THE 8th WORLD CONGRESS OF VETERINARY DERMATOLOGY could not have come at a worse time for the organisers. France was, and is at the time of writing, in the middle of massive industrial unrest.
At issue, to quote the leader writer in The Economist of 4th June, are modest reforms designed to tackle the country’s high unemployment, which remains stubbornly at 10%. A new law would ease rigid collective-bargaining rules and make ring workers slightly less complex.
The country’s biggest union (CGT) has opted to confront the government in the time-honoured way and, at a moment of maximum pressure, with Euro 2016 looming. Thus, the more modest veterinary dermatology congress found itself a victim of a labour dispute that had no relevance to its delegates.
First, there were reports of riots in Bordeaux the week before the congress. Secondly, a petrol strike threatened coach and car travel, not ideal for those opting for road transport. Thirdly, a rail transport strike cut off that means to travel and finally an air traffic controllers’ strike, their 47th since 2009, was due to run from 3rd to 5th June (the weekend of the congress). The strike was called off at the last minute, thank goodness.
In spite of the above problems the conference got under way with the largest number of delegates so far, around 2,000, for a world veterinary dermatology conference. The opening ceremony was a mixture of welcoming speeches and music and the highlight was the announcement of the Hugo Schindelka award. This award was inaugurated at the 6th world congress in Hong Kong. Dr Schindelka was a teacher at the Vienna Veterinary School and published the first book on skin diseases of domestic animals in 1903.
George Muller was the first recipient of the award in 2008, followed in 2012 by Professor Richard Halliwell of the Royal (Dick) in Edinburgh. This year’s winner was David Lloyd, professor of veterinary dermatology at the RVC. He delivered a sparkling plenary lecture on day one of the congress, to prolonged applause.
The scientific programme was superb, covering every aspect of the discipline imaginable from general presentations designed to get you up to date to cutting-edge scientific topics.
The continuing education programme of the congress was extensive, as evidenced by the 433 pages in the proceedings book. In addition, there were a large number of free communications and workshops.
It is difficult to summarise the enormous number of contributions. What I can say is that the presentations were of an incredibly high standard and often presented by young members of the profession, as with lectures on the cutaneous ecosystem for example.
The “state of the art address” in this field was delivered by A. Rodrigues Hoffman from the veterinary college at Texas A&M. She stated that the number of microbial cells colonising the human body is 10 times more than the number of cells.
Recent studies have indicated that the composition of this skin microbiome varies across different body sites and across individuals, along with many other factors. Furthermore, it has been shown that in several skin conditions there is a significant alteration in the diversity and composition of the microbiota colonising the skin. Dr Hoffman considers there is no doubt that the microbiome has an important role in maintaining skin health.
Her PhD student, Courtney Smith, followed her, with a paper entitled Fungal microbiome of healthy and allergic skin: a next generation sequencing study. This highly technical presentation was the speaker’s first at an international congress.
The object of the study was to describe the fungal microbiome of feline skin, identify selection of fungi to distinct body sites and determine if fungal dysbiosis occurs in feline skin.
The most prevalent fungi observed were Cladosporium, Alternaria and Epicoccum, with no dysbiosis observed. It was, however, the CV of the speaker that amazed me. She has the basic science degree, is about to complete her PhD and is at the end of her first year at the veterinary college in Texas with three years to go.
Talking to her afterwards, she is looking at a dermatology residency and an academic career in the discipline. Her presentation took place at the same time as her daughter’s 2nd birthday – that’s dedication for you, although her daughter did have a party a little early.
As might be expected, bacterial skin disease and anti-microbial resistance had an extensive airing at
this conference. Anette Loeffler of the RVC gave an excellent presentation on how to interpret bacterial culture and susceptibility reports.
Luca Guardabassi of the Ross School of Veterinary Medicine in St Kitts, West Indies, gave an equally excellent talk on Rational antimicrobial use: critical steps in decision making. He prefaced his talk by comparing the climates of Copenhagen (his previous workplace) with the new one in St Kitts. The picture of a beautiful beach did seem enticing and St Kitts must be one of the most beautiful settings for any veterinary college.
His talk considered nine questions:
- Is systemic antibiotic needed?
- Is empiric antibiotic therapy needed?
- If empiric therapy is needed, which antibiotic should be used/prescribed?
- Regardless if empiric therapy is initiated or not, should a clinical specimen be submitted to the microbiology laboratory?
- Which antibiotic to use based on susceptibility data?
- Should therapy be changed if the strain is reported as resistant to the antibiotic that was prescribed empirically?
- What is the appropriate dose?
- What is the most appropriate administration interval?
- What is the most appropriate treatment duration?
This was a good way to teach as the question was followed by an answer over a relatively short time – thus losing focus, so often a problem in lectures, was minimised.
The answer to question 6 was surprising because although in theory in this situation the drug should be changed, that is not always necessarily a wise decision.
Various studies have shown that the therapeutic outcome is not always predicted by in vitro susceptibility testing. Thus, the patient’s condition and treatment outcome to date should be checked before changing antibiotic therapy based on susceptibility reports.
Douglas Deboer of the University of Wisconsin veterinary school lectured on Managing recurrent pyoderma, a very useful version of similar concepts, which complemented Dr Guardabassi’s contribution. Elsewhere in the programme there were items on this subject including a panel discussion on guidelines for methicillin-resistant staphylococcal infections.
One lecture at the cutting edge of veterinary dermatology caught my eye. This was Mesenchymal stem cell therapy in veterinary dermatology by Lluis Ferrer, latterly of the Barcelona veterinary school and now at the Boston school.
In his presentation he amusingly described the use of “Snake Oil”, the panacea for all ailments and popular in the 19th century, wondering, with tongue in cheek, whether stem cell therapy might be the “new snake oil”.
Certainly, most diseases treated currently with immunosuppressive drugs could be adequate candidates for stem cell therapy, so potentially a large number of conditions might benefit – with a much better scientific understanding as explained in the lecture.
So far, two main types of mesenchymal stem cells have been used in veterinary dermatology:
1. Autologous stem cells obtained from the adipose tissue or from bone marrow of the patient; and
2. Heterologous stem cells, using established stem cell lines, from human (xenogenic) or canine origin (allogenic), in most cases of embryonic origin.
Stem cells have been used to treat two dermatological conditions: atopic dermatitis and perianal fistula in dogs. Best results to date have been with the latter condition. Controlled trials are under way to define dosing, route and frequency of administration and the use of stem cell therapy in combination with other therapies. Something I had not seen before was a “for and against” debate with the audience deciding the outcome. This was to decide whether antihistamines were of any use in atopy.
Thierry Olivry, professor at the North Carolina school, said they were not while Craig Grif n, a specialist clinician in referral practice and one of the authors of the standard text, said they were.
Thierry presented an elegant Cochrane review demonstrating no evidence. Craig got the first blow in with “I do clients, not statistics”. An amusing bout followed with the audience split 50:50 at the end. You might think at a surgeons’ conference this type of debate might be less than fraternal, but the hug at the end showed that the dermatologists do things differently.
The highlight of the social programme on the Friday evening was the banquet at the Chateau Giscours. As this event was part of the registration, some 1,700 or more people attended. It started off brilliantly with a reception, welcoming band and drinks.
The Chateau is part of the Margaux appellation of Bordeaux and made for a spectacular and imposing venue, giving the attendees a chance to catch up with old friends and meet new ones – in the veterinary dermatology tradition. Then there was a sit-down meal followed by dancing.
Chateau Giscours is also the homeground for the Bordeaux Giscours cricket club – participants in the Aquitaine Division of the French National League and current national champions – not too many people know that!
- The next world congress (WCVD 9) will be at the International Convention Centre at Darling Harbour, Sydney, Australia, from 22nd to 24th October 2020. Start saving! If you can’t wait that long to update your dermatology knowledge, the next ESVD conference is in Lausanne, Switzerland, from 7th to 9th September 2017.