bluuebunny/crossref_metadata_2025 huggingface dataset:
P015 Acne: clues to the mechanism of disease
Authors: Fleming Sarah , Enright Helen , Molloy Kevin , Hackett Caitrionna
Published: June 2024

Acne vulgaris continues to result in a significant psychological and physical burden on patients, mostly occurring at an important time of psychosocial development. We would like to highlight the novel case of a 19-year-old male patient who attended the dermatology department for treatment of nodulocystic acne. On presentation, he had large cystic lesions affecting the forehead, cheeks and neck and abutting the left medial canthus. He had a background history of aplastic anaemia, treated with eltrombopag, antithymocyte globulin and ciclosporin. Unfortunately, the patient developed idiopathic intracranial hypertension (IIH) secondary to treatment with ciclosporin. Due to the severity of his IIH, treatment with isotretinoin was contraindicated. He was commenced on erythromycin 500 mg twice daily along with adapalene gel topically but had a suboptimal therapeutic response. During his care, he was admitted under the haematology team with diffuse abdominal pain and a raised lactate dehydrogenase. He was subsequently diagnosed with paroxysmal nocturnal haemoglobinuria (PNH) and was commenced on biweekly eculizumab infusions. Within 1 month, he noticed a significant improvement in his acne. He was reviewed 3 months later, and his acne was clear, with only a few scattered pustules. The patient continues to report that scattered papules and pustules appear 1–2 days before his biweekly infusions; however, these quickly resolve after infusion. Eculizumab was first approved for treating PNH in 2007 and is a recombinant humanized monoclonal antibody inhibiting complement component C5. In vitro studies investigating the role of the complement pathway were carried out in the 1970s, at which time it was thought that colonizing bacteria can activate the complement pathway through stimulation of the reticuloendothelial system. Both acne and hidradenitis suppurativa (HS) are disorders of follicular occlusion; 23–70% of patients with HS report concomitant acne. Phase IIa/IIb clinical trials of C5a inhibition have shown promise in the treatment of HS. Although the pathogeneses of both acne and HS remain distinct, there have been studies showing positive response to C5 inhibition in patients with acne, supporting the theory that perhaps complement does pay a role in acne development. The authors present this case to highlight the complement pathway as a possible alternative therapeutic target in severe nodulocystic acne.
P016 A case of poikilodermatous plaque-like haemangioma
Authors: Ross Hannah , Motta Luisa , Griffin Liezel
Published: June 2024

An 89-year-old man was found to have an incidental asymptomatic, erythematous, scaly, slightly atrophic plaque on the left hip, measuring 5 × 2.5 cm. The patient reported that it had been present for several years and attributed it to previous radiotherapy for prostate cancer. An incisional biopsy showed histological features of hyperkeratosis, focal parakeratosis and acanthosis, with mild focal spongiosis and scattered intraepidermal lymphocytes with focal Langerhans cell vesicles. Additionally, there was remodelling of collagen in the dermis with proliferation of blood vessels, and perivascular and interstitial infiltrates of lymphoid cells in the superficial dermis. There was no evidence of neoplastic activity, and a reactive or inflammatory process was favoured. Several treatments were trialled including moderate and potent topical corticosteroids under occlusion and pressure-relieving foam dressings, but with no resulting change to the appearance of the plaque. A repeat biopsy was undertaken, which again showed hyperkeratosis, patchy parakeratosis and mild spongiosis. The main abnormality was the presence of a plaque and bandlike proliferation of small thin-walled blood vessels in the upper dermis and upper reticular dermis, which had morphological features reminiscent of postcapillary venules. The findings in the initial biopsy were similar, but much more subtle; subsequently a diagnosis of poikilodermatous plaque-like haemangioma was suggested. Poikilodermatous plaque-like haemangioma was proposed as a newly defined clinical entity by Semkova et al. in 2019 (Semkova K, Carr R, Grainger M et al. Poikilodermatous plaque-like hemangioma: case series of a newly defined entity. J Am Acad Dermatol 2019; 81: 1257–70). This case series identified 16 patients presenting with a solitary atrophic erythematous or violaceous plaque occurring on the extremities or buttocks with an indolent clinical course. The mean age of patients was 72 years, with a male predominance. Duration of lesion, available for 13 patients, confirmed a mean of 2.5 years, and the mean diameter was 5.8 cm. All lesions were asymptomatic. Histology demonstrated a distinctive bandlike proliferation of vascular channels suggestive of postcapillary venules within the superficial dermis. There was also evidence of background fibrosis, oedema and loss of elastic fibres. Awareness of poikilodermatous plaque-like haemangioma is important in differentiation from other dermatological conditions including mycosis fungoides, inflammatory dermatoses, Bowen disease and necrobiosis lipoidica. Histological examination is essential in diagnosis and may prevent unnecessary investigation and treatment.
P018 Puzzling vesicles: a clinicopathological challenge
Authors: Jain Sejal , Bishnoi Anuradha , Dev Anubha , Chatterjee Debajyoti , Mahajan Rahul , De Dipankar , Handa Sanjeev
Published: June 2024

An 8-year-old male child presented with a history of multiple vesicles and bullae on the ear, nose, upper trunk, lower legs and feet for the past 4 years. There was no history of photosensitivity. There was no history of similar conditions in family members. On examination, the child had erosions with haemorrhagic crusting on the above-mentioned sites. The lesions were healing with hypopigmentation and scarring. A few milia-like lesions were seen on the nose and ears. Superficial tiny erosions with haemorrhagic crusting were present on the lip mucosa and tongue. Dystrophy of the left great toe was also noted. Differential diagnoses of Kindler syndrome, porphyria cutanea tarda, bullous pemphigoid and chronic bullous dermatosis of childhood were considered. A 3-mm punch biopsy from the vesicle revealed epidermis with psoriasiform hyperplasia and hyperkeratosis. The upper dermis showed a perivascular and perifollicular lymphomononuclear infiltrate with multiple eosinophils. A perilesional 3-mm punch biopsy was sent for direct immunofluorescence, which revealed at least three IgG linear deposits along the dermoepidermal junction in an N-serration pattern. There were no IgA or IgM deposits. A genetic analysis showed no mutation in the FERMT1 gene. Porphyrin levels in the blood, urine and stool were normal. Based on the histopathology and direct immunofluorescence findings, the patient was diagnosed with childhood bullous pemphigoid. Weight-based azathioprine was started and there was improvement in the lesions within 2 months of initiation of therapy. Bullous pemphigoid is a subepidermal blistering disorder that commonly affects older patients (60–80 years), but it can rarely affect children. It demonstrates considerable clinical and histopathological overlap with other acquired and/or congenital blistering disorders. A high index of suspicion coupled with appropriate investigations are imperative for diagnosis. Histopathology and direct immunofluorescence are more cost-effective. In a limited-resource setting, this can eliminate the need for more expensive tests, such as genetic analysis.
P019 Cutaneous amyloidoma: a rare variant of primary cutaneous marginal zone lymphoproliferative disorder
Authors: Fleming Sarah , Brennan Shane , Molloy Kevin
Published: June 2024

A 71-year-old male patient presented to the dermatology department with a nontender erythematous nodule on the left arm. Incisional biopsy illustrated a dermal-based perivascular plasma-cell infiltrate with kappa-light chain restriction. There was also marked deposition of dermal amorphous eosinophilic material, with similar amorphous material deposition within vessel walls. Apple green birefringence under polarized light with Congo red staining was observed. Review at the UK National Amyloidosis Centre concluded that this was consistent with cutaneous amyloid-L (AL) amyloidosis. A bone marrow trephine and PET-CT ruled out systemic involvement. The patient was listed for surgical resection and monitored clinically by the dermatology and haematology teams. Amyloidosis represents a spectrum of disease including systemic and localized cutaneous subtypes. There is much discussion regarding the nosology of AL amyloidosis; however, there is consensus among clinicians, who consider cutaneous amyloidoma to be a rare variant (< 1%) of primary cutaneous marginal zone lymphoproliferative disorder. Cutaneous amyloidoma presents as small waxy nodules and/or plaques usually located on the extremities, and is histologically characterized by prominent amyloid deposition and few perivascular plasma cells. Surgical excision is the treatment of choice. AL amyloidosis presents in an older population and has a more indolent clinical course compared with the systemic subtype, leading to the proposal that cutaneous amyloidosis (AL type) may represent a precursor to the systemic process. Although progression to high-grade lymphoma or systemic amyloidosis is rare, it is recommended that patients undergo staging of the disease, eradication of the cutaneous disease and close clinical follow-up. Classification of cutaneous AL amyloidosis is hindered by its rarity; however, the authors hope that this case will add to the growing literature available on the condition.
P022 A case of cutaneous plasmacytosis occurring in a patient with pulmonary adenocarcinoma
Authors: Teoh Joelle , Gan Alex , Elsheikh Somaia , Tang Ting Seng
Published: June 2024

A 43-year-old woman of Japanese origin presented with a 4-year history of a slow-spreading rash over her face, torso and legs. This consisted of symmetrical hyperpigmented nodular lesions, which were asymptomatic and persistent with no identifiable triggers. Apart from iron-deficiency anaemia, she was otherwise fit and well, with an unremarkable family history. Examination revealed a widespread hyperpigmented erythematous rash distributed symmetrically across the back, with multiple smaller lesions over the face, axilla, torso and legs. Routine biochemistry was unremarkable apart from low ferritin level. Electrophoresis and IgG subclass analysis showed a mildly raised IgM, but was otherwise unremarkable. Investigations for HIV, hepatitis, syphilis and chlamydia were unremarkable. Histopathology showed a mild to focally moderate perivascular and minimally interstitial mononuclear cell infiltrate in the superficial and deep dermis. The infiltrate consisted of lymphocytes, histiocytes and particularly large numbers of CD20+ plasma cells. There was no cytological atypia, with most of the plasma cells expressing IgG. Kappa and lambda in situ hybridization showed a polytypic population of plasma cells. Subsequent imaging studies detected a lung nodule, which was later surgically excised and confirmed to be a pulmonary adenocarcinoma. There was no evidence of significant lymphadenopathy to suggest Castleman disease or lymphoma. Cutaneous plasmacytosis (CP) is a rare skin disorder characterized by multiple reddish-brown nodules with polyclonal plasma-cell proliferation, usually accompanied by a polyclonal hypergammaglobulinaemia. CP is seen predominantly in Asian populations and commonly affects the trunk, particularly the axillae, but can also involve the face and extremities. The pathogenesis of CP remains poorly elucidated; however, existing evidence indicates that an aberrant production of interleukin-6 might be a cause. Histopathology typically shows perivascular and periadnexal mature, polytypic, plasma-cell-rich infiltrate in the superficial and deep dermis. Treatment modalities such as topical and systemic corticosteroids, topical tacrolimus, systemic chemotherapy, cyclophosphamide, psoralen plus ultraviolet A (PUVA) phototherapy and radiotherapy have been used, with varied response. In our patient, topical and systemic corticosteroids did not result in significant improvement, and further PUVA phototherapy has been planned.
P031 Experience from a UK dermatology regional virtual biologics and high-cost drugs multidisciplinary team
Authors: Katira Arnav , Ramsay Helen
Published: June 2024

There are over 20 biologics and high-cost drugs (BHCD) in routine use in dermatology in the UK, each associated with NICE technology appraisals and local guidelines, and there are more emerging. This, coupled with increasing clinical complexity, can make individual decision making challenging. In January 2021 a fortnightly BHCD multidisciplinary team (MDT) was initiated to support clinical practice and audit. Meetings are held virtually on a fortnightly basis using Microsoft Teams and are attended by dermatology consultants, trainees, specialist nurses and a biologics coordinator. Regional colleagues join to discuss patients needing a supraspecialist view (e.g. fourth or more BHCD) and to support shared care service level agreements for NHSE specialized commissioned drugs (e.g. adalimumab for hidradenitis). We work to locally agreed pathways, incorporating NICE standards. Between January 2021 and December 2023 there were 632 case discussions (106 in 2021, 250 in 2022, 276 in 2023) comprising psoriasis (n = 318), atopic eczema (n = 246), hidradenitis suppurativa (HS; n = 64) and other (n = 4). Examining outputs and outcomes from 2022, we discussed 250 cases (133 psoriasis, 92 atopic eczema, 22 HS, 3 other) and demonstrated 100% compliance with local and national standards for the cases of eczema and psoriasis. There was 100% compliance with national standards and 93% compliance with local standards for HS. This collaborative approach to decision making in a virtual MDT for BHCD has supported clinical practice, improved adherence to guidelines and reduced the time needed to undertake audits for individual drugs. A regional ‘hub and spoke’ arrangement for NHSE-commissioned drugs has supported care closer to home. The MDT further supports cost-effect­ive practice (e.g. drug choices, sequencing and Blueteq submission via the coordinator), research (e.g. recruitment into national registry studies), continuing professional development, teaching and training, and provides MDT support for individual funding applications.
P034 Using artificial intelligence to bridge the technical gap in dermatology: the role of large language models in creating an interactive Fitzpatrick skin phototype assessment
Authors: Zeina Mohamad , Zeina Bassam , Nachev Parashkev
Published: June 2024

Patient engagement is evolving with the advent of digital tools such as interactive websites and artificial intelligence (AI), yet significant barriers remain in the technical expertise required to create tools that benefit patients. We explore how large language models (LLMs), a type of AI that can facilitate and accelerate programming tasks, can enable clinicians and researchers to create interactive web-based patient engagement tools without the need for a dedicated web developer. We explore this possibility by developing, with the help of an LLM, an interactive skin self-assessment web tool. We used GPT4, a state-of-the-art LLM, as a web development assistant, and created an interactive JavaScript web page that guides patients through the Fitzpatrick skin phototype questionnaire. This involved building a minimal version first, and iteratively improving it. The web page initially asked the user the first two questions of the assessment, calculated a score, and returned this to the user. Once the code written by GPT4 was tested and shown to work, the tool was gradually improved to include all questions in the Fitzpatrick scale, and the result was modified to provide not only the total score, but also the result category. GPT4 allowed us, with no experience writing interactive JavaScript web pages, to develop and launch a web page that guides patients through a Fitzpatrick scale assessment. When GPT4 was asked to expand the questionnaire from two questions to the whole test, it gladly did so; however, the questions were not accurate. It then had to be given the specific wording of the questions and answers for the test, which it incorporated into functioning JavaScript code. This had to be performed in stages, adding two questions at a time, due to context limitations at the time. When this introduced issues, such as the code breaking or the website style looking inconsistent, GPT4 was able to fix these issues when they were described to it. Since the web page’s launch in March 2023, the web page has been viewed 1875 times by 1419 unique users. This study demonstrates one way that LLMs can be used to enhance patient engagement in dermatology, by facilitating the creation of interactive skin assessments with utility in many dermatology settings. Hallucination remains a problem, and any created tools must be thoroughly verified for factuality. Although no authors had any experience writing interactive JavaScript, they have coding experience elsewhere, and future work should assess whether similar results can be achieved by a broader user base. Two authors received funding from a commercial organization for this work (A & Z Dermatology Clinic Ltd).
P047 Dermatology Life Quality Index used as a standard in validation of 101 quality-of-life instruments: a systematic review
Authors: Vyas Jui , Johns Jeffrey , Abdelrazik Yasmina , Ali Faraz M , Ingram John R , Salek Sam , Finlay Andrew Y
Published: June 2024

Over the last 30 years many new quality-of-life measures have been described in dermatology; a critical aspect of their validation is demonstrating correlation with an instrument measuring a similar construct. The aim of this systematic review was to analyse peer-reviewed publications describing use of the Dermatology Life Quality Index (DLQI) in validation of other patient-reported outcome (PRO) and quality-of-life (QoL) measures. Seven databases were searched for papers published between January 1994 and December 2022 for articles containing data using DLQI in validation of other PRO or QoL measures. Methodology followed the PRISMA guidelines. The protocol was prospectively registered in PROSPERO. Of 1717 screened publications, 122 articles including 33 969 patients from 34 different countries with 38 diseases met the inclusion criteria. The DLQI was used in validation of 80 different dermatology-specific QoL measures, mostly disease specific, and of 21 generic measures. Of these studies, 42 were cross-cultural adaptations, 112 were single arm, 100 were cross-sectional, 18 were longitudinal and six were randomized controlled. DLQI was used for 14 known-group, 10 construct, 101 convergent, 10 concurrent, 10 divergent/discriminant and three criterion validity tests using the Mann–Whitney U-test (2), Spearman’s correlation (80), Pearson’s correlation (25) and Student’s t-test (1). The DLQI was used in responsiveness analysis in 13 studies. This review identified widespread use of DLQI in validation of other dermatology PRO and QoL measures, which confirms the central role DLQI plays in instrument development and validation across dermatology and beyond. The use of the DLQI by so many developers of other instruments has provided a common standard for comparability.
P092 Bidirectional association between alopecia areata and herpes zoster: a nationwide population-based study
Authors: Li Chia-Lun , Ma Sheng-Hsiang , Tai Ying-Hsuan , Dai Ying-Xiu , Chang Yun-Ting , Chen Tzeng-Ji , Chen Mu-Hong
Published: June 2024

Alopecia areata (AA) is the most common cause of immune-mediated alopecia. Due to the autoimmune nature of AA, researchers have investigated its potential links with infectious diseases. Herpes zoster (HZ) is one of the most common infectious diseases encountered in clinical practice, with a lifetime risk of 30%. However, only a few studies have reported a potential association between AA and HZ. This nationwide, population-based cohort study aims to explore the bidirectional relationship between AA and HZ, using data from the National Health Insurance Research Database (NHIRD) of Taiwan between 1997 and 2013. Individuals aged ≥ 10 years with a diagnosis of AA or HZ were included. Both AA and HZ diagnoses were confirmed by board-certified dermatologists on at least three occasions. For every patient with AA or HZ, 10 matched controls were randomly selected. These individuals were matched for age, sex, monthly income and residence. The primary outcomes assessed were new-onset HZ for patients with AA and new-onset AA for patients with HZ. Using a Cox regression model with adjustment for potential confounders, we assessed the risk of HZ in patients with AA, and vice versa. The cumulative incidence of disease was analysed using Kaplan–Meier survival curves with log-rank tests. In study 1, we included 9072 patients with AA and 90 720 matched controls. In study 2, we included 31 570 patients with HZ and 315 700 matched controls. Compared with controls, patients with AA had a 3.93-fold [95% confidence interval (CI) 3.42–4.52] increased risk for HZ, while patients with HZ had a 5.20-fold (95% CI 4.21–6.42) increased risk for AA. Both associations remained significant after stratification by sex and age. The 15-year cumulative incidence of HZ in the AA group was significantly higher than in the controls, and vice versa (P < 0.001). Furthermore, patients with AA had 4.97-fold (95% CI 2.55–9.68) and a 3.42-fold (95% CI 2.55–4.59) elevated risk for HZ ophthalmicus (HZO) and HZ with nervous system complications, respectively, in comparison with controls. Patients with HZO and HZ with nervous system complications exhibited 3.85-fold (95% CI 1.43–10.4) and a 5.00-fold (95% CI 3.42–7.32) increased risk for AA, respectively, compared with controls. We also found that patients with AA had a significantly younger age at HZ diagnosis compared with controls (40.6 vs. 50.6 years, P < 0.001). Our study revealed a bidirectional association between AA and HZ. Clinicians should remain vigilant regarding this link in both patient cohorts.
P102 Cutaneous noninfectious manifestations of chronic granulomatous disease: a prospective study
Authors: Keshavamurthy Vinay , Dev Anubha , Aggarwal Ridhima , Vignesh Pandiarajan , Rawat Amit , Chatterjee Debajyoti , Dogra Sunil
Published: June 2024

Dermatological manifestations in chronic granulomatous disease (CGD) include skin infections and sterile cutaneous inflammatory lesions. The objective of this study was to assess the clinical and histopathological features of noninfectious skin lesions in patients with CGD. This was a cross-sectional observational study from January 2022 to June 2023, carried out at a tertiary care centre. Forty-eight patients with CGD who were registered in the paediatric immunology clinic were screened for cutaneous noninfectious lesions during their routine follow-up. We describe the frequency of cutaneous noninfectious lesions among patients with CGD, along with their clinicodemographic and histopathological features. Noninfectious inflammatory skin lesions were present in 11 of 48 (23%) patients with vCGD. The mean age of this cohort (n = 11) was 19.8 years (SD 5.2). Centrofacial papulopustular lesions and erythematous infiltration involving the nose and the perinasal area (nose sign) were observed in 5 of 11 patients. Five patients presented with yellowish-orange, discrete, papular lesions involving the face and trunk, mimicking acne-like eruptions. Two patients had lesions of hidradenitis suppurativa. Histopathological examination revealed ill-formed granulomas with a mixed inflammatory infiltrate in the patients with facial lesions, while three patients with acneiform eruptions showed well-formed granulomas. The median age at onset of symptoms of CGD (48 vs. 7 months, P = 0.005; difference between groups 35 months, 95% confidence interval 12–78) and the median age at diagnosis of CGD (150 vs. 48 months, P = 0.008, difference between groups 72 months, 95% confidence interval 22–132) were significantly higher in patients with CGD who developed noninfective, inflammatory skin lesions compared with those without such skin lesions. The proportion of patients with NCF1 mutation was significantly higher in patients with noninfective inflammatory skin lesions (73% vs. 27%, P = 0.011). No correlation was seen between the type of skin manifestation and pathogenic mutation. In conclusion, inflammatory noninfectious cutaneous lesions can occur in CGD in the form of perinasal infiltrated papules and pustules (nose sign), as well as acne­iform lesions, and can be clues towards clinical diagnosis.
P106 Clinical outcomes and quality of life in a cross-sectional study of patients with moderate-to-severe psoriasis treated with bimekizumab in routine clinical practice
Authors: Wicker Gemma , Tredwell Amanda , Topliffe Joanne , Smith Maureen , Vistenia Jason
Published: June 2024

Psoriasis is a chronic, systemic, immune-mediated disease that is associated with severe comorbidities including depression, psoriatic arthritis and cardiovascular disease. As a result, psoriasis impacts on patient wellbeing and quality of life. Biologic therapies are highly effective for psoriasis; however, 11–35% of patients do not respond to their first treatment within the first year. Bimekizumab is a humanized monoclonal antibody that neutralizes the activity of the proinflammatory cytokines interleukin-17A and interleukin-17F, which are pivotal in developing psoriasis. This study assessed changes in disease severity and health-related quality of life in patients with psoriasis who were treated with bimekizumab in routine clinical practice. This cross-sectional study included adult patients with psoriasis who were attending routine clinical practice visits at five hospitals in the UK. Patients may have received prior therapy for psoriasis, and all were subsequently treated with bimekizumab. In total, 66 patients were included in the study; 35 (53%) were women, the mean age was 47.1 years (SD 15.5), the mean duration of disease was 19.6 years (SD 9.9) and the mean body mass index was 31.2 kg m−2 (SD 6.4). At baseline, the majority of patients (38 of 62, 61%) had extensive or widespread psoriasis, and 23 of 58 (40%) had psoriatic arthritis. Seven patients (11%) were treatment naive to biologic therapy, 55 of 65 (85%) had not responded to previous biologic therapy, and 43 of 65 (66%) had received adalimumab. After initiation of bimekizumab, there was a substantial improvement in disease severity at week 16. The mean Psoriasis Area and Severity Index (PASI) at baseline was 17.1, and no patients had a score of 0; the mean PASI at week 16 was 1.7, and 20 of 52 patients (38%) had a score of 0. This improvement in PASI was accompanied by an improvement in quality of life (Table). Qualitative data reported by patients indicated that treatment with bimekizumab improved their daily lives and decreased psychological stresses. In this study, bimekizumab reduced the severity of psoriasis and improved patients’ quality of life and overall wellbeing. These results indicate that bimekizumab should be considered for the treatment of patients with severe psoriasis where rapid and significant clearance of psoriasis is clinically appropriate, including treatment-naive patients and those resistant to previous biologic therapy. Medical writing support was funded by UCB; the study was conducted independently of the sponsor.ParameterPatientsBaselineWeek 16PASI scoreaMean (SD)17.1 (7.3)1.7 (4.1)Median (range)14.8 (4–43)0.5 (0–27)DLQI scorebMean (SD)20.2 (6.1)3.6 (5.4)Median (range)20.0 (10–33)1.0 (0–25)Psoriasis Area and Severity Index: baseline, n = 65; week 16, n = 52. Dermatology Life Quality Index: baseline, n = 64; week 16, n = 51.
Poster presentationsBC04 Clinical efficacy of oral tranexamic acid in lichen planus pigmentosus: case series
Authors: Bhalla Mala , Arora Astha , Kalia Aashali
Published: June 2024

Lichen planus pigmentosus (LPP) is a rare pigmented variant of lichen planus first described in India in 1974. It has an insidious onset and predominantly affects the photoexposed areas of darker skin phenotypes. The blue grey pigmentation is of great cosmetic concern and extremely difficult to treat. Various topical agents have been tried without much success, probably because the pigment is deeper in the dermis. The aim of this study was to assess the clinical efficacy of oral tranexamic acid 250 mg twice daily in LPP. In total 10 consecutive patients clinically diagnosed with LPP were included. A detailed history was taken to ascertain the onset and any possible risk factors. A skin biopsy was done in the patients who consented, to establish the histopathological diagnosis. All the patients were started on oral tranexamic acid 250 mg twice a day after excluding the risk factors for coagulopathy along with strict photoprotection. No other topical treatment was given. All patients were assessed for improvement in the pigmentation every 4 weeks until 12 weeks according to the following scale: no improvement (0%), mild improvement (0–25%), moderate improvement (26–50%), good improvement (51–75%) or very good improvement (76–100%). Photographs were taken and the patient’s satisfaction was also noted. Six of the 10 patients consented for biopsy and their histopathology was consistent with LPP. At the 4-week follow-up, four patients showed mild improvement, four had moderate improvement and two had good improvement. All the patients showed improvement and fading of pigment. Oral tranexamic acid seems to be effective in LPP, but more studies are required to establish the optimum dose and duration of treatment.
BH03 Do patients with afro-textured hair who are experiencing hair loss feel understood by their dermatologists? A cross-sectional study
Authors: Amoafo Emma , Baker Holly , Akhras Victoria
Published: June 2024

Providing good-quality care for skin and hair conditions in patients with skin of colour is an important area of dermatology. This study aims to analyse patient perceptions of their dermatology experience with hair loss and caring for afro-textured hair. We also examined whether they were signposted to the British Association of Dermatologists patient information leaflet (BAD PIL) ‘Caring for Afro-textured hair’ [British Association of Dermatologists. Caring for Afro-textured hair. Available at: https://www.bad.org.uk/pils/caring-for-afro-textured-hair (last accessed 19 April 2024)]. Patients with afro-textured hair attending a consultation for hair loss between 2020 and 2023 were included. Patients consented to participating in an anonymous online survey. A Google form was emailed to participants between December 2023 and January 2024, with responses recorded. A link to the BAD PIL was attached to the survey. Seventeen patients responded. Of these, 59% did not receive a diagnosis prior to seeing a dermatologist. In total, 71% of patients did not fully understand the cause of their hair loss and commonly used social media (53%), online websites (41%, including 18% using the BAD website) and family and friends (35%) to seek information about hair loss. Social media (35%) and family and friends (29%) were the most common forms of seeking information regarding caring for their hair. After seeing a dermatologist, 13 patients (76%) received a diagnosis. Fourteen patients (82%) were offered a biopsy, which 12 underwent. Overall, 29% of patients believed their dermatologist understood their hair loss very well, 24% somewhat well, 35% not very well and 6% not at all. Most patients (63%) had the same understanding about their hair loss after their consultation, and half of patients (47%) did not gain any confidence about managing their hair loss. Patients are more likely to refer to the BAD website after seeing a dermatologist (35%). However, only five patients (29%) were signposted to the BAD PIL during their consultation. Overall, 41% of patients found the leaflet somewhat or very helpful. Patients expressed that their consultation was more beneficial when they were seen by a doctor with afro-textured hair, and were disappointed when signposted to leaflets that featured hair loss in non-afro-textured hair. Others feel saddened because there is ‘no cure’ and current management has not helped. This study highlights the challenges that patients with afro-textured hair face in the management of their alopecia. There appears to be a perception that dermatologists do not fully understand hair loss in afro-textured hair, unless they have such hair themselves. Further education to dermatology colleagues is imperative to improve patient care and satisfaction. The BAD PIL is a useful signpost, which can be more reliable than patients relying on social media for advice.
Poster presentationsBH07 Intralesional vitamin D as immunotherapy for palmoplantar and periungual warts: how effective is it?
Authors: Bhargava Shashank
Published: June 2024

Warts are a viral infection of the skin caused by human papillomavirus, occurring in the form of verrucous growths over the surface of the skin. Incomplete removal or local recurrence of the infection is the disadvantage with the currently available local tissue destructive therapies. Newer therapy, such as intralesional immunotherapy with purified protein derivatives, offers the advantage of taking care of the viral infection not only at treatment site but also at remote sites, and also offers lifelong immunity. The current study was conducted on 40 patients of all ages with palmar, plantar and periungual warts. After clinical examination, patients were given 0.1–0.2 mL of vitamin D intralesionally in the largest wart at intervals of 3 weeks for three sessions. Patient assessment in follow-up visits was done with clinical photographs and by filling in pro formas for effects and side-effects. Complete clearance was seen in 31 patients (78%), partial clearance in 5 (13%) and no clearance in 4 (10%). There was variation in response in different morphological types of warts, with 100% clearance in plantar and palmar warts, and 70% clearance in periungual warts. In conclusion, intralesional vitamin D is useful in all types of warts; it can be used as a valuable first-line treatment in difficult-to-treat sites like palmoplantar warts and periungual warts.
BH16 Central centrifugal cicatricial alopecia and fibroproliferative disorders: exploring the association with uterine leiomyomas
Authors: Bala Laksha , Tsang Christie , Agarwal Vani , Elshimy Noha
Published: June 2024

Central centrifugal cicatricial alopecia (CCCA) is a type of scarring alopecia, which typically starts on the crown and progresses in a centrifugal manner. It predominantly affects women of African descent and often has devastating psychosocial implications. The pathogenesis of CCCA is not fully understood and therapeutic options are limited. It has been proposed that CCCA is a fibroproliferative disorder (FPD) with persistent, low-grade inflammation resulting in end-stage fibrosis. People of African descent are at increased risk of FPDs including uterine leiomyomas (ULs), possibly due to the protective effect of profibrotic alleles against helminthic infections (Dina Y, Okoye GA, Aguh C. Association of uterine leiomyomas with central centrifugal cicatricial alopecia. JAMA Dermatol 2018; 154: 213–14). There are only eight publications to date that explore the potential link between CCCA and ULs. A retrospective cohort study found that Black women with CCCA have nearly five times increased odds of ULs, compared with Black women without CCCA (Dina et al.). Fibroproliferative genes (e.g. platelet-derived growth factor and collagen genes I and III) are upregulated in areas of scalp affected by CCCA, compared with unaffected scalp in the same patients, with an overlap in pathogenic mediators with other FPDs including atherosclerosis and hepatic fibrosis (Aguh C, Dina Y, Talbot CC Jr, Garza L. Fibroproliferative genes are preferentially expressed in central centrifugal cicatricial alopecia. J Am Acad Dermatol 2018; 79: 904–12). These findings may help identify future therapeutic targets to treat CCCA. Current approaches use anti-inflammatory medications to halt disease progression. However, unlike other scarring alopecias, patients with CCCA often have minimal visible scalp inflammation, despite worsening fibrosis and hair loss. Hence, particularly for patients who do not improve with anti-inflammatory treatments, antifibrotic agents may play a therapeutic role in the future, with medications such as losartan and statins demonstrating potential for halting CCCA progression. We conducted a retrospective cohort study among patients with CCCA presenting to our tertiary-centre hair clinic, using Black women with lichen planopilaris (LPP) as a comparator group (n = 20). We found that 80% of Black women with CCCA had reported ULs, compared with 50% of Black women with LPP. In light of this potential association, dermatologists should be encouraged to screen for symptoms of ULs, alongside other FPDs, and counsel patients regarding potential comorbidities associated with CCCA. This may allow for prompt diagnosis of life-altering comorbidities and significantly ameliorate patients’ quality of life.
PD06 (P035) Quantifying the mutation burden of a therapeutic course of narrowband ultraviolet B (UVB) to help inform on the carcinogenicity of narrowband UVB
Authors: Coltart George , Fowler Joanna , Sood Roshan , Lai Chester , Nadarajah Noeline , Jones Philip , Healy Eugene
Published: June 2024

Narrowband ultraviolet B (NB-UVB) is recommended by NICE as a treatment for chronic plaque and guttate psoriasis that cannot be controlled with topical therapies. However, ultraviolet radiation is a carcinogen that causes DNA mutations in the skin, and in some cases results in skin cancer development. To date, there have been no studies determining how many mutations develop in human skin as a result of a therapeutic course of NB-UVB, and therefore we investigated the mutation burden of NB-UVB in the current study. Although whole-exome or whole-genome sequencing and target-enriched sequencing can detect mutations in large clones of mutated skin cells, these approaches do not detect mutations occurring only in single skin cells, hence we used a novel type of sequencing called Nanorate sequencing (which can identify mutations occurring in just a single molecule of DNA) in this study. We obtained 6-mm punch biopsies of normal skin (buttock and/or forearm) before and after a course of UV from patients (n = 16) undergoing NB-UVB treatment for psoriasis. Epidermis was microdissected from the dermis and the epidermal DNA was sequenced using Nanorate sequencing. DNA from venous blood underwent whole-genome sequencing as germline control for accurate identification of mutations in the epidermal samples. The numbers of DNA mutations were compared between the skin samples taken before and after NB-UVB in order to quantify the mutation burden attributable to the course of NB-UVB. Minimal erythema doses ranged from 0.3 to 0.9 J cm−2 and the total dose received during the course of NB-UVB ranged from 14.8 to 133 J cm−2. There was a significant rise in the number of mutations in buttock and forearm skin due to the NB-UVB treatment, with median increases in single-base substitutions per megabase of 1.09 SBS/Mb (P = 0.001) and 3.77 SBS/Mb (P = 0.0098) in buttock and forearm epidermis, respectively. The change in number of mutations secondary to NB-UVB treatment was predominately due to UV signatures SBS7a and SBS7b, with the DBS1 (CC>TT mutations) double-base substitution signature also identified in buttock and forearm skin samples. Comparison of the increase in mutation burden from NB-UVB with the mutation burden in keratinocyte cancers indicated that, for more susceptible patients, a course of NB-UVB therapy contributed as much as one-sixteenth of the total mutational burden of a cutaneous squamous cell cancer.
Poster presentationsPD10 Photosensitivity diseases in children: 10 years’ experience from a tertiary photodiagnostic service
Authors: McKeever Jessica , Lesar Andrea , Ibbotson Sally H
Published: June 2024

Photosensitivity diseases are a wide-ranging group of disorders, with heterogeneity in diagnostic categories, characteristics and management. Photosensitivity at any age poses specific challenges, with adverse impact on quality of life being highly significant, and children are of particular concern (Rizwan M, Heylett AK, Richards HL et al. Impact of photosensitivity disorders on the life quality of children. Photoderm Photoimmunol Photomed 2012; 28: 290–2). Our aim was to review the clinical and photodiagnostic characteristics of 209 children (aged ≤ 16 years), assessed through a tertiary photodiagnostic service between 2013 and 2023. We conducted this retrospective study with Caldicott Guardian approval (CALDICOTT-2023-011) and the presenter, a final-year medical student, analysed clinical photodermatology notes and our in-house photodiagnostic database with support from senior clinical supervisors. The median age of presentation was 8 years (range 4 months to 16 years), with a male-to-female ratio of 1 : 1.2. Most patients were of skin phototype II (40.6%), with only five being phototype IV and two phototype V. The median time from onset of symptoms to assessment was 3 years (range 1 month to 14 years). Polymorphic light eruption (PLE) was the most prevalent condition, diagnosed in 50.4%. A range of other diagnoses were seen, with photosensitivity excluded in 7.3%. Of those who underwent monochromator phototesting (n = 180), abnormal results were detected in 29 patients (16.1%), and 27 of 128 patients (21.1%) tested had an abnormal ultraviolet B TL-01 minimal erythema dose. Of 128 patients who were photopatch tested, 27 (21.1%) showed positive reactions. Vitamin D levels were insufficient in eight (24%) of the 33 patients tested. Paediatric antinuclear antibodies were tested in 29% of patients, with 11 (18%) being positive (≥ 1 : 80), although lupus was diagnosed in only two cases. Of 109 patients tested for porphyria, 11 (10.1%) were positive, seven being diagnosed with erythropoietic protoporphyria. One patient was diagnosed with xeroderma pigmentosum (XP). Children’s Dermatology Life Quality Index (CLDQI) assessment was available in 69%, with a median score of 10 (range 1–29). This study provides detailed characterization of photosensitivity diseases in children seen through a national photodiagnostic service. While PLE was the most common diagnosis, a range of other diagnoses were seen, including lupus, porphyrias and XP, highlighting the need for such specialist services. The delays in diagnosis and severity of impact on quality of life are of concern and emphasize the importance of raising awareness of photosensitivity in children in primary care. Prompt diagnosis, psychological support and holistic care are identified aspects of service provision.
PD12 Roadmap on how to set up home handheld phototherapy in the National Health Service: implementation of evidence-based treatment in the ‘real world’
Authors: Eleftheriadou Viktoria , Francis Carla , Hale Joanne , Halpern James
Published: June 2024

Vitiligo is the most common pigmentary disorder, and affects around 0.4% of the population in the UK. Recently conducted, two large retrospective observational studies using the UK Clinical Practice Research Datalink and Hospital Episode Statistics databases demonstrated that adults with vitiligo have an increased risk of subsequently being diagnosed with new-onset depression (25%) and anxiety (23%). The studies also found that people with both vitiligo and a mental health comorbidity have increased use of primary care services and are twice as likely to have recorded time off work and unemployment. Interestingly, the majority of patients (85%) were not prescribed any vitiligo-related treatments within a year of diagnosis for vitiligo. Second-line treatment for vitiligo includes either whole-body or localized phototherapy. Traditionally, narrowband ultraviolet B (NB-UVB) is reserved for people with extensive vitiligo and is delivered in secondary care using full-body units, requiring regular hospital attendance. In the current National Health Service (NHS) crisis, many NHS dermatology departments offer phototherapy either to a very limited number of patients with vitiligo or not at all, due to constraints on phototherapy services. The British Association of Dermatologists guidelines recommend that limited vitiligo can be treated with handheld NB-UVB devices. This recommendation was based on the results of a large, pragmatic, randomized controlled trial of home handheld phototherapy combined with topical corticosteroid for people with active, limited vitiligo (HI-Light trial). The trial was completed almost 5 years ago; however, only one centre in Wales chose to continue with the home handheld phototherapy service on the NHS after the completion of the trial. A new, unique, national, tertiary, research and treatment centre for children and adults with vitiligo has recently been established in England. In our centre, we offer home handheld phototherapy to eligible patients, who are often referred from out of area, therefore making a combination of topicals and NB-UVB more accessible. We designed patient-facing literature, a special pro forma for vitiligo clinic, and several other documents to assist in safety assurance and quality improvement processes. We describe the pathway that we followed when establishing this new service in the NHS. We have trained 20 patients so far. We describe the safety and efficacy results of home handheld phototherapy combined with topical treatments such as calcineurin inhibitors and corticosteroids, as well as oral antioxidants. We hope that our roadmap will pave the way for a home handheld phototherapy service in other centres, which would make phototherapy more accessible for patients with a variety of skin diseases such as vitiligo, hand eczema and scalp psoriasis, among others.