WCD Spots –Dr. Emma Guttman & Prof. Kiarash Khosrotehrani
Two interviews with Dr. Emma Guttman of the Icahn School of Medicine at Mount Sinai and Prof. Kiarash Khosrotehrani of the University of Queensland in Brisbane.
Dr. Emma Guttman-Yassky, MD, PhD, Waldman Professor and System Chair and Director, Center of Excellence in Eczema, introduces her keynote talk on Atopic Dermatitis.
Emma Guttman. Hi everyone. My name is Emma Guttman and I’m coming from New York City from the Icahn School of Medicine at Mount Sinai. I’m super excited to be here with you!
What is atopic dermatitis?
EG. This is, I think, a very prevalent disease. It involves up to 7% of the adult population in the United States, 15% of the children, more in some countries, in Asia.
So, what is atopic dermatitis? It’s something that you’ll hear a lot about in Singapore.
What contribute most to triggering it?
EG. We know that atopic dermatitis is a complex disease that does not have only one explanation and multiple factors. Environmental, genetic, and many, many others contribute to triggering it.
What is the global prevalence of atopic dermatitis?
EG. In the United States, I would say it is 7% of the adults, 15% of children. In Asia, we are talking about up to 10% of the adults and up to 25% of the children. So, a huge size of the population has atopic dermatitis, of course the majority of patients will have it mild, but up to a third of patients will have it moderate to severe.
Are there racial differences in manifestations?
EG. Now, something that is very dear to my heart is the question: are there racial differences in the manifestations of atopic dermatitis? A lot of my research is focused on that, and the answer is yes. There are multiple differences in atopic dermatitis, depending on ethnicity, race, age, and many others.
In 2022, what is the scientific approach to atopic dermatitis?
EG. We are experiencing an amazing time in atopic dermatitis, a real translational revolution stemming from the fact that we know much more about the disease and we are able to target it specifically with drugs that are safe for patients for long term use.
Thank you so much and I hope to see you all in Singapore! Bye.
WATCH THE SPOT
Prof. Kiarash Khosrotehrani, MD, PhD, FACD, University of Queensland, Department of Dermatology, Princess Alexandra hospital, Brisbane, Australia, introduces his keynote talk on Keratinocyte Skin Cancer.
Kiarash Khosrotehrani. Good day everyone. I’m Kiarash Khosrotehrani, I’m a dermatologist, professor of dermatology at the University of Queensland in Brisbane, Australia.
What is keratinocyte skin cancer?
KK. These are the common basal and squamous cell carcinomas. This is the most common malignancy in mankind. Speaking about cancer, this is the main one that happens to humans. It is a major problem in Australia because of our population, you know, the skin type of blonde and red hair; populations living in a sub-tropical area, especially places like Brisbane and Queensland where we are massively exposed to sunlight, creating a lot of chronic sun damage: these keratinocyte skin cancers. In Australia, for example, over a year there is a million intervention: there is a million-surgery required to take care of keratinocyte cancers.
What are the manifestation modes?
KK. The main way these keratinocyte cancers manifest is often through sores that do not heal, or small lumps that can look like pimple, often in red colour, that persist over months and months. Usually, these are very different from common things that we get on our skins that usually disappear within two or three weeks. These would be visions that persist for a long time and are going to be growing over months and months. This is something that should get the general public really suspicious about something unusual happening and require a doctor’s intervention.
What are the primary prevention strategies to be implemented?
KK. Well, the main type of prevention is obviously sun protection. You know, this is by far the best method that we have: sunscreen use is really essential in terms of preventing skin cancer. In Queensland, we have been doing some of the core studies, by Professor Adele Green’s group, to show that sunscreen use can actually reduce the incidence of SCCs (ed. Squamous Cell Carcinomas). So, especially daily sunscreen uses in places like Queensland, where there is a really high UV index most of the year. She has shown that daily sunscreen use can reduce SCCs and can also reduce melanoma. This is really the main tool that we have in terms of prevention. Secondary preventions, obviously to detect the lesions as early as possible and to potentially do chemo prevention with drugs such as nicotinamide. This is a derivative from vitamin B3 that can reduce the onset of new lesions over time. And other drugs and cream such as Fluorouracil Topical, Fluorouracil, that can also help in preventing the onset of these new lesions.
Are there racial differences in manifestations?
KK. There are major differences in terms of your susceptibility to get skin cancer based on the colour of your skin. And this is true, from even small changes of tone in the skin. We know that the highest risk is with people which have skin that has really no ability to tan. Often red-haired, blue-eyed, and with very light skin tones people. And then on the other spectrum, obviously there are darker skin colours, African American type of skin colour: these are much less susceptible to these common skin cancers, and then all the spectrum in between. This is also clearly determined genetically, and the susceptibility genes that drive these changes in colour are well established and have been shown to play major role in predicting the risk of skin cancer, of these type of skin cancers.
In 2022, what is the scientific approach to keratinocyte skin cancer?
KK. The key approaches to keratinocyte skin cancers are really threefold. You know, it is more about how do we stop the epidemic of these keratinocyte skin cancer. How do we improve the prevention? And really, this is a major area of investigation. How do we come up with new chemo, preventive solutions to stop people from getting multiple keratinocyte cancers? Because that is unfortunately what happens in high incidence regions such as Australia. On the other end of the spectrum, another key approach is towards specific populations that are even more susceptible to these keratinocyte cancers. These would be people who have an immunodeficiency either induced by the doctors, so such as organ transplant recipients, people who have received an organ such as a kidney, a liver or a lung transplant, having immunosuppressors that reduce their ability to detect and get rid of cancer. As a result, they had actually a hundred-fold more SCCs and about 34 more BCCs (ed. Basal Cell Carcinomas) over a lifetime. Excessive incidents really require a specific type of approach and the scientific question is: can we come up with new solutions to reduce the flow and the onset of new keratinocyte cancers?
I hope this was and is going to be a subject of interest to you. I’m really looking forward to seeing you all in Singapore next year!