The 95th Annual Meeting of the British Association of Dermatologists took place at the ICC Birmingham 5th - 7th July 2016.
Report by Bryan McDonald (London)
This year’s BAD annual meeting was held in the ICC Birmingham. On arriving at Birmingham New Street Station, I walked the short distance to the ICC, as it was a lovely sunny day, to meet up with the other registrars for the pre-conference trainee day. After a short lunch we filed into the auditorium and were greeted by Dr David DeBerker.
The afternoon program started off with a quiz on dermatopathology by Dr Richard Carr. The questions were wide ranging and challenging with prizes for the top scoring registrars. This was followed by Dr Cameron Kennedy’s lecture using case based discussions of complex medical dermatology cases. Next up was to be Professor Kieron Leslie, but after a false start due to technical difficulties Dr Richard Motley stepped in to give his excellent talk on tips for dermatological surgery, demonstrating how to design and perform good surgical excisions, how to maximize cosmetic outcome, the use of vertical mattress sutures if high tension wounds and the need to not perform punch biopsies for investigation of possible skin neoplasia. By this time the slides for Professor Leslie were working and we had an informative talk, using case based discussion, on cutaneous complications of HIV infection such as bacillary angiomatosis, Cryptococcus infection, nodular prurigo from co-infection with hepatitis C, toxic epidermal necrolysis, psoriasis, warts, Varicella Zoster virus, anal cancer, Kaposi sarcoma and other skin cancers, lipodystrophy and eosinophilic folliculitis. There was then a trainee update by Dr Vincent Li, the trainee representative.
After a short break to stretch the legs and grab some refreshment, Dr Vicky Joliffe gave an update on hair disorders. This highlighted the importance of taking styling history and the utility of dermatoscopy, reducing the need for biopsies. As well as discussing prescription medications, the use of nutraceuticals was also discussed such as Viviscal®, Pantogar® and biotin. From one skin adnexa to another, the nails were then discussed by Dr David DeBerker. He spoke about the importance of a biopsy in single nail dystrophy, conditions affecting the nails as well as the utility of injecting steroid into the nail bed and the NAPSI scoring system. Dr Tamara Griffiths then spoke about cosmetic dermatology, touching on the natural ageing of the face, topical agents, dermal fillers, autologous fat transplantation and Botulinum toxin injections. There was also a discussion of side effects of cosmetic procedures. The final talk of the day by Dr Clare Defty and James Halpern was on preparing to become a dermatology consultant, job planning and private practice. After a long afternoon of lectures, we retired to All Bar One for some refreshments and a time to relax and catch up with friends from around the UK.
Day 1 of the annual meeting and again we had good weather. I walked to the ICC to put up my posters and then tried to decide which talks to attend. I started out by going to the BSDS meeting to hear about hyperhidrosis and the use of microretrodermal axillary curettage and MiraDRY®. Then there were talks on Vismodegib and several quick fire cases demonstrating reconstructive options. This was followed by a talk by Dr Rupert Barry on the avoidance and management of common problems in dermatologic surgery. This concentrated on the need for adequate training, experience, anatomical knowledge and humility! He touched on facial anatomy and the importance of staying above the SMAS, how to manage intraoperative bleeding and using vertical mattress sutures to reduce tension on wounds. I then had a look at some of the posters in the exhibition.
After lunch I attended the plenary session, which was a series of great lectures. The first was from Professor Martin Cook on the interpretation of sentinel lymph node biopsies, which explained how specimens are processed. It was interesting that naevus cells can be seen in lymph nodes in patients with skin naevi. Dr Crasten Flohr discussed the microbiome in atopic eczema looking at recent evidence of distinct and stable microbiomes at various skin sites e.g. moist, dry and sebaceous areas. He also spoke about an inverse relationship between the diversity of the microbiome and the severity of the eczema. Dr Helen Brough followed this with a lecture looking at transcutaneous sensitization vs oral tolerance induction, discussing the EAT and LEAP studies, pointing to reduced allergen induction if there is early introduction by oral exposure. Dr Graham Ogg then discussed ILC2 cells in eczema and that they may also have a role in other inflammatory disease with further research needed. There was then a lecture discussing the use of radiotherapy by Dr Michael Veness. Following some refreshment it was time for the BAD AGM and an update on what the BAD has been doing and deciding on its future direction.
After this full day there was the BADfest. This was instead of the formal dinner that has occurred at previous annual meetings. We moved into one of the halls and were greeted by several stalls with a buffet style selection of dishes from around the world. Drinks were also provided and seating was on picnic style benches. This allowed delegates to mingle and catch up. As well as table football tables, there was a band playing music. Overall it was a great evening with a fantastic ambiance and hopefully this will be repeated next year.
Day 2 started with a lecture from Dr Richard Barlow discussing the ageing face. After this we moved to the medical dermatology section and an update on acne by Dr Alison Layton. She discussed some strains of P. acnes being more pathogenic, maintenance therapy with epiduo, adapalene or spironolactone and discussion of the evidence for using isotretinoin and possibly individualizing the total dosage for each patient. After a short break for refreshments Dr Jane Setterfield gave an overview of oral dermatology and discussed the utility of the
oral scoring system that is in use in her clinic at Guy’s and St Thomas’ hospital. After this I went to the meet the experts talks on psoriasis and heard Dr Catherine Smith explain what to do if biologics fail. This was a discussion of antibodies to biologics with a mention of the use of methotrexate to prevent immunogenicity, however evidence behind its use is poor. This was followed by a talk on the increased risk of infection whilst on biologics from Professor Nick Reynolds.
At lunchtime I attended a symposium on eczema where there were talks by Professors Thomas Bieber, Alan Irvine and Michael Cork. This was a well-attended symposium with people sitting on the stairs. They went though diagnosis and assessment of atopic eczema, followed by scientific advances and a discussion of possible newer therapies that were on the horizon for eczema including dupilumab, omalizumab, nemolizumab, etc. Overall a great session and well worth attending. After lunch I attended some of the teledermatology talks and heard Dr Andrew Lock talk about use of teledermatology in his local hospital. This was followed by several other talks by Dr Alexander, Dr Nelson and Dr Al-Nuaimi discussing the use of teledermatology in other settings, which was thought provoking and may gain greater importance in the future.
Once again, after a break, I attended the plenary session. This was kicked off by the keynote lecture by Professor Kieron Leslie, a discussion of the auto-inflammatory syndrome, in the language of Shakespeare. I think I learned as much about auto-inflammatory syndromes as I did about Shakespeare! Professor Martin Steinhoff then spoke about itch and targeting IL31, 4 and 13 may lead to future therapies. Dr Stephen Smith then discussed computational biology and the skin and its use to individualize treatment depending on the patient’s physiology. Next Dr Michael Ardern-Jones spoke about drug allergies and the tests that can be done to investigate such as prick testing, patch testing, intradermal testing and use of the elispot assay. The last lecture of the day was a keynote lecture on mechanisms of infection in atopic eczema. This looked at the need to use nasal mupirocin as well as oral antibiotics if treating a patient with infected eczema. After that I needed to relax and had some dinner with friends and watched the Portugal vs Wales Euro2016 match.
Last day of the annual meeting again kicked off with the paediatric section meeting. There was a talk about of the use of acitretin in children followed by a discussion of sustaining a workforce by Dr Phillips looking at Circle and its involvement in Nottingham. This discussed the use of paediatric consultants filling the lack of paediatric dermatologists by undertaking competence based subspecialty training. This was followed by an invited lecture on the skin barrier in atopic eczema by Professor Mike Cork, highlighting the importance of moisturizing in high-risk children from birth, that skin pH rises in patients with atopic eczema and how soap and other detergents exacerbate this. After a coffee break, Professor George du Toit gave a lecture on paediatric allergy. This was a well-attended session and again looked at cutaneous sensitization through the skin of infants leading to food allergies. He presented work being done in infants to induce tolerance by using oral exposure early in life. There were then talks on aplasia cutis congenita, Langerhans cell histiocytosis and a talk on phototherapy in children.
I attended the plenary session after lunch, which started with a keynote lecture from Dr Chetan Mukhtyar discussing recent advances in vasculitis, which discussed IgG4 disease and ANCA associated vasculitis. This highlighted that cumulative corticosteroid is associated with increased damage in ANCA positive vasculitis and hence need to taper glucocorticoids early. Dr Ophelia Dadzie gave a very informative lecture on ethnic dermatology. After a break there were the final updates of the annual meeting. These short talks examined updates in various areas of dermatology with lectures on melanoma by Dr Julia Newton-Bishop, non-melanoma skin cancer by Dr Catherine Harwood, paediatrics by Dr Celia Moss and lymphoma by Professor Sean Whittaker.
Overall, this a very busy annual meeting with lots of fantastic and informative talks. It was also a great opportunity to catch up with colleagues and friends from around the U.K. and I look forward to attending next years meeting.