The 2013 Summer Meeting of the American Academy of Dermatology
The 2013 Summer Meeting of the American Academy of Dermatology (AAD) came to the New York Hilton Mid-town from July 31 to August 4. The hotel and conference center buzzed with the latest research, news and exhibits in the field. The meeting’s Plenary Session was held on Friday, August 2, 2013 from 9 AM to 12 pm. In addition to the address from AAD President Dirk M. Elston, MD, the crowded session featured talks on the genetics and immunology of alopecia areata, notable advances in melanoma screening and therapy, consideration regarding tattoos and piercings, accountable care organizations and old and new technologies in medicine. In a highlight of the session, Mark Lebwohl, MD, discussed dermatologic treatment advances with his presentation of the Everett C. Fox, MD, Lectureship, “Dermatologic Therapy: A Bright Future.”
The Plenary Session
Dr. Lebwohl, who is professor and chair of dermatology, at the Icahn School of Medicine, at Mt. Sinai Hospital, New York, began with a few jokes. Then he quickly drilled down to the recent advances that have been made in several difficult-to-treat dermatologic conditions using a variety of exciting new treatments, including oral therapies, biologics and topical therapies. He discussed research and clinical experience with these therapies for basal cell carcinoma, actinic keratosis, psoriasis, vitiligo, eczema, rosacea, urticaria and onychomycosis.
“One of the remarkable things is that so many of the new treatments that have come out in all of medicine have come from work done in dermatology,” he explained. “We have been at the forefront of biologic therapies, which are taking over all of medicine. There are many other treatments that were recently introduced to dermatology or are on the horizon for dermatology that make the therapeutic outlook for our specialty very good,” he said.
Dr. Lebwohl highlighted research for numerous new drugs including:
• Vismodegib, the hedgehog inhibitor for the treatment of catastrophic basal cell carcinoma and metastatic basal cell carcinoma
• Ingenol mebutate a new topical therapy (applied for 2 or 3 days) that is effective in treating precancerous skin lesions
• Four new BRAF inhibitors approved for treating melanoma — ipilimumab, vemurafenib, dabrafenib and trametinib. A fifth treatment — nivolumab — is under FDA review.
• Three new effective biologics — brodalumab, secukinumab and ixekizumab — to treat psoriasis are expected to gain FDA clearance early next year.
• Two oral therapies for psoriasis, apremilast and tofacitinib, could soon be approved, he said. (Tofacitinib is approved for the treatment of rheumatoid arthritis.)
• Omalizumab, a new biologic used in asthma, is also effective for chronic urticaria. He also discussed a patient who had a “life-changing” experience with the drug.
Other treatments Dr. Lebwohl mentioned included: afamelanotide (for vitiligo), alitretinoin (for hand eczema), sodium hypochlorite (NaOCl) as an adjunctive therapy for atopic dermatitis, brimonidine (for rosacea), efinaconazole (for onychomycosis), and the new biologic dupilumab (for atopic dermatitis).
Terrance A. Cronin Jr., MD, in practice in Melbourne, Florida, discussed the changing landscape of dermatology with regard to tattoos and piercings. “More and more dermatologists must deal with patients with tattoos and skin piercings because they have to treat patients for their skin decorations,” he explainsed “Other patients want their tattoos removed and don’t understand the difficulty involved.”
Patients need to recognize some of the side effects when people decorate their skin, whether it is chronic infections, side effects from the pigment and other reactions, he said.
New trends in tattooing include the use of fluorescent inks that glow in special light and also cosmetics that cover tattoos when they are at work or in a more professional environment. “Dermatologists are poised to be experts on the side effects and problems of skin decorations,” he concluded.
In her lecture “Basepairs to Bedside: Genetics and Immunology of Alopecia Areata,” Angela Christiano, MD, PhD, associate professor of molecular dermatology at Columbia University Medical
Center, updated attendees on the genetics and immunology of alopecia areata. Dr. Christiano’s laboratory identified the first set of susceptibility genes for the disease, which then provided insight into its immunopathogenesis. She provided an overview of ongoing clinical trials using targeted immunomodulatory therapies and spoke of her collaborative research efforts with several other researcher groups in various specialities.
Concurrent daily sessions left attendees with a plethora of presentations across a variety of categories. Hot topics at the meeting included effective sunscreen applications; advancing indoor tanning regulations; treatments for acne presenting at a younger age; the dangers of non-melanoma skin cancer; proper skincare as the foundation for successful acne and rosacea treatment and current acne guidelines, among others.
At the “What’s Hot in Pediatric Dermatology” session, directed by Nanette Blythe Silverberg, MD, a range of relevant and timely topics were discussed. They included sunscreens for children, contraceptive therapy for adolescent acne, vascular birthmark treatments and trends in pediatric contact allergy and dermatitis. Also in the session, Barry Lloyd Smith, MD, gave a comprehensive look at new trends and guidelines for the prevention of sexually transmitted diseases of adolescence.
Another popular session was “Treatment and Prevention of Actinic Keratoses (AK) and other Non-Melanoma Skin Cancers” directed by Gary Goldenberg, MD. The session outlined therapeutic considerations for AK. He reviewed his method to methodically evaluate and treat patients. Treatment options for mild to intractable field cancerization was discussed and included topical agents, photodynamic therapy, resurfacing, chemowraps and oral medications.
The conference included numerous sessions on the effective use of laser and light therapies in dermatology practices. One presentation by Nazanin Saedi, MD, assistant professor, and director, laser surgery and cosmetic dermatology, Department of Dermatology and Cutaneous Biology, Thomas Jefferson University, discussed how dermatologists can continue to maximize laser use in their practices.
Lasers have applications for a variety of conditions, including vascular lesions (ie, vascular lesions, port wine stains, rosacea (erythema, telangectasias), and poikiloderma), scars, laser resurfacing and pigmented lesions, noted Dr. Saedi, who also is a research consultant with Cynosure/Palomar. Dr. Saedi provided an overview of pulsed dye lasers (PDL) and then showed his techniques for various conditions. He also offered pearls for common complications and pitfalls, including PDL on tan skin, PDL hyperpigmentation and scars and bruising.
See You in Denver
The AAD’s 2014 Annual Meeting will be held in Denver, Colorado, March 21-25, 2014. Registration opens November 20, 2013, and discounted registration for members and approved non-members ends at 12 pm (CT) on Wednesday, February 12, 2014.