Day 3 :
- Track 10: Dermatological Oncology Track 13: Herbal Dermatology
Location: Texas B
Maurice Efana Asuquo
University of Calabar
Thomas de Aquino Paulo Filho
Rio Grande do Norte University
Maastricht University Medical Centre, Netherlands
Klara Mosterd has completed her Ph.D at the Maastricht University Medical Centre at the age of 30, one year after becoming a dermatologist. She is part of the Head and Neck team and next to her clinical work as a dermatologist specialized in oncology has conducted large phase 3 trials that have been published in reputed journals such as the Lancet Oncology. She is now focusing on translational research for BCC treatments.
Although surgical excision is still the gold standard treatment for BCC, the high incidence of BCC necessitates the use and further development of non-invasive therapies. Individual treatment may be offered based on guidelines and randomized trials, such as the trial we recently published in the Lancet Oncology comparing 3 topical treatments for superficial BCC. The choice for a treatment is not only based on response rates, but also involves practical aspects, cosmetic result and costs. Development of topical and systemic targeted therapy, such as SMO inhibition has opened new perspectives. However the cure rate of none of those treatments equals that of surgical excision. Probably, because more pathways are involved in the development of BCC. We performed mutation analysis in tissue secondary resistant to systemic SMO inhibition. The found information may offer insight in how we can improve targeted treatments. Although second-generation SMO-antagonists have already been developed, a different option is to combine different treatments, which is common in other oncological treatments. Targeting GLI may be an option and also Itraconazole has been found to inhibit the Hh pathway. We recently performed a phase 3 trial to investigate the effects of topical application of diclofenac 3% and/or calcitriol 3 ug/g on BCC. We found a good clinical response of the diclofenac cream to superficial BCC's. Results of this trial will be presented. The future of BCC treatment is non-invasive treatment. Combination of different agents may have the advantage of additive inhibitory effects and possibly minimizing the development of tumor resistance to a drug.
University of Medicine and Pharmacy, Romania
Anca Bordianu has completed her Ph.D. at the age of 30 years from “Carol Davila” University of Medicine and Pharmacy Bucharest, University that she graduated from in 2008. She currently works as a plastic surgeon at the Plastic and Reconstructive Surgery Department of the “Bagdasar-Arseni” Clinical Emergency Hospital Bucharest, Romania. She has published numerous papers in reputed journals and participated in national and international congresses and training courses. She is a member of Romanian Plastic and Reconstructive Surgery Society.
Introduction: Skin tumor incidence is continually increasing worldwide, and the fact that it occurs more frequently in younger people, is alarming. Therefore, early detection is required, starting with the family doctor, dermatologist, oncologist, plastic surgeon, and last, but not least, the pathologist. In Romania, the occurring of BCC and SCC is not known exactly. Developing strict records of all patients with BCC and SCC would allow accurate assessment of social and financial impact of skin tumors upon society. All these, would lead to the implementation of a surgical and adjuvant treatment, one that would take into account the histopathological staging of the lesion excised, regardless of the geographic area. Matter and Methods: The casuistry of the Plastic Surgery and Reconstructive Microsurgery Clinic of the Emergency Hospital "Badgasar-Arseni", Bucharest, is one of the richest in Romania, in malignant lesions in the head and neck. The wide area coverage of this casuistry regarding the BCC and SCC, and the treatment methods applied in the field, often of own conception, places the successive medical teams of the clinic, among the prestigious European medical services with similar concerns. We have studied a sample consisting of 216 patients diagnosed with carcinoma (basal cell and squamous cell) in the cephalic end and neck; the patients received ambulatory treatment or they were hospitalized in the Emergency Hospital "Badgasar-Arseni", Bucharest, Department of Plastic Surgery and Reconstructive Microsurgery, for a period of 5 years (January 1, 2008 - December 31, 2012). Results and discussions: The analytical indicators, in each particular case, included: age of the patient, gender, profession, origin (urban/rural), the date of tumor formation, the passed time until hospitalization, clinical form, location and type of the tumor, histological subtype, and not least, the received treatment (surgery and adjuvant). Curative surgery was performed in 236 tumor cases (BCC and SCC), out of which 27 were recurrences (representing 10.3% of the total of 263 formations detected on the 216 patients in our study). Regarding surgical treatment, the size of the loss of initial sutured substances varied between 0.5 cm - 4 cm. The availability and the laxity of the tissues adjacent to the coverage defect were considered to perform suture. In cases where it was necessary, the nearby skin was removed (which allowed the use of extrinsic skin availabilities, by mobilizing skin in deeper tissues). In most cases, the excision of the lesion was performed so that the axis of the resulted scar was placed in the direction of the skin tension lines. Conclusions: The large number of interventions performed for the diagnosis and the surgical treatment of skin carcinoma in the face or on the neck, without serious intraoperative complications, represent clear arguments in favor of surgical treatment applied as first choice.
University of Calabar, Nigeria
Upon completion of the Fellowship in Surgery (FWACS) in 2000, he joined the University of Calabar as a lecturer in 2001. Today he is a Professor/Chief Consultant Surgeon, University of Calabar/University of Calabar Teaching Hospital, Calabar, Nigeria. He is a Fellow of the International College of Surgeons (FICS), and served as the Head of Department of Surgery, University of Calabar, Calabar, Nigeria and is the current Dean, Faculty of Medicine, and Dentistry. His major research interest is dermatologic oncology. Current Head of the Oncology unit of the University of Calabar Teaching Hospital, Calabar, Nigeria. Attended several International and Local conferences, presented several papers on dermatologic oncology and member of Dermatology-2014-Organising Committee. He pioneered research resulting in over 80 publications with 35 publications on dermatologic oncology. Kaposi sarcoma: Changing trend in Calabar (Asuquo et al 2008) and recently, Major dermatological malignancies encountered in the University of Calabar Teaching Hospital, Calabar, South Nigeria (Asuquo et al 2012), Oculocutaneous albinism and skin cancer in Calabar, South Nigeria (Asuquo et al 2013) and Marjolin's ulcer: mismanaged chronic cutaneous ulcers (Asuquo et al 2013).
Background Moritz Kaposi a Hungarian dermatologist first described Kaposi sarcoma (KS), a malignant tumour of vascular origin from undifferentiated vasoformative spindle-shaped cell in 1872.There are 4 clinical variants: classic (Mediterranean), African (endemic), immunosuppression (transplant) associated and acquired immunodeficiency syndrome (AIDS) associated KS all with identical histologic features. It presents mainly as a cutaneous lesion and musculoskeletal involvement is uncommon and occurs secondary to local extension from the skin. Case presentation A 52-year old male farmer presented with pain and inability to walk properly with the left lower limb of 2 months duration. Three years prior to presentation, he first noticed a painless growth on the left foot, which progressed to multiple nodules with some, ulcerated at presentation. Swelling noticed initially on the foot progressed and extended to the lower part of the left leg. Prior to presentation, he hadtradomedical treatment with oral and topical medications to no avail. On examination, he was chronically ill-looking, afebrile, pale, anicteric, unilateral (left) non-pitting pedal oedema, and left groin lymphadenopathy. Chest and abdominal examination were unremarkable. Left lower limb examination revealed a patient that walked with a limp with the aid of a walking stick, non-pitting oedema of the left foot extending to the middle third of the leg with a slight deformity of the lower third. Other findings were hyper pigmented patches, multiple nodules that ranged from 0.5-2.5cm with some ulcerated. Investigations revealed a packed cell volume (PCV) of 25%, white blood cell (WBC) count of 5.5 x 109/l, neutrophils- 70%, eosinophils- 1%, and lymphocytes- 29%. Platelets 236 x 109/l, erythrocyte sedimentation rate (ESR) 112mm/hr, retroviral serology I&II negative. X-ray of the left foot and leg showed soft tissue swelling with lytic destruction of the distal third of the tibia as well as pathological fracture of the tibia and fibula, with an ill-defined stippled soft tissue calcification seen in the distal third of the soft tissue of the leg adjacent to the lytic bone destruction. Incision biopsy of the foot nodule mesenchymal tumour composed of spindle cells enclosing vascular channels - KS. A diagnosis of advanced KS with pathological fracture of the left tibia/fibula and dystrophic calcification of soft tissue (muscle) was made and managed with cytotoxic chemotherapy, Vincristine and Epirubicin with partial response (diminishing sizes of the nodules/oedema). Conclusion Kaposi sarcoma if neglected present with significant morbidity. Ignorance, sociocultural and poverty were underlying issues, health education on early presentation and diagnosis will improve outcome. Not all is known of the tumour biology of KS hence the need for further research.
RMIT University School of Health Sciences, Australia
George Lenon has completed his Ph.D in 2004 from RMIT University. He is currently a lecturer of TCM as well as an avid researcher at RMIT University. His research focuses on atopic diseases and obesity. His works have been presented in numerous local and international conferences. He has published over 15 papers in peer-reviewed journals.
Atopic dermatitis is a chronic, itching skin disease which highly impacts on quality-of-life. Increasingly, atopic dermatitis sufferers are turning to Chinese medicine. However, the current state of evidence of Chinese herbal medicine treatment for atopic dermatitis remains unknown. This study systematically evaluates the clinical evidence of the efficacy and safety of oral Chinese herbal medicine for atopic dermatitis. Searches were conducted on major electronic databases using the keywords "randomized controlled trials", "atopic dermatitis", "traditional Chinese medicine", "traditional East Asian medicine", "herbal medicine", "Chinese herbal drugs", "medicinal plants", "phytotherapy", "Kampo medicine", and "Korean traditional medicine". Results were screened to include English/Chinese randomized controlled trials. Meta-analysis was conducted on suitable outcome measures. A total of 1014 articles were yielded from electronic searches. After screening, seven studies were included - one comparing Chinese herbal medicine and western medicine with western medicine alone; and six placebo-controlled trials. Treatment with integrated Chinese herbal medicine and western medicine was superior to western medicine alone; while significant treatment efficacy was shown in three placebo-controlled trials and two showed significantly reduced concurrent therapy with Chinese herbal medicine. No abnormalities in safety profile or severe adverse events were reported. Risk of bias assessment showed that the overall quality of studies were poor. Chinese herbal medicine was reported as well-tolerated and significantly improved symptom severity. However, the poor quality of studies denied valid conclusions to support its tolerability and routine use. Further studies addressing the methodological issues are warranted to determine the therapeutic benefits of Chinese herbal medicine for atopic dermatitis.
Shaanxi Provincial TCM Hospital, China
Yan Xiaoning has completed his M.D at the age of 34 years from Xi'an JiaoTong University . He is the director of Shaanxi Provical TCM Hospital, a premier Bio-Soft service organization. He has published more than 22 papers in reputed journals and serving as an editorial board member of repute.
Objective: To determine the therapeutics and safety of combined surrounding needling, moxibustion with Hot Compress Therapy on treating Scleroderma. Methods: 42 cases of patients with scleroderma were randomized into two groups, a treatment group(23 cases ) and a control group(19 cases). In the treatment group, surrounding needling, moxibustion and Hot Compress therapy were used locally. In the control group heparin sodium cream was applied externally. Centella triterpenes tablets were taken orally, 24mg each time and VitE 0.1g three times in two groups. In 6 months treatment , the skin sclerosis score, joint pain score, and joint function score were compared before and after treatment for patients between two groups. The efficacy on Chinese medicine symptoms and safety were evaluated between two groups. Results : In the treatment groups , the score of skin sclerosis, joint pain, and joint function were superior to those in the control groups with statistical significant differences (P<0.05). Concerning to the comparison of the effective rate of Chinese medicine symptoms,the total effective rate was 86.4% in the treatment group and the total effective rate was 52.6% in the control group.The differences were significant statistically between two groups (P<0.05),For the safety evaluation, it is safe. Conclusion: The integrations of surrounding needling, moxibustion and Hot Compress therapy were effective in significantly improving the severity of scleroderma.Tt is relatively safe and deserves to be promoted in clinic.
AVICENNE Hospital, Morocco
Hafsa Benzzi has completed her general medicine degree from University of medicine of Marrakech, Morocco in 2008 and is presently working as Resident in Dermatology Department from Ibn Sina hospital, Morocco since 2009. She is a member of Association of Internal doctors of Marrakech "AMIMA" & "OUR RIGHTS", Founding member of the Association: GLIMMER OF HOPE.
Ophthalmic zoster is a viral infection of the fifth cranial nerve by HZ (herpes-zona) virus, potentially severe by its complication that can impair visual function such as oculomotor palsy. Once organism is infected, the virus still latent in sensitive ganglion during life. There is a large distribution of the virus around the world so we identify more than 1 million cases occuring each year in the U.S. That major every year the cost of medical care. Among the US population, more than 90% of adults have a Varicella-zoster virus (VZV) positive serology. Ophtalmicus Herpes zoster is a common infection; but occurence of oculomotor palsy still unusual, and regressive most of times, its early management helps the patient to recuperate visual function. We report the case of patient presenting an oculomotor palsy concomitant to a herpes zoster. Case-report: Mr. AA, 50 years old, without medical history presented to dermatologic consultation for painful erythematous vesicular rash on left-side of his forehead. The patient could not open his left eye ,this symptom was preceded by headache and photophobia . On physical examination, the patient had an unilateral vesicular rash, surrounded by some brown crusts on dermatome of trigeminal nerve. This areas was hyperesthesic, without necrosis, or extension to another dermatome. Ophthalmologic examination showed a pupillary symmetry, without kerato conjunctivitis or uveitis, intraocular pressure was normal, and there was no pain on palpation of the temporal arteries bilaterally. Neurological examination objectified paralysis of the levator palpebrae superioris, without a chemosis or palpebral oedemas, with a negative sign of hutschinson, examination of other cranial pairs showed unremarkable anomaly. Brain MRI was normal. We treated our patient with oral acyclovir 4g per day, initiated 48 hours after onset of symptoms, for ten days. We obtained a complete improvement of skin lesions in 10 days with persistent of ptosis. The patient was seen in a month with a persistent ptosis, then after 03 months, with a relative improvement of the muscle function after physic rehabilitation indicated by neurologists. Discussion: Varicella zoster is a DNA virus, belongs to Herpesviridae family of viruses. The first infection in childhood is varicella, the virus still latent in sensitive nodes, controlled by cellular immunity, that maintain the infection asymptomatic. The reactivation is caused by a regression of cellular immunity, even if humoral immunity still the first defense but don't preserve a stable state. The mechanism of oculomotor palsy still discussed, it might be direct by direct cythopatic virus. The frequency of this complication is relatively high in several old series: hackneyed and al, Edgerton Neverobserved paralysis oculomotor in 12%, 15%, 10% ophthalmic herpes. The nerve most frequently affected was the ipsilateral III.Risk factors for the development of HZO are related to advancing age with cell-mediated immunity decrease. Conclusion: Ophthalmicus herpes zoster with oculomotor palsy is uncommon affection by, its clinic presentation and its mobidity, it alters quality of life. Our case-report stress on necessity of precoce diagnosis, to treat and to keep monitoring , till resolution of the pathology form is potentially serious , by its complication such as oculomotor palsy that taint visual prognosis, then quality of life. Each physician must search it while physical examination, it might regress in few months but close monitoring is always necessary.
Hospital & Clinic Balear, Spain
Maria-Magdalena Roth is a dermatologist, researcher and head of the Dermatology Department at Hospital & Clinic Balear, Palma de Mallorca, Spain. Dr Roth earned her doctoral degree in medical sciences in 2007 at "Victor Babes" University of Medicine and Pharmacy in Timisoara, Romania, where she also received her medical education and residency training in dermato-venereology. She published more than 40 peer-reviewed publications, book chapters or conference papers, with her work being published in academic journals such as American Journal of Clinical Dermatology, Journal of the European Academy of Dermatology and Venereology, Acta Dermato-venereologica Alpina, Pannonica et Adriatica, Dermatology Nursing. She is a member of the "Dermatoses of Pregnancy" European Task Force, European Women's Dermatologic Society, International Dermatoscopy Society, Romanian Association Society of Dermatology, and Romanian South-West Dermatology Association.
Pemphigoid gestationis, impetigo herpetiformis, polymorphic eruption of pregnancy, and the papular dermatoses of pregnancy (prurigo of pregnancy, pruritic folliculitis of pregnancy, or the new atopic eruption of pregnancy) are skin conditions - directly and indissolubly linked with the state of gestation or with the products of conception - that fall under the pregnancy-speficic dermatoses conceptual umbrella. Intrahepatic cholestasis of pregnancy - a condition with secondary skin manifestations - defined as pruritus with onset during pregnancy, associated with abnormal liver function but in the absence of other liver conditions - is commonly linked with the pregnancy-specific dermatoses group (with some authors actually including it within the group itself). However, the existence of several classification schemes - each delineating specific clinical algorithms and medical criteria - and, in some cases, still subject to academic controversies and debates as to lacking sufficient etyopathogenetic data required to support a certain theoretical architecture - can lead to terminological and nosological confusion. This article offers updated information on pregnancy dermatoses and provides a practical clinical algorithm for their diagnosis and management. Subsequently it offers effective treatment strategies for each of the conditions, with the main aim to contribute to the decreasing of maternal and fetal mortality and/or other associated risks, like prematurity.