“At a glance” at the American Academy of Dermatology meeting.

Denver, Mile-High City
Denver, Mile-High City

Once again this year, the highly anticipated meeting of the American Academy of Dermatology (AAD) has attracted a great deal of interest. And when I say “towering” I don’t just mean the geographical position and altitude of the city, Denver is located less than 30 kilometers from the Rocky Mountains and its altitude is exactly 1 mile (1609 meters) above sea level, that’s why it is also called Mile-High City.

This year I would like to highlight the wonderful organization and the mainly practical approach of the scientific sessions. Although the general feeling has been of a decrease in the number of attendees at this meeting, the fact is that most of the rooms were full from the beginning to the end of each session.

In this post I only intend to convey the overall impression that I have just arrived from the meeting “from a big bear’s eye view”, not “from a bird’s eye view” because of the “fauna” that roams the Colorado Convention Center…

Main entrance to the Colorado Convention Center. Downtown, Denver
Main entrance of the Colorado Convention Center. Downtown, Denver

And so I am going to share with you the trends on three topical issues that have been discussed at the 72nd AAD meeting

Vitamin D and photoprotection: what to recommend to our patients

Lately we dermatologists have been encountering resistance from patients to protect themselves from the sun because other doctors (their family doctor, internist, gynecologist…) have recommended that they expose themselves to the sun in order to manufacture all the vitamin D they need… and when we reflect on this, doubts arise as to what and how to recommend to each of our patients.

Dr. James S. Spencer of the Mt Sinai School of Medicine in New York did an exhaustive review of the scientific evidence on the risks associated with “supposed” vitamin D deficiency, finding that most of the studies are observational and do not allow definitive conclusions to be drawn. He summarized that there are NO clinical studies showing that vitamin D supplementation has a beneficial effect on health while photoprotection has been shown to reduce the risk of skin cancer. There is NO agreement on the recommended level of vitamin D in the blood, although it tends to be considered higher than 20 mg/ml and a daily intake of about 600 IU of vitamin D is recommended, which can be provided in the diet, for example, with a glass of milk and a serving of salmon.

Taking all this evidence into account, I believe that the most sensible thing to do is to continue recommending sun exposure with “common sense” according to the different skin types. Light-skinned people synthesize vitamin D much faster than those of darker phototypes, and therefore need very little sun exposure. For them, 30 minutes of sun exposure before 10:00 am or after 6:00 pm in the summer months (without sunscreen) may be sufficient. Dark-skinned people have greater resistance to solar radiation in the skin and therefore need more exposure time to synthesize the same amount of vitamin D. However, it is neither beneficial nor advisable for any type of skin to be exposed to the sun during the hours of maximum intensity: 12-16h in the summer months. At that time the harmful effects of the sun far outweigh its beneficial effects and the advice is to avoid it as much as possible.

Psoriasis in children

The benefits of UVB-narrowband phototherapy for this type of patient were discussed as it has high efficacy with minimal side effects. This therapy was also recommended in combination with other systemic treatments such as acitretin, since it allows a significant reduction in its dose and therefore its possible side effects.

Narrowband UVB lamp
Narrowband UVB lamp

Numerous studies are underway on the new biological treatments in children and all bet that in the future they may become the first line of treatment, taking into account their safety and efficacy profile. The most difficult to estimate is the most appropriate time for drug discontinuation once the disease has been controlled. The general recommendations for this type of treatment in children is the gradual withdrawal of the drug once the outbreak is controlled.

Dermatological manifestations of new oncological treatments

Treatments with chemotherapy and other targeted cancer therapies together with radiotherapy have improved the survival and quality of life of cancer patients in recent years. However, most of them present important dermatological adverse effects that in many cases force to reduce the dose or to withdraw the treatment.

Acneiform eruption on the back secondary to an Epidermal Growth Factor Receptor Inhibitor drug.
Acneiform eruption on the back secondary to an Epidermal Growth Factor Receptor Inhibitor drug.

I would like to draw attention here to the importance of treating the patient preventively at the beginning of the oncological treatment and NOT waiting for skin problems to appear, as they are much more difficult to solve at this time. This preventive attitude has been shown to reduce the incidence of the most frequent and limiting cutaneous side effects such as dryness, fissures, pruritus, rash or hand-foot disease.