PDA vision quickly becoming reality

The recently organized Pigmentary Disorders Academy (PDA) already can be credited with a number of significant accomplishments. These accomplishments exemplify its aims to increase awareness of pigmentary disorders within the medical community and to update and educate physicians about these conditions and their treatments to enhance patient care.

What is it?

The PDA comprises 14 dermatologists who are internationally recognized experts on disorders of cutaneous pigmentation. It convened its inaugural meeting in October 2003 and began work then to develop recommendations for best practice in the treatment of melasma and solar lentigines. literature and expert opinion on various treatment modalities, rating the quality of available evidence for each option, and making recommendations about the evidence supporting its use. The final reports on those treatment recommendations will appear in an upcoming supplement to the Journal of the American Academy of Dermatology. That publication will also feature a position paper on problems of nomenclature in pigmentary disorders along with review articles on non-invasive evaluation techniques and recent literature.

"The PDA is serving as an excellent venue for bringing together clinicians and scientists with an interest in pigmentation and pigmentary disorders," says Amit G. Pandya, M.D., associate professor of dermatology, University of Texas Southwestern Medical School, Dallas, and a member of the PDA steering committee. "By enabling interaction and collaboration, it has allowed us to undertake more ambitious projects and complete them more rapidly and efficiently than if we continued to pursue our research interests as individuals. We expect that our efforts will translate into important benefits for encouraging further research, creating greater awareness, and improving the management of these conditions that carry a significant burden through their effects on quality of life."

The PDA was created by Galderma and is supported by that company through an unrestricted grant. Its chairman is Jean-Paul Ortonne, M.D., professor of dermatology, University of Nice, Sophia-Antipolis, France.

Getting down to business In April of this year, Dr. Ortonne, Dr. Pandya and other members of the PDA steering committee met to refine the draft treatment recommendations, review the most recent relevant literature and establish objectives and an agenda for the group's second annual meeting, scheduled in November.

At the upcoming meeting, the PDA will begin work on developing treatment recommendations for vitiligo. It will be characterizing regional differences in various disorders of pig-mentation to see if the information holds clues to etiology and better treatment.

"For example, we know melasma predominantly affects persons with darker skin types," Dr. Pandya notes. "However, that is a broad population characterized by significant racial and ethnic diversity, including persons of Hispanic, African, Asian Indian and Middle Eastern descent, among others. There are certainly genetic differences between those subgroups, which we would expect might translate into biologic differences, such as with respect to melanocyte number, melanocyte sensitivity or immune system response, that could ultimately influence disease development and treatment success."

Hispanics will be the first racial-ethnic group that will be considered at the upcoming meeting, which convenes in Rio de Janeiro. PDA members will look first at the literature, but, recognizing that information may be sparse, will also draw particularly on the clinical experience of South American members who have treated thousands of Hispanic patients.

Using the Consolidated Standards of Reporting Trials statement as a reference, PDA members will also begin drafting guidelines for conducting clinical trials investigating treatment of pigmentary disorders in order to improve the quality of those studies. In a related area, the group will continue to work on definitions for terms used when discussing skin color, pigment andpigmentary disorders.

"There are many words that clinicians and researchers use interchangeably, and sometimes improperly. Development of standardized definitions has importance for both interpreting results from clinical trials and in the care of patients in daily practice," Dr. Pandya says.

At the annual meeting, the group will also continue its review of post-inflammatory hyperpigmentation, which Dr. Pandya observes is one of the most common but probably least understood of the pigmentary disorders. The group's work will focus on defining its etiology, developing a classification system and considering evidence for the use of various treatments.