The 83rd Annual Meeting of the British Association of Dermatologists took place at the Brighton Hilton Metrople 1st - 4th July 2003.
Report by Dr Ian Coulson (Burnley)
I am certain that some electronic early warning system circulates the local medical establishment on the Monday morning prior to Tuesday’s scheduled departure for the BAD! Urgent clinic appointments and ward consult requests, demands to tweak medical reports and in-patient calamities arrive with unprecedented ferocity. So on the Tuesday morning, as the BA flight from Manchester to Gatwick rose above the Damp City, expectation follows relief as the aircraft undercarriage clunks into place. Brighton BAD beckons!
Basking in sunshine (it’s so warm down South), Brighton seems to have lost any sense of tackiness. Swanky restaurants abound. Even my female cabbie demonstrated unprecedented cheerfulness! The stroll along the prom from my last minute deal Hove hotel to the Metropole, accompanied by evocative squawking of gulls was partaken with increasing expectation.
Tuesday afternoon was a quiet time for verbal presentations, so it was an ideal opportunity to look over the posters. Personally instructive favourites usually identify what I might have missed! Cutaneous larva migrans contracted from the tropical climes of the River Trent was such an example. Jonathan Bowling’s poster on hair dye allergy reminds us that PPD is not the only culprit allergen. Sara Macfarlane’s review of the Nottingham Psychodermatology clinic’s 380 patients made instructive reading. Am I recognising depression as often as I should? Reports of new indications for recently introduced therapies (topical tacrolimus for erosive oral lichen planus and granuloma annulare), several posters on PDT, and a review of the use of chlorambucil when you are stuck with bullous pemphigoid satisfied my quest for new therapies. An “ask the dermatologist” service for GPs, running via the internet, was an interesting innovation answering general matters dermatological. It sounds more useful than NHS Direct!
Tuesday evening started with a wonderful reception in the Brighton Museum and Art Gallery; promises to limit myself to one generous glass of the President’s champagne were broken within minutes. It was a wonderful time to renew old friendships, and natter about day to day dermatology delivery. So much of what I end up changing about my practice is determined by what I glean at these “social events” rather than in the lecture hall. My evening finished with a Vietnam Dowling Club trip reunion graced by the presence of three Vietnamese dermatologists sponsored to visit the UK by the generosity of the Dowling Club. They greatly enjoyed and benefited from the experience.
With a clearing hangover after a disturbed night, (seagulls shrieking from my hotel window sill on the hour every hour), the AGM went off with little controversy. The expansion of the BAD website sounded far thinking and an excellent “front window” for British dermatology, but overt sponsorship was voted against. I too would be wary of visible sponsorship in the public areas of the site, lest it be regarded as endorsement which may diminish the credibility of the site, but advertising in the members only area does not offend me particularly if the generated revenue helps to extend the project.
I especially liked the themes of this year’s meeting: the international perspective of dermatology, and that of education. The invited speakers shed interesting insights. Rod Hay identified the priorities of dermatology in the developing world, and Barbara Leppard recounted her experiences of the cutaneous manifestations of HIV in Tanzania. Tinea capitis in an adult in Tanzania equals HIV. Shingles in an adult usually equals HIV. Adult onset atopic eczema or photosensitivity usually equals HIV. In a country where access to antiretroviral therapy is non existent, we really must count our blessings. This was contrasted by an interesting view of French dermatological delivery. With 3500 dermatologists (3000 in office practice) serving a population similar to that of the UK, and only 50 specialists being trained a year, Luc Thomas, from Lyon warned us of their impending manpower crisis!! Many of the practicing dermatologists are mature and reaching retirement age, and input (France’s brightest medical graduates) will not match “wastage”. How our friends across “La Manche” spend their time intrigued me. They see 20-25 patients a day (a staggering 19 million episodes a year), with skin cancers and melanoma being a sizeable part of the case mix. However 30% of their work relates to viral warts. Again, count your blessings!
Robin Marks’ Arthur Rook oration was inspirational. He had met Dr Rook on a number of occasions in England when spending a year as an overseas registrar at St. John’s. Even in failing health Robin was struck by the twinkle in Dr. Rook’s eye. Something of that twinkle shone out from Robin Marks in Brighton! He really has an evangelical zeal for the teaching of dermatology in its widest sense: to the public, pharmacists, undergraduates, GPs and trainees. His maxim of “I think this is how I can help you” has obviously won him admiration and friends. It was fascinating to hear that 50% of all people who eventually see either a GP or a dermatologist in Australia will have sought advice from a pharmacist first. Rather than perceiving this in any way as a threat, Dr. Mark’s has produced an educational package for pharmacists ton help steer patients towards the right type of care. I wonder what the statistics are in the UK, and how this matches up with current political dictate. From my contacts in pharmacy locally, I gather that even rudimentary undergraduate training in dermatology is non existent so opportunities abound!
Oral presentations covered the new, the not so new and the old that might just come back again! It was good at last to hear the fact rather than tabloid fiction about pulsed dye laser treatment for acne (a 47% reduction in inflammatory lesions at 12 weeks after a single treatment), and that HRT can be used without worry in women with a history of melanoma. But the debate “to MED or not to MED” pre phototherapy goes on (did we not hear something similar four years ago!) Colin Long’s account of the 1962 outbreak of smallpox reminded us that dermatologists may have a role in the management of bioterrorism.
I could only dip in and out of the special interest group meetings, which were well and avidly attended. I was staggered to learn from the photobiologists that sunbed use is so common in Sweden (with 12% of under 15s being habitual users – that even beats Burnley!). The St. John’s light doctors described a series of six patients with “postinflammatory cutaneous hyper-reactivity syndrome”, a new, long lasting, therapy-resistant dysaesthetic, hyperalgesic erythema occurring after either severe sunburn or cold injury. At least I have a name form this when I see the next one. The skin surgeons had offerings from cold steel traditionalists, those with excitable light sources, PDT and botulinum exponents.
Congratulations to the presenters at the contact meeting who managed to make what can be a very dry subject so entertaining. Steve Walker reminded us that imported Toxicodendron can be grown in the UK, and be an unexpected sensitiser! His presentation revolved around the old sixties hit, and students of the exanthemata, dermatological therapy and phytodermatology had a lot to learn from this ditty:
She’s as pretty as a daisy
But look out man she’s crazy
She’ll really do you in
If you let her under your skin
Measles make you bumpy
Mumps’ll make you lumpy
Chickenpox’ll make you jump and twitch
Common cold’ll fool you
Whooping cough’ll cool you
Poison ivy love’ll make you itch
Gonna need a notion
You’ll be scratching like a hound
The minute you start to mess around!
The social events were a huge success. The president of the American Academy was at pains to compliment us on the vigour (note – not skill or finesse) of our dancing at the Annual Dinner and there’s a chap who must have seen a few conference dinners! I thought that the band’s name, “Then String of Pearls” was a spoof, alluding to the President’s interest in linear IgA disease! They really were called that! More dermatological band names on a postcard please!
So I return to Burnley charged with enthusiasm for another year. Congratulations to Meg Price for organising such an inspiring meeting, and Allan Marsden for a successful presidential year and looking so relaxed throughout!