Bioderma Congress Reports RADLA 2025

Speaker: Dr Susana Puig Sarda (Spain)

She spoke about the relative importance of the ozone layer on the skin as it is more complex, and influenced by natural climate changes and human activity, thereby generating gases that retain heat and increase temperatures. Global warming with shorter winters and higher UVR (UV radiation) intensity increases exposure and exacerbates the incidence of skin cancer. With regard to Vitamin D, she mentioned that, although the main source of this vitamin is the sun, it also comes from food. The absorbance curve is the same as that which causes DNA damage and skin cancer, so the time needed is less than that needed to burn. As it is fat-soluble, it can accumulate and is toxic. She suggested little time daily and not overdoing exposure at weekends. The use of photoprotection and vitamin D synthesis capacity is controversial. Studies in children have shown that those who used photoprotection had higher vitamin D levels. Regarding questions about whether the use of sunscreen has an impact on skin cancer, its usefulness is well documented. When asked whether it is possible to repair UVR damage with topical treatment, she showed studies with Eryfotona and Anthelios in which improvements have been found in

field cancerisation when monitoring with confocal OCT microscopy which combines confocal optical tomography and confocal microscopy. She then also discussed whether there was a relationship between diet, microbiota and skin cancer as a controversial topic. She said that the Mediterranean diet could lower the incidence of BCC and MM, citrus fruits could increase the risk of MM/BCC/SCC and ultra-processed foods could increase the risk of MM. Coffee (2 cups a day) could reduce the risk of non-melanoma cancer by 3–8% and MM by 25%. Alcohol increases the risk of BCC/SCC and MM. As for vitamins, only nicotinamide is presumably protective. Rice irrigated with arsenic-contaminated drinking water increases the risk of BCC/SCC. As for the microbiota, the role of the microbiota as a predictor of immunotherapy evolution in metastatic MM still needs to be investigated, as different profiles have been observed in different countries. Transplantation of faecal microbiota could make them responders according to a study.

Speaker: Dr Alina Patricia Hernandez Santos (Dominican Republic)

She spoke about the coexistence of HS and psoriasis which share comorbidities due to the same        physiopathogenic          mechanisms         as well as triggers (smoking/obesity). She mentioned concurrent pilonidal cyst in 23% of cases with HS, with some authors considering it to be a localised form of the same pathology. Other comorbidities include: RA, ankylosing spondylitis and spondyloarthritis, metabolic diseases, cardiovascular diseases, non-alcoholic fatty liver disease, IBD, psychiatric pathology, and dermatological conditions such as SCC, acne, PG, dissecting cellulitis of the scalp and pilonidal cyst. Screening should be performed annually. She explained its physiopathogenesis and, with regard to approach, she mentioned the usefulness of ultrasonography carried out by someone familiar with the pathology for correct reporting as a support in therapeutic decision-making. She mentioned that CRP is an important marker of progression and that it is important to work on earlier diagnosis as it takes an average of 8 years for the correct diagnosis to be made and to access dermatological treatment. It reaches moderate-to-severe stages in 73% of cases (“therapeutic window of opportunity concept”). Apart from the general algorithms and measures already known, she concluded that there are no standardised treatments. There should be a focus on holistic treatment and a combination of innovative therapies should be used such as small molecules (JAK inhibitors), liraglutide in patients who do not respond to biologics (the skin has GLP-1 receptors in psoriasis lesions and in HS, although it is not known whether this is due to a direct anti-inflammatory effect or weight reduction).

THE NUMEROUS ASPECTS OF UNUSUAL VULVAR LESIONS

Speaker: Dr Martin Sangueza (Bolivia)

He showed cases of vulvitis facticia, emphysematous vaginitis due to gas-forming bacteria in immunocompromised patients, Lipschutz ulcers (rare pathology caused by non-bleeding and typically “mirror-like” EBV), Jacquet’s erosive dermatitis (volcano lesions on a papillomatous cobblestone secondary to erosive diaper dermatitis), papular acantholytic dyskeratosis (HPV must be ruled out and patients may develop pemphigus), lichen sclerosus with naevus pigmented lesion (histopathological differential diagnosis impossible but screening for fibrosis should be performed: “pseudomelanoma”) and, finally, vulvar melanoma (very aggressive behaviour).

VULVAR LICHEN SCLEROSUS (LS): WHAT EVERY DERMATOLOGIST SHOULD KNOW

Speaker: Dr Cristian Vera Kellet (Chile)

It is generally asymptomatic at onset until infectious complications, atrophy or introitus narrowing occur, usually 4–6 years from onset to diagnosis. After a general review of the pathology, he focused on the importance of high- and very high-potency topical corticosteroids as the only treatment that in randomised studies and meta-analyses has been shown to reduce the risk of malignant progression and recurrence, but must be used for life: 1 to 2 times per day for 3 months and then 2 to 3 times per week for very high-potency or every other day for moderate-potency topical corticosteroids. Other treatments are used for symptomatic relief: calcineurin inhibitors, topical retinoids, topical JAK inhibitors, and topical PDE-4 inhibitors provide unconvincing data, only reports or are under active research. Topical hormonal treatments, oral or intralesional corticosteroids, immunosuppressants, IL-17 and IL-4 inhibitors also show limited evidence and should not be used as monotherapy or as a replacement for topical corticosteroids. The same applies to procedures such as PRP, radiofrequency and photodynamic therapy. Lasers can only be complementary treatments by enhancing topical steroid absorption and delaying/preventing hyperkeratosis. There is a 4–5% risk that LS can progress to vulvar intraepithelial neoplasia and then to SCC 10 years after LS diagnosis. However, when the diagnosis is histological, it increases to 28–76%. Furthermore, 61% of SCC have histological alterations of LS and should ALWAYS be biopsied.

VULVAR GENITAL ULCER; NOT EVERYTHING IS SYPHILIS

Speaker: Dr Viviana Leiro (Argentina)

They can be acute (without systemic involvement: trauma, contact, infections or with systemic involvement: Lipschutz ulcers) or chronic (with

and without oral involvement). She showed case reports of primary syphilis, multiple chancres, persistent chancres and secondary syphilis. She also showed HSV, soft chancres, Rollet’s mixed chancre (syphilis associated with soft chancre), donovanosis, trichomoniasis, and Mpox. She then continued with PG. She highlighted the diagnostic and therapeutic challenges posed by these pathologies.

IF ALL WOMEN HAVE HPV, WHY DOES IT SCARE US SO MUCH?

Speaker: Dr Mariana Jimena Martinez (Argentina)

A total of 80% of women will be infected with HPV at some point in their lives. This particularly generates a lot of anxiety and stress. Studies have been conducted on the impact chronic stress has on the manifestations of HPV infection and carcinogenesis through the hypothalamic-pituitary-adrenal (HPA) axis and sympathetic nervous system (SNS) by suppressing cellular immunity with HPV reactivation, promoting the expression of viral oncogenes, shifting the immune response from Th1 to Th2, which reduces the body’s ability to eliminate the virus, thereby increasing the likelihood of pre-cancerous lesions and associated cancer. Therefore, in addition to the usual therapy adapted to each case, she suggested an interventional strategy aimed at stress management (mindfulness, cognitive behavioural therapy), support and clear information (most HPVs are low-oncogenic-risk HPVs), promotion of healthy living and follow-up/monitoring.

Speaker: Dr Steven Feldman (United States)

Dr Feldman suggested tailoring screening to patient age as the risk of AMI is higher in severe psoriasis, thus requiring lipid and BP monitoring. He emphatically stressed trying to simplify treatments to improve patient adherence. In patients with lesions resembling a “coral reef”, there is a tendency to think that topical treatments would be ineffective due to thickened skin. However, clobetasol spray has very good results. With regard to topical non-steroidal anti-inflammatory drugs, he suggested reserving them for steroid-sensitive areas, but not complicating things for the patient with combination treatments as this will not improve adherence and consequently will not improve psoriasis. Regarding scalp psoriasis, he said it is very frustrating. The right vehicle must be chosen and the patient must be informed that if it is strong or itchy, it will get better faster. There are many treatment options for severe psoriasis. One of them is home phototherapy, which makes it easier for the patient to comply with treatment. Acitretin is very easy to use and increases the efficacy of UVB, with simple monitoring and adequate side effect reporting. It is also very useful in palmoplantar psoriasis. Regarding associated joint pain, if the skin needs systemic treatment, he recommended using it; if the joints require a biologic, he recommended using it. However, if the skin requires only UV and the joints only need NSAIDs, he recommended not using biologics. Dr Feldman advised providing MTX side effects in writing. Finally, he said that there is probably no one biologic that is better than another, but there is more or less patient compliance depending on how calmly we inform them of potential risks. These are revolutionary drugs for those who really need them!

Speaker: Dr Eckart Haneke (Germany)

The developer of the functional, non-amputative, conservative technique for nail MMs was able to demonstrate that survival with this technique was greater than with amputation. He demonstrated the tangential biopsy technique, several case reports and the functional and cosmetic repairs it promotes. As a tip, always keep MM in mind, especially in individuals over 25 years of age.

Speaker: Dr Josep Malvehy (Spain)

With the advent of the industrial revolution, we have reached the current era of the Internet and renewable energies, but we are already facing the 5.0 revolution (AI) and the next one, 6.0 (nanotechnology, robotics, synthetic biology, biotechnology, neuroscience, neurotechnology and, finally, communication and information technologies). We face an ageing population (>80 years) that will triple by 2050, a population over 65 that will outnumber 24–35 year olds globally, chronic diseases by 1:3 and an even more severe healthcare workforce deficit in addition to financial constraints and inequality in access to health. In dermatology, AI and big data help us create predictive models and machine learning, identify complex phenotypes and optimise therapeutics. An Expert Consensus on AI competency items for healthcare professionals was conducted and comprises 6 items: 1) understanding the value, limitations and use of AI solutions; 2) understanding basic data science concepts; 3) choosing the best AI tool for each medical indication; 4) integration into patient workflow; 5) legal and ethical standards; 6) communication to patients. It should be stressed that AI must go hand in hand with human intelligence. Work is also underway on DIGITAL TWIN, a kind of patient avatar by digital phenotype that enables a personalised simulation. Synthetic biology enables targeted manipulation of the microbiota, cellular reprogramming and skin regeneration. This could become a possible therapeutic strategy for the treatment and study of diseases. Skin organoid cultures are laboratory-grown cultures of human cells where drugs are screened by genetic characterisation to predict toxicity and efficacy for precision medication. Continuing medical education, as well as patient education and empowerment are fundamental in all of this. Regarding the use of social media, he described the known benefits, but emphasised the lack of publications by dermatological doctors. This leads patients to quickly access poor quality educational information from influencers with no scientific knowledge. His conclusion was optimistic: the dermatology of the future will include disruptive technologies, a better understanding of skin biology and a new patient relationship model. A strategic vision, investment in digital infrastructures and continuous updating of professionals are needed. However, regulation that guarantees the ethical, safe, sustainable and equitable use of the new tools is imperative.

PERSONALITY TRAITS AND DISORDERS

Speaker: Dr Rolando Hernandez Perez (Venezuela)

He spoke of PERSONALITY TRAITS as inherent to human beings; they are flexible, allow people to adapt to different situations and are not necessarily harmful. Then he spoke of PERSONALITY DISORDERS, which constitute a lasting pattern of inner experience and behaviour that deviates markedly from the expectations of the individual’s culture and manifests itself in two or more areas: cognitive, affective, interpersonal functioning or impulse control. He classified them into GROUP A: paranoid/schizoid/schizopathic. GROUP B: antisocial/borderline/histrionic/narcissistic. GROUP C: avoidant/dependent/obsessive-compulsive. PERSONALITY is the individual’s unique way of relating to themselves and others, which may determine how they develop their illness, their relationship with their doctor and their response to treatment. Personality traits are often accentuated during the illness, with the illness requiring adjustment and hospitalisation being a stress test for the personality.

ADDRESSING PERSONALITIES IN PATIENTS WITH ATOPIC DERMATITIS (AD)

Speaker: Dr Lourdes Bolla (Paraguay)

When considering the skin as a communication channel and anxiety modeller (common ectodermal origin), if modulation is deficient, there is a predisposition to somatisation. She emphasised early tactile skin experience (before the development of speech) for emotional and physical development. Skin perception organises the body image and the individual can resort to artefactual diseases to affirm their existence and define boundaries. AD is associated with high levels of stigma, anxiety, depression, isolation and low self-esteem, resulting in impaired quality of life and disruption of family dynamics. A holistic, multidisciplinary approach is essential,

with the participation of psychologists and psychiatrists when the patient shows signs of not showing emotions and feelings. DLQI-type indices should be used.

ADDRESSING PERSONALITY IN ACNE PATIENTS

Speaker: Dr Karina Malvido (Argentina)

At a time when appearance is more relevant than ever, skin diseases have a significant psychological and social emotional impact, and should never be dismissed. This impact can include depression, low self-esteem, anxiety, shame, suicidal ideation and suicide attempts. These diseases are often accompanied by social isolation, fear, anger attacks, drug and alcohol use and abuse leading to compulsive behaviours such as picking and self-harm. Patients may have an uncontrollable urge to harm themselves as a way of coping with difficult emotions. Associated disorders include anger, depression, anxiety, borderline personality disorder, narcissistic personality disorder, OCD, delusions and BDD (body dysmorphic disorder). Empathic listening and a good doctor-patient relationship will help early diagnosis and multidisciplinary treatment.

ADDRESSING THE PERSONALITY OF PSORIASIS PATIENTS

Speaker: Dr Lianet Silverio Carrasco (Dominican Republic)

Chronic stress acts as a trigger for flare-ups. Up to 30% of patients develop depressive symptoms, depression or anxiety. Personality traits include perfectionism and difficulty expressing emotions, sensitivity to rejection and high neuroticism. While there is no such thing as a “psoriatic personality”, some traits may influence patient adjustment to the disease and impact its clinical course. In addition to the approaches mentioned above, referral to support groups and in some cases to a rheumatologist is of utmost importance.

ADDRESSING THE PERSONALITY OF PATIENTS SEEKING AESTHETIC TREATMENT

Speaker: Dr Susana Misticone (Venezuela)

In some cases, these patients represent a real psychological challenge that affects our clinical practice since we are often able to recognise that they have a psychopathological problem, but we do not know how to identify the correct clinical diagnosis. Social media often lead to unrealistic body images, increasing body image dissatisfaction and BDD comorbidities, such as depression and eating disorders. She spoke of Zoom dysmorphia in the wake of the COVID pandemic, the Instagram face, the “fan” patient, the demanding, the cautious, the fickle, the status-dependent and the intolerant. In the aesthetic practice there is a higher number of patients with personality disorders: up to 15% present with BDD and borderline personality disorder. The most frequent are borderline, narcissistic, histrionic and obsessive-compulsive. They should be carefully referred to a

psychiatrist. It is unlikely that a BDD patient will be satisfied, and they usually become aggressive, escalating into serious situations and/or initiating legal action. If they are satisfied, they move their concern to another area. Not treating them and only in some cases correcting minimal defects after psychiatric assessment are recommended.

ADDRESSING PERSONALITY IN PATIENTS WITH ONCOLOGICAL PROBLEMS

Speaker: Dr Maria Vasquez (Argentina)

A total of 10% of patients will require psychological treatment within the first year of diagnosis and 73% of patients with depression do not receive adequate treatment. The most common disorders are: depression, anxiety, adjustment disorder and PTSD (post-traumatic stress disorder), especially in more aggressive cancers or in more advanced stages. Comorbidities related to body image and suicidal ideation are also common. In addition to all the tools mentioned, there is also social support.

Speaker: Dr Julio Sartori Valinotti (United States)

New emerging therapies target the individual phenotype of each patient.

• SLE: He mentioned the following:

1) LITIFILIMAB: BDCA2 target/phase 2 trial; fairly well-tolerated in trials, but not yet available. Adverse effects: hypersensitivity, oral HSV and HZV.

2) ANIFROLUMAB: IFN-1 receptor subunit 1 target/phase 3 study; minimal adverse effects in SLE, HZV and bronchitis. Rapid response in CLE.

3) LENALIDOMIDE: Thalidomide analogue/minor side effects: mild leukopenia/DVT. It should not be forgotten that proton pump inhibitors are the drugs that most frequently cause drug-induced SLE and are very easily accessible to patients.

• DM: always rule out occult cancer, screening according to risk (IMACS guidelines). ANTI-TIF1 would be a predictive marker of cancer associated with myositis. ANIFROLUMAB in recalcitrant DM.

• SCLERODERMA: NINTEDANIB, TYK inhibitor/TOCILIZUMAB, IL-6 receptor antagonist/RITUXIMAB, anti-CD20/ABATACEPT, T-cell inhibitor/LENABASUM, cannabinoid receptor 2 agonist/ROMILKIMAB, anti IL-4, IL-13/INEBILIZUMAB, anti-CD19. Moreover, botulinum toxin was recommended for use in digital ulcers for pain reduction, disappearance of haemorrhages and is much more inexpensive than other therapies. Never apply it on the thumb; the dilution is 50 U/1.25 ml of saline solution, every 4 weeks, 10 U per finger (5 on each side at the base of each finger), i.e. 40 U per hand.