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98th Annual Meeting of the British Association of Dermatologists

The 98th Annual Meeting of the British Association of Dermatologists took place at the EICC Edinburgh 3rd  - 5th July 2018.

Report by Krishna S. Mukkanna and Mabs M.U. Chowdhury (Cardiff)

Congratulations to Tanya Bleiker and the whole Conference team who extended us a warm welcome to the 98th BAD Annual Meeting in Edinburgh 2-5 July 2018 in the introduction in the meeting programme. This was one of the most well attended meetings with over 1800 UK and international delegates and we all definitely needed the air conditioning in the excellent conference facilities in the Edinburgh International Conference Centre (EICC). This venue was outstanding in a beautiful capital city and the constant sunny weather made the whole week very enjoyable including walking to the EICC, restaurants, museums and the Castle in the evening. The senior author can just about remember attending the last meeting held in Edinburgh but had definitely forgotten this was 16 years ago!

This meeting was a cultural, educational, social and networking extravaganza with Ceilidh dancing, Highland games and the tense World Cup England winning match at BADfest and certainly some high spirits (and seemingly lots of spirits consumed including the 8 Whiskey glasses one delegate was carrying). Having attended previous meetings for a day or two it was an extremely enjoyable experience to stay and attend sessions all week from Monday to Thursday.

The formal feedback for the meeting is awaited but new innovations which seemed to be popular were: Guided Poster Walks for a few selected posters (from over total 100 posters) with entertaining experts leading their subspecialties such as cutaneous allergy, surgery, genetics, basic science; Hot Topics including mobile devices, practical job planning and guidelines for pemphigus; and Journal Clubs and the special BAD 2018 mugs which were presented to guest speakers. The Pharma workshops were well presented and appreciated by the attendees. There were some gripes with 2 halls for the Pharmaceutical stands but this actually made the whole place feel more spacious and very relaxed.

As ever the Monday pre-meeting sessions were excellent. DermSchool (organised with Dr Amr Salam, London and the DermSchool committee) was attended by 180 medical students and junior doctors all enthusiastic about Dermatology. The BAD supports most of these attendees with small Travel Bursaries. This superb meeting was a pleasure to chair (MMC) and attend and reminded all of us why we did Dermatology with many thought provoking talks on sunscreens, tropical and global health, research and academic life and excellent talks on surgery, skin cancer and paediatrics. It was well organised and chaired by junior colleagues with encouraging Quiz and Poster prizes at the end.

The Trainee session (again organised by Amr Salam) started with David Fenton discussing useful practical approaches and management of hair loss with Anshoo Sahota talking on different modalities of management of hyperhidrosis e.g. microwave technology. Other fantastic talks included photosensitivity disorders, using mobile phones at work highlighting apps e.g. Visual Dx, Medscape and UpToDate with live demos on how to use them and their pros and cons, vulval disease and rosacea and finally a fantastic keynote lecture from Professor Warren Piette on cutaneous microvascular occlusion attended jointly with the SAS attendees. The SAS session (organised by Jui Vyas, Cardiff) was well attended with excellent Newport, South Wales speakers amongst others e.g. Natalie Stone on vulval disorders, Caroline Mills on dermoscopy for amelanotic melanomas, Tabi Leslie from London on urticaria, and handy tips on surgery and neutrophilic dermatoses.

The Specialist Society meetings are always well attended and are usually competing on various days but some highlights are mentioned here. On Tuesday morning, the BSCA hosted Professor Jacob Thyssen who presented an excellent summary on metal allergy issues and highlighted the use of the cobalt spot test which is still not widely used. There were some good abstract presentations including photocontact sunscreen allergy, PPD eyelash allergy, hairspray hazards and a reminder of contact urticaria to chemicals e.g. chloroxylenol (dettol)  with clear domination by speakers from a few centres, well done to them! Professor David Gawkrodger summarised the latest on orthopaedic implants and metal allergy which is still a very controversial area. A main plenary abstract presented in the joint Medical Dermatology session on an multicentre epidemic of methacrylate allergy in the UK was well received and generated much discussion highlighting the importance of some more subspecialty areas being presented to a larger audience for wider learning.

The BSDS guest speaker was Professor Hywel Williams who spoke on designing robust surgical trials, asking the right questions and most importantly how not to do it. He is a truly fantastic speaker with his unique method of getting his ideas across: a true inspiration to us all including junior and senior Dermatologists. If you don’t wish to do research after that talk then please think again; and in contrast, he then did address ways of reducing waste in Dermatology research in an excellent Rook oration. Other interesting oral presentations included Cochrane systematic reviews, melanoma and Vitamin D levels and survey of surgical techniques for forehead flaps, flipped island pedicle flaps, deroofing surgery in hidradenitis and local anaesthesia and tourniquet techniques in digital surgery. Dr Vishal Madan did a nice sharp overview of some surgical Top Tips which was definitely Tip Top.

On Tuesday, other groups with sessions running concurrently with excellent full programmes were BSCCII, BSD, BSGD, British Geriatric Society and Dermatology Teachers. The afternoon sessions started with the British Geriatric Society meeting with an interesting talk about pruritus in the elderly and in the Dermatology Teachers session surveys such as oral medicine exposure and training as a UK dermatology trainee were presented and impact of visual literacy courses DermARTology.

The Plenary Session was fantastic with well-presented and absorbing Keynote Lecture by Dr Eleni Linos (San Francisco, USA) on skin cancer treatment in the frail elderly discussing over-diagnosis and over-treatment of skin cancers at the end of life. Then followed Dr Wolgang Weyers (Freiburg, Germany) speaking on overdiagnosis in skin cancers with increasing numbers of skin biopsies and describing risk-minimising clinical and pathological practices. Professor Warren Piette (Chicago, USA) really did highlight to us his large experience in how to interpret skin signs and patterns when dealing with patients with purpura and vasculitis.

The final thought provoking presentation was led by Professor Mike Cork who in his inimitable style interviewed one of his lovely patients Sarah Burley with severe atopic dermatitis looking at impact of the disease on her life and the remarkable life changing effect of the latest biologic therapy dupilumab. She was later seen enjoying the dancing and when speaking to her directly it really struck home her long and difficult journey with her skin condition to remind us all why we practice dermatology and why supporting both basic science and clinical research on new molecules and treatments is so essential…it can literally be life-saving. UK TREND, BADGEM, and the BSID all had highly successful meetings in Edinburgh to continue their excellent work in encouraging and supporting research in the UK.

The AGM closed the day which is for all BAD members including trainees (but only very few seemed to be in the room with a show of hands). It is a unique opportunity to hear about all ongoing Dermatology issues and the work being led by the Officers and over 150 members contributing to the various service, education, guidelines and research committees and workstreams.

On Wednesday, the day started with sponsored symposium on urticaria looking at the new EAACI Guidelines 2017. The Plenary session on Medical Dermatology covered interesting topics such as risk of post-surgical infections in psoriasis with biologics, methotrexate for adult atopic eczema, Medical Dermatology pearls (Ian Coulson), Cutaneous amyloid (Richard Groves) and Lymphoedema (Kristiana Gordon). In parallel, BADGEM Clinical meeting presentations included phenotypic spectrum of 146 cases of autosomal recessive congenital ichthyosis, and invited talks such as Tuberous sclerosis (Julian Sampson). The British Cosmetic Dermatology Group  had interesting talks on modern management of scars, subcision, complications of cosmetic procedures, management of melasma and experience of running an independent practice.

The Lunchtime sponsored symposiums were diverse and covered new biologic Guselkumab and other IL-23 inhibitors, treating psoriasis in women of child bearing age and evolving therapies in Atopic Dermatitis. Post lunch sessions included submitted papers from the BMJ Dermatology Team of the Year describing Social Enterprise, BSID meeting presentations including Best Presentation and Best Young Investigator Awards, and Professor Sara Brown describing what genetic studies can teach us about eczema. Psychodermatology UK, Historical Symposium and British Teledermatology Society contained interesting talks like Artificial Intelligence in dermatology (Colin Morton), use of dermatology apps and guest lectures on Psoriasis and the Brain (Elise Kleyn), and Photodermatology in Scotland from Professor James Ferguson who deservedly received the Sir Archibald Grey Medal 2018.

The final Wednesday Plenary session on Melanoma MDT had fantastic keynote speaker Professor Hensin Tsao from Boston speaking on Therapeutic checkmate in melanoma who made a tricky subject sound understandable with some excellent animated slides. All the speakers presented very eloquently on Skin Cancer MDT (Martin Gore), Early diagnosis (Catriona Henderson), Melanoma staging and new AJCC guidelines (Jonathan Pollock) with focus on the patient experience (Peta Hughes). This year UK TREND focussed on translational research in keratinocyte cancer such as keratinocyte carcinoma incidence, molecular mechanisms of cutaneous SCC and skin cancer prevention.

The final day on Thursday 5th July was another sunny day which started with sponsored symposium on Management dilemma of defining moderate psoriasis and the timing of treatment. The Professors and Registrars session was excellent again in showcasing some of the best research of our trainees including cutaneous sarcoid in a tertiary referral centre, post-transplant skin cancer incidences, mutations in female genital melanoma and the virtual systemic monitoring clinic. Professor Charlotte Proby presented key issues in cutaneous SCC and her work with BSSCII as an international expert. Professor Ralf Paus highlighted why we need enthusiastic investigators in basic science as he did an excellent talk on the immunology of the hair follicle. Professor Richard Warren succinctly explained optimisation of psoriasis therapies and the hugely important work he has been involved with BADBIR, followed by a truly engaging and humbling description of her career’s work on eczema from Professor Sara Brown. We would highly recommend this session and felt better attendance would do more justice to all the speakers. It was clear to see where one can start in research and the dizzy heights we can all aspire to reach with lots of hardwork and dedication to our patients as shown by leading Professors in the UK.

The BSPD had a successful joint session with the British Society of Paediatric and Adolescent

Rheumatology with talks on diagnostic criteria for psoriasis in children, paediatric vulval sclerosus,

patch testing, emotional effect of eczema and Guest lectures on connective tissue disease (Ruth

Murphy) and Behcets disease (Clare Pain). The British Photodermatology Group also had fantastic

guest lectures on using home phototherapy (Robert Dawe) and Drug photosensitivity (Professor Sally

Ibbotson). Other sessions included British Hair and Nail Society with talks on the Nail unit melanoma

(Professor Trakatelli) and Hair transplants benefits and pitfalls (Bessam Farjo).

After lunch onto the Final Plenary Session with some inspiring talks on diagnosing Tropical Disease (Rachael Morris-Jones), huge impact of Global Health Dermatology (Claire Fuller) and Ethiopian Dermatology training (Richard Weller and Dagnachew Shibeshi) which hopefully widens our understanding of the impact of skin diseases worldwide. As mentioned previously Professor Hywel Williams held the floor with his Arthur Rook Oration describing potential large areas of research waste and how to minimise and reduce the effect of this by good planning, robust study design and effective dissemination of the results. Ruth Murphy eloquently summarised some of the current issues for Dermatology in her President’s Address and how she wishes to direct matters in the next 2 years during her presidency to improve services for all of us and our patients.

The afternoon sessions were Dermoscopy teaching with talks on melanoma diagnosis, and Health Service Delivery and Getting It Right First Time (GIRFT) symposium highlighting the important work Nick Levell will be leading in the next few months aiming to visit and discuss services in all Dermatology departments in England.

The Advanced Medical Dermatology session featured a number of interesting cases presented by panel members including blistering disorders, Behcets syndrome and Dermatomyositis. There was great audience interaction and discussions reminding us the benefit of both clinical experience and evidence based knowledge and a very successful format to be repeated in the future.

Overall this BAD meeting in Edinburgh was full of enjoyable experiences and the verbal feedback from colleagues was excellent. Future meetings will have a lot to live up to with the mix of excellent UK and International speakers, great venue and surrounding facilities including spectacular views from the beautiful Castle, the 4 yearly World Cup, fantastic organisation and very happy attendees who needed their sunblock all week. See you all in Liverpool for the next meeting!

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