Assessing the Microbiome's Role in Skin Disease

Dr. Patrick Ott speaks with Dr. Kerri Purdy about the Herculean effort currently underway to design a vaccine against melanoma. Developing a vaccine for melanoma is particularly challenging because it needs to be different for every person. Dr. Ott discusses: How personalized neopeptide antigen vaccines are made specifically for each individual patient. The challenge they face implementing this in the clinic because in metastatic melanoma it can take 2-3 months to sequence the specific tumour and make the vaccine Cancer patients who have more neoantigens have better T-cell responses Newer cancer vaccines using neoantigens to drive T-cells into the tumour and trigger an immune response are more effective than those designed two decades ago We now want to use the vaccines in a metastatic setting with improved delivery of the vaccine and use of adjuvants We can use molecular tools to show that vaccines can drive T-cells into the tumour. Dr. Ott is Clinical Director of the Melanoma Center and the Center for Immuno-Oncology at the Dana Farber Cancer Institute. He is a physician and an Associate Professor of Medicine at Harvard Medical School.

CDA President Dr. Kerri Purdy sits down with AAD president Dr. George Hruza to have a conversation about the challenges dermatologists face on both sides of the Canada-US border. They discuss: The biggest challenge facing dermatology today is the infringement on dermatology’s scope of practice with non-physician providers advertising and providing dermatologic services Priority for dermatology is to offer patients safe and effective care. In the US there is a considerable restriction in funded residency slots resulting in a significant shortage of dermatologists. The best model is to have a dermatologist on-site directly supervising nurse practitioners and physician assistants in conducting procedures. Dr. Hruza’s personal priority as president is to reinforce the joy of practising dermatology and relieve the stressors leading to burnout Dr. Hruza is a dermatologist and Moh’s surgeon practicing in St. Louis. He is an adjunct professor of dermatology at St. Louis University. He has written four laser dermatology textbooks and published more than 150 articles.

Dr. Anna Bar speaks with Dr. Kerry Purdy about how the tremendous technological evolution in device-based treatments over the past 15 years makes this an exciting time for dermatology. In this conversation from the floor of the CDA’s 2019 Annual Conference in Calgary, Dr. Bar and Dr. Purdy discuss: The recent invention of microneedling with radiofrequency devices Acne scarring is one of the most challenging things dermatologic surgeons face because there is no way to return skin to the unscarred state; often, it takes multiple treatments with multiple approaches that can work synergistically Treatment plans must be tailored to the patient – their age, type of scarring and capacity to take downtime needs to be taken into account Using a professional photographer under standardized conditions is ideal for monitoring progress in treating acne scarring New indications for microneedling with radiofrequency including treating scars, postpartum striae and Hyperhydrosis In purchasing a laser, it is important to test the laser in your office before purchase. Dr. Bar is an associate professor of dermatology and a Mohs micrographic surgeon at Oregon Health & Science University. She is also the director of the fellowship program in Mohs micrographic surgery and dermatologic oncology.

Immense change is coming to the field of healthcare. Zayna Khayat believes medicine will advance more in the next ten years than it has in the last 100. And according to Dr Khayat, dermatologists are perfectly positioned to take advantage of the coming waves of innovation Zayna Khayat is Future Strategist with SE Health (formerly, Saint Elizabeth Health Care) a health and social impact enterprise with a major focus on creating a better future for aging adults in their homes and communities. Zayna is Faculty of Singularity University’ Exponential Medicine stream and is adjunct faculty in the Health Sector Strategy stream at the Rotman School of Management at the University of Toronto. In this conversation with Dr Kerri Purdy, Zayna Khayat says: The healthcare sector is not good at dealing with change In future health care delivery will be much more of a blend of physical and digital care and there will be a shift to preventive care and home care Doctors should be excited that patients are taking more control of their health and using Google to check their symptoms Co-design of health care programs with patients can increase uptake “The Patient Will See You Now” and “Deep Medicine” by Dr Eric Topol and “The Innovators Prescription” by Clayton Christensen required reading to learn about coming changes in health care

Dr. Heidi Kong is an Adjunct Investigator at the National Cancer Institute. She is a board-certified Dermatologist and currently directs a research program at the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) that includes clinical and translational investigations on the human microbiome and inflammatory skin diseases. Dr Kong spoke at the CDA’s 2019 Annual Conference about the human microbiome and its roles in health and disease, particularly in inflammatory skin diseases. Some takeaways from her conversation with Dr Kerri Purdy: Generations of dermatologists know from clinical experience that microbes likely plays a role in several dermatologic disorders Atopic dermatitis “low-hanging fruit” for assessing the role of the microbiome Understanding microbiome reinforces the use of antimicrobials to treat atopic dermatitis Still at early stages of research with the microbiome – still seeing associations rather than showing causation Rare primary immunodeficiency populations helping to understand differences in the microbiome Be skeptical of microbiome research and temper enthusiasm until solid evidence emerges

Professor Dr Swen Malte John is a world-renowned expert in occupational dermatology. In this conversation with CDA president Dr Kerri Purdy they discuss:   Occupational dermatology as a neglected field A global group of scientists is assessing the burden of occupational skin cancer In-patient contact dermatitis care permits proper diagnosis, keeping patients away from exposure to materials of concern and allowing for proper education and training of patients Reporting of occupational dermatologic cases (50% of all occupational diseases) essential to properly address the issue For the first time in Canada, provincial-level work has been done to assess UV exposure in the workplace Outdoor workers must be regularly screened for skin cancer Professor John is Chairman of the Department of Dermatology and Environmental Medicine at the University of Osnabrueck. He is also chair of the Institute for Interdisciplinary Dermatological Prevention and Rehabilitation at the University of Osnabrück (iDerm) and of the Lower-Saxonian Institute of Occupational Dermatology.