Amy Paller, MD: Reviewing Top Insights for Clinical Practice From ESPD

Amy Paller, MD, is the chair of dermatology at Northwestern Feinberg School of Medicine and a pediatric dermatologist from Chicago.

At the 2024 Society for Pediatric Dermatology (SPD) Annual Meeting in Toronto, Ontario, Canada, Paller presented a session alongside colleagues Esteban Fernandez Faith, MD, Nationwide Children's Hospital; and Leo Shmuylovich, MD, PhD, Washington University.

The session was titled, "Updates from ISSVA, ESPD, and SID: What You Missed that Could Change Your Practice."

Paller spoke with Dermatology Times to discuss the highlights of her session and what clinical pearls can be gleaned from the 2024 European Society for Pediatric Dermatology (ESPD) Congress in Košice, Slovakia, earlier this year.

"I'm particularly looking forward to hearing about some new therapies and new directions in therapies for our pediatric patients who have so many of these chronic skin disorders for which we need better treatment," Paller said.

Transcript

Amy Paller, MD: Hi, I'm Amy Paller. I'm the chair of dermatology at Northwestern and a pediatric dermatologist from Chicago. I'm here at the Society for Pediatric Dermatology meeting and really excited about the new developments I'll be hearing about at this meeting. I'm particularly looking forward to hearing about some new therapies and new directions in therapies for our pediatric patients who have so many of these chronic skin disorders for which we need better treatment.

At this meeting, I will be talking for 10 minutes about highlights at the 4-day European Society for Pediatric Dermatology meeting. That's quite a challenge, because there were many amazing talks. I'm going to touch very quickly on the keynote talks.

Eli Sprecher from Israel gave his usual eloquent conversation about his thoughts about genetics. I had a lot of takeaways from that, but I think that one of them was just the concept that we've gone from just having a genotype to explain the basis for one of our pediatric genetic disorders, to really start thinking about other factors that modify the phenotypic presentation beyond just the actual gene or even the exact genotype. For example, environment can modify manifestations, and I'm particularly intrigued by other modifier genes that are being found in individuals that might make the disease worse or of earlier onset. An example of that is ichthyosis vulgaris, with some of the disorders of epidermal differentiation, and that tends to make them more severe in their manifestation. If there's more than one person in a family, we can start to look for these kinds of modifiers when there is different phenotypic severity of the genetic disorders.

I give a keynote talk at the European Society, and I'll talk a little bit about some of the new concepts about itch and the fact that so many of the disorders that we deal with have a pathway that's non histaminergic. We have to figure out, even among those, which particular neurogenic factors are activated, so we can more precisely target them. I'll be mentioning some of our experience. For example, with dupilumab for itch in genetic disorders, I've had some dramatic results, including an improvement, not just in itch, but in terms of phenotype, particularly with epidermolysis bullosa. Then there are people who don't respond at all, again, leading to the question: Why are there differences?

Another keynote speech was by our own Ilona Frieden, and I'll mention a little bit in this talk about the hemangiomas and what we've learned from them now that are different from what we knew back several decades ago when Ilona and I were first starting out in parallel. She also talked quite a bit about vascular malformations.

We had Veronica Kinsler give a riveting talk, hypothesizing and really showing evidence from looking at patterns that there are 3 different origins for melanocytic-looking lesions for our pigmented mosaicism and how some really have to do with changes in keratinocytes while some have to do with origin and keratinocyte alterations, whereas others may have to do with 2 different origins of melanocytic cells that give very different patterns.

We had a great talk from Angela Hernández[-Martín], who talked about her use of ultrasound in her own office and how she can use that to screen lesions to decide whether she needs to biopsy or how aggressive she needs to be.

I was particularly intrigued, as well, by a presentation by Dr Ulrike Blume-Peytavi, who spoke about her experience with a new herbal extract called Coacillium that contains a variety of herbs and can be topically applied to the scalps of children with alopecia areata with some very good results, including even progression in terms of improvement after stopping the medication, something that we're not seeing right now with JAK inhibitors. It was a great meeting, and lots of take home points for our office practice.

[Transcript has been edited for clarity.]