Abstract
The 3rd Continental Congress of the International Society of Dermatology
Durban, South Africa, Kwa-Zulu Natal, 24–27 October 2012
The Nelson R Mandela School of Medicine (University of Kwa-Zulu Natal, Durban, South Africa), Dermatology Department, under the auspices of the Dermatology Society of South Africa, together with the International Society of Dermatology hosted the 3rd Continental Congress of the International Society of Dermatology in Durban, South Africa from 24 to 27 October 2012. The main purpose of the meeting was to provide a venue for bringing an international perspective to a regional dermatological meeting with international speakers and a broader international attendance. About 400 faculty members and delegates participated in the meetings, which had over 30 sessions. Topics of interest ranged from ethnic skin and hair, drug reactions, infections, sexually transmitted diseases and HIV dermatoses to dermatologic surgery, Botox and fillers with exciting diagnostic interactive sessions, rapid communications, a registrars forum and dermatology nursing sessions.
The 3rd Continental Congress of the International Society of Dermatology (ISD) was held in conjunction with the 65th annual National Congress of the Dermatology Society of South Africa in Durban, Kwa-Zulu Natal, South Africa, from 24 to 27 October 2012.
Faculty were invited from: local South African, African and international academic dermatology institutions; dermatologists from the private sector; representatives from the dermatology nursing group; the International Psoriasis Council ‘Meet the Experts’ group and representatives of ‘Skin care for All’, a community dermatology initiative led by Terence Ryan (International Society of Dermatology, UK) for the Task Force; and industry.
The meeting was organized by the Nelson R Mandela School of Medicine (University of KwaZulu-Natal, Durban, South Africa), Dermatology Department, under the auspices of the Dermatology Society of South Africa, together with the ISD. The overarching aim of the meeting was to provide a venue for bringing an international perspective to national or regional dermatological meetings with international speakers and a broader international attendance to this unique grouping of individuals and organizations.
More than 400 faculty members and delegates took part in the meetings. Chairs and speakers were invited from the global dermatology community while still giving exposure to African and South African dermatologists. We had over 30 sessions in total with parallel sessions on topics of interest which ranged from ethnic skin and hair, drug reactions, infections, sexually transmitted diseases and HIV dermatoses to dermatologic surgery, Botox and fillers. There was also exciting diagnostic interactive sessions, rapid communications and a registrar forum where they presented a potpourri of intriguing case reports and dermatology nursing sessions.
Local congress organizers included Ncoza Dlova, chair of the local organizing committee and co-chair of scientific committee (Nelson R Mandela School of Medicine), Anisa Mosam, chair of the scientific committee (Nelson R Mandela School of Medicine), Percy Naidoo secretary general of the local organizing committee (Durban, South Africa), Nokubonga Khoza (Nelson R Mandela School of Medicine) and Jamila Aboobaker (Nelson R Mandela School of Medicine) as well as the ISD committee members, Francisco Kerdel, ISD President (University of Miami, FL, USA), Keyvan Nouri, chair of the continental congress of dermatology scientific committee (University of Miami), Dedee Murrell (St George Hospital University of New South Wales, Sydney, Australia), Evangeline Handog, Secretary General (Asian Hospital and Medical Centre, Muntinlupa City, Philippines), Carrie Kovarik (University of Pennsylvania, PA, USA) and Nellie Konnikov (Boston University, MA, USA).
Human papillomavirus
Human papillomavirus (HPV) is an important cause of cancers especially in the setting of HIV. This session on sexually transmitted diseases was chaired and co-chaired by Tebebe Berhan (Mauritania St Villa Berha, Addis Ababa, Ethiopia), Prashni Moodley (Nelson R Mandela School of Medicine) and Mihael Skerlev (Zadgreb University, Croatia), respectively, and included recent information on HPV prevention using prophylactic HPV vaccines.
Over the last decade, significant progress has been achieved in the investigation of HPV prevention. Approaches to this include prophylactic HPV vaccines for both men and women. This is supposedly the only way to significantly decrease the numbers of infected persons. The results of the most recent studies have clearly shown that a quadrivalent HPV vaccine (types 6, 11, 16 and 18) was generally well tolerated, induced high titers of serum antibodies to HPV types and effectively prevented acquisition of infection and clinical disease caused by common HPV types. Thus, the role of quadrivalent HPV vaccine in preventing genital warts and other HPV-associated diseases in men has definitely proven to be very significant.
Skin cancer
This session was chaired by George Reizner (University of Wisconsin Hospital and Clinics, WI, USA) and Dagmar Whitaker (The Blaauwberg Therapy Centre, Cape Town, South Africa) as the co-chair and the president of the Melanoma Society of South Africa. Whitaker presented aspects of melanoma in South Africa.
South Africa has one of the highest, if not the highest incidence of malignant melanoma (MM) in the world. Estimated figures for the Western Cape in 2012 is between 60 and 69 per 100,000 (Australia 65/100000), meaning one in 1429 people will develop MM. Environmental factors are important and must be addressed (sun-wise behavior), but so are genetic factors and the necessity for early diagnosis.
More than 33,000 gene mutations are linked to the development of MM and new ones are constantly added to the list. Newer biological treatments, such as ipilimumab and vemurafenib (for BRAF mutations), are working on those genetic defects, and show promising results but it is too early to speculate whether this has a major impact on the outcome of metastatic disease.
Better screening tools such as computerized epiluminescence (mole mapping) are more widely used and will enhance early diagnosis resulting in better management.
Photodynamic therapy
This session was chaired by Konnikov, with Nouri and Maria Lina Tsoukas (University Of Chicago Dermatology, IL, USA) as co-chairs. Konnikov discussed new developments on the use of photodynamic therapy (PDT).
The most spectacular new development was the presentation of results from daylight methyl aminolevulinate-PDT. This new procedure is painless, does not need a lamp for illumination, is simple to perform and the clinical efficacy results are the same as with conventional PDT. It can be used in spring, summer and autumn in the Northern and Southern Hemispheres and throughout whole year closer to equator. It has been shown to work excellently for actinic keratosis and basal cell carcinomas.
Telemedicine
Another critical issue that arose was the lack of specialist physicians to serve the rural and peripheral communities. Developing countries continue to face the challenge of a shortage of physicians, and teledermatology can be used to address these challenges. This innovative field facilitates mobile phone consultations, making it possible for remote areas to have access to health care, particularly in the developing world. The use of both Internet and cell phone-based teledermatology systems in Africa was discussed.
Cosmetic dermatology
This session was chaired by Jana Hercogova (Charter University, Uralu, Czechoslovakia), Ncoza Dlova and Rekha Sheth (Indian Association of Dermatology, India).
Skin lightening creams
Dlova discussed the use and abuse of skin lightening creams which is still prevalent in South Africa and the rest of the African continent. Her research showed that the commercial market continues to be flooded with skin lighteners which are mostly illegally imported, however, some are also locally manufactured in South Africa. Research conducted at University of KwaZulu-Natal revealed that very few products declared ingredients and many mislabelled banned active depigmenting compounds as natural products. The recommendations were put forward to a public education campaign on the dangers of skin lighteners and lobby to the Government to monitor and ban the use of the implicated creams.
Dlova also analyzed indigenous plant extracts and found some to inhibit melanogenesis more than hydroquinone, while causing less cytotoxicity. As such, these compounds represent good prospects for future candidates for further development of novel skin lightening agents to be used in cosmetic and clinical arenas.
Sunscreens
Bice Martincigh (University of KwaZulu-Natal) and Beverley Summers (University of Limpopo, Pretoria, South Africa) alluded to the worldwide increase in the incidence of skin cancer with emphasis on effective means of photoprotection. The topical application of sunscreen products is widely practiced to protect both healthy and photosensitive skins from the sun; however, there are a number of reports that sunscreen products are photo-unstable, particularly in the UVA region of the solar spectrum. It was, therefore, of interest to assess whether products available commercially in South Africa, Europe and Australia afford the consumer the necessary degree of protection. A number of the products tested proved to provide inadequate protection particularly in the UVA region. The analyses revealed that the photoinstability was mainly a result of the photodegradation and/or photoisomerization of the two chemical absorbers: octyl methoxycinnamate and avobenzone.
As a number of the commercial products tested did not provide the consumer with adequate photoprotection, photostability testing should, therefore, be a mandatory requirement to ensure the quality, safety and efficacy of these products.
August 2012 saw an explosion of media publicity which questioned the efficacy and safety of South African-produced sunscreens. It was stated that locally produced sunscreen products ‘didn’t meet standards’, which led to product testing.
The products tested all had sun protection factor and UVA tests data that complied with the existing requirements. Hence, it is unlikely that the products posed any danger in their use if reapplied regularly as recommended.
Psoriasis
This session was chaired by Francisco Kerdel (University of Miami), Alberto Giannetti (University of Modena, Italy) and Alan Menter (University of Witwatersrand, South Africa). Menter, a member of the International Psoriasis Council, reported that psoriasis has traditionally been considered a ‘skin disease’ with a small percentage of patients developing psoriatic arthritis. With the revolution of our understanding of the immunopathogenesis of psoriasis driven by inflammatory T cells, and the development of multiple comorbidities in addition to arthritis in a subset of patients, we now have to consider psoriasis as a systemic disease.
There is evidence that psoriasis patients have an increased risk for myocardial infarction and young subjects with severe disease maintained the greatest risk. Psoriasis has also been linked to traditional risk factors for coronary artery disease, such as hypertension, diabetes mellitus, hyperlipidemia as well as high-risk behaviors such as smoking and alcohol consumption.
Chronic inflammation and immune dysregulation appear to be the common underlying link between psoriasis and cardiovascular disease; further studies are needed to confirm the risk of heart disease in psoriatic patients.
Mosam presented a paper on HIV psoriasis highlighting psoriasis as a common presentation in HIV patients. There has been an increase in the prevalence of psoriasis in HIV infected populations in sub-Saharan Africa and in Durban it has been documented as the 6th commonest condition associated with HIV in outpatient dermatology clinics. Psoriasis emerged as one of the most common causes for admission to dermatology wards. Erythroderma, a common manifestation of psoriasis is a well documented marker of HIV in populations with high prevalence of HIV. Atypical presentations of psoriasis require clinicians to have a high index of suspicion as psoriasis has been noted as a great mimicker in sub-Saharan Africa. However, patients respond well to topicals and retinoid therapy.
Other topics in the HIV session dealt with Kaposi’s sarcoma and the myriad of infective and inflammatory conditions associated with HIV which have further strained an already overburdened healthcare system in African countries. Although the rollout of antiretroviral treatment is welcome and lifesaving, the incidence of drug reactions has been a serious cause for concern. The high morbidity and mortality associated with Steven Johnson syndrome and toxic epidermal necrolysis due to antibiotics, nevirapine and antituberculous agents continues to challenge dermatologists working at the coalface of the TB and HIV epidemics.
Public health update & launch of website and booklet
Ryan spoke of the burden of skin diseases in the developing world and has been spearheading a task force called ‘Skin care for all’. This website was launched at the conference Citation[101], has more than 40 achievements and now it selects an ABC of public health issues that need dermatological interventions. Examples are aging, empowerment of women, climate change, housing, mobile populations and traditional medicine. These are also summarized in the form of a booklet.
Conclusion
A measurable outcome for the meeting was not only the exponential learning from our collective experiences and research endeavors, but also the forging of academic partnerships and cooperation between colleagues, which will further enhance both our clinical skills as well as research opportunities and output for our young and upcoming dermatologists.
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.
Website
- Skin Care For All.www.skincareforall.org