Schedule, times and titles are subject to modification!
L1 - Use of IVIg in Dermatology
Thursday, 17 May 2007
13.00 – 14.00 Hall K
B. Volc-Platzer (Vienna, Austria)
Learning Objectives:
Following this session, the attendee will be able to
- identify indications for the use if IVIg in dermatologic diseases based on published data
- know about therapeutic regimens (“established regimens” versus more experimental protocols, alone or in combination with other immunomodulatory treatments)
- discuss side effects and safety features
- have an idea about possible effector mechanisms
Description:
In addition to their role in immune substitution IVIgs - when used in high-dose such as 2g/kg body weight - are highly effective in autoimmune diseases such as idiopathic thrombocytopenic purpura (ITP), Guillain-Barre Syndrome, Kawasaki’s disease and habitual abortion in antiphospholipid-antibody syndrome. A double-blind, cross-over, placebo-controlled study established IVIgs as highly effective therapy for dermatomyositis. IVIgs have been used successfully in therapy-refractory pemphigus vulgaris and cicatricial pemphigoid, and, most recently, in combination with rituximab. IVIgs appear to be established in the treatment of toxic epidermal necrolysis, possibly due to an anti-apoptotic mechanism. In autoantibody-mediated diseases binding of high-dose IVIgs to intracellular neonatal FcRs (FcRn) appear to impair the binding of pathogenic autoantibodies thereby inducing rapid clearance. IVIgs may also be used successfully in patients with severe recalcitrant atopic dermatitis. Side effects include mainly headache and nausea. Aseptic meningitis has been – albeit rarely- described. Careful, multistep preparation techniques and effective screening procedures guarantee viral safety.
L2 - Morbus Behcet
Thursday, 17 May 2007
13.00 – 14.00 Hall L
M. Gürer (Istanbul, Turkey)
D. Seckin (Ankara, Turkey)
A. Boyvat (Ankara, Turkey)
At this session the attendee will learn about:
- epidemiological and clinical characteristics of the disease in the year 2007
- recent ethiopathogenetic approaches on the subject
- recent therapeutic approaches
Description:
Behcet’s disease is an enigmatic vasculitis of unknown etiology.
It was first described as a separate entity in 1937 by Hulusi Behcet, a Turkish professor of dermatology. Hulusi Behcet described a disease characterized by “recurrent oral and genital ulcerations and iritis with hypopyon” in his original report in the Journal Dermatologische Wochenscer.
Behcet’s disease is marked by oral and genital ulcerations, cutaneous lesions, arthritis and ocular, gastrointestinal, vascular and neurologic manifestations.
It is frequently seen in Japan, Mediterranean countries including Turkey, and the Middle East, and is rare in America and northern Europe.
The etiology of Behcet’s disease is uncertain. Genetic, environmental, bacterial, viral and immunological factors have been suggested as causal agents. The pathogenesis is probably mediated by a combination of these factors.
As complete cure cannot be achieved, the main aims are to slow progression of the disease, control symptoms, and prolong survival.
L3 - Drug Metabolism
Thursday, 17 May 2007
13.00 – 14.00 Hall M
Hans Merk (Aachen, Germany)
Learning objectives:
After this session the attendee will:
- be aware of current concepts concerning the skin’s capacity to metabolize xenobiotics,
- comprehend the contribution of these enzymes and transporter molecules to the skin’s barrier function,
- define the role of these pathways in the metabolic activation of small-molecular-weight compounds mediating disease, including allergic sensitization and skin cancer.
Description:
The skin is a major body interface with the environment and can metabolize small-molecular-weight compounds including drugs, allergens and chemical carcinogens. David R. Bickers will present data showing that drugs and carcinogens (xenobiotics) applied to human skin can induce cytochrome P450s (CYPs); the consequences of this measure are relevant to skin carcinogenesis. Recent observations indicate that small-molecular-weight compounds cannot reach pharmacologically critical levels in cells by simple passive diffusion, but that active transporter molecules drive the influx of certain xenobiotics and the efflux of their detoxified metabolites from epidermal keratinocytes. This will be discussed by Jens M. Baron who will present recent developments in this exciting and developing field of molecular skin pharmacology. Finally, data on the role of CYP-mediated xenobiotic metabolism in the pathogenesis of allergic contact dermatitis to small-molecular-weight haptens as well as allergic reactions to drugs will be presented by Hans F. Merk.
L4 - Mastocytosis
Thursday, 17 May 2007
13.00 – 14.00 Hall N
T. Zuberbier (Berlin, Germany)
Learning objectives:
After this session the attendee will know about the:
- pathophysiology,
- clinical forms,
- and guidelines for the treatment of mastocytosis.
Description:
The increased number of mast cells (MC) in the skin of patients with mastocytosis is mainly due to mutation of the receptor for SCF, leading to autophosphorylation. The release of mast cell mediators results in a variety of problems. Skin lesions and/or symptoms are among the most frequent SM manifestations presented by patients. Common cutaneous signs of mastocytosis include disseminated maculopapular lesions (most frequently seen in adult patients) and multiple nodular lesions, which are typically seen in children. Small blisters and bullae occur in rare cases, usually during the first three years of life. Rare manifestations include lichenoid, plaque-like, xanthelasma-like, and erythodrodermic skin involvement. In less than 1% of adult patients, focal solitary or multiple teleangiectatic lesions, usually located in the trunk, are the sole clinical manifestation of mastocytosis (teleangiectasia macularis eruptiva perstans). Common dermatologic problems due to mediators released by skin MCs include episodic flushing, pruritus, and urticaria. The activation of skin MC population in systemic mastocytosis patients can also lead to extracutaneous problems. Systemic mastocytosis needs to be excluded. Both, skin signs and symptoms in mastocytosis can be treated symptomatically. Treatment with PUVA or topical steroids can reduce the size of skin lesions and pigmentation as well as MC infiltrates. The occurrence of skin problems caused by MC activation and mediator release can be reduced by avoiding physical exercise, friction, temperature changes, alcohol ingestion, or the use of medication that can trigger acute MC responses, such as nonsteroidal anti-inflammatory drugs. As histamine is the single most important mediator involved in the induction of SM skin problems following MC activation, antihistamines are commonly used as first-line treatment to alleviate symptoms.
L5 - Autoimmune Diseases of the Skin
Thursday, 17 May 2007
13.00 – 14.00 Hall O
H. Bachelez (Paris, France)
Learning objectives:
After this session the attendee will be able to:
- identify unusual or recently defined forms of autoimmune skin disease, commonly lupus erythematosus,
- make a decision regarding therapy and monitor treatment-related side effects, relying on evidence-based knowledge,
- integrate innovating therapeutic strategies such as mycophenolate mofetil and rituximab in the management of refractory forms of autoimmune skin diseases.
Description:
From a general point of view, the session will focus on recent insights in the management of patients with lupus erythematosus (LE), lichen planus, dermatomyositis, and autoimmune bullous diseases. Thus, a part of the presentation will deal with the diagnostic criteria of unusual forms of LE (chilblain lupus, Rowell’s syndrome), recently reported lupus-inducing agents, and the optimal treatment and surveillance of patients with chronic LE. It will also cover new theses on the subject of dermatomyositis, such as the existence of an underlying immune deficiency.
Finally, the session will provide an updated and critical overview of recently developed therapeutic tools and strategies that might be of help in refractory forms of autoimmune skin diseases, such as mycophenolate mofetil, intravenous immunoglobulins, and rituximab in B-cell-mediated bullous (pemphigus, mucous membrane pemphioid) and non-bullous autoimmune disorders.
L7 - Radiotherapy of Skin Diseases
Friday, 18 May 2007
13.00 – 14.00 Hall L
R. Dummer (Zurich, Switzerland)
Learning objectives:
After this session the attendee will be able to:
- select patients for radiotherapy,
- correctly inform patients about the advantages and disadvantages of this treatment modality,
- explain to patients how this treatment is performed and the treatment schedule.
Description:
With the increasing age of the population, there will be an increase in skin neoplasms. Since radiotherapy is an ideal treatment modality for this age group, the benefits of radiation treatment for precancerous and malignant tumours as well as some general aspects of radiation and indications for benign diseases will be discussed.
L8 - Apoptosis and Skin Disease
Friday, 18 May 2007
13.00 – 14.00 Hall M
C. Pincelli (Modena, Italy)
Learning objectives:
At this session the attendee will:
- learn the basic apoptotic mechanisms with special reference to skin physiology,
- understand the critical pathogenetic role of apoptosis in inflammatory as well as neoplastic skin conditions,
- gain knowledge of how alterations of apoptotic processes could be used as targets for new therapies in dermatology.
Description:
Apoptosis is a biologically active process that plays an important role in tissue development (programmed cell death), homeostasis, and the pathogenesis of many diseases. Apoptosis is mediated by the activation of caspases, namely caspase-8 for the extrinsic and caspase-9 for the intrinsic (mitochondrial) pathway. Initiator caspases stimulate the activation of executioner caspases which, in turn, lead to the activation of endonucleases that favor DNA fragmentation Apoptotic cells have been observed in many inflammatory and neoplastic skin conditions such as sunburn skin, GVHD, lichen planus and Bowen’s disease. Increased apoptosis could lead to Lyell’s syndrome, pemphigus and alopecia areata, whereas decreased apoptosis could be responsible for hyperproliferative skin conditions such as psoriasis and cancer. The aim of this workshop is to promote understanding of the basic apoptotic mechanisms involved in the pathogenesis of various skin conditions and evaluate the potential use of this knowledge in developing new treatment strategies.
L9 - Atopic Skin Diseases
Friday, 18 May 2007
13.00 – 14.00 Hall N
G. Girolomoni (Verona, Italy)
T. Werfel (Hanover, Germany)
Learning objectives:
After this session the attendee will:
- know more about the pathogenesis and clinical features of atopic dermatitis,
- be aware of comorbidities of atopic dermatitis,
- gain insight into how one approaches patients with atopic dermatitis.
Description:
Atopic dermatitis (AD) is a common skin disease with a strong genetic background. Knowledge of the pathogenesis of the disease has markedly extended and clarified many aspects of the disease, including new mediators of pruritus. AD may be associated with a number of other diseases whose recognition is very important for a global approach to patients. The influence of environmental factors in the pathogenesis of AD is relevant, but in most cases their recognition may be very difficult. Allergological work-up should be reserved for severe cases.
L10 - Clinicopathological Presentation of Exceptional and Rare Dermatological Diseases
Friday, 18 May 2007
13.00 – 14.00 Hall O
K. Rappersberger (Vienna, Austria)
Description:
At this session we will present patients who suffered from severe general diseases that needed the collaboration of several specialists from diverse clinical fields. We will highlight the important role played by dermatologists in diagnosis and therapy. We present a variety of diseases such as a "European" variant of Kala Azar, generalized subcutaneous tuberculosis, unusual cases of erythroderma, certain rare variants of (bullous) autoimmune diseases such as generalized cicatricial lichen planus and the Brunsting-Perry variant of bullous pemphigoidm and unusual (obscure) presentations of infectious dermatoses, both bacterial and viral, and rare tumours of the skin. We will provide "classic case presentations" by showing slides of clinical features, histopathology and immunomorphology, X-ray and tomographies etc., discuss differential diagnoses and appropriate therapies. One of the purposes of this session is to demonstrate the importance of our specialty in so-called generalized medicine, primarily in an in-patient environment.
L11 - Vitiligo
Friday, 18 May 2007
13.00 – 14.00 Hall J565
T. Lotti (Firenze, Italy)
Learning objectives:
After this session the attendee will be able to:
- analyze and accurately diagnose different types of vitiligo,
- devise effective treatments,
- use a team approach to the treatment of patients with vitiligo.
Description:
Vitiligo, a chronic and recalcitrant disease, is difficult to treat. Patients and dermatologists alike may be frustrated and discouraged by the persistence and the irregular remission and relapse of the this disease, which is also influenced by psychological factors. A positive and emphatic approach to the vitiligo patient is of crucial importance. In my experience, subjects present with three major questions:
- Can the progression of the disease be stopped?
- Can hyperpigmentation of non-affected skin be avoided during treatment?
- Is 100% repigmentation possible?
Our responses to these questions include non-surgical and surgical explanations and suggestions.
L12 - The Full-Thickness Skin Graft in Dermatologic Surgery, or the “Art of Grafting”
Thursday, 17 May 2007
13.00 – 14.00 Hall J565
V. Blatiere (Montpellier, France)
Learning Objectives:
When to choose a graft, how to perform it, how to enhance the cosmetic results
Following this session, the attendee will be able to:
- Perform a full-thickness skin graft
- Deal with various complications (necrosis, scarring, pigmentation)
- Enhance the results: donor site location, contouring, dermabrasion
Description:
The full-thickness skin graft is one of the surgical repair alternatives used to reconstruct skin defects too large to close primarily. The technique is stereotyped: template, harvesting, suturing the graft, and closing the donor site or not. All effort and attention should be directed toward ensuring the viability of the graft: a proper vascular bed and intraoperative and postoperative management remain essential for grafting success. The donor site selection must take into account the ability to provide a rich vascular bed, color and texture matching, adequate thickness. Trimming all the subcutaneous fatty tissue off has to be emphasized. The graft must be secured with the most appropriate suture material and an adequate dressing. Some difficult areas to reconstruct, such as the nasal tip, nasal alar, medial canthus, and lower eyelids, are presented and will be discussed.
