PracticeUpdate Dermatology Best of 2018

EXPERT OPINION 23

AAD 2018 Annual Meeting: Dr. Eliot Mostow's Take-Aways By Eliot N. Mostow MD, MPH

Dr. Eliot Mostow is Professor and Head of the Dermatology Section at Northeast Ohio Medical University (NEOMED) in Rootstown, Ohio. I really enjoyed the AAD Meeting and went to a number of favorite sessions that prompted me to think and consider new ways to help my patients and colleagues. The Medical Dermatological Society had another great meeting on the Thursday before the official opening, but my favorite lecture was Dr. Tim Berger talking about itch. My take home is to get more comfortable with gabapentin and other agents that work more on nerve hyperactivity leading to itch, rather than hoping antihistamines will work when I know they won’t (eg. prurigo nodularis). Sancy Leachman’s symposium on melanoma diagnostics was excellent, blending cut- ting-edge imaging technology (not ready for prime time for most of us) with artificial intelligence (great lecture by Dr. Rob Novoa from Stanford helping us understand how the AI diagnostic algorithms work…and don’t sometimes). Sancy’s enthusiasm to “do something” in concrete ways in Oregon is really great too. She outlined a multipronged approach to identifying melanomas at earlier stages (including everything from working with hairstylists and masseuses to education of all doctors to “pay attention” to focused screening efforts to genetic testing to guide us for more effective traditional cancer screening exams). I also enjoyed Michael Ming’s review of apps for patients that might help improve engagement and identification of changing lesions. The plenary session highlights for me were Dr. Meg Chren’s presentation that focused on patients and meaningful measurements we can apply to domains of function and other measures of quality of life. It was practical and inspired. That being said, Dr. Abraham Verghese’s keynote speech was genuinely inspiring. Addressing burnout by recogniz- ing and acknowledging our humanity and needs along with those of our patients and colleagues will go a long way to improving the quality of all our lives! I hope we have the option to watch that talk again. As the incoming chair of the Practice Operations commit- tee of the AAD, we are tasked with addressing physician burnout as one of our priority items. While I think this is a bit overwhelming as a committee item, I’m looking forward to taking some concrete actions, listening to others suggestions, and optimistically hop- ing that dermatologist burnout becomes less of an issue for our specialty. Our own Dr. Bob Brodell gave an inspirational talk on ways to “take action” to make a difference for people who are less fortunate and have problems accessing derma- tology services. He highlighted his experience in Mississippi, but his regular message over many years of knowing him is to have a vision of making things better and then “do something about it”….he walks the walk in this regard with tireless optimism and enthusiasm. This was part of a series of short talks aimed at this same topic…how to improve access! I hope we all go home and do just a little more in some way to make a difference. Of course, I’m biased that I loved the wound care symposium I helped moderate. Dr. Fivenson gave a great presentation reminding us of the wide differential diagno- ses that can underlie difficult to heal wounds. Once that issue is identified and treated, wound healing generally proceeds much better. Of course, multiple diagnoses can complicate things and Dr. Andrea Maderal gave a great presentation featuring Case vignettes to highlight connective tissue disease issues leading to or complicating cuta- neous ulcers. She was followed by Dr. Jennifer Tang who discussed treatments options for acute wounds including the consideration of secondary healing with adjunctive advance healing dressing as appropriate. Finally, and I had to leave at the beginning of his presentation to catch a plane, Dr. Hadar Lev-Tov gave a presentation on the pre- vention of venous leg ulcers including a practical demonstration activity of effective compression therapy. If you read this far, thanks. I hope you enjoyed the meeting as much as I did. www.practiceupdate.com/c/64545

holoclones that repopulated the grafted areas and replenished the population of corrected cells. Although this treatment was expensive and is not commercially available, it provides hope to patients and clinicians that this technique might be successfully replicated in future patients with this highly debilitating disease. References 1. Pöyhönen H, Nurmi M, Peltola V, et al. Dental staining after doxycycline use in children. J Antimicrob Chemother 2017;72(10):2887-2890. 2. Olijve L, Jennings L, Walls T. Human parechovirus: an increasingly recognized cause of sepsis- like illness in young infants. Clin Microbiol Rev 2018;31(1):e00047-e00017. 3. Chong JH, Mermin D, Marti A, et al. Red palms associated with adenovirus gastroenteritis. Arch Dis Child 2017;102(9):868-869. 4. Chuh A, Panzer R, Rosenthal AC, et al. Annular eruptive pseudoangiomatosis and adenovirus infection: a novel clinical variant of paraviral exanthems and a novel virus association. Acta Derm Venereol 2017;97(3):354-357. 5. Yilmaz M, Chemaly RF, Han XY, et al. Adenoviral infections in adult allogeneic hematopoietic SCT recipients: a single center experience. Bone Marrow Transplant 2013;48(9):1218-1223. 6. Yu J, Streicher JL, Medne L, et al. EPHB4 mutation implicated in capillary malformation-arteriovenous malformation syndrome: a case report. Pediatr Dermatol 2017;34(5):e227-e230. 7. Amyere M, Revencu N, Helaers R, et al. Germline loss-of-function mutations in EPHB4 cause a second form of capillary malformation- arteriovenous malformation (CM-AVM2) deregulating RAS-MAPK signaling. Circulation 2017;136(11):1037-1048. 8. Jeng MR, Fuh B, Blatt J, et al. Malignant transformation of infantile hemangioma to angiosarcoma: response to chemotherapy with bevacizumab. Pediatric Blood Cancer 2014;61(11):2115-2117. 9. Heller E, Murthy AS, Jen MV. A slime of the times: two cases of acute irritant contact dermatitis from homemade slime. Pediatr Dermatol 2018 Aug 28. doi: 10.1111/pde.13617. [Epub ahead of print.] 10. Zhang AJ, Boyd AH, Asch S, Warshaw EM. Allergic contact dermatitis to slime: The epidemic of isothiazolinone allergy encompasses school glue. Pediatr Dermatol 2018 Oct 15. doi: 10.1111/ pde.13681. [Epub ahead of print.] 11. Hirsch T, Rothoeft T, Teig N, et al. Regeneration of the entire human epidermis using transgenic stem cells. Nature 2017;551(7680):327-332. www.practiceupdate.com/c/75535

VOL. 2 • NO. 4 • 2018