IMCAS

Jury

Nose challenge

Objectives: Young Derm Award

We report 2 cases of basal cell carcinoma of the perinasal area treated by surgery and reconstructed thanks to Burow’s flap advancement

Introduction: The incidence of skin’s cancer has increased in past years, with a predilection for face and neck, and are mostly treated by surgery.
Various techniques are available to repair these induced defects including skin graft and local flaps.
Advancement or rotation flaps can be associated with the formation of cutaneous excess at the base of the flap.
These cutaneous excesses can be excised along the natural facial contour line with a burow’s advancement flap.

Materials / method: We report and decribe 2 cases of basal cell carcinoma of the perinasal area treated by surgery and reconstructed thanks to Burow’s flap advancement

Results: The Burow’s flap is a modified advancement flap introduced first by Lisfranc in 1835 then by von Burow in 1855. It makes full use of the ipsilateral skin of the defect and advances it to cover the wound without affecting the contralateral skin.
The triangular skin and subcutaneous tissues in the pedicle should be resected to avoid skin excesses (dog-ears). Advantages are fewer and relatively concealed aiding incisions, wide base of the flat skin with sufficient blood supply, and ideal match between the flap and surrounding skin with no secondary deformity.
In both cases unaffected skin has

Conclusion: Burow’s flap advancement is suitable for reconstruction of defects in the paranasal region with excellent tumoral outcome and hidden scars.

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Management of red tattoo reactions: case series and systematic review of the literature

Objectives: 1- To evaluate safety and efficacy of various treatment modalities for red tattoo reactions.
2- To establish a stepwise approach for treating red tattoo reactions.

Introduction: Tattoos may elicit several cutaneous inflammatory reactions. Red pigments account for a substantial part of these reactions. Several modalities have been reported useful in treating red tattoo reactions. However, efficacy data is sparse.

Materials / method: A case series of 7 patients who were treated in our clinic due to red tattoo reactions is described. In addition, a systematic review of studies evaluating treatment of patients with red tattoo reactions was conducted. Treatment included both tissue destructive and non-destructive modalities. Studies of all designs, published in English without date limits were included. The primary outcome was partial or complete clinical response. Secondary outcomes were adverse events.

Results: Our case series included 7 patients with red tattoo reactions. All patients had multi-color tattoos, with a localized skin reaction confined exclusively to the red area. Treatment included several modalities: topical intralesional and oral steroids, cryotherapy and non-ablative lasers. The systematic review included 14 studies (29 patients). Overall, steroids demonstrated clinical response in 23% of the cases. A single study reported complete response in 7 patients using Q-switched 532 nm Nd:YAG. Destructive modalities ended in complete response in 82% of the cases. Adverse events were rare.

Conclusion: Steroids remain the most well established non-destructive modality for red tattoo reactions, yet with limited efficacy. Destructive modalities, either ablative laser or surgical excision, are most efficient, but result in scarring, and thus should be kept for treatment failures.

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CO2 laser treatment of genital intraepithelial neoplasia

Objectives: The aim of the study is to describe the long term efficacy , the tolerance and the safety of Carbon Dioxide (CO2) laser treatment for the management of high grade and differenciated genital intraepithelial neoplasia.

Introduction: Genital intra épithelial neoplasia (IEN) are precursors of squamous cell carcinomas and their incidence is increasing. There is little consensus regarding the optimal management of IEN. Conventional surgery remains the gold standard but we now consider that the ideal treatment must be efficient, conservative and well tolerated. Topical application of Imiquimod 5% or 5 Fluoro-Uracil is proposed as an alternative but there is a high risk of recurrence and a lot of adverse effects (application site pain, pruritus, erythema, bleeding). We evaluate safety of th CO2 laser for these indications.

Materials / method: It was a retrospective single center study.
16 patients (8 women and 8 men) were included.
A biopsy was performed to achieve a histological diagnosis before any laser treatment to rule out invacell carcinomas.
The CO2 laser treatment was performed in a continuous wave mode, under local anesthesia and with 4-5mm of macroscopical margins. The laser power chosen was between 10 to 25 Watts, with a handle piece from 4 to 5mm. The session lasted 15 to 30 minutes. Follow up take place at 1 month and 3 months and then each year during 10 year

Results: Regarding women, there were 5 high grade vulvar IE neoplasia (VIN) and 3 differentiated VIN. Lesions were most of the time unique and extensive. The relapse rate of VIN was 58%, occuring mostly after 20,4 months.
Regarding male patients, 7 had high grade penian intraepithelial Neoplasia (PIN) and 1 had a differenciated PIN. 40% of the patients had a relapse after 12 months.
The follow up at 1 and 3 months showed a perfect healing in 90% of men and women and 50% of women and 76% of men were very satisfied of the cosmetic outcome. There were no impact on sexuality and no adverse effect.

Conclusion: This study shows that the CO2 laser tratment for the management of IEN offers a good alternative to the medical and surgical treatments. There is a high risk of relapse whatever the treatment. A long term dermatological surveillance is warranted to detect the relapse.
We point out that CO2 laser treatment is the most conservative method for the treatment of IEN. It is safe and well tolerated, functional and anatomic outcomes are optimal and it can be repeated to treat the recurrences.

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Chronic wound healing: an original treatment for an atypical case

Objectives: Chronic ulcers and wounds are still a challenge for treatment, due to their multiple pathophysiology, but also due to their high rate of recurrence and their slow tissue deterioration. These lesions are now a real public health matter. As an example chronic ulcers account for up to 25 billions dollars in health care costs annually in the United States. Besides treating the original disease, it’s now consensus to provide also local treatment.

Introduction: Laser therapy for chronic ulcers has been practiced for more than thirty years, starting with photobiomodulation by LEDs, then followed by sub-ablative C02 and Erbium:Yag lasers. By targetting water, these lasers are able to provide a tissue vaporization, leading to skin improvement, but also to post-traumatic and burn scars improvement. Therefore many authors described successful cases of chronic wound healing with such technology. There are several proposed mechanisms of action : texture and pliability improvements leading to decreased tension, debridement and biofilm disruption, and molecul

Materials / method: Case Report

The patient is a 58 year-old caucasian male patient, who has suffered from leukemia. He underwent a few complications including a right knee osteitis, which needed a surgical treatment 3 years ago, causing a tissue loss. Sking graft was performed, but with poor outcomes. He’s now in remission for the leukemia, and complains mainly about his wound aspect (fig 1), which affects his daily life quality.

Results: Despite some healing mechanisms after laser wound healing remain unclear, the treatment definitely shows promising outcomes. New collagen is essential in the wound closure mechanism, such as active vascular neoformation. Many studies have concluded to an interest of classical CO2 and Er:Yag laser in scars, vascular ulcers and chronic wounds. This case looks very insolite, regarding the wound medical story, but mainly due to the laser acoustic mechanism, while other classical treatments use photothermic effects.

Conclusion: It is now well known laser induced healing is an interesting, effective and safe procedure. The mechanical-accoustic effect has been observed in skin rejuvenation and scar resurfacing indications, and more quality studies should be held about wound healing. These treatments could have an influence on healthcare costs by decreasing healing time. Gold standard in this indication remains indeed at the moment expensive specific bandages.

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Treating psoriasis while thinking out of the box

Objectives: Psoriasis:
- Reviewing the pathogenesis of psoriasis
- Treatments of psoriasis: Old treatments revisite
- Influence of environmental factors on Symptoms

Introduction: Psoriasis is a common, chronic, disfiguring skin disorder, and is considered to be a systemic inflammatory disease. The pathogenesis of psoriasis includes a genetic susceptibility, an immune system activation, inflammatory response environmental factors. There is no absolute consensus about the treatment, although many treatment forms exist. A TCA chemical abrasion will induce skin regeneration and reestablish the barrier by inducing superficial skin necrosis, expansion of the dermis snd skin regeneration.

Materials / method: TCA causes no allergic reactions or systemic toxicity. When applied on the skin, TCA does not penetrate into the dermis blood vessels, and therefore does not spread into the body. TCA is neutralized by water and by proteins in the skin. When all of the compound is neutralized, the effect stops. It can be used on many different kinds of psoriasis lesions leading to a disappearance of psoriasis plaques for a certain period of time. It is generally followed by a recurrence when not associated with a dietary approch.

Results: Notrition and psoriasis in literature
• national psoriasis foundation: at least 25% of patients with psoriasis have a gluten sensitivity, both patients with celiac disease and gluten sensitivity require an elimination of gluten from their diet.
• pr. Mrowietz, derma-update 2018, and 2019, mainz, de : it can be useful to consider a Wheat free diet for psoriasis patients not only with but also without celiac markers. Nutrition plays an important role in the Pathogenesis of Psoriasis, whether it be on the Fatty acid front, Microbiome, or Amylase Tripsin Inhibitors.

Conclusion: In conclusion, psoriasis can be a very disabling and distressing disease. Local treatments can work but are very binding and patients tend to stop them. Oral treatments can be of help but with often many side effects, whereas local applications of TCA solution help the lesions to resolve more quickly. Aditionnaly, diets and especially gluten avoidance, when followed properly, will prevent recurrences which will be milder and spaced until disappearance, but the disease tends to recur if the diet is discontinued.

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Successful treatment of lupus panniculitis induced lipoatrophy with lipofilling

Objectives: - To discuss the cosmetic treatment options in a patient with an autoimmune skin disease with a focus on autologous fat transfer (lipofilling).

- To present a treatment option for lupus panniculitis induced lipoatrophy

- During the presentation, the literature will be reviewed on this topic (aesthetics in auto-immune diseases)

- During presentation, pictures of the follow-up of the treated patient in week 1, week 6 and month 9 will be shown

Introduction: Lupus panniculitis is a form of cutaneous lupus erythematodes. It is a rare auto-immune disease characterized by inflammation in the deep dermis and subcutaneous tissue. The end stage is clinically characterized by lipoatrophy of the affected area. Cosmetic treatment options in patients with lipoatrophy resulting from autoimmune diseases are limited because of a theoretical risk of reactivation of the connective tissue disease.
We present a case of lupus panniculitis induced lipoatrophy in a young female who was successfully and safely treated with autologous fat transfer (lipofilling).

Materials / method: A 21-year-old female visited our autoimmune clinic with a deep depression on her right cheek. She was diagnosed with lupus panniculitis at the age of 13. Physical evaluation revealed a 2.0 x 2.5 cm depressed atrophic plaque on her right cheek without epidermal changes. Laboratory evaluation revealed a negative antinuclear factor and normal inflammatory parameters. Patients primary request for help concerned the cosmetic treatment of the disfigured plaque.

Results: MRI of her face demonstrated a decreased volume of the subcutaneous tissue on the right side, but did not show any involvement of the underlying muscles or bone. Because at the time of the consultation there were no signs of local or systemic disease activity and there had been a stable condition for years , she was treated with autologous fat transfer (lipofilling). We treated her using the Coleman technique under local tumescent anesthesia. Subcutaneous fat from her abdomen was harvested, washed and filtrated. The harvested material was implanted in the selected areas of her right cheek

Conclusion: Treatment resulted in a successful restoration of her facial contour. She did not develop a flare of her cutaneous lupus during nine months follow up. A slight resorption of the implanted fat was observed and patient underwent a second treatment session.

Patients with connective tissue skin diseases may end up at the dermatology outpatient clinic with questions regarding the possibility and safety of cosmetic treatments. Autologous fat transfer might be a safe option but requires several treatment sessions.

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Время	Спикеры	Заголовок сессии	Абстракт	Номер
15:00	Доктор Michael BENZAQUEN	Jury		100062
15:00	Prof Marie BEYLOT BARRY	Jury		99124
15:00	Virginie COUTURAUD	Jury (unrestricted educational grant from Esthederm / NAOS)		97750
15:00	Prof Merete HAEDERSDAL	Jury		98429
15:00	Доктор Anne LE PILLOUER	Jury		98430
15:00	Prof Marie BEYLOT BARRY	Presentation of young dermatologist case awards		98613
15:03	Доктор Aurore LE GUERN	Nose challenge	Посмотреть	99377
15:11	Доктор Eran GALILI	Management of red tattoo reactions: case series and systematic review of the literature	Посмотреть	99458
15:19	Доктор Marie CUCHET	CO2 laser treatment of genital intraepithelial neoplasia	Посмотреть	99493
15:27	Доктор Arnaud LAMBERT	Chronic wound healing: an original treatment for an atypical case	Посмотреть	94354
15:35	Доктор Maelle SERRANO BREZINA	Treating psoriasis while thinking out of the box	Посмотреть	94355
15:43	Доктор Meelad HABIB	Successful treatment of lupus panniculitis induced lipoatrophy with lipofilling	Посмотреть	99851
15:51	Доктор Michael BENZAQUEN	Young dermatologists awards winner announced by jury		94360

World Congress 2020
Программа

ФОКУС НА S334

Награды молодых дерматологов

Лекции сессии

Рекомендуемые сессии

World Congress 2020 Программа

ФОКУС НА S334

Награды молодых дерматологов

Лекции сессии

Рекомендуемые сессии

World Congress 2020
Программа