Abstract
The Dubai World Dermatology and Laser Conference and Exhibition (Dubai Derma 2011) was recently held in the elegant city of Dubai, United Arab Emirates. The 3-day scientific program included condensed lectures and specialized workshops on the treatment methods for a variety of skin disorders. The conference highlights are presented here, along with the accompanying exhibition for the latest on cosmetics and laser technologies.
We attended the Dubai World Dermatology and Laser Conference and Exhibition – Dubai Derma 2011 – which concluded 3 days of activities between 19 and 21 April 2011 at the Dubai International Convention and Exhibition Centre with more than 5000 visitor and participants. Planning for this meeting was under the guidance of the Conference Chairperson Professor Ibrahim Galadari, a native of Dubai and a Professor of Dermatology at the Faculty of Medicine and Health Sciences, United Arab Emirates University. The legendary opening ceremony was inaugurated by his Royal Highness Sheikh Hamdan Bin Rashed Al-Maktoom, Deputy Ruler of Dubai, Minister of Finance and President of the Dubai Health Authority. Sheikh Maktoom is a leading national figure in supporting research and academic activities.
The Dubai Derma conference presented condensed and specialized workshops and lectures. The scientific program included the current treatment methods for a variety of skin diseases. In addition, dermatologists had a unique opportunity to see the latest variety in modern technologies used for permanent hair removal and wrinkles. Numerous well-known international specialized companies participating in the accompanying Dubai Derma exhibition competed to show their latest laser machines, skin care products, and cosmetic and pharmaceutical products.
Qadhi Saeed Al Murooshid, the Director General of the Dubai Health Authority, said in a speech delivered during the opening ceremony that the continuous success achieved by Dubai Derma Conference and Exhibition over the past 11 years reflects the prestigious status of the conference as a unique platform for doctors and specialists in the field of dermatology and perhaps the increasing number of participants that Derma records every year is an indication of the international prominent reputation of the emirate of Dubai as a regional hub for international companies to promote their products from Dubai to the region. He also indicated that the Dubai Health Authority has always been keen to address dermatology and skin health matters as part of the vision of the leaders of the United Arab Emirates in striving to provide comprehensive and high-quality healthcare services that cover all curative and prevention aspects. The Dubai Health Authority had previously initiated a specialized medical center for dermatology and plastic surgeries. The center is fully equipped with the latest medical equipment and qualified medical cadre to provide the local community with the best medical services.
Amal Kurban, a Professor of Dermatology at Boston University School of Medicine (MA, USA), pointed out that the successive Dubai Derma conferences have reflected the worldwide trends both in medical and surgical dermatology. In this regard, he emphasized four specific points. First, the conference offers a forum and opportunities to present interesting and challenging scientific topics and cases. Second, it attempts to develop new leadership from among the junior dermatologists to ensure future continuity of the mission and long-term vision of this annual conference. Third, it addresses, among its activities, new thoughts, methods, technologies and promising new horizons. Fourth, it provides educational and academic sessions for continuing professional development and resident graduate training.
Lectures by Jouni Uitto
Jouni Uitto (Professor and Director of Jefferson Institute of Molecular Medicine, PA, USA) initiated the conference with very informative and useful lectures.
The first lecture discussed progress in heritable blistering diseases towards molecular therapy. He described that epidermolysis bullosa as a group of disorders demonstrate considerable phenotypic severity: the milder forms are life-long without affecting the overall lifespan, while in most severe cases, children can die prematurely within a few days of birth. No effective treatment is currently available.
The second lecture demonstrated the clinical features of fibrotic skin diseases, including localized involvement (e.g., morphea and keloids) and systemic involvement (internal organs as in systemic scleroderma). Pathomechanisms of cutaneous manifestations may include ingestion of nutrients (tryptophan-induced eosinophilia–myalgia syndrome), drugs (neomycin-induced skin and lung fibrosis) and diagnostic procedures (gadolinium-induced nephrogenic systemic fibrosis). In some cases, fibrosis can be autosomal dominant.
The third lecture discussed the genetic disorders of the elastic fibers in the skin. Recent studies have indicated that different gene mutations underlie different elastic fiber disorders. For example, Pseudoxanthoma elasticum has been shown to result from mutations in the ABCC6 gene, while a number of different genes may be at fault in different forms of cutis laxa.
The fourth lecture offered updated information regarding treatments for skin aging. Uitto and his group have recently tested nonablative treatments for skin aging as an alternative to the traditional laser rejuvenation. They have utilized 1320-nm Nd:YAG lasers as well as electro-optical surgery techniques that represent a combination of intense pulsed light and radiofrequency. The effects of these approaches were shown to stimulate the repair processes and reverse the clinical and histopathological signs of aging.
Neurotoxin
Heidi Waldorf (Director, Laser and Cosmetic Dermatology, Mount Sinai Medical Center, NY, USA) summarized the art and science of neurotoxin injection for face and neck rejuvenation as an integral part of the cosmetic dermatology practice.
Hassan Galadari (Assistant Professor of Dermatology at the United Arab Emirates [UAE] University, UAE) discussed the elevator and depressor muscles of the face being the main areas that are treated with the neurotoxin.
Mohamed Al-Turkmani (Riyadh, Saudi Arabia) expressed the main concerns to patients and physicians regarding the side effects of botox, which could be minimized by the appropriate dose and proper site of injection based on the precise understanding of anatomy and function of the superficial muscles of facial expression.
Psoriasis
Several presentations demonstrated the epidemiology, clinical features and biological therapies of psoriasis.
Ali Mustafa (King Fahad Medical City, Riyadh, Saudi Arabia) discussed biologic systemic therapy of moderate-to-severe psoriasis. Four biologic therapies (adalimumab, efalizumab, etanercept and infliximab) had been thoroughly revised, and are currently licensed for the treatment of moderate-to-severe psoriasis. Randomized, double-blind, placebo-controlled studies have demonstrated the short-term efficacy and safety of all psoriasis therapies. Patients who need biologic therapies are those who are suffering from severe forms of psoriasis. However, there might be a need for a combination of traditional systemic and biologic therapies.
Anwar Al Hammadi (Dubai Medical College, UAE) covered both common and uncommon clinical presentations of psoriasis. The most common clinical presentation is plaque psoriasis (psoriasis vulgaris), while less common forms include pustular, guttate, inverse and erythrodermic psoriasis.
Ashraf Reda (Dubai, UAE) discussed the challenging decisions of choosing biological therapeutic agents and the clinical factors influencing such decisions.
Jamal Ali Al Saleh (Dubai, UAE) shed light on guidelines for biologic therapy in UAE. To overcome the cost of biologics and to enlighten the healthcare provider in prescribing anti-TNF-α, several regulatory bodies drafted evidence-based guidelines for biologic therapy.
Biologics mechanisms & adverse events
Salah Al Rubaie (Dubai, UAE) discussed the biologic mechanisms of psoriasis. Advances in the understanding of the immune/inflammatory pathways leading to psoriasis necessitate developing new approaches to treat psoriasis.
Biologics are in the form of monoclonal antibodies and fusion proteins selectively targeting key cytokine and receptor molecules on T cells and antigen-presenting cells involved in psoriasis pathogenesis. A comparison between old and new biologics’ mechanisms of action was made.
Moving on to the topic of adverse events of TNF-α antagonists, Hussein Abdul Dayem (Abu Dhabi, UAE) discussed the cutaneous adverse events of anti-TNF-α agents used for different indications (rheumatologic, gastrointestinal and cutaneous). Definite associations were found for infusion-/injection-site reactions, while strong associations were found for psoriasis and psoriasiform lesions, lupus-like syndromes, vasculitis and cutaneous infections. The majority of cutaneous adverse events are of mild-to-moderate severity, resolving with short-term topical or systemic therapy and not always leading to discontinuation.
Mustafa Al Azzi (Dubai, UAE) expressed the concern surrounding the use of TNF-α inhibitors due to increasing risk of opportunistic infections, particularly tuberculosis. Screening for latent tuberculosis infection has been recommended, as well as offering preventive treatment to all patients with evidence of latent tuberculosis infection before starting any anti-TNF-α therapy.
Laser technology
Suhail Hadi (NY, USA) explained the advantage of treating psoriasis with the 308-nm excimer laser by its ability to target only the psoriatic plaques through the fiber-optic delivery system sparing the healthy skin and decreasing the risk of photoaging and skin cancer which might occur with using UV light. Hadi shared the results of excimer laser treatment for localized, recalcitrant psoriasis. A total of 98 patients with various forms of localized stable psoriasis (scalp, body, palms and soles), with the duration of disease ranging from 3 months to 30 years, were treated (treatment given twice a week). Treatment response demonstrated that 60.2% of patients achieved 75% or more clearance with an average number of sessions of 17 and an average cumulative dose of 6.46 J/cm2. Difficult locations achieved good results where 66.7, 60 and 59.9% of patients with scalp, soles and palm involvements, respectively, achieved 75% or more clearance. In conclusion, the 308-nm Excimer laser is an effective and safe treatment modality for resistant localized stable cases of psoriasis, and the remission period lasts several months or even over 2 years in stable patients.
Martin Kassir (dermatologist and internist from Dallas, TX, USA) presented one of the most useful presentations, reviewing various laser technologies, contraindications for each technology and laser physics, and the acute and chronic management of resulting burns.
Ahmed Al Issa (Riyadh, Saudi Arabia) reviewed the fast growing new laser devices and the expanding new indications by using different wavelengths and pulse durations. He elaborated on collagen remodeling laser (laser devices that target collagen) and laser lipolysis that targets lipocytes. Ahmad Khalaf presented the long pulse Nd:YAG laser as an alternative therapy for many epidermal lesions with satisfactory results for many patients.
Several presentations continued the discussion on laser technology and its uses for various dermatologic conditions. Andriana Ribe Subira (Barcelona, Spain) considered the 1064-nm wavelength-emitting laser very effective in treating telangiectasia and reticular veins of the legs. Possible adverse events include ulcers with skin scars and pain. A clinical study with a new laser device that sequentially fires 755- and 1064-nm wavelength to treat telangiectasia and reticular veins of the legs was presented.
Mario Trelles (Cambrils, Tarragona, Spain) illustrated the greater benefits of the 2940-nm Er:YAG laser in fractional resurfacing when used for skin rejuvenation. The 2940-nm Er:YAG laser can be programmed to deliver subablative energies, which may be used in several passes over the skin, which leads to a progressive build-up of heat achieved without ablation and to formation of coagulation damage in the dermis, serving to stimulate collagen formation during wound repair.
Ercin Ozunturk (Istanbul, Turkey) stressed the importance of Q-switched Nd:YAG laser (532 and 1064 nm) in successfully treating a variety of epidermal and dermal pigmented lesions with minimal damage to the adjacent normal-appearing skin.
Mahaveer Mehta (Dubai, UAE) shared his experience in combining fractional CO2 laser and other lasers in aesthetic practice.
Ashraf Badawi (Cairo University, Egypt) discussed laser treatment of lower eyelid veins.
Photoprotection
Isam Oumeish (President, Jordanian Private Physicians Association, Amman, Jordan) offered a comprehensive update on photoprotection, which is considered the mainstay of caring for skin health. He discussed progression in nanotechnology, secondary photoprotection at the cellular level and the major changes in US FDA guidelines of labeling sunscreens.
Photodynamic therapy
Rolf Soehnchen (Dubai, UAE) discussed photodynamic therapy as a new and effective option that can be used to treat actinically damaged skin, basal cell carcinoma and other skin changes. He also discussed the mode of action, patient selection, effects and potential side effects as well as the broader spectrum indications for photodynamic therapy including large areas of actinic keratosis.
Acne
Acne received attention in two presentations. Sahar Natour (Al-Khobar, Saudi Arabia) presented a study evaluating the perceptions and beliefs of Saudi youths regarding acne. Suhail Javaid Akhtar (Faisalabad, Pakistan) tried to evaluate the efficacy of novel fractional CO2 laser for treatment of acne scars.
Hair loss & hair disorders
Marwa Faezi (Cairo, Egypt) presented a study using follicular stem cells in treating alopecia areata.
Abdullah Al Khalifa (Riyadh, Saudi Arabia) demonstrated the various therapeutic agents that have been described for treatment of alopecia areata that are neither curative nor preventive.
Adel Alsantali (Jeddah, Saudi Arabia) discussed the emerging therapies in hair loss and hair disorders including cellular therapy for hair loss, roxithromycin as a new therapeutic option for androgenetic alopecia, the use of simvastatin and ezetimibe in the treatment of alopecia areata, and a recent clinical trial using N-acetyl cysteine in the treatment of trichotillomania. There are several recent trials on the potential involvement of the peroxisome proliferator-activated receptor pathway in the pathogenesis of lichen planopilaris, which raises the question as to whether these findings will have therapeutic benefits.
Fillers
Heidi Waldorf (Director, Laser & Cosmetic Dermatology, Mount Sinai Medical Center, NY, USA) reviewed the scientific differences among available filling agents, and she highlighted pearls for satisfactory outcomes and management of complications. In another presentation, she emphasized that “tissue augmentation is no longer a process of ‘filling’ but one of ‘shaping’ or ‘volumizing’. An understanding of the normal progression of facial aging is critical, particularly the changes that occur in bone, dentition and fat. Correcting these defects produces a more youthful appearance and brings the face closer to the cultural and artistic aesthetic ideal. She then discussed the modern method of volumizing requiring a 3D evaluation of the patient and a focus on areas of the face that are frequently not to be what the patient expects to treat.
Sabine Zenker (Munich, Germany) considered calcium hydroxylapatite advances to be the longest lasting biodegradable filler for global facial augmentation, and that the well-trained injector can achieve remarkably natural aesthetic results with a high patient satisfaction rate.
Based on her experience, Fatma Al-shehri (Riyadh, Saudi Arabia) expressed her interest in fat as an ideal filler compared with plenty of fillers that are produced in a competition to be the ideal.
Fat grafting
Zuhair Al Fardan (UAE University, Al Ain, UAE) presented the most recent fat-transfer procedure and clinical applications, and discussed the factors that increase its survival rate. The survival of transferred fat cells has been explained by two theories: the replacement theory and the revascularization theory.
Cutaneous vasculitis
Fouad Elsayed (Beirut, Lebanon) considered the classification of the cutaneous vasculitis a difficult problem. He gave examples of diagnostic features and procedures including clinical manifestations of systemic vasculitis, biopsy and direct immunofluorescence staining to check for IgA, IgM and IgG deposition in and around the vessel wall, which suggests an immune-mediated process.
Childhood vasculitides
Khalid Al Hawsawi (Makkah, Saudi Arabia) presented childhood vasculitides, including the most common forms in children (Henoch–Schönlein purpura, isolated cutaneous leukocytoplastic vasculitis and Kawasaki disease) and the lifelong chronic rare forms in children (e.g., giant cell arteritis, Wegener’s granulomatosis, polyarteritis nodosa and Takayasu arteritis). The most recent classification of childhood vasculitides is based on vessel size and histopathology, which was defined by the International consensus conference in Vienna in 2005.
Skin tumors & infection
An excellent presentation by Khalifa Sharquie (Baghdad, Iraq) evaluated the frequency of cutaneous manifestation in pemphigus, especially skin tumors and infections with renal transplant recipients.
Hayder Al Hamamy (University of Baghdad, Iraq) discussed the treatment of pityriasis versicolor (a superficial fungal skin infection) and he presented a study evaluating the effectiveness of topical 4% potassium hydroxide in the treatment of pityriasis versicolor in comparison with topical 1% clotrimazole solution. There was a significant difference in clinical response with better clinical and mycological improvement in patients treated with topical 4% potassium hydroxide.
Hesham Moneer Ahmad (Dubai, UAE) compared clinical and histopathological outcomes of a single session of treatment of 15 cases of basal cell carcinoma on face or scalp using liquid nitrogen cryotherapy versus high-energy pulsed CO2 laser; both showed high cure rate and good cosmetic outcome, with better results shown with the pulsed CO2 laser.
Cutaneous leishmaniasis
Sahar Natour (Al-Khobar, Saudi Arabia) discussed the present and future management of cutaneous leishmaniasis, including drug resistance and side effects. The pentavalent antimonial (Sbv) compounds remain the gold standard for treatment.
Vitiligo
Abdullah Al Eisa (Riyadh, Saudi Arabia), Ahmed Al Issa (Riyadh, Saudi Arabia) and Sanjeev Mulekar (Henry Ford Hospital, MI, USA) offered a course on vitiligo consisting of three parts: medical aspects of vitiligo, surgical aspects of vitiligo and a round table discussion for challenging cases. He discussed pathogenesis, clinical types and broad principles of management, including phototherapy and excimer laser, in addition to topical and systemic medical treatment (calcineurin inhibitors and steroids). The surgical aspect included general guidelines for surgical therapies as well as cellular grafting (cultured and noncultured).
Surgery
Khalid Al Ghamdi (Riyadh, Saudi Arabia) attributed the ingrown toenail (commonly the great toenail) to many anatomic and behavioral factors. He discussed the various surgical approaches, including partial nail avulsion and complete nail excision with or without phenolization. Other options were also discussed, such as electrocautery, CO2 laser ablation of the nail matrix and the less-invasive sleeve method.
Faiez Ali Ghanam (dermatologist and laser surgeon, Damascus, Syria) demonstrated the suction blistering graft as a method of melanocyte transplantation for resistant and acral vitiligo lesions.
Cutaneous warts
Heba Mashaly (Cairo University, Egypt) presented a study evaluating and comparing the expression and possible role of human β-defensin 3 (hBD-3) in the pathogenesis of cutaneous warts.
Spectroscopic imaging
Simone Presto (Hamburg, Germany) presented a novel technique to educate patients on applying a sufficient amount of sunscreen aided by in vivo Fourier transform infrared spectroscopic imaging that has proved a powerful rapid visualization of a huge number of compounds on the skin.
Autoimmune bullous disease
Abdul Razzaque Ahmed (Boston, MA, USA) lectured on the pathogenesis and treatment of autoimmune bollous disease. The most important factors contributing to pathogenesis of blistering diseases were the identification of the HLA genes (MHC class II), and distinguishing pathogenic from nonpathogenic autoantibody based on epitope and subclass specificity. He also offered two pivotal advances in therapy that changed the prognosis of blistering diseases. The first was the discovery of intravenous immunoglobulin (IVIg) using a defined protocol. In mild or moderate responders, the addition of dapsone or dapsone to methotrexate converts them into high responders. The second major discovery was the use of rituximab with IVIg in a defined protocol.
Facial anatomy
Eric Mensah-Brown (UAE University, Al Ain, UAE) described the vasculature of the face, including the five types of variation of the facial artery and its branches of significance to both anatomists and practitioners.
Periorbital rim & periorbital area
Alain Lajeunie (Paris, France) discussed the rejuvenation of the periobital rim and periorbital area. The periorbital rim can be rejuvenated by combined therapy including volume restoration, dermal fillers for eyebrow reshaping and correction of crow’s feet and tear troughs with fluid fillers (little cross-linked). As for the perioral area, the rejuvenation include; filling periorbital wrinkles, redefining lip contour (vermillion border), increasing red lip volume and mesolift technique for skin hydration and elasticity.
Face lifts
Saaed Kaldari (Doha, Qatar) discussed the evolution in face lift procedures and recent techniques requiring the understanding of facial anatomy to avoid complications.
Melatonin & pigmentary disorders
Matteo Tutino (Palermo, Italy) presented a study showing that a new melatonin multivitamin complex in combination with vitamin C 15% stabilized with melatonin, resveratrol and Vitis Vinifera improves the intrinsic aging and photo-aged skin. Quantum molecular response technology significantly improves the results, increasing the amount of collagen and ameliorating the skin texture. He also presented another study showing that combining melatonin, resveratrol and L-ascorbic acid increases L-ascorbic acid stability, promotes re-epithelialization and adjusts the color of the hyperpigmented skin.
Kew-Ho Kim (Younsei University, South Korea) stressed that there is no evidence of a direct effect for hydroxy acid supplementation on primary or secondary skin pigmentation such as melasma, juvenile freckle, solar lentigo and senile lentigo. Hydroxy acid promotes cell proliferation and extracellular matrix synthesis and protects cellular function. Pigmentation is thought to be affected indirectly by the resumption of skin volume, transparency and its rejuvenation.
Education & experiences
Amal Kurban (Boston University, MA, USA) described the residency training program at Boston University, including rotations, clinical activities in different dermatologic subspecialties and academic activities.
Jouni Uitto (Thomas Jefferson University, PA, USA) shared his experience at Thomas Jefferson University (Department of Dermatology and Cutaneous Biology), which has grown over the past three decades. Residents are exposed to different facets of dermatology through direct interactions with fulltime faculty in the clinical and laboratory settings, which provides the graduated residents with rewarding careers in both clinical dermatology and academic settings for those interested in cutaneous biology research.
Osman Taha (Professor of Dermatology and Venereology, Sudan) discussed the past, present, and vivid and bright future of dermatology.
Yahya Dowlati (Tehran, Iran) discussed the factors involved in a patient’s dissatisfaction and how to manage them.
Fatima Al Faresi, a resident physician (Al Ain, UAE) discussed the challenges facing the Arab residency training programs and possible solutions.
Khalid Douieb (Larache, Morocco) presented a study aimed to show if the Maghreb dermatology associations follow the worldwide electronic revolution.
Chondrodermatitis of the ear
The first case of relapsing chondrodermatitis of the ear in Jordan was reported by Oumeish Youssef Oumeish (Visiting Professor, Tulane University, LA, USA). The reported case improved dramatically with a combination of oral corticosteroids and methotrexate.
Lymphangioma circucriptum
Thamer Fahad Al Mubki (Riyadh, Saudi Arabia) reported a case of lymphangioma circucriptum treated with intralesional injection of 1% sodium tetradecyl sulphate sclerotherapy with very good results.
Dermal fractional infusion therapy
Martin Kassir (Dallas, TX, USA) introduced dermal fractional infusion therapy as a new cost-effective and advanced method for dermal micro-injury, skin rejuvenation and transdermal drug delivery.
Closing event
At the conclusion of the conference, the Dubai Derma Scientific Committee met on the third day where they had presented their gratitude to Ibrahim Galadari, Professor of Dermatology at the United Arab Emirates University and Chairman of Dubai Derma Conference for his efforts. Members of the organizing committee also expressed their gratitude to HH Sheikh Hamdan Bin Rashid Al Maktoum, Deputy Ruler of Dubai, Minister of Finance and President of the Dubai Health Authority, for his continuous support for all medical events organized by Index Conferences and Exhibitions Organization Est. The twelfth edition of the Dubai Derma will be held on 27–29 March 2012. Abdul Salam Al Madani, Executive Chairman of Dubai Derma Conference and Exhibition and President of INDEX Holding, promised the upcoming event to be an exciting continuation of this legendary event that has become part of the heritage for the medical community in the United Arab Emirates.
Financial & competing interests disclosure
Ossama T Osman is employed by the United Arab Emirates University which provided accreditation for the conference. The authors have no other 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 apart from those disclosed.
No writing assistance was utilized in the production of this manuscript.