The skin, as a touchstone, reflects our mental and physical health, and protects us from mechanical impact and infection. The majority of dermatological diseases are not a threat to life, but cause discomfort and often cause emotional and psychological distress: after all, our skin is, quite simply, how we present ourselves to the world. SHM had a conversation with the lead dermatologist of the Waldhotel Health & Medical Excellence medical center, (part of the Bürgenstock Resort Lake Lucerne), Ahmad Jalili, about contemporary methods of prophylaxis and the medical treatment of skin diseases.
– Doctor Jalili, at your medical center you conduct full examinations of the skin, which are extremely important for prophylaxis and early diagnoses of skin cancer. What do they consist of?
– Based on the skin color type, number of moles, and family history of skin cancer, we schedule skin check-ups, which are based on a thorough clinical and dermoscopical examination of the skin. In high risk patients we perform Whole Body Mapping (WBM), taking high resolution digital photos from head to toe, which allows us to study every single birthmark. In follow-up visits, the same procedure is performed and the photos are compared using dermoscopy and, if detected, suspicious lesions are excised. Using WBM, we track the process of the appearance of birthmarks and are able to remove suspicious ones promptly. This is very important because skin cancers are the most common cancers worldwide and the malignant type melanoma is unfortunately the most common cancer among women aged from 22 to 30.
– What is that connected with?
– Excessive tanning, either outdoors in the sun or in indoor tanning rooms, which often operate improperly and cause harm to the skin. There is only one course of action: for us to constantly remind everyone how harmful this is. In Switzerland, a law was recently passed which prohibits visits to solariums for women under 18. And concerning exposure to the sun, it is important not to forget to apply sunblock creams and to stay in the shade from 11:00am until 3:00pm and thus to avoid the ultraviolet (UV) light when it is most potent.
– You are known in Europe not just as an experienced dermatologist but also as a leading specialist in healing psoriasis, which requires long-term follow-ups. Can significant results be achieved when visiting the medical center for a comparatively short period of time?
– Yes. It also depends on the severity of the disease and whether the other organs or joints are involved, or if there are other diseases such as diabetes, high blood pressure and obesity (so called metabolic syndrome). For mild to moderate psoriasis, a one-week stay is enough to establish the diagnosis and start the optimal therapy. In moderate to severe cases, and when associated with metabolic syndrome, we recommend a minimum of two to three weeks for all medical investigations and treatment recommendations, together with our interdisciplinary team, which includes specialists from internal medicine, rheumatology, physiotherapy and dietary studies. Psoriasis therapy is a lifelong thing. After starting systemic therapy in the case of moderate to severe psoriasis, further checks can be planned by us and also by the patient’s general practitioner in their home country. The main point is to visit us every three to six months for dermatological and rheumatological supervision. Our goal is to find the optimal treatment for each patient.
It is important to remember that psoriatic skin lesions can appear on any part of the body: on the hands, head, face or genital areas. It also happens that people suffering from psoriasis need psychological help. The disease is of an auto-immune nature, and two percent of the western world is vulnerable to it.
– You are often visited by the parents of children suffering from atopic dermatitis. Are there any programs for such patients at your center?
– Yes. We conduct special education for parents and provide them with the most up-to-date information on how to control the unpleasant symptoms of atopic dermatitis in their child. This disease is very common these days: up to 20 percent of children are affected by atopic dermatitis in western countries. After a selection of therapies, they can go home and continue the treatment of their child independently.
– Such problems as excessive sweating also comes under the expertise of dermatologists. Is one consultation enough to help the patient in such cases?
– Yes. We are encountering excessive sweating or hyperhidrosis in our daily practice more and more often. The disease can be divided in two groups: primary, with unknown etiology, or secondary, to systemic diseases such as malfunction of the thyroid gland, hormonal abnormalities, or diabetes mellitus and/or different infections. In secondary cases, as the underlying problem is solved the excessive sweating decreases, but in primary cases (mostly having genetic causes), only therapeutic intervention (such as iontophoresis, injections of botulinus toxin or surgical intervention) can efficiently remedy the problem. Injections are made once or twice per year. In the underarm area it is absolutely painless, and in the area of the feet and hands it is tolerable when combined with simultaneous cryotherapy. Generally, one or two consultations are enough to assign the correct therapy.
– Waldhotel Health & Medical Excellence is in such a marvelous place: 500 m above Lake Lucerne, surrounded by mountains, and sunny even on cold winter days. Are you able to use this location for dermatological treatment procedures?
– Yes. One of the most common dermatological diseases in elderly patients is basal cell carcinoma and a precancerous lesion of the skin called actinic keratosis, both of which belong to the group NonMelanoma-Skin-Cancers (NMSC). One of the most effective therapies against these cancers is photodynamic therapy (PDT), comprising of the application of a photosensitizer cream in conjunction with a red light, or an intensely pulsed light source. The conventional PDT is done by using a lamp as the source of light. Tolerable pain and discomfort in the area treated is a side effect of this therapy. To overcome this, a novel strategy, the so-called Daylight PDT using UV light emitted by the sun, has recently been developed. Here, patients are advised to expose themselves for a few hours to the sun after the application of the photosensitizer cream. This therapy is as effective as conventional PDT but yields significantly less pain and discomfort. However, for Daylight PDT we need sunny days and an external temperature of above 12oC and therefore it is performed from spring to autumn (mainly in the summer).
We are in the process of constructing glasscovered terraces where a temperature of above 12oC will be generated and where natural sunlight, even in winter (because of the altitude of our clinic), will be used. With such a facility, we will not be restricted to the summer months for Daylight PDT Therapy. Such a system is the first of its type in Switzerland, or indeed in central and western Europe. Using this system, patients can comfortably lie/sit on the terrace with a cup of aromatic herbal Alpine tea or a book for three hours, allowing the optimal therapy to be performed. PDT also works efficiently as skin rejuvenation.
– Along with classic aesthetic rejuvenation procedures, you use light therapy. What is the secret there?
– Light therapy, or, in scientific terms, biophotonic therapy (Kleresca.) is a stateofthe-art method, and we have been among the pioneers in this field in Switzerland. The results are fantastic: 400 times more collagen production in the skin can be facilitated. The procedure itself is absolutely painless and lasts for just 15 minutes. We apply special photochrome gel to the patient’s skin, and after that we treat it with a red light emitted by an LED lamp. The light, interacting with the photochrome gel, becomes photochromic, with various fluorescent wavelengths. It penetrates the skin and helps heal scars and wrinkles.
– When do you recommend such a procedure and how many sessions are needed?
– Optimally, as soon as you find the first signs of ageing. Little wrinkles can be smoothed using Kleresca. Deep wrinkles cannot be fully eliminated but they will become less distinct. We recommend a course of 4 procedures, one a week for four weeks. However, in special circumstances it can be also adapted to two treatments per week for two weeks. This therapy is also very effective against acne. Biophotonic therapy helps to preserve the quality of the skin for a longer period of time.
– Can it be used as an alternative to botulinum toxin?
– Only if the ageing signs are not very distinct. Today, the trend is to use biological agents and treatments as a part of anti-ageing therapy. Botulinum toxin and hyaluronic acid are exogenous (foreign to the body) substances which are injected under the skin. There are many other methods, such as fraxel laser therapy, stem cell therapy and radiofrequencies, which use the potential regeneration capacity of our skin (by producing collagen) to combat ageing. The point is: by inducing targeted injuring in the skin, we promote the growth of connective tissue and skin rejuvenation. The effect lasts for a much longer time than that of injections. We offer all those methods to our patients and guests in the resort regardless of whether they are staying in the Waldhotel or other residencies.
– How does the local climate on the Bürgenberg influence the wellbeing of the skin?
– Once a patient came to me and said, “I have stayed here for just a week, but I can already see how my skin has changed for the better”. Nature itself helps your rehabilitation, even if you make no effort beyond just being here. The air is fresh here, the height is optimal for enriching the body with oxygen, and the humidity level is comfortable. The air temperature is also ideal. From spring to November, one can enjoy nature in full: the weather allows for that. And if you add the correctly selected medical treatment to that, the results will be apparent, and our guests and patients always mention that.
M.D., Ph.D. Associate professor of dermatology and a member of the FMH Swiss Medical Association. He studied medicine at the English Division of the Medical University in Warsaw, where he successfully defended his dissertation. He worked as a research scientist and post-doctoral fellow at the Department of Immunology and Center for Molecular Medicine at the Medical University in Warsaw (where he also obtained his Ph.D. in Immunology), as well as the International Institute of Molecular and Cell Biology (UNESCO and Polish Academy of Sciences). Dr. Jalili performed his dermatology training at the Medical University of Vienna, Austria, where he also worked as senior consultant and group leader. He moved to Switzerland in November 2015 as the Head of Dermatology in a private clinic in Zürich. Since 2017 he has been the Head of the Dermatology Department, as well as the Head of the Swiss Psoriasis Center at Bürgenstock Health and Medical Excellence Centre. Dr. Jalili is an active member of both the Swiss and Austrian Societies of Dermatology, has published many scientific articles and book chapters in the field of dermatology, immunology and oncology, and is actively engaged in teaching.