Jane Bellet, M.D., Durham, N.C., takes notes during ‘Advances in Photomedicine' Saturday.

Saturday's "Advances in Photomedicine" session featured some of the foremost international experts and active investigators in the field.

Directed by Henry W. Lim, M.D., C.S. Livingood Chair of the department of dermatology at Henry Ford Hospital and senior vice president for academic affairs for Henry Ford Health System, Detroit, the session offered a glimpse at the newest developments in what Dr. Lim called, "the always challenging area of photomedicine."

Alexander V. Anstey, M.D., an academic dermatologist at St. Woolos Hospital, Stow Hill, Newport, U.K., and Cardiff University's photodermatology unit in Cardiff, U.K., lead off the presentations with "What's New in Photodermatoses?"

The past decade has seen significant progress in the classification and definition of both congenital and acquired photodermatoses, Dr. Anstey said.

"Two new conditions have been added to the inherited photodermatoses," he said. "Two of the most severe and disabling forms of chronic cutaneous porphyria have now been precisely defined for the first time. Additionally, two of the acquired photosensitivity syndromes have been more precisely defined along with a better understanding of their immunopathogenesis."

Dr. Anstey talked at length about Smith-Lemli-Opitz syndrome (SLOS), which results from a failure to synthesize cholesterol due to deficient 7-dehydrocholesterol reductase.

"SLOS was only recognized to be a cutaneous photosensitivity syndrome in 1999, more than 30 years after the original clinical description of the syndrome," he said. "Severe learning difficulties restrict outdoor activities in children with SLOS, which may explain why this prominent problem was overlooked when the syndrome was originally described. Phototesting studies in the U.K. and U.S. have confirmed SLOS to be the only inherited photosensitivity syndrome characterized by sensitivity to UVA."

Dr. Anstey also looked at erythropoietic protoporphyria (EPP) and the more severe congenital erythropoietic porphyria (CEP).

A large cross-sectional study of EPP in the U.K. in 2002 showed that scarring in EPP is usually subtle, which goes against the literature up to that time, he said. The study also made a number of other important new discoveries — providing an explanation for the apparent iron-deficiency found in these patients, reporting on the large impact EPP has on the quality of life of those suffering from the disease and looking at the effect of severe photosensitivity on vitamin D metabolism, which is now understood to be common.

"Perhaps the most unexpected finding of this study was to discover two new genetic variants of EPP — one with palmar hyperkeratosis as a phenotypic marker for a recessively inherited variant of EPP with a reduced risk of liver disease and the other a form of porphyria that is biochemically similar to EPP, with which it has been previously been included," Dr. Anstey said.

Mina Yaar, M.D., professor of dermatology at the Boston University School of Medicine, presented "What's New in Photoaging?"

Dr. Yaar said evidence suggests three main players are responsible for the photoaging process — receptors, mitochondria and DNA.

"When the DNA is damaged, our entire genome is damaged," she said.

Gillian M. Murphy, M.D., presented "Advances in Photoprotection," from the National Photobiology Unit at Beaumont and Mater Hospitals in Dublin, Ireland.

"Ninety percent of skin cancers are related to UVR exposure," Dr. Murphy said. "The three pillars of an effective photoprotection strategy include behavior, clothing and the effective use of topical sunscreens."

Herbert Hoenigsmann, M.D., of the Medical University of Vienna, Vienna, Austria, presented "What's the Role of Phototherapy in the Era of Biologics?"

Dr. Hoenigsmann discussed efficacy and cost data, concluding that phototherapy is still an effective and affordable treatment that cannot be replaced by other measures in many cases.

"Even in the era of biologics, phototherapy will not become unnecessary," he said.

Harvey Lui, M.D., head of the department of dermatology and skin science at the University of British Columbia, Vancouver, presented "What's on the Horizon in Photomedicine?" in which he said that nanomaterials are making amazing things possible in photomedicine.

"The usual Newtonian concepts are out where nanotechnology is concerned because they are on a quantum mechanical stage," Dr. Lui said. "On that stage, the physical properties of even the hardest objects can be fundamentally softer.

"Nanomaterials are highly permeable into healthy tissue, which is great. The question now is how do we get them out and what are the long-term effects. We will need to see how it plays out in the next few years, but the possibilities are very exciting."