Day 2 :
Canadian Association of Cosmetic Dermatology and Surgery
Keynote: The comparative study on safety and effectiveness of restorative treatments for facial lipoatrophy associated with HIV
Time : 09:30-10:00
Dr. Ali Khalifeh is a Board-Certified Dermatologist (YSMU), Board-Certified and Licensed Holistic Health Practitioner, specialized in Cosmetic Dermatology, Laser and Aesthetic Medicine. He is Current President and Chief Director of the Canadian Association of Cosmetic Dermatology and Surgery, and Teaching Professor of Medical Aesthetics Technology Program in CAMACS. He is serving as an Editorial Board member of Journal of Clinical Research in Dermatology, Symbiosis Publishing. He is also the president of Bioptima Medicals Inc., Pharmaceutical and Cosmeceutical Company in Canada.
Facial Lipoatrophy associated With HIV is one the worst adverse effects of HIV and antiviral treatments which not only impacts the quality of life by impairing self-esteem of the HIV infected patients but also is one the most complex challenges of the family members and the community to adjust with the patient’s social situation. rn Thymidine-based nucleoside analog cessation is the only proven treatment for HIV associated lipoatrophy, although plastic surgeons and dermatologists are constantly exploring the new horizons of cosmetic procedures to restore the lost fat and maintain the normal and natural look of the HIV-infected patients.rnAutologous Fat Transfer, biodegradable or permanent injectable fillers and facial prosthetics have been used for HIV facial lipoatrophy treatment and all have offered some acceptable safety and aesthetic results, but apparently there are not sufficient clinical studies in treatment of choice in facial lipoatrophy for HIV-infected patients.rnIn this article we discuss the comparative efficacy of different therapies, assessment of existence and severity of facial lipoatrophy, and treatment measures of various cosmetic procedures for HIV associated facial lipoatrophy. rn
British Columbia Academy of Medical Aesthetics and Skin Care
Keynote: Decorin that regulates dermal wound healing and reduces scar formation can also alleviates skin laxity leading to tissue tightening and wrinkle reduction
Time : 10:00-10:30
Dariush Honardoust has earned his Doctorate (Cranio Facial) from the Faculty of Dentistry, University of British Columbia. He has completed his Post doctorate from the Division of Plastic Surgery, University of Alberta and Master's degree in Anatomy & Cell Biology from University of Western Ontario. The highlights of his qualifications include excellent record of teaching and clinical and research productivity and manuscript publications, conducting research projects and training graduate and undergraduate students, student advising and curriculum development. He is the President of the Canadian Association of Medical Spas and Aesthetic Surgeons. He also serves as the teaching Professor at the prestigious BC Academy of Medical Aesthetics & Skin Care.
Small leucine rich proteoglycans, decorin and fibromuduline are extracellular matrix molecules that regulate collagen fibrillogenesis and inhibit transforming growth factor-β (TGF-β1) activity; thus, they may play a critical role in regulating scar formation and wound healing. Down regulation of decorin and fibromoduline after wound healing in deep injuries to the skin plays an important role in the development of fibrosis and hypertrophic scars. Decreased anti fibrotic molecules such as decorin and fibromuduline in matrix of deep dermis of the skin and the unique features of the associated fibroblasts including an increased sensitivity to TGF-β1 stimulation contribute to the development of hypertrophic scars after injuries involving the deep dermis. Studying the characteristics of superficial dermal injuries that heal with minimal scarring will help us identify therapeutic approaches for tissue engineering and wound healing. Decorin also promotes neocollagenesis leading to skin tightening and reduction of skin laxity, fine lines and wrinkles. Direct injection of decorin or incorporating it with hyaluronic acid based injectable soft tissue dermal fillers can substantially enhance skin rejuvenation and tightening by promoting collagen fibrilogenesis and deposition at the site of injection. Decorin leads to firmer skin when is injected in laxing areas where the sign of aging is apparent as fine lines and wrinkles. Further studies are warranted to explore the significant role of decorin subcutaneous treatment in increasing the quality and quantity of collagen as a skin anti-aging therapeutic strategy
University of Alberta
Time : 10:30-11:00
Barry A S Lycka is one of the most respected and accomplished Cosmetic Dermatologists in the world. Having practiced for over 25 years, he has done over 10's of thousands of liposuction, Mohs Surgery, Injections, Fat Transfer and other elaborate procedures. While practicing in Edmonton since 1989, he has written 17 books, over 30 academic papers and is host of the number one internet radio show on cosmetic surgery: Inside Cosmetic Surgery Today. He is also the Founder of Your Cosmetic Doctor: The number one internet television show on cosmetic surgery.
Breast augmentation has been the number one cosmetic procedure in the world for a number of years according to the ASPS. The modern era of silicone breasts commenced with Frank Gerow’s implantation of the patient Timmie Jean Lindsey in 1962. Despite its ubiquity and generally inert nature, silicone implants generate intense debate and litigation, particularly in America. Still, it is not without complications as they occur in 5-7% in their immediate postoperative course. The worst of these include infections and capsular contracture. What is needed is a more natural augmentation process. Fat has been used as a natural reconstructive substance. Coleman recently reported impressive results in primary BA grafting, a remarkable mean amount of 277 cc per breast. However, that poses several problems; it can become necrotic, calcify and can mimic or hide breast cancer. As a result, the authors of this paper have developed a technique of fat augmentation they have named SVELT (Small Volume Elective Lipo Transfer) that minimizes these complications. The importance of this is that it uses small volumes of fat and does the treatment serially to get the best results. To date, over 1500 cases have been studied. This is an ongoing developing project between Dr. Barry A.S. Lycka in private practice in Edmonton, Alberta, Assistant Clinical Professor at the University of Alberta and Dr. Daryl K. Hoffman, a plastic surgeon from Palo Alto, California.
- Track 5: Clinical and Medical Dermatology
Track 6: Dermatology: Therapies and Advances
Track 7: Diagnostic Techniques in Dermatology
Texas Institute of Dermatology
Center of Dermatology and Cosmetology
Texas Institute of Dermatology, USA
Time : 11:15-11:35
Farrokh Khosravi has completed his Fellowship of Rheumatology in Shiraz University of Medical Sciences. He is a part time Assistant Professor of Medicine. His field of interest is autoimmune skin diseases and he has published papers in the field of Behcet's disease and Multicentric Reticulohistiocytosis in reputed journals and served as a Reviewer for Journal of Hormozgan University of Medical Sciences and Rheumatology Research Journal.
In this talk recent advances in understanding of drug induced fractures will be discussed. Fractures are the serious problem of the aged population, which is responsible for significant amount of morbidity and mortality. Any attempt to prevent or decrease incidence of fractures will save lives. Drugs increase Osteoporosis and Sarcopenia which both have a role in increasing fracture incidence. Sarcopenia is characterized by progressive and generalized loss of muscle mass and strength.
Washington University School of Medicine
Title: Clinical response of rosacea to treatment of small intestinal bacterial overgrowth with rifaximin: A case series of patients with ocular rosacea
Time : 11:35-11:55
Leonard B Weinstock has completed his MD at the Rochester University School of Medicine and Gastroenterology Fellowship at Washington University. His research revolves around extra-intestinal manifestations of SIBO (including rosacea, restless legs syndrome, fibromyalgia and chromic pelvic pain syndromes), control of systemic inflammation and intestinal dysbiosis. He has published more than 80 chapeters, papers and abstracts. His academic position is Associate Professor of Clinical Medicine and Surgery at Washington School of Medicine in St. Louis and he is the President of Specialists in Gastroenterology.
Background: Rosacea is associated with Crohn’s disease, liver disease, chronic pancreatitis, achlorhydria, Helicobacter pylori and recently with idiopathic small intestinal bacterial overgrowth (SIBO). Two publications demonstrated that rifaximin, a non-absorbed, gut-directed antibiotic for SIBO led to improvement in facial rosacea. Ocular manifestations occur in up to 58% of rosacea patients and include dry eyes, foreign body sensation, photosensitivity, eyelid inflammation, neovascularization and corneal ulcers. Methods: Patients who had been diagnosed with ocular rosacea by four ophthalmologists were referred for SIBO testing using the lactulose breath test (LBT). All were refractory to rosacea therapy. An open-label, IRB-approved trial of rifaximin 550 mg/3x/day for 10-14 days was performed in LBT-positive subjects. Ten and twenty days after ending rifaximin, subjects were queried if their eye symptoms had marked, moderate or mild improvement or if they were unchanged. Results: Twenty four patients (21F/3M), mean age 59 with facial involvement in 4 were tested. The LBT was positive in 9/24 (38%). LBT-positive subjects had chronic gastrointestinal symptoms in 63% vs., 33% in LBT-negative subjects. Rifaximin was prescribed to 9 LBT-positive subjects. Insurance denied the prescription in one subject. One subject was lost was to follow up. Improvement in ocular rosacea symptoms was marked (4), moderate (1) and mild (2). Conclusions: Rifaximin therapy led to improvement in ocular rosacea in the setting of SIBO. Dysregulation of the innate immune system as a result of gastrointestinal inflammation could lead to an increase in systemic cytokines and microbial antigens/antibodies in the skin and eyelids leading to activation of rosacea.
Professor Svyatenko Tetyana has completed her PhD at the age of 27 years from Bogomolets National Medical University (Kiev, Ukraine), has completed her Professor at the age 35 from Bogomolets National Medical University (Kiev, Ukraine). She is the director of Center Dermatology and Cosmetology of Professor Sviatenko. She is professor of Dermatovenerology department of Dniepropetrovsk state Medical Academy, Ukraine. She has published more than 300 papers in scientific journals and has been serving as an editorial board member of repute. Participant and speaker at more than 200 scientific congresses and symposia in Ukraine and abroad. Founded a school for atopic patients in Dnepropetrovsk region.
The skin is affected in 20-25% of all cases and is very important in the diagnosis, prognosis and course of sarcoidosis. In recent years the number of cases of sarcoidosis increased in Ukraine. We are observed men, born in 1967, complained about skin rash in the area of the upper third of the back slightly itching. The process progresses slowly(2 years). He was treated with the diagnosis: multiple warts? Lichen planus? – without effects. Patient also has a history of atopic dermatitis, androgenetic hair loss. The parents and close relatives are healthy. Physical condition was satisfactory. Pathological skin process is localized on the upper back. Rush is represented by single knots, up to 2 - 5 mm in diameter, multiple scattered and confluent lesions up to 3 cm in diameter, the colour red and pink, with telangiectasias, soft-elastic consistency, the surface smooth and shiny. On diascopy symptom of "dust", the phenomenon of "cape". Blood test results: normal range. Punch biopsy was provided. Histological investigation shown epidermis without changes, multiple epithelioid - cell granulomas are determined in papillary and reticular dermis with the presence of single giant polynuclear cells. Granulomas have clear boundaries, with the presence of single lymphocytes around some of them. When painting on Alcian blue PAS + cells of fungi have been identified. The basement membrane is within norm. No dermal mucin. The diagnosis: Cutaneous sarcoidosis. In our opinion, the case described introduce certain interest in the daily practice of a physician - clinician.This condition is rare and difficult to diagnose.
Gentiana GreLorGen Clinic, Prishtina
Title: Hyperpigmentation and their therapeutic treatment with (highway) magistral preparations and combined
Time : 12:15-12:35
Dr. Ylfete A. Shatri - Muçaj, a clinical dermatovenerology and pharmacology specialist for specialization of clinical pharmacology is one of the first generations for basic specialization in this field in Balkans. She finished post-graduation and specialization studies in the University of Novi Sad. Currently, she works in UCC in Prishtina from 1981; as a specialist of clinical pharmacology she has treated for 4 years patients with chemotherapy near Internal Clinic – Department of Hematology in UCC. She led for many years the laboratory for magisterial preparations in the Center Pharmacy and Dermatovenerology Clinic near CUU in Prishtina. She worked for some years in the Institute of Biochemistry near Diagnostic Center of CUU. Since 2001 she is working as a Clinical Dermatovenerologist and Pharmacologist in KDV and now leads Dermatological polyclinic and laboratory for magisterial preparations for several skin diseases and and aesthetic issues by which she treats patients in the polyclinic “GENTIANA GreLorGen”. She participated in many conferences and congresses in region and Europe with several scientific works in the field of clinical Dermatology, Oncology and Pharmacology and also as a lecturer of chemotherapy in the National Congress of Oncologists in Prishtina. She is a member of EADV and Kosovo Association of Dermatovenerologists and Oncologists.
The changes in the skin in the form of brown spots (hyperpigmentation) at humans, pose an aesthetic problem but also more a health problem/issue. Hyperpigmentation is presented in most of cases in the face region, but they do not spare other body also. During my research and the treatment of my patients, in my professional experience I have gone through patients with hyperpigmentation with different etiologies. Hyperpigmentation have multiethiology (conclusion). In the most of cases, they are signs that indicate and support us to find many internal disorders of the body and organism, just as an ID reaction to many diseases as: Endocrine (hormonal disorder), fungal infections, autoimmune disease (Morphea), therapeutic (either systemic or local), application of cosmetic preparations, and combined. In the time period July 2010 – 2015, in the clinic “GENTIANA GreLorGen” in Prishtina (Republic of Kosova), there have been treated in total 378 patients for various forms of hyperpigmentation, from whom, 34 male (9%) and 344 female (91%). These patients, in this research have been categorized in groups based in the etiology: Group I: Patients with Endocrine etiology (hormonal disorders); Group II: Patients with Autoimmune disease etiology; Group III: Patients with Mycotic (fungal) infections etiology; Group IV: Patients with Local and systemic therapeutics etiology; Group V: Patients with Cosmetic etiology; Group VI: Patients with different/combined etiology. Depending on the hyperpigmentation etiology, beside the local therapy with magisterial preparations, proper field specialists have been consulted as: Endocrinologist, Gynecologist, Cardiologist, and Rheumatologist. In addition, beside the local treatment with magisterial preparations as personal cream: ALBA-HYNOGEN, ALBAHYNOGEN M2, LORGEN SUN DAY, PREVITA-GEN, DEPEOR-KET, DEPEOR-GEN, ITRA-PEN, LOTTI FLU GEN, JORA-XH, PERIORB GEN, ANTISEP-CONT, ANTISEP-V; Patients have been treated with additional physical therapy as: MKDB (Micro dermo abrasion) combined with therapy. Conclusion: Hyperpigmentation treatment requires a proper multidisciplinary research and diagnostification, depending on its etiology and appearance
University Saints Cyril and Methodius
Time : 13:15-13:35
Vesna Grivcheva-Panovska has received her Tenured Professorship in Dermatology in 2013 at University Saints Cyril and Methodius in Skopje, Macedonia. She is the Head of the Unit of Allergy and Clinical Immunology at the University Clinic of Dermatology and she is In-charge of Clinical Diagnostics. She has been working in the field of HAE since 1984, publishing numerous papers in international journals and took active participation in six international scientific projects.
Hereditary angioedema (HAE) is a rare genetic, life-threatening disease. Patients affected by HAE most of the time are without visible signs of the disease, besides the attacks, which can be brutal, painful and lethal. Several therapeutic approaches have been developed and used with various success, recombinant human C1INH (rhC1INH) being the most innovative current approach. Recombinant human C1INH is a purified derivative from rabbit milk which expresses the gene that encodes the synthesis of C1INH. The amino acid sequence of the recombinant form is identical to the human C1INH. C1INH is single-chain plasma glycoprotein with a molecular mass of 73,650 belonging to the super-family of serine protease inhibitors in plasma. C1INH is the only known inhibitor of activated plasma subcomponents C1s and C1r of the complementary component 1 of the complementary cascade classical pathway. Furthermore, C1INH inhibits the Manan-associated serine protease 2 (MASP2) of the lectin pathway of the complement. Additionally, it is the main inhibitor of the activated factor XII, factor XI and kallikrein of the plasma contact system. The rhC1INH was primarily developed for treatment of acute angioedema attacks in patients with HAE due to C1INH activity deficiency. The rhC1INH inhibitory potential of target proteases C1s, kallikrein, factor XIa and factor XIIa is highly comparable to the endogenous human C1 esterase inhibitory potential in vitro. Additional data of the efficacy are obtained by multiple analysis of primary efficacy sensitivity end point as well as the results of secondary and explorative efficacy.
Dr. Sivanthi Aditanar College of Engineering
Time : 13:35-13:55
G Wiselin Jiji has completed his PhD from Anna University and Postdoctoral studies from University Medical Centre, Hamburg, Germany. She is the Research Director of Computer Science & Engineering in Dr. Sivanthi Aditanar College of Engineering, Tiruchendur. She has published more than 55 papers in reputed journals and has been serving as an Editorial Board Member of repute. She had completed 14 research projects in the area of Bio Medical imaging, Pattern Recognition and Remote Sensing Images. Her area of interest is neural network, image processing & medical imaging. She has received 12 National Awards and got HRD fellowship from Indian Council for Medical Research, New Delhi.
Identifying dermatological diseases is a challenging task nowadays. The Architecture employed three phases of operation to perform efficient skin lesion diagnosis. In the first phase, segmentation of Lesion region is calculated. Second Phase carries Color, Texture and shape feature vectors extraction. Iteratively calculated SVM weight values to all combination of feature sets and selected feature sets having highest significant p-map value. Third phase is employed by multi-class PSO Classiﬁcation technique. Experiments on 20 classes of 1450 images are analyzed and results are evaluated using receiver operating characteristic (ROC) curve, which proved that the proposed architecture is highly contributed to computer-aided diagnosis of skin lesions. Our empirical evaluation has a superior retrieval and diagnosis performance when compared to other works.
Belagavi Institute of Medical Sciences
Time : 13:55-14:15
Sushruth G Kamoji graduated (MBBS) from Jawaharlal Nehru Medical College, Belgaum and went on to pursue his Post Graduate Diploma in Dermatology from the prestigious Madras Medical College, Chennai. After completing his Post Graduation, Dr Sushruth G. Kamoji went on to do his Fellowship in Dermato-Surgery from the renowned Post Graduate Institute of Medical Sciences (PGIMER), Chandigarh. Dr Sushruth now works as a Resident Dermatologist at a Govt. medical college – Belgaum Institute of Medical Sciences, Belgaum.
Background: Acne vulgaris is a chronic inflammatory disease affecting majority of the adolescent population. It has been shown to have a severe impact on the psychosocial well being of a person. Objectives: To assess the psychological impact of acne vulgaris, to analyze their beliefs and outlook about treatment of acne. Materials & Methods: A total of 390 cases of acne attending a government tertiary hospital and private skin clinic were analyzed. After obtaining their consent each of them were handed a self administered questionnaire and their grade of acne noted by the investigator. Patients were analyzed using Cardiff Acne Disability Index for their psychological impairment and another set of questions to determine their beliefs on cause, monthly budget for treatment and preference for topical and oral medications in treatment of acne. Results: Out of 390 cases 194 (49.7%) were males and 196 (50.3%) were females. Majority (364-93.33%) of them were students. Of these 390 cases, 321 (82.3%) had either Grade-1 or Grade-2 acne while there were only 9 cases of Grade-4 acne. With regard to the CADI scores 59 cases had a score of >8, signifying psychological impact on due to acne. However, the overwhelming majority (84.87%) had a CADI score <8. This is in contradiction to most studies conducted worldwide. A large number of respondents said that they had acne on and off but persistent acne for more than a year was noted in 121 (31%) cases. Despite this 206 (52.82%) cases had never sought treatment for acne. In the remainder of 184 patients (47.17%) who took treatment, 82 of them had used the medication based on an advertisement, friend’s suggestion or an over the counter product. It was quite naturally that 110 (59.78%) cases were not satisfied with the treatment. Even though 102 cases were treated by doctors only 50 had been explained about the usage of medicines and course of the disease which is very important to maintain adherence in acne therapy. When questioned about the cost of therapy, 136 (34%) respondents said they would not want to spend more than INR 300 per month for treatment of acne. 144 (37%) patients said they wished to use only a night cream for their treatment. 276 (71%) patients considered, dermatologist was the right person to treat acne followed by their family doctor (13.58%). Acne was considered to be a cosmetic problem by 149 (38.2%). 214 (54.87%) cases felt their acne was due to hormones. 169 (43.33%) cases attributed their flare in acne to stress.
Umit Tursen has graduated from Gazi University as Medical Doctor. He has completed the Residency period of Dermatology in Ankara University, Faculty of Medicine and Department of Dermatology during 1995-1999. He has been working in Mersin University, School of Medicine, and Department of Dermatology since 2000. He is the Professor of Mersin University, School of Medicine, and Dermatology Department. He has published more than 80 papers in reputed journals, also books and serving as an Editorial Board Member of repute. He won Behcet’s Disease Research Award of “The scientific and technical research council of Turkey (TUBITAK)” in 1999.
Ingrown toenail is an often painful clinical condition that usually affects the big toe. Chemical matricectomy with phenol has a low recurrence rate and good cosmetic results. However, it produces extensive tissue destruction that can result in drainage and delayed healing. Alternatives such as sodium hydroxide and trichloroacetic acid (TCA) have therefore come into vogue. A total of 39 patients with 56 ingrown toenail edges underwent chemical matricectomy with 90% TCA after partial nail avulsion. In most of the patients, adverse effects such as postoperative pain and drainage were minimal. One patient who underwent matricectomy had recurrence in a single nail edge (1.8%) at 12 months follow-up. No recurrence was observed among 38 patients during the mean follow-up period. This was considered to be statistically significant (P<0.001). Partial nail avulsion followed by TCA matricectomy is a safe, simple and effective method with low rates of postoperative morbidity and high rates of success.
Sun Yat-sen University
Liyan Xi has completed her MD and PhD from Chinese Academy of Medical Sciences, Peking Union Medical College. She is the Vice-Chairperson of Chinese Society for Medical Mycology and the Vice-Chairperson of the Committee of Guangdong Medical Society for Dermatologist. She has published 51 scientific papers in reputed journals and has been serving as an Editorial Board Member of many journals focused on Medical Mycology and Dermatology.
Chromoblastomycosis as a chronic, cutaneous and subcutaneous infection has been reported more than 600 cases in China, but it has not been known to cause outbreaks until now. Several dematiaceous fungi are involved with the disease etiology, Cladophialophora carrionii is the most common agent in the North China, while Fonsecaea monophora instead of F. pedrosoi and F. nubica is the most common agent in the southern region. Infection commonly initiated after the etiologic agents gain through puncture wounds and mostly involved extremities of the males. Clinically, the lesions are polymorphic, including plaque, tumoral, cicatricial, verrucous, pseudo-vacuole, eczymatous and mixed type, which should be differentiated from some diseases associated with similar manifestation. The factors related to successful therapy for chromoblastomycosis might be pathogens, manifestations and severity. The common treatments include chemical therapy (systemic antifungal agents single used or combined) and physical methods, such as surgery, thermotherapy and cryotherapy. Patients with mild type of lesions could be treated successfully with systemic antifungal mono-therapy or combined therapy. But it is extremely difficult to eradicate severe lesions which are recalcitrant and disabling. Photodynamic Therapy (PDT) as a minimally invasive approach combines a non-toxic photoactivatable dye as photosensitizer with harmless visible light of correct wavelength to generate reactive oxygen or molecules that are toxic to target cells. It has recently been applied to the drug-resistant or recalcitrant chromoblastomycosis and showed considerable effects with promising future.