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Everything New Under the Sun at AAD VMX

Op-Med is a collection of original articles contributed by Doximity members.

Attending the American Academy of Dermatology (AAD) annual meeting is exciting and something I look forward to every year. I enjoy selecting which lectures to attend, each given by world-renowned dermatologists, and meeting people who share a common interest. I thought the AAD Virtual Meeting Experience would not meet my expectations of having a similar experience as I would have had during an in-person conference, but I knew it would still fulfill my desire to learn about the most up-to-date research and clinical practice guidelines in dermatology.

The AAD VMX meeting started on a Friday with an on-demand portion scheduled for the morning, followed by live presentations in the afternoon. However, due to technical difficulties, the on-demand portion was not made available until Saturday. Fortunately, I was able to watch a very interesting talk by keynote speaker Dani Shapiro on her experience as a product of artificial insemination until the live sessions started on Friday afternoon. During live presentations in previous years, I experienced only minor technical impairments, including some computer glitches, which hampered certain presentations, and poor Wi-Fi, which made downloading handouts difficult. With that said, I am still amazed by the technological advancements and the AAD’s ability to construct, direct, and virtually cast a conference of this magnitude. 

When the technological roadblocks were addressed, I found there was much to be learned as the meeting showcased an excellent array of speakers who discussed a wide variety of relevant topics. I will highlight a few of the many hot topics addressed at this year’s AAD conference in detail below. 

Therapeutics was a dominant theme, and I gave center stage to JAK inhibitors. Dr. Natasha Mesinkovska spoke of their use in alopecia areata and mentioned their use in psoriasis, atopic dermatitis, vitiligo, lichen planopilaris, lupus erythematosus, dermatomyositis, graft-versus-host disease, and SAPHO syndrome. In a lecture on topical therapies, Dr. Erin Boh spoke of topical ruxolitinib for vitiligo and atopic dermatitis, and Dr. Seemal Desai reminded viewers to monitor lipids in addition to the typical labs required for biologic use when using JAK inhibitors. In a lecture on nail disorders, Dr. Matilde Iorizzo spoke of the usefulness of oral tofacitinib in nail lichen planus. Although there were some industry talks on the itinerary, much of the discussion in the meeting was about off-label use of therapeutics, such as the mention by Dr. Mark Lebwohl in his talk on biologics of a 10-patient study by Paradisi et al. in JAAD wherein a single dose of 50 mg of etanercept was useful in toxic epidermal necrolysis. Dr. Lebwohl, as well as Dr. Bruce Strober, also mentioned a novel IL-17 A and F inhibitor, bimekizumab, which is the most efficacious psoriasis treatment, but it is also highly associated with candida infections in a dose-dependent manner. Drs. Strober and Boh discussed a new topical for both atopic dermatitis and psoriasis, tapinarof, which is an aryl hydrocarbon receptor modulator. Dr. Boh also spoke on the use of a new vehicle in topical medications using PAD™ technology, which enhances the efficacy of drug delivery and is cosmetically elegant compared to ointment, suspension, and foam vehicles. Dr. Terrence Cronin noted a new and welcome indication to treat basal cell carcinoma with cemiplimab, and the use of pulsed itraconazole to augment the response of hedgehog inhibitors in the treatment of advanced basal cell carcinoma. A novel topical androgen receptor blocker for the treatment of acne, clascoterone, as detailed by Dr. James Del Rosso in a stimulating acne therapeutics lecture.

There were many opportunities for surgical instruction, including a course offered for those taking the Mohs certification exam, discussions of reconstructions, and how to avoid surgical complications. Useful surgical techniques for reducing tension during wound closures were explained, such as plication of the deep fascia and the setback suture, as discussed by Dr. Jonathan Kantor. Methods of suturing using absorbable sutures that do not rely on an assistant, such as the SICM, the BiPli, and the Zipper stitch, were detailed by Dr. Cyndi Yag-Howard. A suggestion was made for a non-wound-lengthening method for dog-ear management by Dr. Terrence Cronin, where he discussed tying down the standing cone. A simple suggestion for the minimally invasive management of longstanding dog-ears was made by Dr. Daniel Eisen, which involved using a hyfrecator as a makeshift Fraxel laser by burning small holes in the dog-ear.

Education in dermatopathology was also available, including one of my favorite lectures in the “What’s New in Dermatopathology” session titled “Dermoscopy 360 Clinicopathologic Correlation,” in which Dr. Michelle Tarbox gave an outstanding correlation of dermatoscopic with dermatopathologic findings and detailed the reasons for seeing the string of pearls and rainbow colors that are seen with the dermatoscope. Relevant to our present times, Dr. Nooshin Brinster discussed the “COVID Arm,” which is a reaction most commonly seen with the Moderna mRNA vaccine. It occurs inferior to the vaccination site, appears four or more days post-vaccination, is more common and more severe after the first vaccine dose, and is histopathologically a superficial and deep perivascular and perifollicular lymphocytic infiltrate with rare eosinophils and mast cells (a dermal hypersensitivity reaction). Another COVID-19 vaccine-related encounter is the occurrence of edema in areas of hyaluronic acid filler injection sites; this can be treated with ACE inhibitors.

As skeptical as I was about the virtual meeting-not-meeting, I found it to be a unique and enjoyable experience, and I developed a great appreciation for the virtual format. It eliminated travel expenses, and I was also able to drink coffee all day without arriving late to any meetings from standing in coffee lines. I learned an extensive amount about current hot topics in dermatology, and I did not miss any sessions because the meeting rooms were too far away or difficult to find in an enormous convention center. I was able to rewind to hear things repeated, pause lectures to digest the material, and look up relevant articles that were presented. I am excited to have access to all of the recordings and sessions until July 12, 2021, and did not have to select which lectures to attend while missing others that were at the same time. I have a feeling that future AAD meetings will have a hybrid in-person as well as a virtual option which would benefit those from around the world who want access to this incredibly special event, who share the common interest of dermatology, and who strive to have the most up-to-date information in order to have the best outcomes for their patients.

Steven R. Feldman has received research, speaking and/or consulting support from Sun Pharma, Amgen, BMS, Helssin, Arcutis, Dermavant, Alvotech, Galderma, Almirall, Leo Pharma, Boehringer Ingelheim, Pfizer, Ortho Dermatology, Abbvie, Samsung, Janssen, Lilly, Novartis, Regeneron, Sanofi, UpToDate and National Psoriasis Foundation. He is founder and majority owner of and founder and part owner of Causa Research, a company dedicated to enhancing patients’ adherence to treatment. Caitlin G Purvis and Esther A Balogh have no conflicts to disclose. 

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