disorders of the hair and nails, and focus groups on topics such as diseases of the genitalia, occupational dermatology and oral dermatology.

Social events included a reception in the Birmingham Museum and Art Gallery, and delegates celebrated 10 years of fundraising by the British Skin Foundation at the Annual Dinner and Dance.

BAD awards & prizes

The Wycombe Prize is offered for outstanding contribution to dermatology, specifically for a study published from a district general hospital or nonteaching center in the UK. Neil Cox (Carlisle, UK) was this year’s winner for his study on edema in cellulitis [1]. This study demonstrates that the true frequency of postcellulitic edema, as well as that of further episodes, is probably underestimated. Furthermore, it reveals a strong association between these factors.

In the academic category, the Best Paper prize went to Richard Warren (University of Manchester, Manchester, UK) et al. for his work on the pharmacogenomics of methotrexate response in patients with psoriasis [2]. Methotrexate therapy is an important treatment for psoriasis, but its use is limited in many patients by toxicity and it is not effective for all patients. This study investigates genetic variability in liver enzymes responsible for metabolizing methotrexate and an association with variability in expression of some new enzymes that may explain why some patients experience toxicity and not others. Thus, one could screen for those with poor function that may be at risk of toxicity; further studies are needed.

The Best Poster prize was awarded to Elise Kleyn (Manchester, UK) et al.[3]. Their study investigated brain activity of patients with psoriasis when presented with various facial expressions they would be exposed to when meeting others. They showed similar responses to all expressions except that of disgust, where the responses were muted. The authors hypothesize that they have become inured to this expression by frequent exposure to it.

Susannah George (Southampton, UK) et al. won the Best Registrar’s Paper for their paper on dermatological conditions in intensive care [4]. There is a national database of intensive care admissions and dermatology (which is wrongly considered by some to deal only with cosmetic issues), which lists 2245 admissions to intensive care around the country. These were mainly infections and had a poor prognosis.

The Best British Society for Investigative Dermatology paper was awarded to Tracy Wong (London, UK) et al. for their investigation into intradermal injection of allogeneic normal human fibroblasts into subjects with recessive dystrophic epidermolysis bullosa [5]. The study showed that the genetic defect may be treatable by injecting cells that produce the fibrils (fibroblasts) from relatives with normal skin. This poses the question – could this lead to a cure for a genetic skin disease?

BDNG sessions

The British Dermatological Nursing Group (BDNG) also had a busy academic program in parallel with that of the BAD, and both organizations joined forces for the Joint Meeting on Improving Clinical Practice. The ‘Interactive Case Studies’ session provided nurses with the opportunity to bring along interesting or difficult cases to share and discuss with colleagues from around the UK, and to discuss features and symptoms of the disease as well as the management plan or difficulties encountered.

Two sessions on elderly skin promoted awareness of the changes that take place in the skin owing to aging, recognition of barriers to providing skin care to the elderly and identification of nursing interventions used when caring for elderly skin.

The pediatrics module focused on some specific conditions, while also looking at some of the broader issues involved in the care of children. Sessions included ‘Lumps and Bumps In Children’s Dermatology’, the care of children with vascular malformations and tumors, child protection issues and dermatology and play-based support for children in dermatology.

A hospital visit to Birmingham Children’s hospital offered BDNG delegates an insight into the range of general and specialist health services to children, adolescents and their families, including a comprehensive in- and outpatient service within the dermatology department for children with skin disorders.

‘Basic Dermatology’ looked at the structure of the skin, common terminology used in dermatology, with overviews of some of the common skin diseases, such as eczema and psoriasis.

‘Advanced Dermatology’ explored biological therapies for severe psoriaisis, phytodynamic therapy, dermatoscopy, and the role of the Specialist Nurse for Skin Cancer in providing psychological support of melanoma patients.

Understanding the impact that skin disease can have on a patient’s body image is a vital part of caring for patients. The ‘Body Image’ session therefore examined the many issues within this remit that nurses may face when treating skin disease patients, including body dysmorphic disorder, the psychological effect of hair and scalp disorders, how psoriasis impacts on quality of life, and a patient’s perspective of living with vitiligo.

Media

The conference received a high level of media coverage, mainly focused around two studies being released during the week. The first was a report by Mary Laing, Jessica Sui and Colin Buckley of Waterford Regional Hospital (Ireland) [6]. To better understand sun-safety measures in schools in the southeast of Ireland, they surveyed 345 primary schools. The aim of the survey was to determine whether a sun-protection policy existed in these schools, to find out about current school practices in sun protection and teachers’ opinions about the importance of sun protection for children.

Although every school surveyed had outdoor activities scheduled between 10 am and 2 pm, when the sun is at its strongest, almost half had had no shaded areas in the playground. Additionally, 95% had no documented sun-protection policy, although eight out of ten teachers feel this was a necessary measure. The survey found that:

•	95% of schools had no written policy to limit student’s sun exposure;
•	100% of schools had outdoor activities scheduled between 10 am and 2 pm;
•	44% of schools had no shade-producing structures;
•	The school uniform included hats in 24%, shorts in 38% and short sleeves in 66% of schools. Only 55% of schools allowed students to wear sunglasses during outdoor activities;
•	22% of school personnel (including teachers, physical education teachers and school nurses) never wear hats, long sleeves or sunglasses or carry parasols or umbrellas;
•	Sunscreen was encouraged in only 55% of schools, mainly on school excursions;
•	Although no sun-protection policy exists in schools, 80% of principals and teachers feel this is required;
•	79% of teachers felt that excessive sun exposure in childhood was an important health concern; however, 1% of teachers felt it was not at all important.

The second study, carried out by Alastair Thomson, Richard Corkill and Faheem Bishr of the Royal Cornwall Hospital, Truro and Derriford Hospital, Plymouth [7], was performed to establish updated figures for the incidence of malignant melanoma in Cornwall for 2005, and to investigate whether the rising trend has continued in this region compared with the 2003 data. The study revealed a worrying trend – melanoma cases in the southwest of the UK have risen by a staggering 18% in just 2 years.

These studies were widely covered in the Sunday Telegraph, Belfast Telegraph, Eastern Daily Press, Manchester Evening News, Radio 5 Live, Nottingham Evening Post, Birmingham Post and the Irish Times.

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.