EADV 2012 proves that dermatology is more than just skin deep

Last week, Europe’s dermatological community descended upon the Czech Republic’s capital city to discuss the often over-looked issue of skincare. ‘Skin is Vital’, read the tagline of the European Academy of Dermatology and Venereology’s (EADV) 21^st Congress in Prague, and it is extremely difficult to argue with this assertion. Why is it then that this important subject does not garner the attention that it deserves?

The general consensus seemed to be that dermatologists are not as effective as they might be at communicating the important role that their discipline plays within the European healthcare sector. Dr Monika Gniadecka, head of Denmark’s Herlev Hudklinik, warned that dermatologists are at risk of losing out to other interested practitioners.

"Our speciality is being threatened by other specialists who would like to take over the patients we treat," she told the congress. "There are a lot of cosmetologists and beauticians who would like to perform the procedures that we usually perform. This situation has arisen as a result of the financial crisis and subsequent budgetary cuts. However, we have some good cards at our disposal. As a profession, we diagnose and treat a wide range of diseases and we need to make the media and policymakers aware of this fact."

In Dr Gniadecka’s opinion, the modesty of dermatologists could cause them to lose out to other, more forthright specialists. If the discipline is to receive the attention that it desires from politicians and members of the media, it will have to learn to publicise its achievements. In order for this approach to prove successful, however, it must be built upon substantial medical foundations. Dermatologists must convince the world that their specialty is more than just skin deep.

To this end, EADV 2012 can be viewed as a significant success. Experts from Europe and beyond detailed some of the novel methods that they have developed to treat skin complaints ranging from melanomas to hyperpigmentation.

Speaking at a press conference chaired by Chairperson of the EADV’s Media and PR Committee Professor Myrto-Georgia Trakatelli, Dr Jean-Hilaire Saurat, Professor of Dermatology at the University of Geneva and former President of the EADV, highlighted a condition that is being exacerbated by Europe’s ageing population. Dermatoporosis is a term used to describe various manifestations of chronic cutaneous insufficiency/fragility syndrome. As Dr Saurat explained, dermatoporosis is much more than a cosmetic complaint.

"Wrinkling is not a disease," he said. "Dermatoporosis is a disease. It can be seen in many geriatric hospitals. Some patients cannot even be touched because their skin is so fragile. Dermatoporosis is a condition in which the skin breaks due to fragility."

Dermatoporosis can lead to skin laceration, delayed wound healing, and in some cases, deep dissecting haematoma (DDH). Dr Saurat and his colleagues discovered that selective suppression of keratinocyte CD44 resulted in skin atrophy in mice. In light of the possible role of CD44 platform deficiency in dermatoporosis, his team developed hyaluronate fragments (HAF) and used them to activate CD44-mediated molecular pathways leading to skin hyperplasia. Dr Saurat’s observations suggest that the defects in CD44-mediated molecular pathways represent an appropriate target for future therapeutic strategies.

Following on from Dr Saurat was Professor Johannes Ring, Director and Chairman of the Department of Dermatology and Allergology at Technische Universität München (TUM). Professor Ring spoke about the neglected field of manifestations of food allergies in the skin. As he explained, the prevalence of food allergies is increasing yet it can often be difficult for people to identify potentially harmful presences within the products that they consume.

"Even when patients know that they are at risk, they might still be in danger of being affected by hidden allergens," he told the conference. "In one case, for example, we investigated the occurrence of an anaphylactic reaction to second breakfast (a traditional Bavarian meal). Of all the constituents that we tested, the problem ingredient turned out to be turkey meat contained within the white sausage. This meat should not have been present in the first place. The sausage should only have contained calf meat. The patient almost died from this reaction yet it would have been very difficult for him to avoid."

Also speaking at the press conference was Dr Martin Röcken, Director of the Department of Dermatology at Eberhard Karls Universität Tübingen. During his presentation, Dr Röcken considered the role of the CHEK2 gene in the development of malignant melanomas. As he explained, individuals in possession of the CHEK2 1100delC variant of this gene have a two-fold increased risk of developing any type of melanoma.

Topics such as these might seem incongruous with some of the common preconceptions that surround dermatology. Whilst the cosmetic side of this discipline remains an important and profitable sector, dermatology as a field is concerned with much more than botox and liposuction. Once again, we return to the difficulty of spreading the word. How can medical professionals more effectively communicate news of their accomplishments?

In an attempt to address this issue, Professor Trakatelli chaired a media session on the Friday of EADV 2012. Here, EADV members learned techniques to deal with the stress of being on camera and were coached in how to handle themselves onscreen. Participants also heard about previous and ongoing campaign successes such as Dr Gniadecka’s cancer screening of Danish parliamentarians and the EADV’s ‘Healthy Skin@Work’ initiative.

Europe’s need for dermatologists is just as great today as it ever has been. Indeed, when one considers issues such as our increased exposure to ultraviolet light and our ageing population, one might conclude that it is becoming even greater. The scientific foundations are in place, and have been for some time. It is now vital for the European dermatological community to let the world know about the high-quality skin-related research that it is conducting. Fortunately, the EADV is committed to delivering one simple message: skin is vital, and so are dermatologists.