President of the World Health Academy, Dermatology;
Dermatology and Venereology Department,
University of Studies Guglielmo Marconi, Rome, Italy

Vitiligo is an acquired depigmentary skin disorder of unknown etiology. Vitiligo is not only a disease of melanocytes of the skin. Human melanocytes are derived from the neural crest and are located on various parts of the body. The involvement of skin melanocytes is the most visible one, but a systemic involvement of melanocytes can be observed. Some types of vitiligo (nonsegmental vitiligo) may also be associated with various diseases, mainly with autoimmune pathogenesis. Vitiligo represents a spectrum of many different disorders with different etiologies and pathogeneses, causing a common phenotype: the loss of melanocytes and/or their products. This phenotype is always consistent with a systemic involvement.

Prof. Lotti is Full Professor of the Dermatology and Venereology at University of Studies Guglielmo Marconi, Rome, Italy. He is President of the World Health Academy, Dermatology since 2013.Director , Centro Studi per la Ricerca Multidisciplinare Rigenerativa (CSRMR), of the University of Rome “G.Marconi”, Rome, Italy, since 2015. He is Honorary Professor of Dermatology – China Medical University Shenyang (2011), Lecturer at the New York Academy of Sciences “Howard Fox Memorial Lecture” (14 March 2012 – New York, NY – USA), and Chair, Executive Scientific Committee Vitiligo Research Foundation, New York , NY USA. He has been Full Professor of the Dermatology and Venereology Division at University of Florence School of Medicine, Florence, Italy, from 2006 to 2010. He is Visiting Professor in six International Universities worldwide, and Key Note Lecturer in several international dermatology Societies. His activities in serving Dermatology have been numerous: President of the Italian Society of Dermatology and Venereology (SIDeMaST , 2009-2010) and President of the International Society of Dermatology ( ISD, 2009-2010), President of the European Society for Cosmetic and Aesthetic Dermatology (2003-2004), Editor in Chief of the Journal of the European Academy of Dermatology and Venereology (1992-2002) , Editor “Therapeutic Hotline”- Dermatologic Therapy (2007-)and served as Editor in Chief of the Giornale Italiano di Dermatologia in the period of presidency of the Societa’ Italiana di Dermatologia (2009-2010). He has been President of numerous international congresses and is currently Editor in Chief of the Giornale Italiano di Dermatologia e Venereologia ( 2010-2020 ). He is Ordinary Member of the main Scientitifific Societities worldwide (EADV, SIDEV , ESDR , ISD, AAD, SID) and Honorary Member of several Scientific Societies of the Dermatology field. Moreover, he is a Scientitifific reviewer of ten sectorial journals, among which are the British Journal of Dermatology, Journal of Investigative Dermatology, Journal of the American Academy of
Dermatology , Dermatologic Therapy. He has authored 1507 scientitifific publicatitions (577 peer reviewed articles, 288 books chapters and 365 abstracts). For more informatition, see

Chairman of the Board of the European Venous Foundation;
Editor-in-Chief of International Angiology; “Special Scientist” at the University of Cyprus;
Chairman of the Cyprus Cardiovascular Disease Educational and Research Trust (CCDERT);
Medical Director of the Vascular Screening and Diagnostic Centres in London and Cyprus;
Professor Emeritus at Imperial College
and an examiner for MS and PhD degrees for London University, UK

Venous signs and symptoms

Symptoms are what the patient feels and complains of in contrast to signs which are elicited by the doctor. Signs are the basis of the CEAP classification which does not take any account of symptoms. It is important for the doctor to consider both symptoms and signs in planning treatment, because if symptoms persist the patient will not be satisfied.
The underlying cause of both symptoms and signs is venous hypertension whose effect is modified by two natural protective mechanisms. The first is the ability of lymphatic drainage to increase up to 5-10 times in some individuals but only two times in others and none in the presence of lymphedema. The second protective mechanism is the fibrinolytic activity (FA) in the blood and tissues that enables the body to remove extravascular proteins and macromolecules. In the presence of high FA skin changes may be minimal or absent despite a high ambulatory venous pressure. In the presence of low or absent FA severe skin changes may occur with only slightly raised or even normal ambulatory venous pressure. Also, duration of venous hypertension in years is an important factor that determines outcome.
The most exciting new finding comes from the study of the microcirculation in the skin using Orthogonal Polarisation Spectral (OPS) Imaging which provides us with quantitative measurements of functional capillary density (FCD capillaries/mm2), diameter of dermal papilla (DDP, μm) to quantify edema, largest diameter of the capillary bulk (DCB, μm) to assess its degree of change, capillary limb diameter (CD, μm) to describe diameter changes and capillary morphology (CM, % of abnormal capillaries per field). These measurements increase progressively with each increasing CEAP clinical class and have been shown to decrease after treatment with venoactive drugs.

Understanding Venous Scores and Quality of Life

In Chronic venous disorders (CVD) there are two classification systems (CEAP and REVAS) and four scoring systems (Venous disability score –VDS; Venous Segmental Disease Score-VSDS; Venous Clinical Severity Score-VCSS and the Villalta Scale .

Assessment of efficacy of therapy is achieved by several methods of evaluation of symptoms and several aspects for assessment of quality of life (QoL).
CEAP was created by the American Venous Forum as a common language for chronic venous disorders to be used in publications to clarify what patients are involved. This explains why in CEAP there is no information on type of symptoms or their severity.
REVAS stands for Recurrent Varicose veins After Surgery and it was developed at International Consensus meeting in Paris in 1998 to be used in combination with CEAP classification. It has been evaluated in terms of intra- and inter-observer reproducibility and a worldwide survey was conducted in 2006.
VDS has a maximum of 3 grades defined as: 0 = asymptomatic, 1 = symptomatic but able to carry out usual activities without compression therapy, 2 = can carry out usual activities only with compression and/or limb elevation, 3 = unable to carry out usual activities even with compression and/or limb elevation.
VSDS combines the anatomic and pathophysiologic components of CEAP. Based on venous imaging (duplex or venography). Major venous segments are graded according to presence of reflux and/or obstruction.
VCSS is based on nine clinical characteristics: pain or other symptoms, varicose veins, edema, skin pigmentation, inflammation, induration, and number, duration, size of active ulcers and need to use of conservative therapy (compression and elevation). Characteristics are graded from 0 to 3 and are added to produce a 30 point-maximum flat scale. Only 3 points can be contributed by symptoms !
Villalta Scale for PTS. It scores symptoms: cramps, pruritus, pain, heaviness, paraesthesiae and signs: pretibial edema, induration, hyperpigmentation, new venous ectasia, redness and pain during calf compression; severity from 0 (not present) to 3 (severe), for a maximum of 33 points.
Evaluation of Symptoms. Patients can give global ratings of improvement in symptoms or individual symptoms. They can use quantitative scales such as a Likert scale or a visual analog scale (VAS) (0-10 severity).
Quality of life for patients with CVD can be assessed by: (a) Generic Questionnaires e.g. The Medical Outcome Study Short Form Health Survey (SF-36) or EQ5D-5L TM or (b) Disease-specific measures e.g. the Chronic Venous Insufficiency Questionnaire (CIVIQ), The Aberdeen Varicose Vein Questionnaire (AVVQ), VVSymQ or CXVUQ

Pathophysiology of Chronic Venous Disease (CVD)

Primary varicose veins (VVs) occur in the absence of previous DVT. Recanalisati on after DVT may give rise to relative obstruction and incompetence of the deep, superficial and perforating veins. VVs are present in 14-35% of the population and their prevalence and severity increase with age. 40% of venous leg ulcers are the result of long-standing VVs in the presence of normal deep veins. 60% of venous ulcers are due to the post thrombotic syndrome as a result of previous DVT. Venous hypertension results from obstruction (failure of recanalization) and recurrent DVT, reflux (damage to valves) or from a combination of reflux and obstruction.
Leukocyte-endothelial interaction is the cause of primary VVs. Environmental and local factors plus genetic predisposition produce white cell adhesion, degranulation and leucocyte migration under the endothelium. A chronic inflammatory process produces vein wall and valve remodelling. Eventually valves become incompetent with tortuous dilated veins with venous hypertension as a consequence. Skin changes occur when reflux exceeds 5 ml/sec and ulceration when reflux exceeds 10 ml/sec.
Leukocyte adhesion occurs also in the microcirculation where it produces local edema, red cell extravasation and skin pigmentation due to haemosiderin deposition. The veno-arteriolar reflex is abolished, total skin flow is increased with reduction in blood flow in the nutrient capillary loops with eventual skin ulceration. The most exciting new finding comes from the study of the microcirculation in the skin using Orthogonal Polarisation Spectral (OPS) Imaging which provides us with quantitative measurements of functional capillary density (FCD capillaries/mm2), diameter of dermal papilla (DDP, μm) to quantify edema, largest diameter of the capillary bulk (DCB, μm) to assess its degree of change, capillary limb diameter (CD, μm) to describe diameter changes and capillary morphology (CM, % of abnormal capillaries per field). These measurements increase progressively with each increasing CEAP clinical class and have been shown to decrease after treatment with venoactive drugs.

Professor Andrew Nicolaides is a graduate of the Pancyprian Gymnasium (Nicosia) and Guy’s Hospital Medical School (London University 1962), and a fellow of the Royal College of Surgeons England, and the Royal College of Surgeons Edinburgh (1967).

His higher surgical training was in Oxford University, Kings College Hospital Medical School and St Mary’s Hospital Medical School, London. He was awarded the Jacksonian prize by the Royal College of Surgeons England in 1972 for his work on the prevention of venous thromboembolism and obtained the degree of M.S. (Master of Surgery) in 1976.

He was the Professor of Vascular Surgery at the Imperial College School of Medicine (St Mary’s Hospital) and Consultant Vascular Surgeon at St Mary’s Hospital from 1983–2000 and Medical Director of the Cyprus Institute of Neurology and Genetics from 2001-2004. His research group is known internationally in several areas which include noninvasive vascular screening and diagnostic investigation, early detection and prevention of cardiovascular and venous disease. His research is now directed towards the genetic risk factors for cardiovascular disease, identification of individuals at risk and the development of effective methods of prevention, especially stroke.

He is Past-President of the International Union of Angiology and Past-President of the Section of Measurement in Medicine of the Royal Society of Medicine.

He has received many awards and honorary memberships from many scientific societies. He is Chairman of the Board of the European Venous Foundation, Editor-in-Chief of International Angiology and is on the Editorial Board of many vascular journals. He is Professor Emeritus at Imperial College and an examiner for MS and PhD degrees for London University. He is now a “Special Scientist” at the University of Cyprus, Chairman of the Cyprus Cardiovascular Disease Educational and Research Trust (CCDERT) and Medical Director of the Vascular Screening and Diagnostic Centres in London and in Cyprus. He has trained over 200 vascular surgeons who are practicing all over the world; twelve of them are holding prestigious Chairs as professors in vascular surgery in UK, USA, Greece, Australia and South Africa.

He was made Archon Megas Referendarios, an Honor bestowed by the Patriarch of Constantinople in 1994.

He is co-author of over 500 original papers and editor of 14 books.

M.D., PhD Private practitioner in Dermatology, Lyon, France

European requirements labelling for the cosmetic products: Interest for the Dermatologist?

”Cosmetic product” means any substance or mixture intended to be placed in contact with the external parts of the human body (epidermis, hair system, nails, lips and external genital organs) or with the teeth and the mucous membranes of the oral cavity with a view exclusively or mainly to cleaning them, perfuming them, changing their appearance, protecting them, keeping them in good condition or correcting body odours.
Regulation (EC) N° 1223/2009 on cosmetic products is the main regulatory framework for finished cosmetic products when placed on the EU market. It strengthens the safety of cosmetic products. The dermatologists have to know the European requirements labelling for cosmetics when they are questioned by their patients and when they have to take care of patients suffering from allergic contact dermatitis. There is a non mandatory labelling (hypoallergenic, dermatologically tested, and so on) that is not useful. There is a mandatory labelling (list of ingredients, special warnings and so on) that is very useful.

Scurt CV

Specialist in dermatology and awarded a diploma in study of allergies
In charge of teaching at the university of Besançon
Responsible for the Functional Unit of Study of allergies of the Hospital St Jacques, Besançon
Doctorate in medicine in1978: thesis of medicine : ”Allergy in the nickel and the atopy„

Member of the Group of Studies and Research in Dermato-Allergologie ( GERDA)
Founder of the Network of Vigilance in Dermato-Allergologie (REVIDAL GERDA)
President of the Workgroup in the AFSSAPS, in charge of the cosmétovigilance ( 2000-2006 )
President of the GERDA, on 2008-2011.
Award Robert Degos 1998 for ” Late reading of patch tests „, European Journal of Dermatology ; Award of the City of Paris by the National Academy of Medicine of Paris the City of Paris, on 2003 for « allergie et cosmétiques »Paris expansion scientifique 2003

PhD, ERT, DSc, FATS, DHonC, DHonC, DHonC, HonProf, FMRAS , Academician

Aging process and its modulation: advances on biomarkers for skin regeneration and related
health problems

Telomeres which are the protective end-complexes at the termini of eukaryotic chromosomes shorten during mitotic cell division and lose their ability to divide leading to cellular senescence and aging. When telomeres become too short, cells may be unable proliferate and this situation has been linked to the development of a variety of aging-related diseases. Telomeres have an important role in the life of skin cells, including the aging of skin. Skin is a self-renewing tissue that is required to go through extensive proliferation throughout the lifespan of an organism.Telomere length have been used as a biomarker of cell senescence to explore the role of telomere shortening in photoageing induced by ultraviolet A (UVA) light and it is a useful new target for attempts to prevent it. Previous study has concluded that telomere biology is involved in the aetiology of cutaneous melanoma although the underlying mechanisms of tumorigenesis are to be fully elucidated yet. Telomerase, the tightly regulated enzyme complex that maintains telomere length in rapidly proliferating cells such as germline and cancer cells, has been implicated in having a key role in the maintenance of skin cell function and proliferation. Telomerase RNA component (TERC) and telomerase reverse transcriptase (TERT) function together to elongate telomeres and to protect chromosomal ends. Mutations in genes of the telomerase complex lead to many diseases that involve epidermal abnormalities, such as in dyskeratosis congenita. A delicate balance between telomere length and telomerase activity is required to maintain normal skin cells and avoid cancer. Previous studies have found that telomerase is not expressed in the similar race in skin cells. Human epithelial cells and fibroblasts have low levels of TERT expression although the RNA component TERC is expressed at readily detectable levels in most cell types, including skin fibroblasts and epidermal cells. On the other hand, the exogenous expression of TERC can up regulate endogenous telomerase, in primary keratinocytes and extend their lifespan. Telomerase enzyme is highly active in over 90% of all cancers since up regulation of telomerase is important for skin carcinogenesis. As an environmental barrier for the body, the skin’s exposure to ROS would suggest a role for ROS in telomere shortening and ageing in skin cells. Future studies may lead to treatments or therapies that manipulate telomerase or other factors that alter the length of telomeres, in order to slow down ageing in skin and aging-related diseases.


Short CV
Professor Tsatsakis Aristidis

Professor, Academician Aristidis Tsatsakis, PhD, ERT, DSc, FATS, DHonC, DHonC, DHonC, HonProf, FMRAS.
Aristides Tsatsakis is the Director of the Department of Toxicology and Forensic Sciences of the Medical School at the University of Crete and the University Hospital of Heraklion. Dr Tsatsakis has written over 1000 publications (books and abstracts proceedings), over 400 of them in ISI journals. He is holder of several patents and has an extensive array of citations and reads /downloads to his papers. Dr Tsatsakis has given numerous keynote and plenary lectures in international congresses and was the promoter and chair of noumerous Symposiums and workshops in International Forum. He has coordinated as a PI in over 50 scientific research and technology projects and has established worldwide collaborations. Aristides Tsatsakis was elected EUROTOX President-Elect in 2012 served as President (2014-2016) of the Federation of European Toxicologists and European Societies of Toxicology. Dr. Tsatsakis has a long standing activitiy as Editor in toxicology journals. Prof. Tsatsakis is Emeritus Professor for the Federal Institute of Hygiene and Toxicology in Moscow (2014), Doctor Honoris Causa of the Mendeleev Moscow University (2016), of the Far East Federal University (FEFU), Vladivostok 2017 and of the Carol Davila, in Bucharest (2017). In 2016 was elected Foreign Member of the National Academy of Sciences of Russia (FMRAS) and in 2017 of Fellow Academy of Toxicological Sciences (FATS, USA). Aristides Tsatsakis is the inspirator, founder and chief scientific officer of the University of Crete spin-off Company ToxPlus S.A. The main research interests of Professor Tsatsakis are biomonitoring of various xenobiotics in a variety of biological samples and linking of chemical chronic exposure at low doses with health problems and diseases and risk assessments. He developed numerous biomarkers of exposure and of effects for the pesticide and chemical toxicology area uncovering the mechanistic understanding of the mode of actions and adverse outcome pathways and clinical effects.

M.D., PhD – Vice President of Société Française de Phlébologie;
Attached practitioner of the internal and vascular medicine department of
University Hospital of Bordeaux, France

Clinical Cases of PREVAIT (live voting session)

Doctorate in medicine – Date of thesis: 1982   .Thesis place of achievement:   LYONMedical Association Number: 06687 8Current Job position: –  Private Practice of Angiology, Phlebology and Vascular Laboratory  Since: 1984- Attached practitioner of the internal and vascular medicine department of University Hospital of Bordeaux Part-time university lecturer (Université Victor Segalen Bordeaux); DIU Alimentation santé et Micronutrition (2007)Area of expertise and skills: CW Doppler, Duplex-Scan, Ultra Sound Guided Sclerotherapy, Sclerotherapy, thermal ablation of varicose veins, Phlebectomy, ulcer Care, MicronutritionMembership in professional associations :General secretary of Société Française de Phlébologie (2014 – 2017),Vice President of Société Française de Phlébologie (2017- current), Member of Collège des Enseignants en Médecine Vasculaire; Member of the Société Française de Médecine Vasculaire,  Past- president of Association Régionale des Médecins Vasculaires d’Aquitaine
Publications: since 2014Exploration ultrasonore de l’insuffisance veineuse superficielle (JF Auvert, L Moraglia) in Les explorations vasculaires Elsevier Masson 2014. Chemical ablation of the great saphenous vein: French spirit. L Moraglia Phlebologie 2014, 67, 1, p31-25Sclérothérapie (C. Hamel-Desnos, L. Moraglia, A.- A. Ramelet), in La maladie veineuse chronique Elsevier Masson 2015Le Bilan échodoppler en présence de varices après intervention opératoire (PREVAIT) in Ultrasons et Phlébologie Editions Phlébologiques Françaises 2016Epidemiology of Chronic Venous Disease of Lower Limbs in VAS European Book on Vascular Medicine/Angiology 2018

Medical Communication Lead, Venous Disease, Global Medical Affairs,
Servier, Paris, France

Detralex : the option for the management of patients with chronic venous diseaseDetralex : the option for the management of patients with chronic venous disease


In charge of the international Medical communication in phlebology and proctology, and more specifically of:  • the definition and implementation of the Medical Strategy phlebology and proctology • The scientific aspects of Servier participation in International congresses  (programs of symposia)• The coordination of the relationships with external stakeholders (International Opinion leaders, International Scientific Associations, patients associations…)• The definition and implementation of the medical education programs in phlebology and proctology.

Head of the Phlebologic-Angiological Unit of the University Clinic of Dermatology, Vienna, Austria

Skin changes in patients with vascular diseases

Background: Several vascular diseases can manifest itself with more or less typical skin changes. Principally, a distinction can be made between diseases of the veins, diseases of the arteries, diseases of the lymphatic vessels, microvascular diseases and vasculitis. Many of these diseases are treated by various specialists and often fall on the edge of the respective specialist training. Apart from this, some of these diseases are rare, others are underdiagnosed.
Methods: I will present an overview of the most common vascular diseases. Based on clinical examples I would like to explain the course and the therapeutic response of various vascular diseases. In addition, I will also present rare pictures and interesting cases.
Conclusion: Patients with vascular diseases are often a challenge for the doctor. It is often necessary to have a cooperation between different specialists in order to achieve the best possible care for our patients.

Rook’s Textbook of Dermatology, Volume 3;48.1-51.27


Medical University of Vienna, Austria
Head of the Phlebologic-Angiological Unit of the University Clinic of Dermatology, Vienna
Dermatologist, Specialist for venous diseases and vascular medicine
Member of the European Academy of Dermatology and Venereology
Member of the Board of the Austrian Society of Phlebology and Dermatological Angiology,
Member of Austrian Society of Dermatology and Venereology,
Member of Austrian Society of Dermatosurgery,
Member of the Austrian Working Group Aesthetic Dermatology and Cosmetology,
Member of the Austrian Working Group Photo Medicine

M.D. Pezenas, France

Steam ablation and venous ulcers healing

Endovenous techniques have been available since 20 years , steam since 10 years .Being the most versatile method it is well suited for treating C 6 patients , who often offer a complex hemodynamic pattern . In this presentation will not deal with chronic Iliac obliteration , but they must be diagnosed and treated before dealing with sub-inguinal lesions .
3 main categories can be observed :
1 / Isolated superficial venous insufficiency :
Truncal reflux in the Great or Small Saphenous veins can be belated even if the ulcers is open. As the distal part of the veins are often involved , and skin damage can prevent puncture at ankle level , we often use a twin catheter technique , one long catheter from the garter upward to the junction, and a shorter one downward to the ankle . Steam will penetrate the smaller veins around the ulcers maximizing the venous pressure release .
2 / Combined superficial and deep veins reflux with perforator involvement  These post-thrombotic patients have diffuse lesions .The Great Saphenous veins can be a n outlet for obliterative sequellae , as shown by spontaneous respiratory vvariations of the Doppler signal ,or continuous flow . In such cases , we treat only the leg portion of the Saphena and the perforator. Deep veins valve repair or transplantation is advised only if the ulcers does not deal or reopens early .
3 / Isolated deep leg veins incompetence with perforator insufficiency can be a consequence of post-traumatic deep veins thrombosis . In these patients one of the two Posterior Tibial veins is dilated and refusing , while the other  one is normal. It is thus possible to close the affected trunk : we use coils deployed under ultrasound guidance and complemented by steam to ablate the endothelium . In conclusion , steam ablation is a helpful tool to help close most venous ulcers .

Dr R.Milleret was trained in cardiovascular surgery in Lyon ( France ) under Pr Pierre Marion. He studied e lectronics at the same time and developed Doppler instruments in the Seventies . His main interest lies in Venous surgery , he did the first deep valve repair in Europe in 1978 Using Kistner’technique. He pioneered endovenous surgery of varicose veins by introducing cryo-sclerotherapy of saphenous trunks in 1981 . In 2005 he proposed Steam ablation , à method now widely used In Europe R.Milleret is currently working in Cluj and Bucarest . He was President of the meeting of the French Society of Phlebology in 2017 .

President of the European Institute of Nutritional Medicine, E.I.Nu.M.

Advances in clinical application of Metabolomics:
Treating children with atopic dermatitis

Metabolomics, the quantification and comprehensiveassessment of metabolites, has emerged as a novel and powerful tool in precision medicine. The great advantage of introducing metabolite analysis in clinical practice stems from the fact that they reflect both the genetic predisposition to a disease and the impact of epigenetic factors such as nutrition, environment, drug and lifestyle on phenotype.Gas chromatography/ Mass spectrometry methodology has allowed the detection of low quantity molecules in human biofluid samples. Targeted analysis of organic acids and fatty acids that participate in central biological pathways of the cell, provide information on nutrient deficiency, oxidation status and response to xenobiotics or pharmaceutical treatment. Thus, through the assessment of the overall health status, early detection of a disease and intervention to restore these deficiencies is feasible.
Since the Human Metabolome Project launch in 2004 multiple studies have focused on the identification of metabolites as biomarkers. Providing a systematic approach, metabolomics have great application in several non- communicable diseases including those of skin. Atopic dermatitis is the most common inflammatory skin disease among young children and affects up to 20% of children in developed countries. Primary symptoms of the disease occur before two years of age having major impact on quality life and socio-economic burden of the children and parents. The pathogenesis has not been fully elucidated probably due to high variability of the clinical phenotype along with the presence of other comorbidities.
The primary therapeutic strategy against atopic dermatitis includes topical steroids and oral antihistamines which focus on inflammation suppression and the alleviation of symptoms. Targeted Metabolomic analysis and subsequent personalized treatment were performed in over 30 Korean infants, that did not respond to standard therapeutic actions.Metabolomic analysis revealed significant metabolic disruption in Citric Acid Cyclealong with mitochondrial dysfunction due to xenobiotics toxicity, lack of the amino-acid glutamine and ubiquinol, cytochrome C dysfunction, and imbalances in selected fatty acids markers such as omega 6/ omega 3 ratio, arachidonic/EPA ratio and Homo-g-linolenic acid levels.
Our treatment included restoration of specific nutrient deficiencies and personalized diet based on the metabolomic profileand resulted in improvement of the skin lesions within a few weeks from the initiation of the treatment in most cases.
Overall, metabolomics can be a useful tool for the application of precision nutrition in children suffering from atopic dermatitis.

Dr. Dimitris Tsoukalas, M.D.

Physician, General practitioner
Dr. Dimitris Tsoukalas MD Dr. Tsoukalas graduated in 1991 from the “Universita’ degli Studi di Napoli, Federico II” in Italy. In 2000 he completed his specialization in General & Family Medicine at the Hippokration University Hospital in Athens Greece. In 2013 he completed the Harvard Medical School Update Course in General & Internal Medicine for subspecialists. Dr. Tsoukalas is the President of the European Institute of Nutritional Medicine, E.I.Nu.M. Since 2007 he focuses on metabolomics analysis clinical application in autoimmune and chronic diseases. He is currently researching on telomere biology – nutraceuticals effect on telomere length – and metabolomics biomarkers use in clinical practice with Prof A. Tsatsakis and his team from the University of Crete School of Medicine, Greece.

M.D. Freelance Dermatologist,
Centro Oncologico ad Alta Tecnologia Diagnostica, Azienda Unità Sanitaria Locale
IRCCS di Reggio Emilia, Italy

An update on non-melanoma skin cancers: what’s new?

Non-melanoma skin cancers (NMSCs) represent the most common tumors in humans and consist of a heterogeneous group, mainly composed by squamous and basal cell carcinomas, but also by other less common types of tumors, such as lymphomas, Merkel cell carcinoma, Kaposi’s sarcoma and adnexal tumors.
Over recent decades, new diagnostic techniques have significantly improved our ability in diagnosing NMSCs, being dermoscopy and confocal microscopy the most useful at this purpose.
Several studies have been conducted allowing to identify the main dermoscopic and confocal criteria for cutaneous carcinomas, but also for less common NMSCs.
Furthermore, new insights have been provided in recent years, concerning the role of these techniques in diagnosing NMSCs in special sites, in defining the surgical margins or in assessing the therapeutic efficacy of non-surgical therapies for these tumors.
Finally, confocal microscopy has been successfully used in an ex-vivo setting, as an alternative to Mohs surgery.

Short CV

Dr. Riccardo Pampena is a board-certified Dermatologist specialized in the diagnosis and treatment of skin cancers.
He obtained his degree in Surgery and Medicine (MD) from the Catholic University of the Sacred Heart of Rome in 2011 with full mark; then, he became a board-certified Dermatologist (full mark) in 2016 at the Department of Dermatology and Venereology of the Sapienza University of Rome.
Since 2011 he practices research mainly in the field of psoriasis and non-invasive diagnosis in dermato-oncology, paying particular attention to the use of non-invasive diagnostic methods, such as dermoscopy and confocal microscopy for the in vivo and ex vivo study. Since November 2016, Dr. Pampena has been working at the Skin Cancer Unit of the Arcispedale Santa Maria Nuova of Reggio Emilia, a third-level referral center for skin tumors diagnosis and management and recently became a Board Member of the International Dermoscopy Society.
Furthermore, he’s actively involved, as a statistician, in scientific studies and was the first author of a meta-analysis on “Nevus associated melanoma” published on the prestigious Journal of the American Academy of Dermatology in 2017.

Pathology Unit, Centre Hospitalier Lyon Sud, Lyon, France

Mycosis Fongoid is the most frequent of primary cutaneous lymphoma. It is a low grade lymphoma with good prognostic.
We describe the different clinical presentations , knowing that diagnosis is anatomoclinic. First there is à classical form with non infiltrated plaques, then infiltrated plaques, and tumors. Numerous clinical variants are described: disidrosic and bullous lesions, popular lesions, inflammatory chronic capillaritis, pigmentes plaques, achromic plaques, palmoplantar keratosis, erythrodermia, and invisble form without lesions. Clinical diagnosis is difficult, and need complementary investigations as well as histology, immunohistochemistry, and molecular biology. Some histological pictures suggest the diagnosis: small lymphcytic infiltrate in superficial dermis with epidermotropism. The immunophenotype is T CD4+. And there is a monoclonal population T with PCR in molecular biology..  Apparented forms are described: annexotrop form, chalazodermic form (granulomatous slack skin syndrom), and pagetoid form.
In conclusion, the diagnosis is difficult; dermatoologists need to be aware of different clinical presentations and require histologic examination.

Brigitte Balme
Phone: +33478863066
Doctor es Medecine in 1980 (University of LYON France)
Certificat d’études spécialisées de dermatologie (national board) in 1979
Certificat d’études spécialisées d’anatomie pathologie (national board) in 1983.
Member of the French Society of Dermatology
Member of the section of dermatopathology of the French Society of Pathology
Member of the International Society of Dermatopathology
Functions :
Since 1980 médecin attaché des Hôpitaux
Since 1996, Praticien Hospitalier

Founder of Spandidos Publications; Professor Emeritus,
Medical School, University of Crete, Heraklion, Greece

Publishing in Biomedical SciencesPublishing in Biomedical Sciences

Demetrios A. Spandidos, PhD, DSc, FRCPath, FRSHProfessor Spandidos Publications /

When you have written your paper with the research results as accurately as possible it is necessary to investigate which publication is suitable for its presentation. As you most probably also have important deadlines to meet this is a very serious decision.  Evaluate the level of significance of your findings with the help of others as over-estimation might delay publication greatly. Consider with greatest care whether it is necessary to submit to a very high impact journal, as in this case the competition is very tough due to limited space. However, all established journals enter their papers to various international databases, thus your paper will receive exposure as soon as the publication process has been completed. Novelty of your results, and quality of the presentation, both linguistic and the figures, are the first aspects that the reviewer will attach importance. The Editorial Office, might return your work for improvements unless the Instructions to Authors for the journal have been closely followed, as the very busy reviewers chosen should not have to ponder what the authors intended to say. If in-house backup for linguistic presentation, or preparation of figures is not available, we strongly recommend that you consider professional help for this. Among others, Spandidos Publications (UK) Ltd offers such services. This will cut the total time required before publication as only limited re-writing is likely to be requested by the authors at acceptance stage. It is always a good idea to be brief and to the point, and in case English is not your first language, this is essential. Do not try to impress with complicated sentences, which are hard to follow. The title should be short, giving an appetite to read more, avoid unnecessary details.  The abstract section is of great importance. Include only the essential information for your study to be understood. Make it interesting enough for the reader to wish to continue. Emphasize novel findings.  Introduction should only include previous work very closely relating to your new efforts. Do not ignore closely relevant finding of other authors, both similar or contrary results, and ensure that you indicate your previous papers on the subject. At this point you should very carefully consider that copying other published work too closely is plagiarism. Each paper submitted undergoes an electronic plagiarism check, and if the submission does not pass this strict test, it is immediately rejected. Materials and methods are important, but do not repeat the details on methods that are now standard and easily available. When completed, assess if you would be able to repeat your findings based on the information given. Do not forget to include the necessary ethics statements required by international rules relating to human tissue use, and animal experiments. Good quality figures enhance the final article, and make it easier to understand, and most importantly must show the main findings very clearly. Avoid the temptation of a long Discussion section. Do not generalize, or give endless variations as to the possible importance of your results. Compare your results with other relevant work, without using too frequently words such as suggest, may, might, possibly… Ask for a second opinion from colleagues, as again this would shorten the time you require to your goal, which is to see your work published in a timely manner.

Demetrios A. Spandidos is Professor Emeritus (since 2015) at the Medical School, University of Crete, Heraklion, Greece. He was Professor of Virology and Director of Clinical Virology Laboratory at the University Hospital and the Medical School in Heraklion, Crete (1989-2014) and he was Research Professor and Director of the Laboratory of Molecular Oncology and Biotechnology (1988-1998) at the Institute of Biological Research and Biotechnology at the National Hellenic Research Foundation in Athens, Greece. He is the founder and Editor of the International Journal of Oncology, Oncology Reports, International Journal of Molecular Medicine, Molecular Medicine Reports, Experimental and Therapeutic Medicine, Oncology Letters, Biomedical Reports and Molecular and Clinical Oncology. Dr Spandidos was born in Agios Constantinos, Sparta, Greece and obtained his B.Sc. in Chemistry from the University of Thessaloniki, Greece in 1971, a Ph.D. in Biochemistry from McGill University in Montreal, Canada in 1976 and a D.Sc. in Genetics from the University of Glasgow, UK in 1989. He is Fellow of the Royal Society of Health (1994) London, UK, Fellow of the Royal College of Pathology (1997) London, UK, Awarded the specialty of Clinical Chemistry, Greece (1998), Fellow of the American Society of Angiology (2005), Doctor Honoris Causa of the ‘Carol Davila’, University of Medicine and Pharmacy, Bucharest and of the ‘Iuliu Hatieganu’ University of Medicine and Pharmacy, Cluj-Napoca, Romania, Visiting Scientist and Guest Lecturer, Medical School, University of California, San Diego, USA (1985-1987), Visiting Professor of the University of Catania, Italy, and Kyoto University, Japan, Honorary Professor of Fujian University, P.R. China and corresponding Member of the Academia National de Medicina de Buenos Aires, Argentina (1989). He was an MRC of Canada post-doctoral Fellow at the Department of Medical Genetics at the University of Toronto in 1976-1978, an Assistant Professor (Epimelitis) at the Hellenic Anticancer Institute in Athens in 1978-1979, an MRC of Canada Centennial Fellow at the Beatson Institute for Cancer Research in Glasgow in 1979-1981 and a member of the Senior Scientific Staff at the Beatson Institute for Cancer Research from 1981-1989 when he took up his appointments in Greece.

Private practitioner in Dermatology, IKA Hospital, Skin Clinic, Crete, Greece

PLEXR in Dermatology. Blepharoplasty and other indications

Plexr is a new innovating technology known for its excellent results in non
surgical blepharoplasty. It works by producing plasma the forth state of matter.
In addition to the periorbital area acne scars, stretch marks and skin ellastosis constitute difficult areas of the aging skin. Plexr works by the sublimation of surface
keratinocytes without affecting basal lamina or causing any damage to surrounding tissue. The mild crusting created will fall off in 3-5 days and the moderate swelling soon subsides. Improvement is immediately visible to the patient and the doctor. The sublimation of excess skin gives a true lifting effect. It is a soft surgical procedure without anesthesia, incisions, sutures, scars and risk. Our patients are fully satisfied. Plexr uses a small electric arclike small lighting that selectively increases the temperature on a particular zone. Small spots 500 nm sublimate surface Keratinocytes stimulating instant contraction and tightening of the skin


– 1999 Medical School Graduate Diploma (Faculty of Medicine, University of Athens) Grade: Very Good
– 1999 Education quarterly in General Pathology, Cardiology and Surgery in Regional Hospital of Karpenissi
– 2000 Rural Service in R.C. of Proussos in Evritania Prefecture
– 2001 Education for nine months in specialty of General Pathology at the 1st IKA Hospital (Melissia, Athens)
– 2002-2004 Scientific Associate in Dermatology Clinic of UGHH (University General Hospital of Heraklion)
– 2004-2007 Specialty in Dermatology – Venereology (Dermatology Clinic in University General Hospital of Heraklion, Crete)
– 2005 to 2008 PhD thesis in University of Crete, Faculty of Medicine, Department of Morphology, Histology Laboratory. Grade: Excellent Cum Laude.
Thesis: Biochemical and immunological study of growth factors activity in biosynthesis of secreted Chondroitin and Dermatan sulfate proteoglycans in melanoma and normal melanocytes cell lines.
– 2007 until 2012: Scientific Associate in Dermatology Clinic of UGHH
– 2007 until today: Private Dermatology Clinic
– 2009 April : Internship at Skin Cancer Center Charite Berlin
– 2010 until 2012: Dermatologist in ΙΚΑ Hospital.

Dermatology Department, Centre Hospitalier Lyon Sud, Lyon, France

The use of telemedicine in dermatology: our experience in Lyon, France

Telemedicine has become a new stake in health care systems, to improve the access of weakened populations to a specialist expertise, to palliate the shortage of medical specialists in rural areas, and to limit the number of unnecessary in-person visits. Since dermatology is a very visual speciality, telemedicine may become a major tool for dermatologists. We will shortly review the use of teledermatology worldwide, based on published original articles. These articles mainly focused on cost-effectiveness, effectiveness and concordance of telemedicine in dermatology, which is already accepted as a valid tool.
Teledermatology has developed in the last two decades, based on technological progress. This technological progress permits to respect the confidential medical information, and regulatory, administrative aspects. We will present the telemedicine software set up by our hospital, to precise which rules have be observed, when developing such a tool.
We will then present a brief series of digital clinical cases we encountered with this teledermatological application, to illustrate the different improvements made by telemedicine, for the patient, his general practitioner, and the dermatologist.

Profession: Doctor of Medicine (MD), Dermatologist
Phone: +33478863333
Master II Therapeutic Innovations in Cancerology, University Claude Bernard Lyon 1 (2016)
Inter University Diploma, Dermatology of the Oral Mucosa, University Paris Descartes (2015)
Inter University Diploma, Surgical Dermatology, University Claude Bernard Lyon 1 (2014)
Thesis of Medecine, University Claude Bernard Lyon 1 (2013)
Specialization in Dermatology Diploma, University Claude Bernard Lyon 1 (2013)
Inter University Diploma of Oncological Dermatology, University of Montpellier (2013)
Inter-University Diploma of Pediatric Dermatology, University of Montpellier (2012)
Inter-University Diploma of Infectious and Tropical Dermatology, University of Paris VI Pierre et Marie Curie ( 2011)
Inter-University Diploma of Dermatology and Internal Medicine, University of Montpellier, (2010)
Residency in Dermatology, Hospices Civils de Lyon, University Claude Bernard Lyon 1 (2008-2013)