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91st Annual Meeting of the British Association of Dermatologists

The 91st Annual Meeting of the British Association of Dermatologists took place at the ExCel-London 5th - 7th July 2011.

Report by Sue Welsh (Wirral) and Niall Wilson (Liverpool)

Sunshine – that source of life giving energy and of ambivalent feelings for the dermatologist – undoubtedly improves the look of a place.  Hence the vast hangar that is ExCel London managed to look welcoming on the 4th of July to those attending the pre-conference sessions.  It took some time to locate the small corner where Dermschool and the Trainee and SAS meetings had been tidily boxed away.

Dermschool organised by Laura Proudfoot, Jane Sterling and Minal Singh, proved inspirational for the 130 would-be dermatologists.  Excellent speakers and well illustrated presentations gave a taste of the speciality, as well as career advice and practical insights.  The winner of the Dermschool poster was F. Xie with ‘The effectiveness of propranolol use in the treatment of infants with severe infantile haemangiomas’.  

The Trainee session waslead by Drs Proudfoot and De Berker with 152 delegates. Those I spoke to particularly enjoyed the lectures on keratoderma, neonatal dermatology and lasers. Also the talk on ‘what to expect as a new consultant’ was helpful and rather reassuring. 

A tour of Special interest Groups was the theme of the SAS meeting - again organised by Glenda Hill.  The 70 registered delegates were treated to a lucid explanation of the interplay between genetic and environmental factors  in atopy from Mike Cork;  Sid Orpin’s engaging discourse on Sir Archibald Gray;  John English,  informative and entertaining on the evaluation of hand eczema; Richard Grove’s  clear exposition of the investigation of immunobullous disease and diagnostic tests on the horizon;  Stephen White in the surgical corner with an armoury of contingencies to get out of a hole by knowing how to close it and finally James Ferguson steered us gently through recent research in photodermatology.

Tuesday 5th Julyand the conference proper got underway with the Clinicopathological Cases.  I was impressed by the poise and precision of the presenters – especially with an unnervingly clunky IT system to negotiate.  These presentations covered a range of pitfalls to beware and diagnoses to consider leaving us wondering uneasily which scenario might fit our own puzzling patients.

Running concurrently the British Society for Paediatric Dermatology reflected the diversity of the field, from ‘The adverse effects of sodium lauryl sulphate’ to ‘Variants in the germline melanocortin – 1 receptor’ (which won the Martin Beare Paediatric Silver Salver).  The guest lecturer was Katherine Lachlan speaking on PTEN mutations.

The British Society of Cutaneous Allergy began with the Prosser White Oration from Professor An Goosens on Patch testing in childhood.  This clear, comprehensive talk emphasised the importance of patch testing in this age group.  Allergens to consider were Palladium, capable of producing a granulomatous reaction and Octocrylene in sunscreens.  There followed a series of snappy presentations on emerging allergens and old ones in a new setting!

Also on this very busy morning the Historical Symposium  mined a rich vein of fascinating facts from the past with Nick Levell claiming the Darren Wilkinson historical poster award for ‘Care and Punishment: a history of coal tar and wood tar in dermatology’ while presentations at the  British Teledermatology  Society meeting revealed the scope of this evolving  area .

Papers in the afternoon Scientific session were varied, stimulating and characterised by excellent graphics.  Among many take-home points were;  the importance of recognising  patients with Birt Hogg Dubé syndrome; methotrexate in treating lichen planus and a positive side effect of isotretinoin - on cognitive learning and memory!

Professor John McGrath was the first guest lecturer of the afternoon making everything wonderfully (sadly in my case - transiently) clear by his logical delivery and superb slides. It was heartening to hear that he is truly optimistic about the disease modifying potential of stem cell therapies currently in trials.

Professor Sam Leinster ably kept interest going with his Guest Lecture on the genesis of Problem Based Learning, where and when it works, where it has limitations and the skills it develops.

At the British Society For Dermatopathology meeting Dr R. Suchak won the Wilson-Jones Cup with a presentation on ‘Aggresive digital papillary adenocarcinoma’.

While the champagne sparkled at the President’s Reception on Tuesday evening, the Dragon Boat race – which raised around £250 for the British Skin Foundation – took place, a little dampened by rain but won by the ‘Sky Blue Team’.

Wednesday’s Scientific session began at 8.45 with the stillborn biologic Briakinimab which was trialled against methotrexate in psoriasis.  The data identified early responders to methotrexate as having lower body weight than the slower, poorer responders.

The SWET trial outcome was reported, showing no benefit to childhood eczema from fitting water softeners. This won the CDA trophy for best academic paper.

Another highlight was the Guest Lecture from Professor Hensin Tsao – an Update on Melanoma genetics.  He steered an assured passage through the maze of genetic factors involved in melanoma evolution and how the early promise of treatments such as vemurafenib may ultimately be thwarted by the survival mechanisms of the cancer cell.

At the AGM we learned of the efforts of the executive on strategic planning, the new ‘Quality Standards for Dermatology’ and on workforce issues. Some lively debate ensued.  The Archibald Gray medal was awarded to Professor Rod Hay.

Wednesday lunchtime focus sessions proved popular. In focus were Clinical Services, Surgery for the General Dermatologist and Pearls and Pitfalls. Among the pitfalls was Panton-Valentine Leucocidin - PVL. 

PVL featured again in the afternoon Scientific Session with Professor Rod Hay’s fascinating update on emerging infections – suspect PVL when staphylococcal infections fail to respond to appropriate antibiotic therapy!  Bed-bugs are making an unwelcome come-back and we were advised to consider mycobacterium infection in granulomatous tattoo reactions.

While the scientific session proceeded with the Patch II trial outcomes, the role of adalimumab in the treatment of Hidradenitis Suppurativa and Mark Goodfield’s excellent review of Lupus for the dermatologist, the Joint Session with the BDNG was hearing ‘Top Tips’ across a range of dermatological topics.

Elsewhere British Photodermatology Group met as did the British Society for Dermatological Surgery – responsible for intriguing awards such as the Wooden Curette and the Metal Man! 

With the three day format, time out to look at the exhibition stands was short.  A number of the stands compensated on the catering front by providing hot and cold drinks. Over twenty Societies and Support Groups were there to get their message across - the Lymphoedema Support Group with wry cartoons, the Ichthyosis Support Group by promoting their website while the Scleroderma Society concentrated on information leaflets.

The traditionally high standard of posters was maintained while an innovation - e-Posters - were available at computer stations in the hall. The Bristol Cup for the best poster was won by H. Audrain  for Diphencyprone immunotherapy for viral warts in immunosuppressed patients.

The Annual Dinner has seen many splendid venues but we were especially privileged to dine in the Painted Hall of the Royal Naval College, Greenwich.  The lofty, pillared hall with its fabulous ceiling and candelabra reminded our president of Hogwarts as he welcomed the guests and gave a potted history of the building. The painted ceiling featuring William and Mary took James Thornhill nineteen years to completeNursing and medical prizes were awarded with Dr. D O’Kane taking the trophy for the Best registrar’s Paper.

Following an excellent dinner and a tasty slice of the BDNG 21st anniversary cake there was dancing for those with the energy.

Thursday 7th 08.30 – The Professor’s and Registrar’s Forum was a most interesting session.  Among many useful nuggets were the inadequacies of undergraduate dermatology training; a potential Elispot test to identify T cell mediated drug hypersensitivity; the paradoxical worsening of infections in HIV patients with Immune Reconstitution Syndrome and Celia Moss’s perspective on insights gained through long term follow-up of patients with genetic diseases. Sophie Weatherhead presented the BSID Best Registrar Paper on the Differential Effect of Therapeutic UVB on skin.

The Arthur Rook Oration from Professor Luis Diaz shone a light on Endemic Pemphigus Foliaceous. Here, sophisticated academic research brings hope to a poor and underprivileged society.

In the closing CPD session, Sue Lewis-Jones reviewed recent work on propranolol for infantile haemangioma and its use in practice as well as managing difficult atopic eczema.

Jane Sansom gave an update on contact dermatitis - which allergens are declining (nickel) and which ascending (e.g. Kathon and methacrylates).

The final Guest Lecture on Revalidation and Medical Education was given with a deal of good sense by Professor Sir Peter Rubin. What defines a doctor? ‘Dealing with uncertainty, managing risk and accepting ultimate responsibility’!  Now if I had known that when I started out!

Claire Fuller’s update on Infections of Global Relevance included a water purifying powder which will save lives and money. PVL featured again and the financial implication of misdiagnosing lower leg cellulitis. Finally James Langtry gave an excellent review of non-melanoma skin cancer management.

In his closing speech the President reviewed the current shortened format of the Annual Meeting and the ongoing work of the BAD in the fields of training and research before turning to the less hopeful, less inspiring topic – the White Paper and the possibilities for the future should the concerns of dermatologists, other specialists and their patients go unheeded.

The BAD is being pro-active in driving clinical standards and will provide support and guidance whenever possible.  It is imperative, however, that members keep channels of communication open between primary and secondary care and patient groups such that GP commissioners think of dermatology early in the commissioning process.

With that, a most successful meeting drew to a close.  Congratulations to the organising committee for securing speakers of such a high standard with the right balance of academic and practical topics and thank you to Chris Garret and his ‘Conference and Events team’ for the smooth running of the meeting - and to our generous sponsors.

Come next year this venue for the 91st Annual Meeting will be in a pre-Olympics frenzy while we move to the comparative tranquillity of the ICC Birmingham for the 92nd - hope to see you there! 

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