bluuebunny/crossref_metadata_2025 huggingface dataset:
Generative Sustainable Performance Design Exploration Applied to Greek Urban Typologies
Authors: Christodoulou A , Symeonidou I
Published: June 2023

Generative Design offers a paradigm for the automatic generation of variations of a design so that designers can quantify the bounds of possible Key Performance Indicator’s (KPI’s) and identify most promising variants based on their design objectives. While such studies are often performed to provide inspiration for high-end building designs, applying them on standard building typologies gives equally interesting insights on the impact of related design decisions. This paper presents a developed parametric model for the typical Greek Urban Typology, the Polykatoikia, and shows how this was utilized to identify sustainable design strategies for this typology. The methodology is applied on unfinished skeleton buildings in urban areas but can also be extended to new building designs. The KPI’s that the Generative Design algorithm optimizes towards are selected to fit important sustainability criteria, such as the minimization of summer solar loads and the maximization of winter solar load, together with standard User Experience Quality metrics related to Views and Daylight as well as standard leasable floor area maximisation criteria also taking into account standard dimensions of Structural core elements. The paper will also present opportunities for further optimization of the Polykatoikia design process, through the use of advanced design exploration and optimization algorithms and tools utilizing Machine Learning algorithms and advanced data visualisation.
Barriers of large-scale energy efficiency modelling of urban building stocks. Methods to overcome them – the case of the Re-Polis platform.
Authors: Theodoridou I , Mallinis G , Pippis I , Mermigas A , Christodoulou K
Published: June 2023

The European Union has set strict goals towards climate-neutral cities by 2050, pushing private and public stakeholders to develop integrated assessment tools for measuring urban buildings’ energy performance and designing sustainable retrofitting strategies. Within this context, efficient energy use modelling of urban built environments, in a precise and transparent manner, is a crucial driver for global cities’ decarbonisation. Thus, rapid developments of bottom-up and top-down methodologies and tools reflect the current international research and technological developments in the Information and Communications Technology (ICT) software industry. Combined bottom-up based GIS technologies and building typologies (archetype buildings) enable a detailed energy performance analysis of urban built environments. Since the results are produced for each building unit, these methods offer scalability, starting from single buildings to neighbourhoods and whole cities. In order to assess the energy performance of urban buildings in a bottom-up and efficient way, several aspects must be considered, such as substantial differentiations in archetype buildings according to the use, location, year of construction and each country’s profile. Furthermore, access to pan-European building typologies data, developed with the same methodology, is crucial to overcome such barriers. Moreover, although dispersed methodological tools already exist, no integrated methods have yet been developed, that can be easily used on a pan-European base. As an innovative, cloud-based tool, the Re-Polis platform aims to fill the gap in urban buildings’ large-scale energy efficiency modelling. Within this context, this paper describes all barriers identified during the design of the Re-Polis platform, regarding the development of an end-to-end robust methodological procedure and the decisions that were made to overcome them.
Increasing the Content of Reclaimed Asphalt in Asphalt Mixture by using Rejuvenators
Authors: Belhaj Majda , Vackova Pavla , Valentin Jan
Published: June 2023

Recycling pavements is beneficial on various levels, since using reclaimed asphalt (RA) has a positive effect on the economy and environmental protection at the same time. Removed old asphalt pavement is no longer considered as a waste material, which has to be landfilled, but a useful material for further applications. Leading to a reduction of the need for virgin materials and preserve the planet. At the start, RA was used for construction of embankments and unbound granular layers, later cold recycling became another effective solution. After years of experiments, the rate of RA has increased to reach even the 100 %. But typical RA content in hot asphalt mixtures is between 25 % to 40 %. The presence of RA in the asphalt mixture has a negative effect on the mixture properties. Two alternatives were used in order to soften the aged bitumen – use of softer binder or special additives, i.e., rejuvenators. This study evaluated the possibility of increasing the RA content (30 % and 50 %) in asphalt mixture by adding mainly bio-based alternative rejuvenators. Mechanical performance was evaluated by means of laboratory investigations for typical characteristics dedicated to durability, stiffness, and cracking potential.
Investigation on the use of PET and XLPE plastic wastes as aggregates in cement-based mortars
Authors: Kesikidou F , Georgilas A , Tsiakaloglou G , Anastasiou E K
Published: June 2023

End-of-life plastics are an increasing environmental problem that needs to be addressed. Within the scope of utilizing secondary and recycled materials as aggregate in the construction industry, recycled XLPE and PET plastics were used as aggregates in cement-based mortars. The recycled plastics were reduced to fine aggregate granulometry and were used to partially replace natural sand in mortars. The replacement rates tested were 20% and 30% for XLPE, 30%, 50%, and 80% for PET, while a test mortar with 90% combined replacement with XLPE and PET was also tested. The workability of the mortars reduced with XLPE use and increased with PET use and the same pattern was observed regarding the porosity and water absorption of the hardened mortars. Compressive strength and density, on the other hand, reduced for both alternative aggregates, but recycled PET showed better performance overall and could be considered as an alternative for the production of lightweight mortars.
Framework for selecting and setting boundaries for social sustainability indicators in a life cycle perspective
Authors: Heide Mia , Skrøder Nana Kira Prisholm , Steffen Sara Føns , Hauschild Michael , Ryberg Morten
Published: June 2023

The historical consumption of natural resources to fulfil the demands of the growing population have resulted in severe environmental degradation. Therefore, understanding the role of fulfilment of human needs and the social aspect of sustainability is crucial in the transition towards more sustainable societies. We present a methodological framework for a social sustainability assessment that includes a full life cycle perspective and is based on the Sustainable Development Goals (SDGs). The framework comprehends operationalisation of the social aspects of the SDGs and includes means/tools to achieve the environmental targets through a six-step guide. A demonstration of the method’s application is given by applying the six-step framework to a case study: the Danish building sector focusing on SDGs 3 Good health and well-being, 7 Affordable and clean energy, 8 Decent work and economic growth, 9 Industry, innovation and infrastructure, 10 Reduced inequalities and 11 Sustainable cities and communities, 12 Responsible consumption and production, 13 Climate action and 15 Life on land. The final social indicators and the associated targets indicate in which areas a building is absolute social sustainable and in which areas the social performance falls short. The developed framework supports an informed and transparent selection of relevant social indicators across the life cycle while setting objective absolute targets.
Happiness in the urban built environment, people, and places
Authors: Andalib E , Diaconu M G , Temeljotov-Salaj A
Published: June 2023

The built and urban environment have an impact on citizens’ health and well-being. This impact could lead to long-term results on individuals’ happiness and quality of life. The environment we interact with, including our living, working, and social spaces, can significantly affect our health and could be considered as part of the determinants of health. WHO now defines health as a state of complete physical, mental, and social well-being, incorporating the built environment as a factor in promoting individuals’ happiness and well-being. This scoping review examines the impact of the built and urban environment on citizens’ health and well-being. The study explores the factors of the built environment that influence citizens’ happiness and their impact on mental health. It suggests a more integrated, ecosystem-based approach between public, private, and citizens to create healthier and happier places.
Sustainable University campuses. Qualitative and quantitative approach through the scope of an undergraduate, elective architectural technology course
Authors: Alexandrou Eleni , Bougiatioti Flora , Kotsenos Athanasios
Published: June 2023

Universities should promote sustainable development excellence not only through teaching and research but also via in campus operational management. This article presents the set-up, methodology and results of an undergraduate architectural technology course, which challenges the sustainable, bioclimatic and energy performance of buildings at NTUA Patission Campus. The course’s scope is to introduce different approaches so that students get acquainted with various research tools for the analysis of the sustainability indicators on campus and proposals for the sustainable design and redesign of university buildings and open spaces. The investigation and assessment of the existing condition was conducted with qualitative assessment and experimental quantitative methods for selected classrooms in different orientations at two adjacent buildings. Consequently, digital models of the classrooms under study were constructed with energy simulation software, in order to analyse the existing condition and assess the impact of simple interventions on the energy performance and bioclimatic conditions. The results involve the evaluation of the course set-up, but most importantly the structure of a methodology that could be applied not only to undergraduate student projects, but also to actual interventions to existing university buildings and campuses with similar characteristics in order to implement interdisciplinary methods that address environmental challenges.
Shrinking Cities as European Capitals of Culture: Has this Status enabled their Reurbanisation?
Authors: Antonić B , Djukić A , Marić J
Published: June 2023

More than 50 cities across Europe have been designed as the European capitals of culture for one year since the launch of this programme in 1985. Through organisation of different cultural events, this programme gives selected cities accessibility to generate significant cultural and socio-economic advantages, addressing their long-term regeneration and revitalisation and better competitiveness thereof. Several selected cities had gained this status during long-term urban shrinkage, the process where a population loss is caused by local socio-economic difficulties. Therefore, the supreme goal of such cities is certainly the reurbanisation based on better economic performance. The goal of the programme of European capital of culture –culture-led regeneration and revitalisation – perfectly fits with solutions for the economic problems of shrinking cities. The aim of this paper is to analyse has the status of European capital of culture has had an impact on population trends in the selected shrinking cities. Before the analysis, theoretical link between the concept of shrinking cities and urban regeneration and revitalisation is made. The selected cases are the shrinking cities with this status from 1985-2017, to preserve a 5-year threshold, adequate for the most recent demographic trends. The obtained results from the analysis show that the majority of the selected cities have entered reurbanisation after their year of the European capital of culture. Nevertheless, some of them have continued to shrink. The obtained results of the reurbanisation or prolonged shrinkage of the cities are further combined with the other characteristics of the selected cities, to fully understand their context. Comparing this, the paper conclusions target to indicate if and how the status of European capital of culture impacts on the local economy of a selected city though culture-led urban regeneration and revitalisation.
Introducing a methodology to define the negative effects of upward façade lighting in historical buildings.
Authors: Balafoutis Th , Zerefos S , Tomasovits M , Vital R , Doulos L T
Published: June 2023

Light pollution is a phenomenon that affects both humans and the environment negatively. Currently there are no established means to calculate light pollution. This work proposes a method for calculating the levels of light pollution on the facades of buildings, specifically historical buildings, which are the most difficult to light, using simulation techniques. The proposed methodology tested different simulation grid densities and concluded that the highest density produces most accurate results, since lower densities are prone to software errors. Moreover, this research proves that the visual perception of a lit façade is the wrong way to determine if a lighting design produces light pollution and that the comprehensive methodology proposed should be used to determine the percentage of light that spills into the environment.
Application and validation of a method to assess the energy reduction and environmental impact of renovation alternatives
Authors: Gonzalez-Caceres A , Somanath S , Forsberg J , Galimshina A , Theißen S , Hollberg A
Published: June 2023

The renovation of residential stock is one of the most promising areas, in terms of energy reduction, because these buildings are highly inefficient and represent the largest part of the building stock. However, the environmental impact assessment over the life cycle of building renovation is rare. It is more common to develop an assessment for new buildings. This study presents a method that combines the evaluation of the benefits of renovating residential buildings, considering cost, energy and environmental benefits using Life Cycle Assessment (LCA). The method is based on 3 stages of development. First, the database of energy certificates, costs and LCA was analysed. The second step is to develop a workflow in Rhino/Grasshopper/E-Plus to automatically model a residential building and feed the simulation model with the data obtained from the databases. Finally, a simulation campaign was carried out to obtain an optimal renovation package, minimising energy consumption and environmental impact. The research was carried out in a case study in Uddevalla, Sweden. The residential building has different measurements including energy consumption data before and after renovation. This was used to validate the proposed methodology. The validation shows that accurate results are achievable with potential for mass application.
Adaptive reuse of industrial heritage building – comparative life cycle assessment using a case study in Norway
Authors: Kyaw K S , Fufa S M , Kraniotis D
Published: June 2023

Materials production dominates the total Greenhouse gas (GHG) emissions in the construction industry. On the other hand, most existing building stocks are expected to last for the next 30 years, which can contribute to increasing resource efficiency, reducing environmental impact, and creating social, cultural, and economic values for society. Therefore, it becomes vital to investigate the environmental impacts of adaptive reuse of existing buildings using a life cycle approach. The objective of this study is to explore the environmental performance of adaptive reuse of an industrial heritage building compared to new construction using a life cycle assessment (LCA) method. The environmental impacts of the selected case study are evaluated using four scenarios, with two adaptive reuse scenarios, a warehouse or an office building and two new construction scenarios, a new warehouse or a new office building. One-Click LCA is used as an LCA tool, and the scenarios are compared by total carbon footprint, life cycle models, GHG emissions per building elements and material types. The results show that among the four scenarios, the adaptive to warehouse scenario is the best adaptation option with considerably lower environmental impact, followed by the adaptive office scenario. This paper highlights that adaptation of existing industrial heritage buildings, with the least materials replacement option, is worthwhile. The further evaluation needed for the study’s limitation is also highlighted for data efficiency and potential for further research.
Energy efficiency retrofits versus sustainable interventions in the Greek historic building fabric. An overview
Authors: Alexandrou E.
Published: June 2023

The introduction of the first Directive on the Energy Performance of Buildings (EPBD) and its consequent reforms, initiated a wide discussion on the energy efficiency and retrofit of the old building stock. As The EPBD excluded heritage buildings under statutory protection due to conservation conflicts, it soon became apparent that the old fabric and heritage value of a significant number of the old and mainly traditional buildings were at risk, threatened by incompatible interventions. Since then, a substantial amount of research projects, and initiatives were carried out, mostly examining energy efficiency and performance of the old fabric and investigating the application of energy retrofits within the frame of preservation of heritage value. However, issues such as the sustainability of the interventions, the preservation of the inherent sustainable and environment friendly characteristics, along with issues of compatibility, adaptability and resilience have not been studied extensively, even though these aspects could act as decisive parameters on the low impact operation and longevity of these buildings. The Greek old building fabric is an amalgam of integrated materials, architectural and intangible elements which express the historic and cultural evolution of the country’s built environment. This paper attempts to identify the intrinsic elements that need to be evaluated in each restoration and/or energy refurbishment work in order to dignify the proper procedures that need to be followed for low impact sustainable interventions responsive to the requirements of each certain project.
A review of the contributions of Artificial Intelligence in fire engineering, in a world rapidly realising the need for sustainable design
Authors: Bakas I , Kontoleon K J
Published: June 2023

With sustainability being at the forefront of international civil and structural engineering professional bodies agendas, Artificial Intelligence (AI), and its numerous facets, has potential of providing an invaluable tool. Although the notion of AI is not new, it only recently started gaining momentum in the sector of fire engineering. The combination of tangible benefits in scientific and industrial applications, in conjunction with a developing understanding of its functionality, requirements and deliverables, from practitioners and researchers alike, supported a wider acceptance of the method. Acknowledging the scope of AI applications is vast, a focus will be given to fire engineering scientific projects. A selection of recent, representative scientific papers will be reviewed with the aim of debating the attributes of Artificial Intelligence in the context of sustainability, while also assessing its current contribution to the technical advancement of the field.
Preliminary study on the use of Big Data for environmental benchmarks of residential buildings in Flanders
Authors: Mouton L , Ramon D , Trigaux D , Allacker K , Crawford R H
Published: June 2023

Building construction and operation both have a high environmental impact. In Flanders (Belgium), public authorities have defined clear targets for improved building energy performance, but a strategy to reduce construction (embodied) impact is still lacking. Environmental benchmarks based on Life Cycle Assessment (LCA) have been identified as a means to limit embodied impacts. Such benchmarks are often derived with a bottom-up approach consisting of a statistical analysis of the building stock, which is usually modelled based on a limited set of representative buildings or archetypes. In this paper, a data-driven approach is applied based on building data from the Flemish Energy Performance of Buildings (EPB) database. In a recent study, the buildings from the EPB database were clustered based on geometric and energy-related parameters, and for each cluster representative buildings were selected. This resulted in 54 buildings representative of newly built residential buildings in Flanders. The building set distinguishes itself from other existing sets because it was automatically generated from a large building database. Up until now, the EPB building set has only been used to evaluate the financial feasibility of energy performance levels in Flanders. In this preliminary study, an LCA is performed to assess the life cycle environmental impacts of five sample cases in view of benchmarking. The sample includes two detached, two semi-detached, and one terraced house, all solid construction and in line with the Flemish EPB requirements of 2014. The results show that the environmental score of the buildings is comparable to benchmark values obtained based on the analysis of Belgian archetypes. Further, the building geometry and compactness are identified as key parameters, whereas the materialisation has a more limited influence on the environmental impact. Next research steps will focus on the modelling of more cases, including different construction types, energy performance levels, and potential impact mitigation strategies. The study concludes that the EPB buildings are promising to define environmental benchmarks for the Flemish dwelling stock.
Energy retrofit strategies of built heritage: using Building Information Modelling tools for streamlined energy and economic analysis.
Authors: Thravalou S , Michopoulos A , Alexandrou K , Artopoulos G
Published: June 2023

Dynamic simulation tools are widely used in the workflow of energy retrofitting historic buildings as they contribute to the development of an optimised, cost-effective renovation strategy. Additionally, Building Information Modelling (BIM) applied in heritage buildings can provide a holistic platform that improves collaboration between different stakeholders involved in the management, restoration and energy-retrofit of heritage buildings, by facilitating data sharing and project coordination. However, the use of BIM for energy simulation is rarely implemented due to emerging technical complexities regarding data interoperability. In response to the above shortcomings, the paper addresses the challenges of integrating a) dynamic energy performance analysis and b) financial feasibility analysis, using Heritage-BIM (H-BIM) tools. Insights and knowledge acquired through the case of a deep renovation of a historic building in ruin condition is presented. Specifically, an integrated H-BIM approach was developed by the authors in order to propose cost-effective energy efficiency upgrade measures. The energy improvement measures concern the upgrade of the thermal transmission of the building envelope, the incorporation of efficient heating, cooling and mechanical ventilation systems, as well as the incorporation of renewable energy systems. The economic feasibility study is based on widely used financial indicators, including life cycle cost analysis (LCCA). The proposed workflow aims to become a useful methodological tool for public authorities, assisting the attraction of financing mechanisms for the restoration and energy-upgrade of the historic building stock.
The Riemann problem for a two-phase mixture hyperbolic system with phase function and multi-component equation of state
Authors: Hantke Maren , Matern Christoph , Warnecke Gerald , Yaghi Hazem
Published: June 2023

In this paper a hyperbolic system of partial differential equations for two-phase mixture flows with

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components is studied. It is derived from a more complicated model involving diffusion and exchange terms. Important features of the model are the assumption of isothermal flow, the use of a phase field function to distinguish the phases and a mixture equation of state involving the phase field function as well as an affine relation between partial densities and partial pressures in the liquid phase. This complicates the analysis. A complete solution of the Riemann initial value problem is given. Some interesting examples are suggested as benchmarks for numerical schemes.
Recognizing the Paradigm of the Unknowing Victim and the Implications of Liminality
Authors: Ost Suzanne , Gillespie Alisdair A
Published: June 2023

This article presents the novel conceptualization of the unknowing victim (UV) and addresses the ethical ramifications of this status. Criminology and victimology have primarily focused on knowing victims, but certain crimes occur without the victim’s detection (e.g. sexual assault of an unconscious victim). There is a critical liminal dimension to UV’s status: they are on the threshold between unawareness and conscious awareness of their status as victims of crime and are thus situated on the brink of experiencing harm through their own discovery, or someone else’s disclosure, of the crime committed against them. We call for the recognition of UVs and the temporalities of their embodied experiences, and argue that there is an ethical imperative to prioritize their lived experience.
CPC01 A puzzling panniculitis
Authors: McFeely Orla , Carroll Tomas , Wolinksa Anna , Pierce Brian , Molloy Kevin , G. McElvaney Noel , Tobin Anne-Marie , Hackett Caitriona
Published: June 2023

A 51-year-old White woman was seen by dermatology services for a 3-day history of a painful subcutaneous nodule affecting her right distal calf, which was on a background of recurrent erythema nodosum diagnosed in childhood and an admission 6 months prior secondary to neutrophilic panniculitis affecting the right groin. The patient had sustained a traumatic injury to the leg following a fall. She was treated with oral antibiotics for a presumed infected haematoma. As her pain increased, she presented to the emergency department 3 weeks after the fall. On examination, a tender erythematous subcutaneous lesion with central sloughing was noted. She was tachycardic and hypotensive on presentation. Her C-reactive protein was elevated (172 mg L−1), and leucocytosis (15 × 109 cells L−1), with associated neutrophilia and anaemia (9.0 g dL−1), was noted on complete blood count review. Two days later, despite treatment with intravenous (IV) benzylpenicillin, flucloxacillin, clindamycin and topical clobetasol propionate, the lesion enlarged rapidly. Dermatology was consulted. Viral screens, including HIV, herpes simplex virus, Epstein–Barr virus, cytomegalovirus, and hepatitis B and C, were all negative. Serum protein electrophoresis and serum angiotensin-converting enzyme were within normal limits. Her α-1 antitrypsin level was elevated (3.16 g L−1; reference interval 1.1–2.1 g L−1). Her admission was complicated by sepsis, which required escalation of IV antibiotics to meropenem, vancomycin and clindamycin. Punch biopsy revealed epidermal necrosis and ulceration with extensive neutrophilic dermatosis and dermal abscess formation. The inflammation was seen to extend into the subcutis. Findings were reported as consistent with neutrophilic panniculitis. Colchicine was commenced based on ongoing sepsis and anaemia secondary to acute-on-chronic inflammation. Over 2 weeks, the lesion rapidly enlarged, prompting the introduction of oral corticosteroids (0.5 mg kg−1). Adalimumab and doxycycline were further introduced to reduce steroid requirements. Outpatient echocardiogram and colonoscopy revealed no pathology. Reduced levels of α-1 antitrypsin were noted on two occasions (0.89 g L−1 and 0.91 g L−1), coinciding with normal inflammatory markers following her acute illness. To date, no α-1 antitrypsin genetic abnormality has been detected. Panniculitis can be a rare and life-threatening manifestation of α-1 antitrypsin deficiency. Patients presenting with systemic inflammatory response syndrome and panniculitis have a reportedly high mortality risk. No hepatic or respiratory manifestation of α-1 antitrypsin deficiency was seen in this case, highlighting the importance of considering α-1 antitrypsin deficiency in the assessment of panniculitis and rechecking α-1 antitrypsin in this context as it is an acute-phase reactant.
P41 An emerging role of interferon targeted therapy for the treatment of cutaneous systemic lupus erythematosus: a prospective real-world evaluation of anifrolumab for refractory cutaneous lupus
Authors: Carter Lucy , Wigston Zoe , Laws Philip , Vital Edward
Published: June 2023

Cutaneous lupus erythematosus (CLE), particularly discoid lupus erythematosus (DLE), is frequently unresponsive to standard therapies, including antimalarial and immunosuppressive therapies. Recent evidence has identified the importance of type-1 interferon (IFN-1) in the pathogenesis of disease. Anifrolumab is a monoclonal antibody that targets IFN-1 and has been licensed for the treatment of systemic lupus erythematosus (SLE). It is unclear which clinical subtypes of CLE are associated with an IFN-1 signature and may be responsive to anifrolumab therapy. We sought to evaluate the efficacy of anifrolumab on (i) DLE and (ii) rituximab-refractory CLE and (iii) to compare IFN-specific biomarkers and (iv) early and late immunophenotypic and clinical responses. Anifrolumab was available through an early access to medicines scheme. Patients with SLE for whom the phenotype was predominantly cutaneous were treated with anifrolumab 300 mg intravenously every 4 weeks. The Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI) and Dermatology Life Quality Index (DLQI) were reported. Seven patients were identified (five with DLE, one with chilblain and one with subacute CLE were enrolled). All patients were female (median age 46 years; median disease duration 17 years). The median number of failed therapies was six: rituximab in six, belimumab in two and thalidomide in four patients. Four patients required long-term oral prednisolone > 10 mg daily. The median baseline CLASI activity score was 17 and DLQI was 16/30. The median CLASI score reduced after 4 weeks to 6 (range 0–13; P = 0.016) with a median decrease from baseline of 60% (range 19–100%), which was maintained at 6 months. Clinical responses were associated with significant improvements in DLQI (P < 0.001) and the EQ-5D visual analogue scale (P = 0.002) by 3 months. All patients had a marked suppression of IFN-stimulated genes at 4 weeks (mean difference 2.92; P < 0.01). Treatment was generally well tolerated with the exception of one patient who had shingles complicated by sensorineural hearing loss while on anifrolumab and prednisolone > 15 mg daily. This required prolonged aciclovir for effective management. This case series highlights the potential role for anifrolumab in managing treatment-resistant CLE with particular responses observed in DLE and chilblain lupus. The need for enhanced awareness of viral infections, particularly varicella-zoster virus, needs to be considered in higher-risk patients.
P82 Validation of the dermatology life quality index (DLQI): a systematic review of the literature
Authors: Johns Jeffrey , Vyas Jui , Ali Faraz , Ingram John , Salek Sam , Singh Ravinder , Finlay Andrew
Published: June 2023

The Dermatology Life Quality Index (DLQI) was first published in 1994, and, since that time, it has become the most widely used patient-reported outcome measure worldwide in dermatological studies, owing to its robustness, simplicity and ease of use. This study is the first to review systematically evidence of DLQI validation. MEDLINE, Cochrane Library, Embase, Web of Science, SCOPUS, CINAHL (EBSCO) and PsycINFO were searched for relevant peer-reviewed publications in English, combined into EndNote and filtered for inclusion and exclusion criteria. The study followed PRISMA guidelines, and the study protocol was prospectively published in PROSPERO. A bespoke REDCap database was created, and data from included studies were independently extracted into this by two reviewers. COSMIN guidelines were used to determine bias in studies, and only those studies that reported COSMIN-accepted methods of validation were included. A total of 1262 articles were found from online searches; on screening, 69 met the eligibility criteria, describing 19 216 patients. Studies were conducted in at least 26 different countries, with 13 in the USA, 8 in China, and 5 each in the UK, Brazil and Hungary. Most patients were recruited in hospitals (30.4%), clinics (21.7%) and outpatient departments (10.1%), and 22.5% in other settings; 13.0% was not specified. Twenty-nine studies were multicentred. Most studies (n = 38) collected data specifically for validation, five used data from randomized controlled trials, seven were case–control studies and one was an open-label study. One study was validation of a translation, and five were of cross-cultural adaptation. Psoriasis was the most common disease studied (n = 19; 27%), along with 19 other diseases. The UK English version of the DLQI was used in 18 studies, and 20 other language versions were also used in the other studies. Factor analysis was done in 21 studies, Rasch/item response theory (n = 5), test–retest (n = 14), Cronbach’s alpha (n = 33), known group (n = 19), convergent (n = 10), concurrent (n = 3), divergent (n = 2), content (n = 7), criterion (n = 2) and face (n = 2) validation and responsiveness (n = 15). COSMIN risk of bias showed that few studies met the current rigorous requirements of the guidelines. Extensive evidence of validation of the DLQI is provided to inform researchers’ decisions concerning its use. Recommendations for improving the research methodology and reporting of DLQI validation are also given.
CD11 Patch testing in vulval dermatoses
Authors: Stavrou Christiana , Bajaj Vrinda
Published: June 2023

Patch testing is an important tool in the investigation of patients with vulval dermatoses, with a significant impact on patients with a relevant identifiable allergen. There has been little research conducted in this area, with small studies suggesting a higher rate of positivity in anogenital dermatoses (39–78%) vs. patch testing in female patients generally (35–40%) (Woodruff CM, Trivedi MK, Botto N, Kornik R. Allergic contact dermatitis of the vulva. Dermatitis 2018; 29:233–43). There is also a high rate of clinically relevant results (13–49%) (Vandeweege S, Debaene B, Lapeere H, Verstraelen H. A systematic review of allergic and irritative contact dermatitis of the vulva: the most important allergens/irritants and the role of patch testing. Contact Dermatitis 2023; 88:249–62). The aetiology of this increased rate of allergic dermatitis at this site can be attributed to a number of factors. This includes intrinsic immunological characteristics of the vulval skin, local elements including infection and urine exposure, as well as external behavioural factors. There is a lack of site-specific guidance in light of this propensity of allergic contact dermatitis in vulval dermatoses. This review examined 54 patient records retrospectively at the University Hospital North Durham from 2016 to 2021 and prospectively from July to December 2022 referred for patch testing with vulval symptoms. Forty-eight patients were included with an average age of 51 years. Itch (48%) and discomfort or soreness (28%) were the main symptoms for which patients were referred. The most frequently requested patch test batteries after the British Standard Battery were medicaments, then cortico­st­eroid. The overall positivity of this cohort was 73%, in line with the available literature. The most common allergens were nickel, followed by fragrances. Of the patients with positive patch tests, 48% were relevant. Forty per cent had a partial response on withdrawal of the allergen, and 8% had complete response. Given the psychosocial impact of vulval pruritus and discomfort and the high positivity of patch testing in these patients, further population-based research is warranted to standardize patch testing in vulval dermatoses. Additionally, a low threshold for referral for patch testing should be considered to identify any element of allergic contact dermatitis in patients with recalcitrant vulval symptoms.
DP04 Role of multidisciplinary team meetings in management of inflammatory skin conditions
Authors: Shakeel Musfira , Foulkes Amy , Warren Richard
Published: June 2023

The multidisciplinary team (MDT) model has been previously demonstrated to improve early diagnosis and outcomes for psoriatic arthritis [Zheng YX, Zheng M. A multidisciplinary team for the diagnosis and management of psoriatic arthritis. Chin Med J (Engl) 2021; 134:1387–9; Luelomo J, Gratacós J, Martínez-Losa MM et al. A report of 4 years of experience of a multidisciplinary unit of psoriasis and psoriatic arthritis. Reumatol Clin 2014; 10:141–6]. However, there is little evidence for a similar role in inflammatory skin disease (ISD). A monthly psoriasis MDT has been established in our tertiary referral dermatology centre. We analysed referrals from February 2021 to February 2022. A total of 37 patient cases were discussed, 29 from within the geographical region of the centre and eight from outside the region. Reasons for referral were the presence of comorbidities; in the majority of cases, this was the presence of an internal malignancy (n = 15). Additional comorbidities were organ transplantation (n = 2), inflammatory bowel disease (n = 2), coexisting inflammatory arthritis (n = 4) and history of severe infection (n = 2). The secondary reason for referral was a history of multiple treatment failures (n = 8) and/or adverse effects of current biologics (n = 2). Where outcome data for regional patients could be assessed, the majority (n = 16) subsequently demonstrated objective improvement in their skin condition, with a mean reduction in Psoriasis Area and Severity Index score of 79.0% (n = 16) and a concurrent mean improvement of 59.6% in Dermatology Quality of Life Index (n = 11). Three patients died (unrelated to psoriasis/treatment). In summary, the presence of comorbidities and prior treatment failures are the primary reasons for referral to a tertiary referral service psoriasis MDT. Multidisciplinary team discussion results in objective improvements in patient care at early follow-up assessments. Further data on MDT outcomes for ISD are required.
PA07 (P65) Vitamin D deficiency is associated with atopic dermatitis severity in a Bangladeshi population living in the UK
Authors: McCarthy Rebecca L , Thomas Bjorn R , Tawfik Soha S , Atkar Ravinder , McDonald Bryan , Dhoat Sasha , Hughes Aaron , O’Toole Edel
Published: June 2023

Atopic eczema is a common chronic inflammatory skin condition with considerable heterogeneity. South Asian people living in the UK frequently have low vitamin D levels, and those with atopic disease can present with severe eczema. The association between vitamin D insufficiency and eczema severity, and the role of vitamin D supplementation in atopic eczema is inconsistent, and it is under-researched in people with Asian ancestry living in low-ultraviolet (UV) areas. This cross-sectional study investigates the association between serum 25-hydroxy vitamin D3 [25(OH)D3] and eczema severity in a cohort of South Asian children and young adults living in the UK. Eligible participants were Bangladeshi children and young adults aged 0–30 years with eczema, participating in the THEA study. Data for the study were collected via parent/patient self-reporting, clinical history and examination, and hospital databases. Levels of 25(OH)D3 were documented retrospectively, if available, from hospital databases. Eczema severity was classified by an Eczema Area and Severity Index (EASI) score less than or greater than 10. Multivariate logistic regression was used to adjust for confounding factors. In total, 682 patients were recruited between May 2018 and December 2021. The EASI score was available for 681 participants [mean (SD) 7.9 (9.1)], and 25(OH)D3 results were available for 49.7% (n = 339). Eighty-four per cent were deficient (< 25 nmol L−1) or insufficient (< 50 nmol L−1) in 25(OH)D3. Vitamin D3 levels were inversely correlated with EASI score (Spearman’s rank R2 = –0.22; P < 0.001). After adjustment, there was a significant association between eczema severity (EASI > 10) and lowest 25(OH)D3 [odds ratio (OR) 0.973, 95% confidence interval (CI) 0.956–0.988; P < 0.001], working class (OR 0.542, 95% CI 0.295–0.991; P = 0.047), previous immunosuppression/biologic therapy (OR 2.432, 95% CI 1.189–5.077; P = 0.016), mild-to-moderate potency topical steroid use on the face and neck (OR 3.566, 95% CI 1.730–7.696; P < 0.001) and topical calcineurin inhibitor use on the face and neck (OR 3.421, 95% CI 1.140–10.288; P = 0.027). These findings demonstrate an inverse correlation between 25(OH)D3 level and eczema severity in a cohort of exclusively South Asian children and young adults living in a low-UV region. Vitamin D plays a role in the modulation of proteins required for skin barrier function and regulation of the innate immune system, suggesting that vitamin D deficiency in this population may contribute to inflammation in the skin. Further research on the role of vitamin D supplementation in atopic eczema, particularly in people with skin of colour, is required.
PA09 (P79) A multidisciplinary expert consensus on the assessment of and support for mental health in children and young people living with skin conditions
Authors: Moledina Zahra , McPherson Tess , Ravenscroft Jane , Ali Rukhsana , Baron Susannah
Published: June 2023

Psychological and mental health concerns are common in children and young people (CYP) living with skin conditions, and can have a profound impact on wellbeing. However, there is limited guidance on how best to assess and support the mental health of this population, who are at risk of poor health outcomes. The British Society for Paediatric and Adolescent Dermatology formed a working group to address the mental health needs of CYP with skin conditions, including hair and nails. A systematic review, appraisal of literature and a national survey were carried out, and a multidisciplinary consensus guideline group was convened, comprising dermatologists with expertise in paediatric dermatology and psychodermatology, psychologists, psychiatrists, general practitioners, paediatricians and specialist nurses. Two multidisciplinary virtual panel meetings took place: (i) an initial meeting to discuss the scope, review the current evidence and identify areas for development; and (ii) a second meeting to agree the content and wording of the recommendations. The primary objective was to provide consensus-based guidance on the assessment and monitoring of, and support for, mental health in CYP with skin conditions. Secondary objectives were to address important practical clinical questions relating to primary guidance objectives, and provide audit and research recommendations. The expert panel achieved consensus on 11 recommendations for health workers managing CYP with skin conditions. A new patient-completed history-taking aid called ‘You and Your Skin’ was developed and is being piloted. The recommendations focus on improved mental health assessments for CYP presenting with a skin condition, with clinical guidance and suggested screening measures included. Information regarding accessing psychological support for CYP when required is given, and recommendations were provided for training in mental health and neurodiversity for staff. The methodology and recommendations will be presented in full. Embedding a psychosocial approach within services treating CYP with skin disease should ensure that CYP with psychological needs are able to be identified, listened to, supported and treated. This is likely to improve health outcomes.
PD04 Real-life experience of Scottish patients with idiopathic solar urticaria
Authors: McMullan Alexandra , Lesar Andrea , Ibbotson Sally
Published: June 2023

We conducted a retrospective study to characterize our most recent cohort of patients with idiopathic solar urticaria (SU), to compare with our previous findings (Beattie PE, Dawe RS, Ibbotson SH, Ferguson J. Characteristics and prognosis of idiopathic solar urticaria: a cohort of 87 cases. Arch Dermatol 2003; 139:1149–54). We analysed data derived from our in-house database and paper and electronic records of patients with SU seen through the Scottish Photobiology Service between 2003 and 2022. Eighty-four patients with SU were seen in this period, 57 (68%) women and 27 (32%) men. Twenty-nine (35%) had a single consultation/phototesting and 55 (65%) had follow-up assessments. The average age of onset was 37 years, with the average age of diagnosis being 41 years, with delays from symptom onset to diagnosis ranging from 6 months to 24 years. Importantly, 20 (24%) patients self-reported systemic symptoms, most commonly fatigue, dizziness and nausea. Of 61 patients using antihistamines before diagnosis, 31 (51%) reported benefit. Of patients who tried sunscreens, 31 of 65 (48%) reported benefit. On monochromator phototesting, sensitivity predominantly involved the ultraviolet (UV)A waveband (335–400 + 27 nm in 55%), extending into the visible spectrum (> 430 + 27 nm) in 44% and UVB waveband (305 + 5 nm) in 1%, consistent with previous reports of predominant UVA/visible light dependency in SU. On review of follow-up data, we analysed the fold benefit in minimal urticaria dose (MUD) from testing on H1 antihistamines alone, H1 and H2 antihistamines combined and the addition of montelukast. Most (65%) responded with a more than twofold improvement in MUD after a single dose of H1 antihistamine, with only 35% not responding. Increasing the dose of H1 antihistamine did not provide notable additional benefit. There was a suggestion of improved responses by the addition of an H2 antagonist (in 76% vs. 66% with H1 antagonist alone), but this was not statistically significant (P > 0.05). No additional improvement in threshold sensitivity (MUD) was observed by the addition of montelukast. Small numbers of patients used other treatments such as photo(chemo)therapies and systemic immunosuppressants, and these were found to be of limited benefit. Since 2011, we have used omalizumab for patients with treatment-resistant SU. Of the current cohort, 13 received omalizumab, with 62% reporting a good clinical response and a further 15% a partial clinical response. Phototesting in these patients showed complete abolition of photosensitivity or excellent responses (more than fivefold increase in MUD) in 73%, demonstrating the efficacy of omalizumab in recalcitrant SU. Given the systemic features reported by some patients with SU, this supports a management approach, which includes systemic immunomodulation as a potentially effective option.