Day 1 :
Keynote Forum
Thomas Haffner
Heumarkt Clinic, Germany
Keynote: New methods for centro-facial rejuvenation
Time : 09:45-10:45
Biography:
Thomas Haffner is a Board Certified Reconstructive, Vascular and Cosmetic Surgeon in Germany. He was trained in the Reconstructive-Plastic Surgery and Senology Section at the Semmelweis University, Budapest. He is specialized in Vascular Surgery and has worked as Department Leader in German clinics. He was a Resident Assistant under Professor Rettinger in Ulm. In 2000, he established his private clinic for vascular-reconstructive and aesthetic surgery in Cologne, Germany. His primary focus is the breast and facial surgery using minimal invasive and endoscopic methods. He invented the innovative vertical scar free reconstructive 3D mastopexy.
Abstract:
Background: Centro-facial structures, such as the midface and the orbital with the periorbicular region are the main regions, in that aging with tissue weakness and depletion arise first. Early changes by aging are characterised by tissue depletion and ptosis, which are focused on orbital and the midface. Jawline is not caused by sunken lateral facial portions, but can cause down sliding of tissues from mid face towards the jawline. The result is Jawline and deepening of nasolabial folds. The skeletonisation of the lower lid and arcus marginalis give an effect of hollow eyes with dark circles which are the typical signs of midface ptosis.
Objectives: The authors show the limitations of old fashioned cosmetic rejuvenations such as a classical lower lid blepharoplasty, conventional facelift or brow lift procedures. According to their experience of more than 20 years in facial plastic surgery they developed sophisticated new methods for all centro-facial portions, for the brows and foreheads, for the upper-and lower lid and for the midface too. The goal is to present the pro- and contra of established and new methods.
Methods: The new technique of facial surgical reconstructions of the forehead and brows, of the upper eyelids, of the lower eyelids and the midface are presented by demonstration of typical cases. Semi-invasive and non-invasive methods such as thread lift, fillers and fat sculpture of the face are shown in contrast. The different techniques of midface and lower lift such as subciliar, transconjunctival and endoscopic temporal approaches such as the orbicular augmented blepharoplasty are shown also by teaching videos.
Results: A coronal forehead lift should be done only exceptional; the stigmas after this procedure are no more justifiable in the era of endoscopic procedures. However, the hairline is lifted backwards by an endoscopic forehead lift. Therefore, an endoscopic forehead lift is suitable only for patients with short brow-hairline distance. In any other cases, the authors perform temple lift or temporoparietal endoscopic lift with short scar hidden by the hairline. Conventional upper eyelid rejuvenation with excessive resection of the orbicular muscles is obsolete. The prevention of iatrogenic hollowing by blepharoplasty is stressed. The authors show their excellent results by their orbicular preserving and augmenting blepharoplasty. According to the experience of the authors, a conventional lower lid blepharoplasty should be made in the 21st century without skin excision. For tightening the lower lid and other methods, such as the transconjunctival blepharoplasty, the midface-lower lift and the dual plane midface lift with skin-excision free blepharoplasty are to be done.
Keynote Forum
Marcela Del RÃo-Nechaevsk
Universidad Carlos III de Madrid (UC3M), Spain
Keynote: Innovative therapies for inherited skin disorders
Time : 10:45-11:45
Biography:
Marcela Del Rio Nechaevsky is full Professor of Experimental Dermatology at the University Carlos III de Madrid (Spain). She is the head of the Unit 704 at Centre for Biomedical Research on Rare Disease (CIBERER), as well as the director of the Regenerative Medicine and Bioengineering Group at the Fundación Jimenez Diaz hospital. She has worked on regenerative medicine for more than 20 years. Her current research interest lies in discovering what causes inherited skin diseases and what can be done to develop new clinically relevant, evidence-based personalized medicine for people living with inherited disorders of the skin. She now leads and collaborates on several National and International projects to develop advanced therapies (cell-, gene- and tissue engineered based therapies).
Abstract:
Monogenic skin diseases, also known as genodermatoses, constitute about 7-8% of rare diseases and together represent a significant part of dermatology. Currently the genetic basis of more than 400 genodermatoses, have been elucidated which allows classification, molecular diagnosis, understanding their pathogenic mechanisms and finally the development of safe and effective curative evidence-based therapies treatments. As with other types of rare diseases, often the consequences of genodermatosis are devastating for the patients, their families and friends.
Genetic skin diseases comprise epithelial adhesion, keratinization, pigmentation, DNA repair, and connective tissue disorders. In this conference, the focus will be set on epithelial adhesion disorders, ie epidermolysis bullosa (EB). EB comprises a group of skin diseases characterized by defects in epithelial-mesenchymal adhesion. EB is genetically and clinically heterogeneous. Phenotypes range from mild to severe muco-cutaneous presentations. In the last years, remarkable advances in the development of innovative treatments for EB have been achieved. The strategies include, read-through drugs, cell therapy, tissue bioengineering and gene therapy approaches (viral and non-viral) employing exon skipping, gene addition and gene editing strategies among others. During the conference preclinical and clinical breakthrough from our laboratory and others will be thoroughly reviewed and discussed.
Keynote Forum
Irdina Drljevic
Medical Faculty University of Zenica, Bosnia and Herzegovina
Keynote: Small-diameter melanomas: clinical-dermoscopic challenge in early diagnosis
Time : 12:00-13:00
Biography:
Irdina Drljevic is currently employed at the “Private Dermatology and Venereology Practice - Dr. Drljevic” in Sarajevo and at the Department of Public and Preventive Health and Infectious Diseases of the Medical Faculty and School of Health Care University of Zenica, where she was awarded the title of Assoc. Professor in 2011, and Professor in 2017. In 2008 she completed a respectable International School of Dermoscopy at the Department of Dermatology, Medical University of Graz, Austria, under the guidance of esteemed professors Peter Soyer and Giuseeppe Argenziano, and a year later she was educated in a class led by professor Harald Kittler in Viena, Austria. She was a visiting lecturer at several plenary conferences and symposiums on dermatology in the Region of SI Europe, and in Bosnia and Herzegovina. She is one of the founders and the first vicepresident of the Balkans Association of Dermoscopy (BAD) active since 2011, where she has been engaged as a licensed lecturer of the BAD. Dr. Drljevic is the first and current President of the Dermoscopy Association of B&H established in 2011. In December 2013, in the capacity of the President of the Organization Committee of the First Winter School of Dermoscopy with International Participation, she made a large contribution in education of specialists dermatologists, plastic surgeons, family medicine doctors and others.
Abstract:
Background: Melanoma is a leading cause of death from skin diseases due to potentially lethal nature. Thus, early diagnosis of melanoma cannot be overemphasized because thin melanomas have an excellent prognosis. Special difficulties in early detection of melanoma lie in melanocytic lesions whose diameter is below 6 mm, hypo-pigmented and non-pigmented lesions, and regular and rather clearly defined papular and nodular lesions regardless of their color (differential diagnosis: desmoplastic melanoma, Spitz nevus, Blue nevus). Briefly, there are many reasons to miss the diagnosis of small-diameter melanoma, particularly because melanoma is an excellent imitator of benign skin tumors. On the other hand, we can always use clinical, well-known ABCDE acronym for small-diameter melanomas and the dermoscopy as an additional diagnostic test often prevents the application and questions the “excellence” of known dermoscopic algorithms.
Aim: Emphasize and pay attention to this diagnostic challenge in everyday clinical and dermoscopic practice.
Method: We have demonstrated several interesting clinical-dermoscopic cases of patho-histologically verified melanoma with the diameter below 6 mm, including a rare naevoid malignant melanoma. We analyzed gender, age, anatomic localization, dermoscopic structures and patho-histological parameters, especially in terms of prognostic factors.
Conclusions: In order to recognize very small melanoma total body skin examination (TBSE) needs to be performed, detailed family and personal anamnesis needs to be obtained, the clinical ABCDE acronym is to be followed as much as possible and the classical algorithm, so called pattern analysis, should be applied in dermoscopic analysis of a suspicious lesion. Timely diagnosis and excision of the suspicious lesion with pathohistological verification are crucial for the prognosis, i.e. patient’s survival.
Recent Publications:
1 Drljevic I. Face melanoma and dermoscopy including differential diagnosis. IV Congress of Dermatovenerologists of Mecedonia with international participation. Ohrid, Macedonia,2009.
2 Drljevic I. Risk of a second cutaneous primary melanoma and basal cell carcinoma in patients with a previous primary diagnosisof melanoma: true impact of dermoscopy follow-up in the identification of high-risk persons. Serbian Jornal od Dermatology and Venereology. 2010; 2 (4): 146-148.
3 Drljevic I. Dermoscopy of head melanoma-case studies and review of references. Our Dermatology Online Journal. 2012; 3(2): 123-125.
4 Bandic J, Dobrosavljevic D, Drljevic I. et sur. Double coparison of teledermoscopy: Interobserver variability and relation to histpathology. Abstracts from the 3rd World Congress of Dermoscopy, May 17 to 19, 2012, Brisbane, Australia. Dermatol Pract Conc. 2012; 2 (2 suppl):16
5 Drljevic I. Melanoma malignum and basal cell carcinoma. Skin cancer of the skin-case reports of skin tumors. Our Dermatology Online Journal. 2014; 35-36.
6 Drljevic I. Superficial spreading and nodular melanoma. Skin cancer of the skin-case reports of skin tumors. Our Dermatology Online Journal. 2014; 50-52.
7 Drljevic I. Supeficial spreading melanoma and basal cell carcinoma. Skin cancer of the skin-case reports of skin tumors. Our Dermatology Online Journal. 2014.
8 Drljevic I, Bjeloševic E, Denjalic A, Drljevic K. Melanocytic lesions and dermoscopy in childhood: diagnosis, therapy and foloving. Our Dermatol Online. 2016; 7(1): 97-100.
- Skin Cancer | Melonoma | Infectious Disease | Psoriasis | Vitiligo | Overview of dermatitis
Chair
Thomas Haffner
Heumarkt Clinic, Germany
Co-Chair
Marcela Del RÃo-Nechaevsk
Universidad Carlos III de Madrid (UC3M), Spain
Session Introduction
Thomas Haffner
Heumarkt Clinic, Germany
Title: LHP - Laser haemorrhoid Plastic Operations: the revolution in the haemorrhoid treatment
Biography:
Thomas Haffner is a Board Certified Reconstructive, Vascular and Cosmetic Surgeon in Germany. He was trained in the Reconstructive-Plastic Surgery and Senology Section at the Semmelweis University, Budapest. He is specialized in Vascular Surgery and has worked as Department Leader in German clinics. He was a Resident Assistant under Professor Rettinger in Ulm. In 2000, he established his private clinic for vascular-reconstructive and aesthetic surgery in Cologne, Germany. His primary focus is the breast and facial surgery using minimal invasive and endoscopic methods. He invented the innovative vertical scar free reconstructive 3D mastopexy.
Abstract:
Background: Centro-facial structures, such as the midface and the orbital with the periorbicular region are the main regions, in that aging with tissue weakness and depletion arise first. Early changes by aging are characterised by tissue depletion and ptosis, which are focused on orbital and the midface. Jawline is not caused by sunken lateral facial portions, but can cause down sliding of tissues from mid face towards the jawline. The result is Jawline and deepening of nasolabial folds. The skeletonisation of the lower lid and arcus marginalis give an effect of hollow eyes with dark circles which are the typical signs of midface ptosis.
Objectives: The authors show the limitations of old fashioned cosmetic rejuvenations such as a classical lower lid blepharoplasty, conventional facelift or brow lift procedures. According to their experience of more than 20 years in facial plastic surgery they developed sophisticated new methods for all centro-facial portions, for the brows and foreheads, for the upper-and lower lid and for the midface too. The goal is to present the pro- and contra of established and new methods.
Methods: The new technique of facial surgical reconstructions of the forehead and brows, of the upper eyelids, of the lower eyelids and the midface are presented by demonstration of typical cases. Semi-invasive and non-invasive methods such as thread lift, fillers and fat sculpture of the face are shown in contrast. The different techniques of midface and lower lift such as subciliar, transconjunctival and endoscopic temporal approaches such as the orbicular augmented blepharoplasty are shown also by teaching videos.
Results: A coronal forehead lift should be done only exceptional; the stigmas after this procedure are no more justifiable in the era of endoscopic procedures. However, the hairline is lifted backwards by an endoscopic forehead lift. Therefore, an endoscopic forehead lift is suitable only for patients with short brow-hairline distance. In any other cases, the authors perform temple lift or temporoparietal endoscopic lift with short scar hidden by the hairline. Conventional upper eyelid rejuvenation with excessive resection of the orbicular muscles is obsolete. The prevention of iatrogenic hollowing by blepharoplasty is stressed. The authors show their excellent results by their orbicular preserving and augmenting blepharoplasty. According to the experience of the authors, a conventional lower lid blepharoplasty should be made in the 21st century without skin excision. For tightening the lower lid and other methods, such as the transconjunctival blepharoplasty, the midface-lower lift and the dual plane midface lift with skin-excision free blepharoplasty are to be done.
Ugo Onyeka
University of Debrecen, Hungary
Title: Skin bleaching: a neglected form of injury and threat to public health
Biography:
Dr. Ugo Onyeka is a graduate of University of Debrecen where she also worked as a researcher at the University of Debrecen Clinical Laboratory. She is passionate about Dermatology and developed a deeper sense of engagement towards the specialty while working in Nigeria. She continues to advocate the need for education, intervention and public awareness on good skin practices.
Abstract:
The objective of the data collated in this survey research is to: Call to action the public health crisis that is skin bleaching and discuss more compatible forms of intervention.
Skin bleaching is the use of chemical agents such as creams, ointments, gels or soap to lighten the skin. Skin bleaching, as a public health crisis is a peculiarly understudied area of public health and efforts to prevent injuries to the skin or skin safety has received little or no attention despite the increasing number of casualties? While exposure to solar radiation accounts for a larger proportion of skin traumas in the form of cancer among vulnerable population, skin damage resulting from skin bleaching is one of the most common forms of potentially harmful body modification practices worldwide and comparatively, has been given little research attention. Obtaining prevalent rates on skin bleaching is challenging particularly in Nigeria where there is an unspoken precedent towards bleaching with an existential reality to how lighter skin is socially perceived and rewarded. For the purpose of this survey research, the focus is on the Nigerian market analysis conducted on women who bleach or have used bleaching products in the past. References to other countries faced with the same conundrum such as: Jamaica, India, Japan, Tanzania will be inferred. Results showed that 80% of women who use bleaching products had no knowledge to the harmful ingredients contained in the products or the extent to it’s effects on general health and skin health. 70% of users from the sample do not use sunscreen consistently or at all and 58% of users would like to stop but either does not wish to get darker or are sensitive to societal pressure and obscenities. These contemporary motivations are linked to cultural contributions in society (i.e. westernization) and psychological contributions. Personal motivation was largely based on societal perception of beauty. Key factors in the survey included:
- Age, Marital Status, Educational Level
- Awareness of side effects or ingredients contained in products
- The use of sunscreen
- Monthly expenditure on products
- Duration of use
- Personal motivation for use and efforts to stop.
Bleaching agents contain active ingredients such as hydroquinone, mercury, or corticosteroids, which reduce or inhibit the synthesis of melanin (Olumide et al. 2008). Repeated exposures of the skin to the bleaching agents inhibit the activity of the enzyme tyrosine. This results in reduction in the quantity of melanin in the skin. Eventually, the skin colour becomes lightened. Since the epidermal turnover period is approximately 28 days, there is a need for recurrent usage of the bleaching agents on the skin and uniformity of skin color. This causes the skin to become fragile and irritable, putting bleachers at high risk for serious skin conditions that pose both aesthetic and medical complications, including Skin lesions, hyperpigmentation, ochronosis, eczema, and severe acne (Faye et al. 2005; Ly et al. 2007). The long-term use of skin-bleaching creams is also linked to a higher risk of developing cancers, hypertension, liver and kidney disease or failure, and infertility (Pitche et al. 2005; Ramsay et al. 2003). In fact, research in sub-Saharan Africa suggests that skin bleaching is a major contributor to the high incidence of skin cancer and leukemia in Africa and among the four leading malignancies in Africa (Amir et al. 1992). Despite these great risks, skin bleaching is still prevalent on the African continent.
References
Adebajo, S. B. (2002). An epidemiologic survey of the use of skin lightening cosmetics among traders in Lagos, Nigeria. West African Journal of Medicine, 21, 51–55. Fitzpatrick, T. B. (1988). The validity and practicality of sun reactive skin type I through VI. Archives of Dermatology, 124(1), 41–43.
Hall, R. E. (1999). The myth of third world solidarity: Hypergamy by skin color as a vehicle of racism vis-a`-vis African-Americans. Psychologia, 7(1), 1–23.
Consequences of skin bleaching in Nigerian men and women, Frances O. A. Ajose, FRCP. Skin bleaching: highlighting the misuse of cutaneous depigmenting agents OE Dadzie,†* A Petit‡ . Skin Bleaching and Dermatologic Health of African and Afro-Caribbean Populations in the US: New Directions for Methodologically Rigorous, Multidisciplinary, and Culturally Sensitive Research Emma K. T. Benn, Andrew Alexis, Nihal Mohamed, Yan-Hong Wang, Ikhlas A. Khan, and Bian Lin
Tanja Planinsek Rucigaj
University Medical Centre Ljubljana, Slovenia
Title: Our experience with different endovenous procedures
Biography:
Tanja Planinsek Rucigaj is currently working as Head of Dermatovenereological Clinic, University Medical Centre Ljubljana, Slovenia. She is also active Vice-President of Balkan Venous Forum; President of Slovenian Flebological and Lymphological Society; Teacher of Dermatovenereology at Faculty of Health Angele Boskin, Jesenice, Slovenia and Member of the Expert Council of the Association of Vascular Disease in the Slovenian.
Abstract:
From September 2017 to the end of September 2018, 106 patients with venous insufficiency were treated surgically at the Dermatovenereological Clinic, University Medical Centre Ljubljana. We performed endovenous ablations with laser, radiofrequency, glue, steam and mechano-chemical ablation. The results of both radio frequency and laser methods were are comparable to each other. We have only few cases treated with glue and mechano-chemical ablation, therefore statistical comparison to other methods is not yet possible. However, we find slightly higher percentage of smaller recanalisations in patients who were treated with steam. Patients were very satisfied with the result after all types of the procedures.
Biography:
DR AJAY KUMAR SINGH has completed medical graduation from Agra, India at the age of 26 and Dermatology, Venereology, Leprosy Postgraduation from Pondicherry University, 2008, India. He is the Chief Consulant Dermatologist & director of DSL clinics, New Delhi, INDIA, He has presented various dermatology,venereology papers at national and international congresses-EADV,IADVL. He was associate editor to write a book on Paediatric Dermatology. Had comleted laser course from Havard Medical School, Boston.USA and advance cosmetic dermatology trainings from, London, Germany & Slovakia. EADV fellowship winner at Kracow, Poland.
Abstract:
Lymecycline is a semi synthetic tetracycline antibiotic with improved oral absorption,enhanced tissue penetration and slower elimination relative to tetracycline.Lymecycline has been in clinical use for several decades in the proposed indications and has a well –established benign profile.Lymecycline generally bacteriostatic against a wide variety of organisms both gram positive and gram negative.These drugs enter gram negative bacteria by passive diffusion through hydrophilic channels formed by the porin proteins of the outer cell membrane and by active transport via an energy-dependent system that pumps all tetracyclines across the cytoplasmic membrane.Entry of these drugs into gram positive bacteria requires metabolic energy,but is not as well understood.This system is also believed to exist in gram positive bacteria.
PHARMACOKINETICS
Lysinomethyl-tetracycline
Plasma t1/2: 8 (7-14) hrs
Time to peak concentration (tmax): 3 hrs (after 300mg PO)
Peak concentration (Cmax): 2.1 mg/L (after 300mg PO)
Around 30% of active drug excreted unchanged in urine
Water soluble prodrug of tetracycline (Better oral absorption)
PHARMACODYNAMICS
Lymecycline is a tetracycline broad-spectrum antibiotic
Antibacterial and anti-inflammatory effects
It inhibits ribosomal protein synthesis by preventing the association of aminoacyltRNA with the bacterial ribosome (30S subunit)
Bacteriostatic (Reversible association with ribosome)
Spectrum of action: Gram-positive and negative bacteria, chlamydiae, mycoplasmas, rickettsiae, spirochaetes, protozoan parasites (P. falciparum, Entamoeba histolytica, Giardia lamblia, Leishmania major, Trichomonas vaginalis, Toxoplasma gondii)
INDICATIONS
Acne,Rosacea,Perioral dermatitis,Chlamydia trachomatis infection,Reactive arthritis, Hidradenitis Suppurativa, M.marinum infection, Progressive macular hypomelanosis, Frontal fibrosing alopecia, Pyoderma gangrenosum
CONTRAINDICATIONS
Hypersensitivity to tetracyclines.
Pregnancy or lactation in women breast feeding infants.
Advanced renal/hepatic insufficiency.
Concurrent treatment with oral retinoids
It has seen that during the treatment duration the acne lesion especially nodule and cysts have responded very well from Lymecycline in comparisons to Doxycyline moreover patients who developed some resistance to other systemic drugs, responded wonderful by Lymecycline 408 mg. There is also not seen any Phototoxic reaction with Lymecycline which are usually seen with Doxycycline. Patients have fewer side effects by lymecycline. Lymecycline is also found to be effective in patients with mild inflammatory papules and Pustules.
DOSAGE & ADMINISTRATION
Adults:
For other infections, the usual dosage is Lymecycline 408mg (equiv. tetracycline base 300mg) twice a day. If higher doses are required, 1224- 1632mg (3-4 capsules) may be given over 24 hours.
Biography:
Lely Nurjanti has completed her Graduation from Airlangga University, Indonesia in 2005. She has been working as Dermatovenereologist at Dermatovenereology Department of Abdul Wahab Sjahranie General Hospital, Samarinda, East Kalimantan since 2006. She has been practicing as Dermatovenereologist at Provit Clinic in Samarinda, Indonesia since 2006. She was the Coordinator of Dermatovenereologist Medical Faculty Education Programme at Dermatovenereology Department of Abdul Wahab Sjahranie General Hospital-Mulawarman University, Samarinda, East Kalimantan, Indonesia in 2007. She was the Secretary of Dermatovenereology Continuing Education Organization for East Kalimantan, Indonesia in 2008. She has published some national and international case reports as oral presentation and poster presentation in Dermatovenereologist conferences in 2002-2005 and 2017-2018 (Indonesian Dermatovenereologist Annual Meeting Congress, Yogyakarta, Indonesia 2003- one oral presentation, Regional Dermatology Congress Asian-Australian Bali, Indonesia 2004- two posters, Singapore Dermatology Updated 2004- one poster and oral presentation, Indonesian Dermatovenereologist National Congress, Semarang, Indonesia 2017- one poster, 17th European Dermatology Congress, Paris, France 2018- e-poster and oral presentation).
Abstract:
Introduction: Acne vulgaris was not infectious, and is very common, chronic inflammatory, self-limiting disease of pilosebaceous units. Affected approximately 85% of adolescent was physiological acne and 10-15% manifest as clinical acne. Four major factors were involved in the etiopathogenesis: follicular hyperkeratinization, increased sebum production, abnormality of microbial flora and inflammation process. Acne vulgaris inflammation process was divided into early stages (adaptive Th1 cell and innate immune complement to non-specific antigen) and late stages (innate and adaptive immune response to specific antigen). Acne vulgaris dermal inflammation was not directly caused by bacteria in the dermis, but it was resulted from biologically active mediators that diffuse from follicle. Pro inflammatory mediators in acne had no protective role but it had harmful effect causing persistent inflammation, soft tissue destruction and scar formation, cell cycles control disturbances-cell survival and apoptosis, termination of differentiation and proliferation, hyperkeratinization, sebaceous glands hypertrophy and lipogenesis, pruritus and pigmentation. Biological active mediators were produced in innate immune response by the binding of the bacterial PAMPs to innate surface PPRs (TLR2 and TLR4) of the keratinocytes, sebocytes and phagocytes, through innate cell cytoplasm PPRs-NLRP3 inflammasome activation, through PAR2 gene activation, through FGFR2 of keratinocytes activation. Biological active mediators were also produced by adaptive immune response by the binding bacteria that had been recognized by APC (through MHC class II) to the CD4+ of naive T cells that activated Th1, Th2, Th17 and Treg. Anti-proinflammatory mediator drugs (the effects of some drugs were still in research): acted in NFkB central pathways (steroids), antagonist TLR2 (isotretinoin), acted in NLRP3 (nitric oxide), decreased of expression of PAR2 gene-TNFα (tetracycline, doxycycline, minocycline), inhibited retinoid catabolism-antagonist TLR2 (erythromycin, roxithromycin, clarithromycin), down regulated TLR2 and TLR4 receptors (ALA PDT), antagonist FGFR2 (anti androgen, isotretinoin, BPO, tetracycline, erythromycin), IL1 targeted agents (Anakinra, rilonacept, canakinumab), TNFÉ‘ inhibitor (etanercept, infliximab, adalimumab), leukotriene B4 antagonist (zileuton), leukotriene antagonist (montelukast), immunotherapy (immunization-CAMPS was neutralized and prevented inflammation).
Case Report: Five cases of acne vulgaris 3rd to 4th grade in female patients, 20-30 years old who had been treated by combination of topical tretinoin 0.05% and fluocinolone acetonide 0.025% for four weeks were reported. The results were good (decreasing acne to 1st grade to no acne). Tretinoin 0.025% was chosen as maintaining the treatment.
Discussion: Treatment of choices for chronic inflammation in acne was proinflammatory antagonist drugs. Steroid (acted in NFkB pathway) and tretinoin (antagonist TLR2 and FGFR2) topical combination had good results. Tretinoin decreased comedo, sebum production and hyperkeratinization, normalized keratinization and differentiation, replaced disorganized collagen fibers and formed thicker-elastic epidermis (skin rejuvenation), decreased PIH and scar/keloid formation. Steroid decreased chronic persistent inflammation and scar formation and decreased erythema and irritancy those were caused by tretinoin.
Evi Mustikawati Arifin
Hasanuddin University, Indonesia
Title: The correlation of CYP17 gene polymorphism and increase of Sebum level on Acne Vulgaris
Time : 16:30 to 17:00
Biography:
Evi Mustikawati Arifin is a Skin Specialist from Indonesia. She currently runs her skin clinic Samarinda Skin Center (Medical and Aesthetic Dermatology Center). She completed her Post-graduation from Dermatology and Venereology Department, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia.
Abstract:
Acne vulgaris (AV) is a chronic inflammatory disease on human’s follicle sebaceous gland. Etiology of AV has not been conclusively identified. Generally AV is considered as a multifactorial disease, of which genetic factor is thought to have influential role. The research was intended to explore CYP17 gene polymorphism and increasing of sebum level on mild and severe AV patients. It applied explorative method, conducted in Dermatology and Venereology Clinic of Wahidin Sudirohusodo General Central Hospital Makassar. There were total 43 samples, consisted of 22 severe AV and 21 mild AV patients. Sebum levels were measured using Sebumeter. Blood samples were taken from all patients as much as 1 µL. Polymerase Chain Reaction-Sequencing (PCR-sequencing) was used to detect existence of CYP17 gene polymorphism, genome group was observed and the results of the genotype and allele frequencies were compared with sebum level. Genotype distribution group was compared with previous researches. The results showed that proportion of T gene CYP17 allele frequency is higher than allele C, indicated that T gene CYP17 allele may serve as a risk factor for severe AV cases in Makassar. The genotype frequency towards increase of sebum level revealed that TC is two times larger than TT genotype and five times larger than CC genotype, therefore TC genotype was considered as a risk factor for higher sebum level.