Friday, October 29, 2010

22nd World Congress of Dermatology (WCD)

WCD 2011

Period: May 24 - 29, 2011
Location: Seoul, Korea
Venue: COEX Convention and Exhibition Center

Hosted by International League of Dermatological Societies
Organized by Korean Dermatological Association

Previous World Congresses

(The name of the international congress was changed in 1992 to the World Congress of Dermatology)

No Host City President Secretary-General

1 Paris, 1889 A. Hardy H.Feulard

2 Vienna, 1892 M. Kaposi G.Riehl, Sr.

3 London, 1896 J. Hutchinson J.J. Pringle

4 Paris, 1900 E. Besnier G.Thiebierge

5 Berlin, 1904 E. Lesser O.Rosenthal

6 New York,1907 J.C. White J.Fordyce

7 Rome, 1911 T.deAmicis G.Ciarrocchi

8 Copenhagen,1930 C. Rasch S.Lomholt

9 Budapest, 1935 L. Nekam S.Rothman

10 London, 1952 A. Gray G.B.Mitchell-Heggs

11 Stockholm, 1957 S. Hellerstrom G.H.Floden

12 Washington, 1962 D.M. Pillsbury C.S.Livingood

13 Munich, 1967 W. Jadassohn C.G.Schirren

14 Padua-Venice,1972 F. Flarer F.Serri

15 Mexico City,1977 A. Gonzalez-Ochoa L. Dominquez-Soto

16 Tokyo, 1982 A. Kukita M. Seiji

17 Berlin, 1987 G. Stuttgen C.E. Orfanos

18 New York, 1992 J.S.Strauss S.I. Katz

19 Sydney, 1997 R.Marks A.J. Cooper

20 Paris, 2002 J. Revuz J.-P. Ortonne

21 Buenos Aires,2007 R. Galimberti A.M. Pierini

Monday, October 18, 2010

BLINCK approach

BLINCK approach is simple and useful algorithm to help clinicians determine if a pigmented lesion warrants biopsy. The use of this algorithm will improve the pickup rate of potentially serious skin cancers as well as reduce the number of unnecessary benign lesion excisions.

BLINCK may be especially helpful to clinicians who have only basic or intermediate dermoscopy skills but who are regularly called upon to assess skin lesions in their practices.

BLINCK checklist is introduced by Dr. Peter Bourne, a founder of the Skin Cancer College of Australia and New Zealand (SCCANZ). The score for the lesion was added up to 4 by criteria as following.

1. B. The lesion was not clearly benign at our first initial evaluation
2. L. The lesion appeared to be lonely without any other similar melanocytic lesion near by
3. I. The lesion appeared to be irregular outline and color on our dermoscopic exam
4. N & C. The patient was nervous about the change in color in past 4-6 months
5. K. The lesion exhibited known clues when viewed with a dermatoscope. See "Chaos and Clues" reference below.

BLINCK Score = 4

According to the BLINCK approach, a lesion should be biopsied if the BLINCK score is 2 or more out of a possible 4. Therefore, the we excised this lesion and sent for a pathologic evaluation.


Saturday, October 2, 2010

New Classification Criteria for Rheumatoid Arthritis

Aletaha D et al. 2010 rheumatoid arthritis classification criteria: An American College of Rheumatology / European League Against Rheumatism collaborative initiative. Arthritis Rheum 2010 Sep; 62:2569. (http://dx.doi.org/10.1002/art.27584)


The American College of Rheumatology (ACR) and the European League Against Rheumatism have collaboratively developed new classification criteria for rheumatoid arthritis (RA); the ACR's previous criteria were published in 1987.

First, a working group analyzed data from several large cohorts of patients with early synovitis to determine predictors of eventual requisite disease-modifying therapy with disease-modifying drugs.

Second, 24 RA experts used a consensus-based decision-analytic approach to reach agreement on key predictors of RA. Both sources of information were used to construct the new classification system, which can be applied to patients who have at least one joint with clinical synovitis that is not explained better by another disease.

Four variables constitute the new criteria:

•The number and size of involved joints (score, 0–5)

•Results of rheumatoid factor and anti–citrullinated protein antibody testing (score, 0–3)

•Abnormal sedimentation rate or elevated C-reactive protein level (1 point)

•Symptom duration >6 weeks (1 point)


Maximal score is 10 points; patients whose scores are 6 points are considered to have "definite RA"

Comment:

The goal of this classification scheme is early identification of patients with undifferentiated synovitis who are likely to progress to erosive RA and thus might benefit from early initiation of disease-modifying therapy.

Subdermal Minimal Surgery for Acne Scars

Lee JW et al. Treatment of acne scars using subdermal minimal surgery technology. Dermatol Surg 2010 Aug; 36:1281.

Method:

Subdermal minimal surgery technology makes use of an industrial-strength, needleless hypodermic inoculator that delivers medication into the skin through a high-pressure jet.

One shot covers a 1-cm2 area in the dermal and subdermal planes. In a pilot study from South Korea, investigators evaluated the efficacy of this technology for treating acne scars.

Ten patients with facial acne scars underwent a series of three subdermal minimal surgery treatments, 4 weeks apart, under topical EMLA anesthesia (lidocaine, prilocaine topical cream). Hyaluronic acid (HA) was infiltrated into the area of the scar, at 0.15 mL/scar. The HA used in this trial was 90% cross-linked with butanediol diglycidyl ether; according to the authors, it remains active for 6 to 8 weeks.

Result:

At follow-up 3 months after the last treatment, two independent observers found mean scar improvement of 51% to 75%; in patient assessments, the mean rating was 25% to 50% improvement.

Conclusion:

The authors note that the benefit seemed to last for at least 6 months and that ice pick scars improved more than rolling or boxcar-type scars. Pain was described as none to mild, and no complications were noted.

Comment:

Subdermal minimal surgery technology has interesting potential for delivering filler materials and medications into the skin.

It is not clear whether the observed benefit was related to the fleeting presence of HA or to the trauma of infiltration and resulting wound healing and collagen remodeling.

The authors state that the HA is dispersed within the dermis, but given the density of the dermis, it is much more likely that the material is dispersed in the subdermal plane.