bluuebunny/crossref_metadata_2025 huggingface dataset:
DS17 Two cases of traumatic pseudoaneurysm of the superficial temporal artery
Authors: Phillips Chris , Smith Kirsty , Potter Matthew , Turner Richard
Published: June 2024

We present two cases of traumatic pseudoaneurysm of the superficial temporal artery (STA). An 87-year-old woman was referred to the dermatology 2-week-wait clinic with a 4-cm painless nodule on the left forehead. Three weeks prior she sustained a fall at home, and computed tomography revealed a subgaleal haematoma over the left forehead. She was on warfarin for deep vein thromboses (international normalized ratio 4.2). The nodule was compressible and had a purple hue. A diagnosis of haematoma was made and incision and drainage was booked. On the day of surgery her procedure was cancelled as clinical re-examination revealed the mass was pulsatile and overlying the STA. The diagnosis was revised to STA pseudoaneurysm. She was referred to plastic surgery and underwent ligation of the artery and excision of the pseudoaneurysm. A 51-year-old man presented to dermatology with a 1-month history of a 1-cm painless, pulsatile subcutaneous mass on the right forehead continuous with the STA. Further questioning revealed a cycling accident 3 months prior with polytrauma. STA pseudoaneurysm was diagnosed clinically. He underwent ligation of the artery and resection of the pseudoaneurysm under local anaesthetic in dermatology theatres successfully, with no complications or recurrence. STA pseudoaneurysm is a rare presentation of an enlarging nodule on the forehead or temple, which typically occurs following blunt head trauma. However, cases have been reported following Botox injections, hair transplants and other procedures. The interval between the causative trauma and the onset of the lump can vary (reported range 2–6 weeks to 10 years), and therefore it may not be obvious or volunteered by the patient. Although STA pseudoaneurysm is usually asymptomatic, ear pain, headache and facial nerve palsies have been described. Examination reveals a typically spherical subcutaneous lesion, continuous with the course of the STA. Unless thrombosed, palpation should reveal a characteristic pulse or thrill and a bruit on auscultation. Diagnosis is usually clinical. Doppler ultrasound (demonstrating vessel dilatation and turbulent flow), magnetic resonance imaging, computed tomography (CT), and CT angiography can confirm the diagnosis and are useful to investigate other post-traumatic injuries. Treatment is usually surgical ligation of the artery and resection of the pseudoaneurysm. Embolization is an alternative if surgery cannot easily be performed. In summary, STA pseudoaneurysm is a rare but important clinical diagnosis to consider in a subcutaneous mass on the forehead, before biopsy or aspiration is performed. A history of trauma does not always directly precede its onset despite it being the likely causative factor. Although the clinical history can be suggestive, examination to identify the pulsatile nature is important, so the diagnosis may be missed on reviewing teledermatology images only.
DP12 Comparison of clinical, dermoscopic and histopathological characteristics of salt and pepper pigmentation in systemic sclerosis and vitiligo: a prospective controlled study
Authors: Viswan Parvathy , Behera Biswanath
Published: June 2024

Systemic sclerosis (SS)-associated salt and pepper pigmentation (SAPP) and vitiligo are rather indistinguishable. This study aimed to compare the clinical, dermoscopic and histopathological characteristics of SAPP in SS with vitiligo. Twenty-one patients with SS-associated SAPP, and 43 patients with vitiligo attending the outpatient department were recruited. The clinical, dermoscopic and histopathological characteristics of the depigmented lesions were analysed for a predefined set of parameters by two dermatologists. Sites prone to friction, like the extensor aspect of the arms (P < 0.05), the flexor aspect of the thigh (P < 0.05) and the inguinal folds (P < 0.05), were more commonly involved in SAPP. Depigmentation or hypopigmentation of the palms and soles (P < 0.05) were invariably absent in SS. Clinically, perifollicular depigmentation (P = 0.02), confetti lesions (P ≤ 0.01), trichrome sign (P ≤ 0.01) and leucotrichia (P = 0.02) were seen in vitiligo, while perifollicular hyperpigmentation (P < 0.01) was seen in SAPP. Among dermoscopic features, trichrome sign (P < 0.01), dermoscopic leucotrichia (P = 0.02), perifollicular depigmentation (P = 0.02), lesional and perilesional pigment network (P < 0.01) and satellite white clod (P < 0.01) were characteristically present in vitiligo, whereas perifollicular hyperpigmentation over a background of depigmentation (P < 0.01), white network (P < 0.01), hypo- or depigmented structureless area with angulated border (P < 0.01), alternating hyper- and depigmentation longitudinally (P < 0.01), blue–grey dots (P < 0.01) and telangiectasia (P < 0.01) were more common in SAPP. The histopathological features of depigmented areas of SAPP and vitiligo showed the following significant differences: more epidermal lymphocytes (P < 0.05) and more dermal fibroblasts were seen in vitiligo (P < 0.01), while dermal sclerosis (P < 0.01) and periadnexal infiltrate (P < 0.01) were more common in SS. Histopathological features suggestive of dermal sclerosis such as pandermal sclerosis (P < 0.01), line sign (P < 0.01), square biopsy sign (P < 0.01), cookie cutter sign (P < 0.01), lone arrector pili sign (P < 0.01) and high eccrine gland sign (P < 0.01) were seen exclusively in SS. When in doubt, careful clinical, dermoscopic and histopathological examination of the depigmented lesions in SS and vitiligo will help in diagnosis. This study is limited by the small sample size, and only patients with Fitzpatrick skin types IV and V were studied.
DP20 A case series identifying the clinical and histopathological characteristics of amelanotic melanoma
Authors: Sohail Aroon , Kavaklieva Svetlana
Published: June 2024

Amelanotic melanoma (AM) is a subtype of melanoma where the lesion demonstrates little to no pigmentation. This can lead to delays in referral due to misdiagnosis, with studies showing a higher mortality rate compared with pigmented melanoma. However, there are few reports in the current literature regarding the characteristics associated with AM. In a 10-year period at a single centre in the north-west of England, patients with a histological diagnosis of AM were enrolled and data were collated retrospectively to determine the characteristics of AM lesions. Of the 16 patients identified, 69% were male, and the mean age at diagnosis was 78 years. The most common location for AM was the head (38%), which also demonstrated a higher mitotic rate (10.7 mm2) compared with the average (7.3 mm2). More than half of the lesions (56%) had been present for > 1 year. With a misdiagnosis rate of 88%, the likelihood of delays was evident. Dermoscopic findings were variable, but conspicuous vessels were noted in 63% of lesions. The most common vessel patterns were linear and irregular vessels, each identified in 19% of cases, with 13% of cases showing arborizing vessels. Our case series has demonstrated that AM is typically diagnosed in the older population, with a greater incidence rate noted in men. The age at diagnosis could be secondary to a delay in referral as AM is commonly not identified, with a misdiagnosis rate of 88% in our series. Lesions were most commonly located on the head region, whereas the back and legs were less commonly affected. This is contrary to melanoma, where the legs are most common for women and the back the most common for men. We suspect that a prolonged exposure of the head region to ultraviolet light is the reason for the highest distribution rate noted in the head. Furthermore, AM of the head was noted to have a greater mitotic rate than the average, potentially indicating more aggressive and lethal disease. The gold standard in clinical assessment is dermoscopic examination, with particular emphasis on identifying abnormal vessel features, a finding amplified due to a lack of pigmentation. We have demonstrated that AM can have a significant misdiagnosis rate with the possibility for a more aggressive cancer to form, potentially leading to unfavourable patient outcomes. We have identified key features of suspicious lesions that require assessment, notably abnormal vessels. Practitioners in primary and secondary care should be aware of and vigilant in identifying AM lesions. All suspicious lesions should undergo histopathological analysis to determine their exact nature.
British Society for Paediatric and Adolescent DermatologyOral presentationsPA01 (P094) Oral tofacitinib monotherapy for the management of moderate-to-severe alopecia areata in children and adolescents: a retrospective analysis of 36 cases
Authors: Mehta Hitaishi , Mahajan Rahul , De Dipankar , Handa Sanjeev
Published: June 2024

Alopecia areata (AA) poses a significant challenge in the paediatric population, with limited treatment options. Oral tofacitinib has emerged as a promising modality, with case reports and small series suggesting safe and effective use in children with AA. This retrospective analysis sought to expand the knowledge base around tofacitinib’s role in managing AA in the younger population and to provide valuable insights into challenges encountered when faced with no response to treatment. This retrospective chart review spanned from January 2021 to December 2023 and included 36 patients aged ≤ 16 years with moderate-to-severe AA [Severity of Alopecia Tool (SALT) score > 25], who received ≥ 6 months of oral tofacitinib therapy. The treatment response was defined as ≥ 75% reduction in SALT score (SALT 75) at 6 months. Other outcome measures of interest included times to attain SALT 50, SALT 75, SALT 90 and SALT100, and incidence of adverse events. In total 36 patients were included, with a mean age of 10.1 years (SD 3.8, range 3–16), with 17 male and 19 female patients. AA subtypes included patchy (19%), ophiasis (17%), subtotalis (28%), totalis (8%) and universalis (28%). The mean SALT score at baseline was 73.1 (SD 26.7). The mean duration of oral tofacitinib treatment was 8.69 months (SD 3.17, range 6–16). SALT 50 was achieved by 26 patients, with an equivalent number attaining SALT 75. Additionally, 24 patients reached SALT 90, while 19 patients reached SALT 100. The mean (SD, range) durations in months to achieve SALT 50, SALT 75, SALT 90 and SALT 100 were 2.81 (1.16, 1–6), 4.08 (1.69, 1–8), 5.71 (2.14, 3–10) and 6.74 (2.35, 3–12), respectively. Ten of the 36 patients (28%) were classified as nonresponders. Nonresponders exhibited a higher median total duration of illness, higher baseline SALT score, and higher incidence of atopy and nail involvement compared with responders. Adverse events were noted in nine patients, with two cases necessitating treatment discontinuation due to adverse events. Among those not showing a response, three patients each underwent a transition to combination therapy of oral steroids with methotrexate and topical immunotherapy with diphenylcyclopropenone. Notably, regrowth was observed in two patients from the former group, while none from the latter group experienced similar positive outcomes after the therapeutic strategy shift. Limitations of the study include the retrospective nature and small sample size. This comprehensive analysis enriches the existing literature on the role of tofacitinib in paediatric AA, addressing gaps in approved treatments and providing valuable guidance for clinicians navigating the challenges of nonresponsiveness in this vulnerable population.
Poster presentationsPA10 Hidradenitis suppurativa and trisomy 21: a case series
Authors: Murphy Lisa , Tobin Anne-Marie
Published: June 2024

It has long been postulated that there is a link between hidradenitis suppurativa (HS) and Down syndrome (DS); however, there are limited data in the literature examining the disease trajectory for these patients and the underlying mechanism. We performed a multicentre retrospective chart review to assess whether there is a particular phenotype of HS associated with patients with DS. Nine patients were included in total. The average age of presentation among our cohort was 17.4 years. Overall, 44% of patients had a raised body mass index, 22% had a positive family history for HS and none of the patients currently smoked. Most patients (89%) had trialled at least one oral antibiotic for their HS. The results of our review suggest that DS would appear to be an independent risk factor for developing HS. It would also appear to have an earlier age of presentation and to occur independently of the traditional risk factors for developing HS. It is hypothesized that trisomy 21 contributes to a genetic dysregulation that predisposes patients to this condition. This supports the findings suggested by similar studies.
PA14 An interesting case of congenital syphilis
Authors: Muttoni Elisabetta , Beattie Paula
Published: June 2024

Congenital syphilis occurs due to transplacental transmission of Treponema pallidum from mother to fetus during pregnancy or rarely during childbirth. Intrauterine infection can result in a variety of presentations ranging from asymptomatic infection to cutaneous and visceral changes and even stillbirth and perinatal death. We present the case of a 15-week-old infant with congenital syphilis presenting with a persistent rash, organomegaly, haematological abnormalities and epistaxis. The patient was a 15-week-old male infant seen by the general paediatricians at the age of 6 weeks with a widespread nonspecific exanthematous rash, which was initially felt to be a viral exanthem due to a preceding episode of bronchiolitis. However, the rash persisted, and after developing bilateral epistaxis he attended hospital and was found to have hepatosplenomegaly, confirmed on ultrasound scan, and a markedly raised white cell and lymphocyte count along with low haemoglobin and platelet count. While he was under the haematology team, dermatology were asked to review the patient. He was noted to have small brownish–pink plaques over the fingers and knuckles and scattered throughout the body, bluish macules on the legs, and peeling on the soles. He was also noted to have a flattened nose and sounded congested. A diagnosis of congenital syphilis was suggested and he was referred on to the infectious disease team. Investigations showed he was positive for T. pallidum polymerase chain reaction on rectal and mouth swabs and urine sample, but not in cerebrospinal fluid. He has completed a 10-day course of intravenous benzylpenicillin. In the postnatal period, congenital syphilis can present with haematological, visceral and cutaneous manifestations. The most common early signs, which present at birth or appear in the first 2 years of life, include hepato­splenomegaly, rash, fever, rhinitis (snuffles) and generalized lymphadenopathy. Leucocytosis and thrombocytopenia are also recognized (Woods CR. Congenital syphilis – persisting pestilence. Pediatr Infect Dis J 2009; 28: 536–7). Penicillin is the gold-standard treatment for syphilis as resistance of T. pallidum to penicillin has never been reported (Peeling RW, Mabey D, Kamb ML et al. Syphilis. Nat Rev Dis Primers 2017; 3: 17073). Patients who are allergic to penicillin should be treated with doxycycline or ceftriaxone. It is important to consider congenital syphilis as a potential differential in any infant who presents with a rash, organomegaly and haematological abnormalities such as the case we present, and we hope to increase awareness to facilitate early diagnosis and prompt treatment.
PA29 A case of atypical herpes zoster in an immunocompetent infant with congenital melanocytic naevi
Authors: Johnston Sarah , Honan Alison
Published: June 2024

An immunocompetent 6-month-old child presented with a striking bandlike inflammatory eruption. She was systemically well with no apparent symptoms. Her only medical history was of congenital melanocytic naevi. Brain imaging had not yet been requested. She was exposed to chickenpox at 4 weeks old but had no clinical evidence of primary varicella infection. The patient’s mother had chickenpox in childhood. The patient had crops of grouped vesicles on erythematous bases, on her abdomen and left midback extending onto the left flank. Although perceptibly thoracic dermatomal, the plaques crossed the midline. She also had a large congenital melanocytic naevus overlying the left thoracic region with a number of smaller naevi on her scalp, chest and back. Herpes varicella zoster was confirmed by viral swab. The patient was treated with oral aciclovir and has had complete resolution. Subsequent magnetic resonance imaging confirmed neurocutaneous melanosis. Herpes zoster (HZ) is a segmental eruption due to reactivation of latent varicella zoster virus (VZV) from sensory dorsal ganglia. HZ is typically a painful condition affecting older adults or immunocompromised individuals. Infantile HZ is rare, with an estimated incidence of 0.2 per 1000 person-years in 0–5 year olds (Kurlan JG, Connelly BL, Lucky AW. Herpes zoster in the first year of life following postnatal exposure to varicella-zoster virus: four case reports and a review of infantile herpes zoster. Arch Dermatol 2004; 140: 1268–72). Most cases occur due to intrauterine VZV exposure or early postnatal exposure. Primary infection before 12 months increases the risk of HZ, due to immune system immaturity and less sustained cell mediated immunity. Maternal antibodies can alter primary infection to a subclinical form. Infantile HZ tends to be milder and not associated with complications such as postherpetic neuralgia. Therefore, there is no consensus on whether antiviral treatment is required. Infantile HZ is likely underestimated due to the milder presentation, subclinical primary infections and assumption that maternal antibodies provide protection. Case reports describe vesicles slightly outside the primary dermatome, but to best of our knowledge there are no case reports of eruption crossing the midline. This case highlights the importance of considering HZ as a differential in vesicular eruptions in infants. It highlights the differing presentation where lesions can be asymptomatic and less typically dermatomal. As an additional learning point, this case emphasizes the role of imaging in the presence of large congenital melanocytic naevi to aid diagnosis and prognostication. Early imaging can avoid sedation and increases the sensitivity of detecting melanosis prior to brain myelination in late infancy (Jakchairoongruang K, Khakoo Y, Beckwith M, Barkovich AJ. New insights into neurocutaneous melanosis. Pediatr Radiol 2018; 48: 1786–96).
PA30 Unilateral naevoid telangiectasia: a case series
Authors: Forde Karina , Burrows Nigel
Published: June 2024

Unilateral naevoid telangiectasia (UNT) is characterized by unilateral, linearly arranged telangiectasia in a blaschkoid or dermatomal pattern, most frequently involving the cervical dermatomes. It can be congenital but more frequently is acquired. It is thought to occur as a result of somatic mosaicism, with cutaneous lesions being unmasked under conditions of elevated oestrogen, such as puberty, pregnancy, alcoholism, hormone treatment and liver disease. There is conflicting evidence as to whether affected skin has increased levels of oestrogen receptors compared with unaffected skin. We report a case series of three adolescents who presented to our paediatric dermatology clinic with acquired UNT. Patient one was a 14-year-old boy who presented with a 9-month history of linearly arranged telangiectasia in a blaschkoid distribution along the left arm, forearm and dorsum of hand. Dilated capillaries with surrounding pallor indicating vascular steal phenomenon were evident. Systemic exam was unremarkable. Patient two was a 13-year-old girl referred with a 2-year history of telangiectasia across the left chest and upper back. Clinical exam revealed punctate telangiectasia with surrounding halos distributed in a C4, C5 and C6 dermatomal distribution on the left chest and back, along with a larger well-circumscribed telangiectatic patch on the left posterior shoulder. Clinical exam was otherwise normal. Patient three was a 15-year-old boy referred with a 1-year history of diffuse telangiectasia involving the right chest and arm. Clinical exam demonstrated pinpoint telangiectasia with surrounding halos distributed in a blaschkoid pattern across the right anterior chest with sharp midline cutoff. There was further subtle linearly distributed involvement of the right arm extending to the base of the right thumb. In all three cases liver and thyroid function tests were normal. Patients one and three were discharged with reassurance and patient two was referred for laser therapy due to concerns regarding cosmesis. This case series illustrates the typical presentation of acquired UNT presenting in adolescents, typically around onset of puberty. Although acquired UNT has been reported in association with liver and thyroid disease, previous case series have reported an absence of associated disease in adolescents presenting with UNT, mirrored in our cohort. Clinical diagnosis is appropriate, and no other investigations are indicated in the absence of additional features of concern. Although UNT is reportedly rare, it is likely under-recognized and under-reported. It is therefore important to be familiar with the presentation and natural history of the condition, so that appropriate reassurance can be given to patients and their families.
BI37 Efficacy of psoralen plus ultraviolet A therapy for the treatment of chronic cutaneous graft-versus-host disease: a retrospective study analysis from a tertiary care centre
Authors: Sadhwani Monal , Kulkarni Vinay
Published: June 2024

Cutaneous graft-versus-host disease (GVHD) is a well-recognized complication, occurring in 60–80% of patients after allogeneic bone marrow stem cell transplantation (BMSCT) (Garbutcheon-Singh KB, Fernández-Peñas P. Phototherapy for the treatment of cutaneous graft-versus-host disease. Australas J Dermatol 2015; 56: 93–9). The chronic type manifests as either a lichenoid or sclerodermatous form. Phototherapy is an effective treatment option as it works by immunomodulatory effects. We retrospectively reviewed eight cases of chronic cutaneous GVHD. All the patients had undergone allogeneic BMSCT for an underlying haematological disorder at a tertiary care centre in western India. Each patient was administered phototherapy with ultraviolet (UV)A radiation twice a week. All of them received 8-methoxy­psoralen at a dose of 0.6 mg kg−1 as a photosensitizer, 2 h prior to UVA therapy. The percentage improvement in body surface area involved was calculated at the end of therapy and results were analysed using SPSS. Also, the doses of steroids and immunosuppressants were tapered while the patient was on phototherapy. A total of eight patients were enrolled in the study; five (63%) were male (63%) and three (38%) were female. The mean age at the time of presentation was 37.75 years. Five patients (63%) had lichenoid GVHD, while the other three cases (38%) had sclerodermatous type GVHD. Six patients had undergone allogeneic BMSCT for leukaemia, while one patient had myelofibrosis and one case was diagnosed with Diamond–Blackfan syndrome. The mean time to develop GVHD after bone marrow transplant was 9.5 months and the mean body surface area involved at the time of diagnosis was 50.6%. There was more than 50% improvement in five cases (63%) after an average of 36.3 sessions of psoralen plus UVA (PUVA), while one case (13%) relapsed after achieving complete remission. One patient (13%) was lost to follow-up as he was not able to visit the hospital frequently for twice-weekly sessions. One patient (13%) died while on PUVA therapy owing to relapse of leukaemia. Generally, all the patients tolerated PUVA well, except two patients who experienced nausea after taking psoralen, one patient with dizziness after PUVA therapy and one patient who complained of pigmentation of skin over the extremities. The percentage reduction in the dose of steroids before and after phototherapy was also found to be statistically significant. We conclude that PUVA therapy is an effective nonaggressive modality for treating chronic cutaneous GVHD, especially the lichenoid form. It offers a major advantage of an immunosuppressive sparing effect as well as a good safety profile.
DE02 Mentoring tomorrow’s dermatologists: establishing a mentorship scheme for junior doctors interested in dermatology
Authors: Winter Sarah , Ashton Sally
Published: June 2024

Mentoring is a powerful tool for personal and professional development (Burgess A, van Diggele C, Mellis C. Mentorship in the health professions: a review. Clin Teach 2018; 15: 197–202). It is strongly advocated by the Royal College of Physicians. Several mentorship schemes have been created for doctors interested in competitive specialities. Dermatology remains one of the most competitive specialties, yet to the best of our knowledge, there are no mentoring schemes for junior doctors interested in dermatology in the UK. The aim of our project was to successfully launch a dermatology mentorship scheme to help mentees take control of their own career journey, while enabling mentors to build on their leadership skills. In 2022, a pilot dermatology scheme was created in Cardiff, matching foundation and core trainees to dermatology registrars. There were six delegates in the pilot. With the success of a pilot, where 100% of delegates felt that the scheme was beneficial to their career and progression, the mentorship scheme was expanded to include the whole of South Wales. The scheme was advertised through junior doctor groups on Facebook and through postgraduate medical education centres for mentees. In total, 23 delegates signed up to the 2023 scheme: 12 mentees and 11 mentors. A virtual mentoring workshop was held for all delegates and this was well received. Delegates were also provided with a mentoring contract to use. Initial survey results showed that 100% (n = 12) of mentees felt they had not yet been exposed to enough potential mentors at work or at medical school. Overall, 92% (n = 12) stated that they did not yet have a mentor-like figure, 67% (n = 8) of delegates stated that not having a scheme available was one of the reasons for not having a mentor, and 82% (n = 9) of the mentors wanted to develop their leadership skills through the scheme. Informal feedback has been overwhelmingly positive. Formal feedback will be welcomed in May 2024 to make improvements to the scheme for the following year. Our project shows that there is demand for mentorship in dermatology. We hope that the successful establishment of our scheme paves the way for mentorship schemes to be set up locally to help inspire and support the next generation of dermatologists.
DE07 Dermatology Dungeons and Dragons: simulation in dermatology education
Authors: Lawlor Kate , Mughal Avad
Published: June 2024

It has been shown that dermatology is poorly understood among medical students and doctors of all grades (Chiang YZ, Tan KT, Chiang YN et al. Evaluation of educational methods in dermatology and confidence levels: a national survey of UK medical students. Int J Dermatol 2011; 50: 198–202). A scoping review within dermatology showed better learning effects when the interventions activate students, involve feedback, and are built on case-based learning (Bernges F, Zielbauer S, Weberschock T, Ochsendorf F. Teaching dermatology to medical students: a scoping review of published interventional studies. J Dtsch Dermatol Ges 2022; 20: 1077–87). Unlike more rigid direct case-based teaching, simulation learning allows the student to help build the zone of learning and explore areas of education that may not have previously considered. A novel approach is currently being utilized with year 3 medical students. There are approximately 12 students in each 2.5-h session. They are split into three or four groups, with students with previous dermatology experience allowed to ask fewer questions and those with no previous dermatology experience allowed to ask unlimited questions. Each group is asked to roll a 10-sided die to choose their case. They are then given a clinical scenario that includes a brief history and clinical photographs. The facilitator acts as the patient answering the students’ questions. The clinical scenarios cover the commonly encountered conditions in dermatology. When the students reach a certain point in the decision-making process, they again roll a die to determine the outcome of that choice. This demonstrates the element of chance and multiple potential outcomes in real-life decision making within clinical practice. The students can come up with any of many appropriate management plans, but their success is left up to chance. The crucial step is that the students then follow up that case again and evaluate the consequences of their decision making and the rationale for success or failure. This can be repeated as many times as the session allows, and other students learn from watching their colleagues. The students are provided with feedback forms at the end of the session to gain insight into the positive and negative aspects and whether they felt the session improved their knowledge of diagnosing and managing dermatology conditions. Feedback has been consistently positive including, ‘That is the best teaching I have ever had’. The freedom to make errors is vital and allows the student to reach the highest level of Maslow’s hierarchy. The consequences then ground this in learning.
GD03 (P095) Ten cases of scabies successfully treated with topical ivermectin
Authors: Oldham Jaimie , Sahota Anshoo , O’Toole Edel , Cunningham Malvina
Published: June 2024

Scabies is an increasing problem in the UK with a surge in cases reported by dermatologists and the media. It is intensely itchy and caused by the highly contagious mite Sarcoptes scabiei. There are many theories regarding the increased prevalence, including global warming, increased poverty, reduced treatment availability and resistance. The standard treatments in the UK include topical malathion, topical permethrin and oral ivermectin. All have had significant supply issues as reported by the British Association of Dermatologists. There have also been concerns of permethrin resistance. Oral ivermectin is expensive, with four tablets listed at £116.84 in the British National Formulary (BNF). Finally, oral ivermectin is not licensed in children weighing < 15 kg (although data seem to suggest this is safe). One option that is less used but reported is topical ivermectin. This was in the 2018 Cochrane review looking at the efficacy of topical permethrin, and oral and topical (as 1% lotion) ivermectin. This showed no difference in efficacy and few or mild adverse events. These findings are also replicated in recent studies and there are case reports of topical ivermectin to treat neonatal scabies that seems resistant to permethrin. In our centre, we have used topical ivermectin (as the 10 mg g−1 cream Soolantra) to treat 10 patients, with great success. The first was a 14-month-old child who weighed 9.2 kg. She had previously had three courses of permethrin and two courses of malathion with ongoing signs and symptoms of scabies, including burrows. The entire family had been treated every time and the entire family (except this patient) was treated with oral ivermectin during the final treatment before topical ivermectin. The patient was treated top to toe with two applications of topical ivermectin cream 1 week apart, with resolution after one application. Subsequently we have had success using the same protocol to treat a 21-year-old man (with no response to four courses of permethrin) and his 53-year-old mother (with no response to three courses of permethrin). We have also treated a 31-year-old man, a 48-year-old man and his partner (all of whom had not responded to one course of permethrin), and a 68-year-old man and his family who had no previous treatment. We have had no adverse effects and no treatment failures. We report on 10 patients who we treated successfully with topical ivermectin. Topical ivermectin provides an exciting option for treatment and, of note, one tube is listed at £27.43 in the BNF, making it significantly cheaper than the oral alternative.
GD07 Skin neglected tropical diseases and global health: migration and integration beyond borders
Authors: Parajuli Niraj
Published: June 2024

Skin neglected tropical diseases (NTDs) are a group of diseases that present with cutaneous manifestation. There are at least 12 listed diseases included in the list of skin NTDs by the World Health Organization. Among these, some diseases are typically present more commonly in certain geographical locations compared with others. For example, leprosy is more common in the Asian subcontinent and Buruli ulcer in the African region. In this new world with easy global reach due to the ease of travel, skin NTDs are not restricted only to the tropics. Despite the propensity of these diseases to occur in the tropics and among poorer populations, they can be diagnosed in clinics globally. Therefore, all global dermatologists should have a good knowledge of these conditions wherever they are located. So, should we start on a global health topic for all skin NTDs? Travel data from Nepal showed that 3.48 million passengers travelled internationally from Nepalese airports, which included 1.93 million departures and 1.55 million arrivals. Similarly, a total of 105 million passengers arrive in the UK each year. This unrestricted massive travel between countries poses a huge risk of infectious diseases transferring from their countries of origin in the tropics to European countries. Moreover, mutation of the vectors and climate change have made it possible for certain diseases to adapt to colder climates. Leprosy, scabies, cutaneous leishmaniasis and resistant dermatophyte infection are commonly seen in Nepal. All of these diseases can present with varied clinical presentations. So, due to global travellers, diseases of the tropics may not remain only diseases of the tropics, which has been shown in recent years. Can this be an opportunity for a mutual learning experience between countries of the tropics and Europe? The tropics could learn from research conducted in the Western world, and both can work together in controlling NTDs.
GD08 A retrospective study of skin diversity and disease, in the depiction of protagonists vs. antagonists, in popular global animations
Authors: Tang Edwina , Dubash Faisal
Published: June 2024

Our retrospective study explores skin conditions and diverse skin phenotypes in the depiction of protagonists vs. antagonists, within popular global animations. Animations throughout media, across continents, can influence younger audiences and societal perspectives. These inevitably impact self-perception and a patient’s personal experience of skin disease, for example acne portrayed in a cartoon villain. Shan Yu, Disney’s villain in Mulan, is portrayed with darker skin, a distinct beard and scars. The choice to associate skin colour and disorders with negatively portrayed characters drives cognitive assignment of a character’s morality, which thus may drive societal prejudice. We collected data assessing skin colour and dermatological characteristics of heroes or villains, in animations worldwide. The top 10 most popular animations for each major continent were identified and analysed from rankings obtained from the Internet Movie Database (IMDB) website. Animations were collected from Asia, Australasia, Africa, Europe, North America and South America. Major blocs of Asia included the top 10 most popular animations from India, China, Japan, the Middle East and South East Asia. Skin tones were captured and put into four categories: grey-hued, pallor, darker than ‘normal’ phenotype and fairer than ‘normal’ phenotype. For example, a character is classified as darker than ‘normal’ if their skin tone is darker than the majority skin colour for that region. While grey-hued and pale complexions are consistently utilized to portray popular villains, there was a global pattern of using contrasting skin colour, depending on the continent. In Europe and Australia, villains with darker skin colours were more common. Acne, warts and scarring were commonly portrayed in villains. In contrast, African villains with distinct skin tone were fairer, whereas their animated African heroes had a skin tone representative of the majority population. Interestingly, in India, more than half of villains were portrayed with darker skin. Sociocultural and colonial-rooted influence of skin tone in Indian society could explain why over half of its popular villains are darker in skin tone. The availability of skin whitening products aligns with postcolonial bias, suggesting that lighter skin symbolizes power, status and beauty. Skin colour and skin disorders in character portrayal may push the notion of ‘good guys’ vs. ‘bad guys’, thus driving prejudice against particular ethnic groups. Colonial media narratives ‘othering’ ethnic groups exemplify how discrimination and hatred may develop. We propose that animators carefully consider the negative impact of their work, including perpetuation of stigma in society, prior to release into the public domain.
H07 Skin, science and suffrage: the trailblazing history of Agnes Blackadder
Authors: Dyson Maya
Published: June 2024

Agnes Blackadder, born in Dundee on 4 December 1875, is widely credited as the first female consultant dermatologist in Britain. In 1895 she graduated from St Andrews University, the first woman to do so, with a Master of Arts. Following this she matriculated at Queen Margaret College in Glasgow, going on to obtain her medical degree in 1901. She was known to be a particularly voracious learner, taking multiple subjects simultaneously during her time at St Andrews, resulting in her graduating prematurely. Furthermore, during her medical education she obtained prizes across multiple fields, such as surgery, midwifery and ophthalmology. In 1907 Blackadder moved to London, where she was appointed as a consultant dermatologist at St John’s Hospital for Skin Diseases. Not only is she considered to be the first female consultant dermatologist in Britain, but she was among the first female physicians to be appointed as a consultant in a hospital serving both male and female patients. Her very presence within the medical community was, at the time, considered to be radical. Moreover, her interest in dermatology, radiology and electrotherapeutics diverged from those considered to be more acceptable for female physicians, namely paediatrics and women’s health. Central to Blackadder’s life was her advocacy for gender equality, frequently highlighting the persistent gender disparities in the fields of both medicine and academia. In 1912 she worked as part of the medical team who assessed the impact of force feeding of imprisoned suffragettes participating in hunger strikes. She published her findings, describing this practice as ‘severe physical and mental torture’, and strongly advised against its use. During World War I she served at Royaumont Hospital in France, working as a radiographer. Her research interests continued to be both progressive and wide ranging; she was among the first to identify the radiographic appearances of gas gangrene, and used this to help improve diagnostic accuracy. She observed the impact of music on health and documented its therapeutic implications. She published Music, Health and Character soon after her return to London, and this resulted in the formation of the Council for Music in Hospitals. The exceptional career of Blackadder spanned over 50 years and she continued to practise medicine into her eighth decade before she passed away in 1964, aged 88. Her legacy has left an indelible mark on both medicine and women’s rights. She succeeded in creating space for women in the fields of dermatology and academia, paving the way for subsequent generations to pursue their aspirations.
H10 Extramammary Paget disease: from the 19th century to now – where ‘Paget’ meets the scrotum and beyond
Authors: Frimpong-Manso Honey Brandy , Venables Zoe C , Levell Nick J
Published: June 2024

Sir James Paget (1814–1899), born in Great Yarmouth, Norfolk, and a surgeon at St Bartholomew’s Hospital in London, first described Paget disease of the breast in 1874. He identified 15 women with chronic nipple lesions described as ‘eczematous ulcerative or vesicular lesions with clear yellowish exudate’. All these cases later developed into malignant lesions and this condition was subsequently termed mammary Paget disease. In 1887, Henry Radcliffe Crocker (1846–1909) documented the first case of what is today known as extramammary Paget disease (EMPD). Crocker was a dermatologist at University College Hospital. He was a founding member of the Dermatological Society of London in 1899 and president of the Dermatological Society of Great Britain and Northern Ireland. In ‘Paget’s disease, affecting the scrotum and penis’, published 1889, Crocker detailed a 60-year-old man presenting with an ‘oozing, well-defined area of superficial ulceration’ on the front, left side of the scrotum and under the surface of the penis. He described similarities to eczema but that the lesion was much deeper and well defined. Many treatments and remedies had no effect. Two nodules later appeared in the affected area, suggesting malignancy. This case was presented by Crocker at the Dermatological Society of London, where members identified similarities to mammary Paget disease. Sir James Paget reviewed the patient and agreed with the similarities, suggesting excision of the affected area. Cancerous cells were seen on microscopic investigation of the nodules. Crocker described the sweat coils and ducts forming a cancerous structure, in keeping with the known pathophysiology of EMPD primarily affecting apocrine-rich areas. Darier and Coulillaud reported a patient with perianal manifestation of Paget disease in 1893. These cases identified this rare but significant skin condition associated with underlying malignancy. Today, EMPD represents approximately 6.5% of all cutaneous Paget disease. The management of EMPD has changed little since it was first described in the 19th century, with identification and treatment of an associated malignancy and surgery remaining the mainstay of treatment.
H11 The pioneer of dermatology in Northern Ireland: what a legacy!
Authors: Yong Ji Fung , Griffin Laoise
Published: June 2024

Henry Samuel Purdon (1843–1906) was the pioneer of dermatology in Northern Ireland. Born into a family of doctors, Purdon qualified as a physician in Scotland, earning an M.D. (Glasglow) and an L.R.C.P. (Edinburgh). His interest in dermatology started under the influence of McCall Anderson’s dermatological teaching in Glasglow. After his return to Belfast, he quickly gained the public approval in an open meeting at 12 Wellington Place, resulting in the establishment of ‘The Belfast Dispensary for Diseases of the Skin’ in 1865. With creativity, he made wax models of skin diseases to gain financial support to fund the institute. The models included lupus vulgaris, which was very prevalent during that time. With the steady increase in attendance, the dispensary was renamed ‘The Belfast Hospital for Diseases of the Skin’ in 1866. In 1868, the Belfast Charitable Society funded the construction of a new hospital in Regent Street, which was opened in 1869. This new building provided mainly outpatient facilities with consultation rooms and an operating theatre, which were deemed sufficient, in addition with eight inpatient beds. Despite hectic clinical commitments, in 1870 Purdon became the editor of the Journal of Cutaneous Medicine, which invited articles from the USA, and from Europe and the UK. Further, Purdon published three dermatology textbooks, titled On Neurotic Cutaneous Disease, Including Erythema (1869), Classification, Correct Dietary, and Treatment of Diseases of the Skin: as Practised at the Belfast Hospital of the Skin (1889) and A Treatise on Cutaneous Medicine and Disease of the Skin (1875), which recorded his clinical experience. With Purdon’s famous reputation in dermatology, the need of the service had drastically increased. His fame attracted funding of £4000 from philanthropist Edward Benn, to build a new skin hospital on Glenravel Street in 1873. The Benn Skin Hospital was opened in 1875. This hospital was fully furnished with the finest amenities, with 30 hospital beds and a suite of baths to meet service demand. Purdon was elected president of Benn’s hospital and held this position until his death, at the age of 62. Purdon’s legacy in dermatology was carried down by his son, Elias Bell Purdon, until the hospital was destroyed by a Luftwaffe bomb during the Belfast Blitz in 1941. In 1957, ‘The Purdon Skin Ward’ in the Royal Victoria Hospital Belfast was established to recognize Purdon’s service to dermatology.
H12 A history of evidence-based medicine and dermatology as an early adopter
Authors: Binns Hannah
Published: June 2024

In 1992, a search for evidence-based medicine (EBM) would have only yielded two articles. Now, searching this term in PubMed generates over 276 000 results. But how did the ‘era of evidence-based medicine’ begin and what were its foundations? The concept of using evidence to guide medical practice is thought to date back to Ancient Greece. However, it was not until the 20th century that it started to take hold in modern medicine. Social principles calling for effective healthcare for the masses were a driving force, with British clinical epidemiologist Archie Cochrane (1909–1988) being the first advocate of this practice. Predating Archie Cochrane’s work, the early 20th century’s advancement in statistics and development of the meta-analysis would form the building blocks for modern-day EBM. British statistician Karl Pearson was the first to propose the concept of combining results of individual studies to minimize random error. Later in the 1920s fellow Briton, Ronald Fisher laid the foundation for the systematic approach by developing the statistical method of meta-analysis, first called ‘Fisher’s combined probability test’. In 1976 American statistician Gene Glass coined the term ‘meta-analysis’. By 1989 meta-analysis was changing clinical practice. Sir Ian Chalmers demonstrated that a short course of corticosteroids could drastically reduce complications following delivery of preterm infants. His work, and that of others, highlighted that lives could be saved through the evidence-based approach of performing up-to-date systematic reviews of randomized clinical trials. Meanwhile, in Canada the EBM movement was starting. In 1981 a group led by David Sackett published the first of a series of articles on how to appraise medical literature, influencing the practice of a whole generation. The actual term EBM was announced by Sackett’s mentee Gordon Guyatt in 1992. The levels of evidence that we use today can be attributed to Sackett and his book Evidence-Based Medicine: How to Practice and Teach EBM, which gave clinicians the tools to adopt EBM into everyday practice. Dermatology was an early adopter of EBM. The Cochrane Skin Group (CSG) was founded by Hywel Williams in 1997, with the clear aim of disseminating evidence-based guidelines to prevent, diagnose and treat dermatological disease. The first CSG review was published in 1999, and to date there are 130 active systematic review titles. The work of the CSG elicits tangible effects on international health policy, contributing to national and international guidelines. The work of the CSG is bolstered by the UK Dermatology Clinical Trials Network at the Centre of Evidence Based Dermatology, a group that aims to explore research gaps identified by the CSG reviews.