Balados sur le Congrès de l'ACD (en anglais)

Speakers from Canadian Dermatology Association Annual Conference

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2019 Podcasts

This podcast series features in-depth one-on-one interviews with presenters at the Canadian Dermatology Association’s 2019 Annual Conference in Calgary, Alberta. CDA president Dr. Kerri Purdy guides the conversations with prominent leaders, innovators and researchers in the field of dermatology and medicine. From the role of human skin microbes in eczema to the future of healthcare, this series offers those who attended the conference an opportunity to dig deeper into the topics that were presented. And for those who could not make it, this series offers a sample of what you missed.

Professor Dr Swen Malte John is a world-renowned expert in occupational dermatology. In this conversation with CDA president Dr Kerri Purdy they discuss:

  • Occupational dermatology as a neglected field
  • A global group of scientists is assessing the burden of occupational skin cancer
  • In-patient contact dermatitis care permits proper diagnosis, keeping patients away from exposure to materials of concern and allowing for proper education and training of patients
  • Reporting of occupational dermatologic cases (50% of all occupational diseases) essential to properly address the issue
  • For the first time in Canada, provincial-level work has been done to assess UV exposure in the workplace
  • Outdoor workers must be regularly screened for skin cancer

Professor John is Chairman of the Department of Dermatology and Environmental Medicine at the University of Osnabrueck. He is also chair of the Institute for Interdisciplinary Dermatological Prevention and Rehabilitation at the University of Osnabrück (iDerm) and of the Lower-Saxonian Institute of Occupational Dermatology.

Dr. Heidi Kong is an Adjunct Investigator at the National Cancer Institute. She is a board-certified Dermatologist and currently directs a research program at the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) that includes clinical and translational investigations on the human microbiome and inflammatory skin diseases.

Dr Kong spoke at the CDA’s 2019 Annual Conference about the human microbiome and its roles in health and disease, particularly in inflammatory skin diseases.

Some takeaways from her conversation with Dr Kerri Purdy:

  • Generations of dermatologists know from clinical experience that microbes likely plays a role in several dermatologic disorders
  • Atopic dermatitis “low-hanging fruit” for assessing the role of the microbiome
  • Understanding microbiome reinforces the use of antimicrobials to treat atopic dermatitis
  • Still at early stages of research with the microbiome – still seeing associations rather than showing causation
  • Rare primary immunodeficiency populations helping to understand differences in the microbiome
  • Be skeptical of microbiome research and temper enthusiasm until solid evidence emerges

Immense change is coming to the field of healthcare. Zayna Khayat believes medicine will advance more in the next ten years than it has in the last 100. And according to Dr Khayat, dermatologists are perfectly positioned to take advantage of the coming waves of innovation

Zayna Khayat is Future Strategist with SE Health (formerly, Saint Elizabeth Health Care) a health and social impact enterprise with a major focus on creating a better future for aging adults in their homes and communities. Zayna is Faculty of Singularity University’ Exponential Medicine stream and is adjunct faculty in the Health Sector Strategy stream at the Rotman School of Management at the University of Toronto.

In this conversation with Dr Kerri Purdy, Zayna Khayat says:

  • The healthcare sector is not good at dealing with change
  • In future health care delivery will be much more of a blend of physical and digital care and there will be a shift to preventive care and home care
  • Doctors should be excited that patients are taking more control of their health and using Google to check their symptoms
  • Co-design of health care programs with patients can increase uptake
  • “The Patient Will See You Now” and “Deep Medicine” by Dr Eric Topol and “The Innovators Prescription” by Clayton Christensen required reading to learn about coming changes in health care

Dr. Anna Bar speaks with Dr. Kerri Purdy about how the tremendous technological evolution in device-based treatments over the past 15 years makes this an exciting time for dermatology. In this conversation from the floor of the CDA’s 2019 Annual Conference in Calgary, Dr. Bar and Dr. Purdy discuss:

  • The recent invention of microneedling with radiofrequency devices
  • Acne scarring is one of the most challenging things dermatologic surgeons face because there is no way to return skin to the unscarred state; often, it takes multiple treatments with multiple approaches that can work synergistically
  • Treatment plans must be tailored to the patient – their age, type of scarring and capacity to take downtime needs to be taken into account
  • Using a professional photographer under standardized conditions is ideal for monitoring progress in treating acne scarring
  • New indications for microneedling with radiofrequency including treating scars, postpartum striae and Hyperhydrosis
  • In purchasing a laser, it is important to test the laser in your office before purchase.

Dr. Bar is an associate professor of dermatology and a Mohs micrographic surgeon at Oregon Health & Science University. She is also the director of the fellowship program in Mohs micrographic surgery and dermatologic oncology.

CDA President Dr. Kerri Purdy sits down with AAD president Dr. George Hruza to have a conversation about the challenges dermatologists face on both sides of the Canada-US border. They discuss:

  • The biggest challenge facing dermatology today is the infringement on dermatology’s scope of practice with non-physician providers advertising and providing dermatologic services
  • Priority for dermatology is to offer patients safe and effective care.
  • In the US there is a considerable restriction in funded residency slots resulting in a significant shortage of dermatologists.
  • The best model is to have a dermatologist on-site directly supervising nurse practitioners and physician assistants in conducting procedures.
  • Dr. Hruza’s personal priority as president is to reinforce the joy of practising dermatology and relieve the stressors leading to burnout

Dr. Hruza is a dermatologist and Moh’s surgeon practicing in St. Louis. He is an adjunct professor of dermatology at St. Louis University. He has written four laser dermatology textbooks and published more than 150 articles.

Dr. Patrick Ott speaks with Dr. Kerri Purdy about the Herculean effort currently underway to design a vaccine against melanoma. Developing a vaccine for melanoma is particularly challenging because it needs to be different for every person.

Dr. Ott discusses:

  • How personalized neopeptide antigen vaccines are made specifically for each individual patient.
  • The challenge they face implementing this in the clinic because in metastatic melanoma it can take 2-3 months to sequence the specific tumour and make the vaccine
  • Cancer patients who have more neoantigens have better T-cell responses
  • Newer cancer vaccines using neoantigens to drive T-cells into the tumour and trigger an immune response are more effective than those designed two decades ago
  • We now want to use the vaccines in a metastatic setting with improved delivery of the vaccine and use of adjuvants
  • We can use molecular tools to show that vaccines can drive T-cells into the tumour.

Dr. Ott is Clinical Director of the Melanoma Center and the Center for Immuno-Oncology at the Dana Farber Cancer Institute. He is a physician and an Associate Professor of Medicine at Harvard Medical School.

2018 Podcasts

Terry O’Reilly talks to Dr Mark Kirkhoff about how Dermatologists can stand out in the crowded healthcare field. O’Reilly was the keynote speaker at the CDA’s 2018 Annual Conference. He is the host of CBC Radio’s Under the Influence, a program about the modern world of advertising. Marketing magazine chose Terry as one of Canada’s « Most Influential » marketing people.

Key Points: 
  • It is important to brand your industry and to create a brand as a private practitioner
  • Marketing is about differentiating your industry as dermatologists
  • To create a successful brand as a private practitioner you have to understand what your clients (patients) think now and what do you want them to think
  • To complete against Google, dermatologists have to create distinct value and show the value of the human touch
  • “Bold but smart marketing” creatively showing the value of specialist knowledge and credentials might be the best approach dermatologists could take
  • As a practitioner it is important to work out what makes your practice unique and to market this
  • Dermatologists in an enviable position as there is some much emotion embedded in the services they provide that makes them easier to market

Dr Vaneeta Sheth discusses vitiligo and disorders of pigmentation, as well as managing cutaneous diseases in ethnic skin.  Dr Sheth has set up specialty clinics for vitiligo and multicultural dermatology at the Brigham and Women’s Hospital in Boston.

Key Points
  • Incidence of vitiligo not increasing but more people inquiring about new treatments due to increased publicity about them.
  • Treatment algorithm involves offering all options for most patients including stronger topical steroids, narrow band UVB phototherapy, oral steroids, surgical treatment and alternatives such as vitamin supplements.
  • Steroid sparing agents such as methotrexate and cyclosporine not shown to be effective for vitiligo but JAK inhibitors showing promise for facial vitiligo.
  • Surgical options for vitiligo, especially punch grafting, easy for dermatologist to master but more complex procedures such as melanocyte transplantation take more training and a dedicated space and staff.
  • Some patients will not respond to treatment but can benefit from social support.
  • In India, Asia and Middle East “huge” stigma against people with vitiligo so cultural awareness required.
  • Take-home message is that vitiligo should be taken seriously and aggressive treatment can be successful in resistant cases.

Dr. Mark Davis discusses how to classify and target therapies for neutrophilic disorders. Dr. Davis is a professor and the chair of the The Department of Dermatology at the Mayo Clinic in Rochester, Minnesota. He’s a professor and a specialist in neutrophilic disorders.

Key Points
  • Diagnostic criteria recently published for pyoderma gangrenosum with two main criteria being the characteristic appearance of ulcer and a biopsy documenting neutrophilic infiltrates.
  • Very strongly associated with underlying malignancies, especially hematologic, and inflammatory bowel disease, but about 50% of patients will have no underlying problem.
  • Prednisone the mainstay of treatment (1mg/kg/day) with recent publications suggesting cyclosporine as effective.
  • Investigation of biologics showing promise in early, small trials, especially infliximab.
  • Good wound care also essential
  • Spectrum of neutrophilic disorders exists from Sweet’s syndrome to pyoderma gangrenosum
  • Ulcers can recur with pyoderma gangrenosum and become chronic.

Dr. Kathleen Hectorne discusses the skills needed to be efficient and effective on the job as a dermatologist. Dr. Hectorne practices medical dermatology out of the Mayo Clinic in Minnesota, and she’s a past president of the Women’s Dermatologic Society.

She thrives in her role teaching residents, but she also trains doctors in time management, organizational development and resiliency.

Key Points
  • Time management involves finding others to do the tasks you don’t enjoy and following your own objectives.
  • Getting enough sleep, exercising regularly and maintaining mental and physical health key to being resilient.
  • Work/life balance key for women physicians as obtaining proper leadership training and skills
  • Attributes of a good teacher or supervisor are to truly be involved, asking and answering questions and dealing with residents and students with respect and dignity.

Dr. Jerry Shapiro is one of the only specialists who focuses solely on hair and scalp disorders. He is a professor at the New York University School of Medicine, has written five books in three languages and trained 29 fellows on four continents.  

Dr. Shapiro is the author of more than 150 peer-reviewed publications, and he’s the only dermatologist in the U-S who restricts his practice to medical hair loss.

Key Points
  • Alopecia areata easy to diagnose and treatment depends on degree of scalp involvement
  • JAK inhibitors are very effective for treating alopecia universalis and 70% of patients will grow hair when treated, with side effects being very rare
  • Frontal fibrosing alopecia becoming more common possibly due to sunscreen use and UVA blockage and it can be treated but it may involve using higher-tier medications.
  • Platelet-rich plasma (PRP) shown to be effective in conjunction with other therapies for hair loss due to growth factors within the platelets and the plasma.
  • Topical JAK inhibitors may be the most promising new option for alopecia areata.

Dr. Mary Maloney is the Chair of Dermatology at the University of Massachusetts, where she is active in mentorship activities. She’s the past-president of the Women’s Dermatologic Society, and a practitioner of Mohs surgery. One of her passions is promoting ethics and professionalism.

Key Points
  • In the event of multiple unsuccessful attempts to surgically excise a tumour careful evaluation required and adjuvant therapy may be necessary.
  • Hallmarks of infection at surgical site are increasing redness, tenderness and discharge multiple-days post-surgery.
  • Applying thrombin can be very beneficial for wound healing in mohs surgery and can be applied several times with Q-tips or gauze.
  • Patients need to be reminded scarring inevitable after surgery but can be minimized, most importantly by managing skin tension.
  • Mentorship most successful when it is a two-way relationship with the mentor getting as much out of it as the person being mentored.
  • To be a successful mentor one must learn to listen, have trust and respect and have an alignment of core values with the person being mentored.

Dr. Luca Borradori is the president of the European Academy of Dermatology and Venereology. He’s chairman and full professor at the University of Bern, and his clinical focus is  devoted to autoimmune blistering diseases and the cutaneous manifestations of systemic diseases.

Key Points
  • Bullous pemphigoid one of the most frequent causes of hospitalization in Switzerland with increasing incidence due to an aging population.
  • Should be considered in any elderly patient with a pruritic condition, especially if recurrent.
  • Treatment in elderly patients with multiple comorbidities should not be too aggressive and should aim to control itch and the skin condition while avoiding serious systemic side effects.
  • High potency topical corticosteroid treatment for 2-3 weeks often best treatment for bullous pemphigoid whereas high doses of prednisone associated with significant side effects and mortality.
  • Long-term management a challenge as about half of patients with relapse after treatment halted.
  • Studies suggest association between use of certain drugs and bullous pemphigoid development so medication use should be reviewed; diuretics, spironolactones, gliptines all implicated.

A conversation between Neil H Shear, a Professor of Dermatology at the University of Toronto and Chief of Dermatology at Sunnybrook Health Sciences Centre in Toronto, and Aaron Sihota, a Primary Care Pharmacist and Clinical Instructor at the UBC Faculty of Pharmaceutical Sciences, on the current pharmacist-dermatologist relationship landscape, innovative practical topics to address challenges and partnership opportunities for enhancing patient adherence long-term retention, and maximizing the business sustainability of the dermatologist’s’ clinic.

Key Points: 
  • Enhancing patient care with safer use of medications and better patient adherence to therapy can be supported with closer interaction between dermatologists and pharmacists: Shear
  • Product monographs are intended for the drug approval process and should not guide care: Shear
  • Important for the pharmacist to reinforce messages given by the dermatologist: Shear
  • Dermatologists often don’t have sufficient time to give all necessary drug information and this can be done by pharmacist: Sihota
  • Pharmacists can add value by offering affortable alternatives to prescribed drug: Sihota
  • Community pharmacists in many jurisdictions now have prescribing rights and enhanced scopes of practice: Sihota
  • Pharmacists now focusing on consultative care and not just filling prescriptions: Sihota
  • “Do not substitute” instructions should be respected by pharmacists and pharmacists will no longer be getting large payouts from generic companies: Sihota