bluuebunny/crossref_metadata_2025 huggingface dataset:
DP13 A case of poikilodermatous plaque-like haemangioma: a newly described entity
Authors: Elamin Shahd , Hennell Claire , Dolan Olivia
Published: June 2023

A 56-year-old man was referred with a 1.5 cm × 1.5 cm asymptomatic erythematous and scaly plaque on his right upper calf of 6 months’ duration. He had no similar lesions or prior skin issues. He had no significant comorbidities and was on no regular medications. There was no known family history of relevance. The initial clinical findings were felt to be in keeping with Bowen disease. He was treated once with cryotherapy, followed by two cycles of 5-fluorouracil cream, applied once daily over 4 weeks. Despite this, the plaque persisted and increased in size, measuring 3 cm × 2.5 cm. A 4-mm incisional biopsy was performed. Histopathology findings showed an acanthotic epidermis with compact hyperkeratosis, overlying a superficial dermal vascular lesion that consisted of a distinctive band-like proliferation of small endothelial cell-lined vessels. Background fibrosis and oedema were noted, as well as loss of elastic fibres within the lesional area, demonstrated by elastic van Gieson stain. Positive immunohistochemistry staining included CD31 and erythroblast transformation-specific-related gene stains, helping to confirm this lesion’s vascular origin, with a negative result for D2-40 (podoplanin), suggesting no lymphatic involvement. The histological appearances were thought to fit with a diagnosis of poikilodermatous plaque-like haemangioma (PPLH), a newly described entity of acquired vascular proliferation. Poikilodermatous plaque-like haemangioma, first described in 2019, usually presents as a solitary atrophic erythematous-to-violaceous plaque typically found in the lower limbs (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). Reassuringly, it has a benign course, but it can be persistent (Semkova et al.). Our patient was keen for treatment as the lesion was continuing to grow, causing him concern. However, there is sparse information available in the literature regarding effective treatments for PPLH. The case was discussed at the departmental clinicopathological meeting. The plaque was felt to be too superficial to merit any radiological investigation of the soft tissues. Surgical excision was discussed but given the size and location would most likely require a large skin graft. Sclerotherapy was considered but not felt to be appropriate in this setting. A trial of laser therapy was regarded as the best option given the superficial nature of this vascular lesion. He has since started a course of pulsed dye laser (PDL) at a wavelength of 585 nm, and we wait with interest to determine if it is effective. We therefore present this case to raise awareness of PPLH as a newly described entity and to consider it in the differential of a solitary atrophic erythematous plaque on a sun-protected site.
DP15 ‘Unwell water’: the potential importance of environmental factors in skin cancer in people of colour
Authors: Junejo Muhammad Hyder , Cernova Jeva , Ligaj Marcin , Stodell Matthew , Harwood Catherine
Published: June 2023

Ultraviolet radiation (UVR) is the most common environmental carcinogen to cause cutaneous squamous cell carcinoma (cSCC). However, other carcinogens may also play a role and should be suspected when cSCC occurs in people with skin of colour (SOC) in whom ultraviolet (UV)-induced cSCC is less common. We present the case of a South Asian female who presented with an aggressive cSCC, which we hypothesize was related to previous arsenic exposure. A 70-year-old Bangladeshi woman (skin phototype V) presented with a 4-cm diameter, tender, keratotic plaque at the base of her left thumb, which had been present for 12 years and was slowly enlarging. There was no associated lymphadenopathy. She also had multiple palmoplantar keratotic papules and two hyperkeratotic plaques in UV-protected areas on her trunk. Histology of the lesion on her thumb confirmed a cSCC with high-risk features: poorly differentiated, invasion 9.5 mm into fibromuscular tissue, perineural invasion (nerve diameter > 0.1 mm) and vascular invasion. The truncal plaques were confirmed to be SCC in situ. The cSCC was incompletely excised and subsequently showed extensive involvement of periosteal soft tissues with invasion into bone marrow. Staging computed tomography showed no evidence of nodal or distant metastatic disease. She subsequently underwent ray amputation and remains under close clinical surveillance. Given the cSCC location and her skin phototype, potential non-UV radiation (UVR) causes were explored. In view of the palmoplantar keratotic papules and SCC in situ, chronic arsenic exposure was suspected. Further questioning revealed a history of drinking well water in a rural village in Bangladesh throughout childhood and early adulthood, although exposure had stopped > 40 years ago. Arsenic exposure from contaminated groundwater was therefore considered to be the most likely diagnosis. She was started on long-term chemoprevention with acitretin. Arsenic is a potent human carcinogen and a well-recognized cause of cSCC; the latency period may be 30–40 years. Most cases are likely to be in people exposed through environmental arsenic exposure, such as contaminated groundwater, with some cases of exposure to arsenic-containing traditional medicines also reported. Carcinogenic mechanisms are uncertain but may involve dysregulation of the Hippo signalling pathway. In summary, although the incidence of UVR-related cSCC is lower, this case highlights the importance of considering risk factors, other than UVR, in cSCC arising in people with SOC. Identifying relevant carcinogens may require a detailed travel, social and cultural history and, more importantly, an awareness of the non-UVR causes of cSCC.
DP16 Trichilemmocysticus naevus: a rare birthmark treated successfully with erbium ablative laser
Authors: Bennett Hannah , Urwin Rachel , Merchant Will
Published: June 2023

We report a rare case of a 58-year-old woman with a naevus trichilemmocysticus. The patient presented to a tertiary dermatology centre with longstanding skin changes to her trunk. The changes had been apparent since childhood and became more prominent in her teens. Examination showed a linear Blaschkoid distribution of subtle hyperpigmentation and warty follicular prominence to the left submammary region, extending to the left upper back, where comedones and cystic papules were also noted. Histopathology confirmed the presence of cysts containing keratin, lined by trichilemmal-type squamous epithelium, representing trichilemmal cysts. The overlying epidermis appeared normal. Given the Blaschkoid distribution and the presence since childhood, it was thought that this most likely represented a naevus trichilemmocysticus. Tantcheva-Poor et al. described and named this as a rare type of organoid naevus-type lesion in 2007 (Tantcheva-Poor I, Reinhold K, Krieg T, Happle R. Trichilemmal cyst nevus: a new complex organoid epidermal nevus. J Am Acad Dermatol 2007; 57:S72–7). Only seven cases have been identified and reported in the literature. These have been characterized by multiple follicular filiform hyperkeratoses and trichilemmal cysts in a Blaschkoid distribution. Most cases described involve extensive areas of the skin and present with disfiguring lesions. Histology reports confirm epidermal acanthosis with deep invaginations filled with massive orthokeratosis, parakeratotic columns and an absent granular layer (isthmic or trichilemmal differentiation) with keratosis in sebaceous ducts and acrosyringia. Our patient is currently undergoing successful treatment with erbium laser under local anaesthesia, in order to improve the texture and appearance of the birthmark. This has been achieved by ablation to the warty areas to the level of upper papillary dermis, with focal deeper ablation to the skin overlying each cyst, followed by the use of a meibomian cyst curette for enucleation.
DP20 Necrobiotic santhogranuloma of the scalp with nonprogressive thrombocytopenia: a case report
Authors: Kemp Alexandra , Johnson Peter
Published: June 2023

We present the case of an 84-year-old woman referred with a 6-month history of a lesion on her occipital scalp. Examination revealed a creamy-white, nonscaly nodule measuring 15 × 15 mm with surface telangiectasia. Her past medical history included basal cell carcinoma, stage 3 kidney disease, cardiovascular disease and osteoporosis. A diagnosis of necrobiotic xanthogranuloma (NXG) was confirmed on incisional biopsy, and the patient went on to have full excision. Given the association with haematological malignancies, and following discussion with our local haematologist, investigations included full blood count, bone profile, immunoglobulins, serum and urinary protein electrophoresis and serum free light chains. This revealed a low platelet count of 108 × 109 cells L–1 (reference interval 150–450) but no other significant abnormalities. Our local haematologist considered a bone marrow biopsy, but after discussion with the patient, this was declined. Necrobiotic xanthogranuloma is a rare non-Langerhans histiocytosis. It classically presents as a yellow, red or purplish papule or nodule in the periorbital region, so this case had an unusual site. The mean age of onset is in the sixth decade of life, with an equal sex distribution. Pathogenesis is unknown. Necrobiotic xanthogranuloma is associated with haematological malignancies, particularly paraproteinaemia and lymphoproliferative disease. Differential diagnoses include xanthelasma, chronic lupus erythematosus, sarcoidosis and necrobiosis lipoidica. Where lesions become infiltrative and plaque-like, mycosis fungoides and psoriasis can also be considered. Given the relatively rare nature of NXG, there is no consensus for optimal treatment. In localized skin lesions such as in our patient, surgical excision is often undertaken. Other reported treatments are directed at the associated paraproteinaemia and include chlorambucil and small-dose corticosteroids, cyclophosphamide, melphalan, azathioprine, thalidomide, interferon-α and intravenous immunoglobulin. Classical features on histology include palisading xanthogranulomas with foci of necrobiosis in the mid-dermis and diffuse granulomatous panniculitis with foreign body-type reaction and Touton giant cells. Our histology slides showed a relatively atrophic epidermis with a dense dermal and subcutaneous infiltrate consisting of lymphocytes, foamy macrophages, plasma cells and Touton-type multinucleate giant cells with areas of necrobiosis. There were also reactive lymphoid follicles with germinal centres. Given the association with internal malignancy, it is important to diagnose these lesions correctly. To date, our patient has not developed any haematological malignancy, although is at increased risk in the future and has been counselled and monitored accordingly. It remains unclear whether the presence of thrombocytopenia alongside NXG is a coincidental finding or marker for future lymphoproliferative disease, as there are no other published case reports of such an association.
DP22 Cutaneous lymphoid hyperplasia: clinicopathological correlation and a therapeutic option
Authors: Alassaf Jehad , Alhyari Ramzi , Khasawneh Hayat , Wahidi Sanaa , Al-Ruhaibeh Maysoon , Abdallat Salah
Published: June 2023

Cutaneous reactive lymphoid hyperplasia, also known as cutaneous pseudolymphoma, is an uncommon entity in which there are skin lesions that histologically, and sometimes clinically, mimic cutaneous lymphoma but are not, both morphologically and immunohistochemically. Correlating clinical, pathological, immunohistochemical and, occasionally, molecular findings is essential for the diagnosis (Romero-Perez D, Blanes Martinez M, Encabo-Duran B. Pseudolinfomas cutaneous. Actas Dermosifiliogr 2016; 107:640–51). Although the majority of cases can be regarded as idiopathic, certain infections and inflammatory conditions can precipitate cutaneous reactive lymphoid hyperplasia, examples of which include Borrelia infection, insect bite reactions and folliculitis (Mitteldorf, C, Kempf, W. Cutaneous pseudolymphoma – a review on the spectrum and a proposal for a new classification. J Cutan Pathol 2020; 47:76–97). The first case was an 18-year-old woman who presented with deep dermal and subcutaneous nodules for the last 5 years that started on her limbs and were slightly itchy. The nodules were firm and deep, with minimal surface changes (hyperpigmentation and adherent scale) but did not ulcerate. She also had nodules involving her buccal mucosa, inner lips and soft tissue in the nasal bridge and a couple of deep nodules on the cheeks. Pathological examination showed a dense lymphocytic infiltrate with plasma cells admixed with other inflammatory cells involving the deep dermis with an extension to the dermal/subcutaneous junction. The pathological picture was in the spectrum of deep tumid lupus/lupus panniculitis overlap and cutaneous lymphoid hyperplasia. Immunohistochemical stains showed a mixture of inflammatory cells with CD3+ and CD20+ cells. Lip mucosal biopsy showed florid reactive lymphoid follicular hyperplasia. Her condition was resistant to multiple systemic treatments. Eventually, she underwent treatment with rituximab and had satisfactory results. The second patient is an elderly female who had multiple erythematous papules, plaques and nodules on her face. Pathological examination showed a dense dermal lymphocytic infiltrate with periadnexal predilection and reactive follicles that also were highlighted by CD20, with Bcl2 and CD3+ cells around germinal centres. She was diagnosed as having cutaneous reactive lymphoid hyperplasia. Topical calcineurin inhibitors were initiated, with a good response. In conclusion, this paper highlights the term cutaneous pseudolymphoma/cutaneous reactive lymphoid hyperplasia, presenting a few cases with clinicopathological correlation and exploring some uncommon treatment options.
DS16 Clinicopathological features of metastatic squamous cell carcinoma treated with Mohs micrographic surgery: a case series
Authors: Stefanovic Nicholas , Cosgrave Niall , Killion Lisa , Ormond Patrick , Moran Benvon , Irvine Alan , Barry Rupert
Published: June 2023

Cutaneous squamous cell carcinoma (cSCC) is a keratinocyte tumour with inherent metastatic potential. Approximately 4% of cSCCs metastasize locoregionally and/or distally. Mohs micrographic surgery (MMS) is efficacious, with cure rates in selected cases of 95–99%. Diagnoses of cSCC treated at St James’s Hospital between the years 2010 and 2019 were identified via histopathology reports. Clinicopathological and treatment data in cases with metastatic disease were collected. Nodal metastasis was defined as biopsy-confirmed cSCC in locoregional lymph nodes and/or supporting radiological evidence. During the timeframe, 3455 cSCCs occurred in 2522 patients. Metastatic disease was identified in 116 patients, with complete data available in 105 cases. Six patients had undergone MMS to the primary tumour. Mean age at time of surgery was 75.6 years (range 65–85); five patients were male. Tumours were located on the cheek (n = 2), ear (n = 2), lower eyelid and nasal tip. Mean time to first metastasis was 6.67 months (range 2–16). Two patients were immunosuppressed at time of metastasis. All patients demonstrated high-risk cSCC features, with four patients demonstrating very-high-risk features as defined by the British Association of Dermatologists. One patient received adjuvant radiotherapy prior to detectable metastasis. All patients were discussed at either skin or head and neck multidisciplinary team (MDT) meetings. No patient received preoperative imaging. This series highlights the importance of risk stratification in cSCC management, irrespective of treatment modality. Consideration should be given to patient age and relative immune status, with dedicated locoregional imaging being guided by MDT discussion.
DS17 Postoperative wound complications following dermatological surgery: an audit leading to improved clinical practice, patient outcomes and informed consent
Authors: Kennedy Jake , Potluru Aparna , Farled Maria , Jones Ruth , Rice Shantini
Published: June 2023

In 2021, an apparent spike in wound complications presenting to our dressings clinic prompted a prospective audit of complications following dermatological surgery. The aim was to quantify the rate of and identify risk factors leading to postdermatological surgery complications for clinical governance and to improve clinical practice and patient outcomes. Secondary outcomes were to provide operators with individual annual complication rates. A further outcome pertinent to the Montgomery ruling was to use the data to refine preoperative patient information with precise detail on risk prior to surgery. Patients undergoing a dermatological surgery procedure between 1 April 2021 and 31 December 2022 across three hospital sites were included in this audit. Prospective data were collected via a departmental surgical complications proforma, supplemented by collating retrospective data from nurse-led wound review clinics via our electronic patient record system. Data were gathered on patient age and sex; operator grade; presenting problem (pain/dehiscence/infection/bleeding/other); surgical site; route of referral; microbacterial swab, cultured organism, antibiotic prescribing; anticoagulation; type of procedure; suture type; days to suture removal; and provision of pre- and postoperative patient information on skin surgery. Over a 21-month period > 11 000 procedures were performed, with a median of 574 procedures per month. In total, 256 patients reported 331 complications: 124 were suspected infections (37.5%); 63 were reports of pain (19.0%), 62 of bleeding (18.7%) and 52 of dehiscence (15.7%); and 30 (9.1%) were other complications such as graft failure. Surprisingly, the majority of complications (41%) occurred on the head and neck. Of patients presenting with bleeding, most were not taking prescribed anticoagulants. Seventy-two per cent of positive swabs grew Staphylococcus aureus. In 2019, the British Association of Dermatologists (BAD) performed a national audit of process, based on measures of quality in a dermatology skin surgery service. Sixty-four per cent of 201 respondents from the BAD and British Association of Dermatological Surgery reported no formal mechanism for determining wound complications following skin surgery (https://cdn.bad.org.uk/uploads/2022/02/29200022/Skin-Surgery-National-Audit-Report-2019.pdf). In our experience, using a departmental proforma has enabled quantification of departmental postoperative complication rates against anatomical site, procedure, patient factors and level of operator, improving clinical practice, governance, informed consent and patient outcomes. It is hoped that our work might usefully contribute to the development of a national proforma for collating data on wound complications, which has wider implications for maintaining high standards of dermatological surgery practice across the UK.
DS18 Efficacy of intralesional sodium tetradecyl sulfate in pyogenic granuloma
Authors: Mathachan Sinu
Published: June 2023

Data on sclerotherapy in pyogenic granuloma (PG) are sparse and limited to a few case reports and series (Plachouri KM, Georgiou S. Therapeutic approaches to pyogenic granuloma: an updated review. Int J Dermatol 2019; 58:642–8). We present a series of 18 patients with PG treated with intralesional sodium tetradecyl sulphate (STDS). The aim of this study was to evaluate the efficacy, safety and recurrence rates of STDS sclerotherapy in the treatment of PG. Eighteen patients with PG (based on history and clinical features) of any age consenting to be part of the trial were included. Intralesional STDS 1% was injected slowly using an insulin syringe until the lesion blanched, and a maximum of 1 mL was used in one sitting. Patients were followed-up weekly; if the lesion did not show complete resolution, repeat injections were given up to a maximum of three sittings. A final assessment for relapses was done at 4, 8 and 16 weeks after treatment completion. All patients had complete clearance (100%) of the lesions with STDS 1% in one or two sittings. Noted side-effects included pain (n = 6), oedema (n = 4), purpuric staining (n = 2), paraesthesia (n = 1), ulceration (n = 2), necrosis (n = 2) and urticarial rash (n = 1). All side-effects resolved completely; two patients had to take analgesics and oral antibiotics. No bleeding episodes occurred in any patient after the first sitting. Further, none has shown recurrence over a follow-up period of 4 months. Eight patients developed mild atrophic scars as post-treatment sequelae. Sclerotherapy is a simple procedure; however, surprisingly, the literature on its use in PG, a very suitable indication for sclerotherapy by virtue of the pathology involved, is sparse. In this study, STDS successfully cleared the lesions in all patients without major complications or recurrence.
DS24 Prospective study comparing ex vivo confocal laser scanning microscopy and frozen section histopathology of 23 basal cell carcinomas treated with Mohs micrographic surgery
Authors: Demirel Sibel , Hill Rachel , Fleming Colin , Khalid Amina
Published: June 2023

Ex vivo confocal laser scanning microscopy (CLSM) is an emerging technique that is used for the rapid analysis of freshly excised tissue during Mohs micrographic surgery (MMS). Previous studies on fluorescence CLSM have shown 88% and 99% sensitivity and specificity, respectively, of diagnosing basal cell carcinomas (BCCs) vs. conventional histology. The fourth-generation Vivascope 2500 allows fresh tissue to be scanned after minimal preparation with acetic acid and acridine orange, creating digitally coloured mosaic images, mimicking conventional histological haematoxylin and eosin slides. The scanning speed of < 3 min creates the potential to improve patient experiences, allowing multiple stages and repair in a single session, reducing overall operating times and improving efficiency. After a 2018 pilot study on a limited case series, we have begun the process of testing the real-world use of this technology. We present an initial prospective case series to assess BCC excision of stage 1 Mohs specimens using the Vivascope 2500 vs. conventional frozen section histology. Caldicot approval was sought. Over a 3-month period, 23 cases of stage 1 facial BCCs on one Mohs list were processed. Samples were obtained as standard bevelled Mohs excisions, and Mohs maps were created for all cases. There were three false-negative BCCs, of which two were infiltrative BCCs with small foci missed on the initial review on CLSM images and one superficial BCC not visible due to lack of epidermal capture. Of the four false-positive cases, the foci appearing to be BCC included inflammation in one, follicular structures in two and conjunctival glands misinterpreted as BCC in one eyelid case. Time taken to process specimens and read the digital images by CLSM was compared with the time taken to obtain and read frozen section slides. The shortest time recorded for CLSM and frozen sections was 6 min and 31 min, respectively. The longest time recorded for CLSM and frozen sections was 20 min and 57 min, respectively. In summary, CLSM shows promise in MMS for selected BCCs. Improved techniques to flatten the epidermis for better visualization and further experience with image reading and interpretation have the potential to minimize errors.
DE07 Enhancing social media engagement for Clinical and Experimental Dermatology: the educational journal of the British Association of Dermatologists: a quality improvement project
Authors: Li Danning , Charalambides Maria , Patel Chandn , Hutton Emelie , Shipman Alexa
Published: June 2023

Social media is an efficient method for direct communication between a journal, clinicians and patients. Increased social media engagement also increases the impact factor of medical journals (O’Kelly F, Nason GJ, Manecksha RP et al. The effect of social media (#SoMe) on journal impact factor and parental awareness in paediatric urology. J Pediatr Urol 2017; 13:513). The aim of this quality improvement project was to assess the impact of three interventions on social media success (defined as reach, engagement or follower count) of the Clinical and Experimental Dermatology Instagram page (@ced_journal), founded in July 2020. Impact on reach, engagement and follower count was investigated after each intervention cycle. Cycle 1 (April–June 2022) investigated the impact of a checkerboard grid design to increase visual appeal, standardized journal branding and a consistent posting schedule. User analytics revealed a large proportion of Middle Eastern followers, and, therefore, cycle 2 (July–October 2022) used non-English hashtags to target these audiences. Cycle 3 (November–December 2022) investigated the boost in engagement through encouraging authors who had recently published in the journal to post their publication on their personal accounts and tag the journal. Qualitative data were gathered from the Meta Business Suite and directly from the Instagram page. Data were analysed using GraphPad. Cycle 1 resulted in mean increases in content reach by 568% (P < 0.001), unique profile visits by 281% (P = 0.014) and number of new followers by 642% (P = 0.188). Cycle 2 demonstrated a mean increase in the number of new followers by 194% (P = 0.025) but did not significantly increase the reach (P = 0.414) or number of new profile visits (P = 0.410). There was no significant increase in reach (P = 0.229), unique profile visits (P = 0.055) or number of new followers (P = 0.397) in cycle 3. This study demonstrates improvements in social media success following cycles 1 and 2. Cycle 3 results emphasize the importance of novel interventions in further varying content to maintain and further increase engagement, as well as studying additional factors that influence engagement, such as standardized journal branding across all social media platforms. Overall, this study emphasizes the effectiveness of innovative and interactive education resources for disseminating dermatology research among scientific and nonscientific users, which can be adopted by other dermatology journals.
H07 Papyri and sarcophagi: a tour of dermatology in Ancient Egypt
Authors: Zaki Faaris
Published: June 2023

Long before medicine was demystified by the Renaissance, Enlightenment and modern thinkers with whom we are most familiar, the skin and its diseases were pondered on by the Ancient Egyptians. Through their writings and remains, modern scholars are able to assemble a picture of what dermatological conditions ailed the Egyptians and how they were contemporaneously perceived. The Ebers Papyrus (c. 1550 Bc), the largest record of Ancient Egyptian medicine, is noted for its vivid descriptions of lesions and grisly details of treatments. Some of the conditions mentioned therein are straightforwardly identified from their descriptions, whereas others are open to interpretation. Recent DNA evidence has also shed light on this topic, causing scholars to re-evaluate the presence of various conditions, such as leprosy and tuberculosis, in different parts of the ancient world. The Egyptians are perhaps most famed for the preservation of bodies through the process of mummification, which provides us with a unique glimpse into the nature of skin disease in the ancient world. Mummified skin tends to be shrunken, deeply pigmented and brittle. Even so, nails, hair and epidermal ridging are preserved. Prolonged rehydration and staining can reveal the stratum corneum, keratinocytes, melanin, collagen and elastic fibres, along with adnexal structures and subcutaneous tissue. Mummies with identifiable dermatological disease include Ramses V (d. 1145 Bc), whose face, neck, shoulders, lower abdomen and scrotum bear the marks of smallpox. The diagnosis was later confirmed by electron microscopy, which identified the variola viral corpuscle in his skin. Skin tumours have also been found in mummified remains, as have syndromic features of diseases, which predispose to multiple dermatological malignancies, such as Gorlin–Goltz syndrome, which is suspected in two fraternal mummies from around 3000 Bc. One specimen from c. 1300 Bc was identified as having a venous ulcer, which was subsequently confirmed when histology demonstrated perivascular haemosiderin deposition. Other tentative diagnoses have been made on appearance alone, including pustular dermatosis, impetigo and pemphigus foliaceus. Too often do we perceive medical history as starting in earnest during the last few centuries. The Ancient Egyptians have bequeathed to us a wealth of information, both historical and archaeological, which, combined with modern techniques, has allowed us to peer through the millennia into a dermatological world that can feel simultaneously alien and familiar. This presentation/poster will showcase what we understand of this world and what future research might hold in store.
H13 Leprosy and psoriasis: a heated controversy
Authors: Sarfraz Rabia , Butt Eman
Published: June 2023

In the Old Testament, the term ‘Lepra’ was used to describe many skin diseases, including psoriasis, eczema, vitiligo, alopecia areata and boils. The word ‘leprosy’ was derived from this and was previously used as a generic term that included multiple inflammatory dermatological diseases. It was a disorder of great religious significance during ancient times, with intense stigmatization—‘lepers’ were pronounced unclean by priests. Hippocrates (460–377 Bc), the Greek ‘father of medicine’, can be credited with being the first to separate medicine from religious superstition. However, there was little differentiation between leprosy and psoriasis, two distinct diseases we know today. He used the word ‘psora’ to describe itch, and ‘lopoi’ to describe the dry and scaly features of skin conditions, thus continuing the confusion between leprosy and psoriasis. The failure to differentiate psoriasis as its own clinical entity from leprosy meant that for many centuries, patients with psoriasis also suffered the same cruel fate as those with leprosy in society. Those suffering from leprosy were wrongly believed to be highly contagious and were forced to carry a bell or clapper to announce their approach to those who were considered healthy. They were required to wear distinctive clothing so that they were easy to recognize by the public, and were not permitted to talk to or even touch a healthy person. They were outcast in society and could only mix with other ‘lepers’. In 1313, Philip the Fair of France horrifically ordered all those outcasts to be burned at the stake. In 1809, Robert Willan (1757–1812), an English doctor, marvellously developed a simple classification of skin diseases that offered a clear description of the different types of psoriasis. This was a crucial milestone in the recognition of psoriasis as a separate skin disease from leprosy. However, while he was the first person to describe psoriasis as a separate condition, he failed to eliminate leprosy completely as an associated disease. He used the term ‘lepra vulgaris’ to discuss modern psoriasis, which once again further perpetuated the confusion between psoriasis and leprosy. Ultimately, it was Ferdinand von Hebra (1816–1880), an Austrian physician, who permanently shed the term ‘lepra’ from the description of psoriasis in the 1800s, finally allowing the two diseases to be separate.
H17 Traditional medicine: a warts-and-all tale
Authors: Murphy Lisa , Tobin Anne-Marie
Published: June 2023

A viral wart is a common benign lesion caused by infection with human papillomavirus. They typically present in children; however, they are also often seen in adults, particularly in immunosuppressed patients. Modern treatments for viral warts include cryotherapy, cantharone, cautery and curettage, and topical chemotherapeutic agents. However, historically, a variety of methods were employed to treat viral warts: animal-based, plant-based, mineral-based and magicoreligious. These can be further categorized based on the principles of chance and transference (Barron C, Soverino T. Snails, water in a stone, and Holy Wells: an examination of wart cures from the Irish Schools’ Folklore Collection, 1937–38. Folklore 2020; 131:386–412). One popular method that combined both the principles of chance and transference involved finding a snail by chance and then rubbing it on the warts, and skewering the snail to kill it. The concept behind this method was that the warts would be transferred to the snails and then the warts would subsequently decay with them. Another animal-based cure involved stealing a piece of meat, usually bacon, and rubbing the meat into the wart before burying the meat. In terms of mineral-based cures, there were many popular methods. The most commonly encountered treatments included holy water, forge water (often from a blacksmith), water from a stone or ‘wart rocks’. People would also attend ‘wart wells’ and make offerings of stones. The use of water was the most widespread mineral-based cure. Plant-based cures were also prevalent, with the milk of a dandelion, the juice of a potato, rushes and straw being just a few examples. Plant-based cures were often combined with aspects of religion. One cure involved cutting a potato in two, and rubbing the cut part to the wart in the name of the Father, Son and Holy Spirit. The potato was then put away in an old wall; when it shrivelled up, it was believed the wart would disappear. There were also ritualistic methods. Certain healers could perform prayers, and it was believed that when a funeral would pass, one should lift clay three times from under the right foot and rub it on the warts. They would then need to throw it away after the funeral. As the corpse wasted away, the warts would decay, too. While the natural trajectory was that these warts would have self-resolved irrespective of the cures used, our ancestors were proactive and employed many different methods to treat this common ailment.
H19 The bronze diabetic
Authors: Mulholland Orlagh , McKenna Kevin
Published: June 2023

Many works of art throughout the centuries have not only garnered intrigue, but also debate among physicians relating to a possible medical diagnosis depicted by the artist. Representation of both anatomy and disease with the use of votive offerings and forms of grotesque art is well recognized. Such work was particularly prevalent in pieces produced during the Hellenistic Age and includes statuettes, anatomical replicas, coins and other art work. Diseases such as acromegaly, Gorlin syndrome, lymphoedema, neurofibromatosis and ophthalmic disorders, among others, have been represented in such pieces. It had been thought by the suppliants that in presenting these offerings to the Gods, particularly Asclepius, the Greek god of medicine and son of Apollo, they could be cured from their ailments. An example of an artistic piece representing an individual with disease is that of a small bronze statuette described as a ‘Statue of an Emaciated Man’ and housed at the Dumbarton Oaks Research Library and Collection, Washington DC. It is a small bronze statue measuring at just 11.5 × 5 × 8.3 cm, and is thought to date from around the first century Bc to the first century Ad. It depicts a gaunt young man sitting atop a bench with his left hand held limply and an apparently swollen right foot. It has been suggested that this individual could have suffered from lead poisoning. However, lead neuropathy is typically symmetrical and emaciation is uncommon. A more common source of lead poisoning in ancient times was wine drinking, as lead was used both as a sweetener and preservative. In addition, occupational exposure was common as lead was used widely in pottery, painting, lead smelting and glass ceramics. A disease that could explain the three features of emaciation, wrist drop and a swollen foot is diabetes mellitus. Diabetes had been recognized in Egyptian manuscripts dating back to 1500 Bc commenting on ‘honey urine’. Diabetes has been well documented during the Hellenistic Age with Apollonius of Memphis in 250 Bc being credited for coining the term ‘diabetes’. Insulin insufficiency can cause emaciation mainly through ketosis. The neuropathy of diabetes mellitus can affect single nerves, and a radial nerve palsy resulting in a wrist drop has been recognized. The appearance of an apparent swollen foot could be due to a Charcot joint, which is a result of repetitive microtrauma-induced complications of polyneuropathy. In conclusion, we believe this statuette represents features consistent with diabetes mellitus and is a ‘bronze diabetic’.
PA08 Do parents and carers of children with eczema understand topical steroid potency? Results of a patient survey
Authors: Moss Celia , Lambert Alice , Haider Zahra , Proctor Andrew
Published: June 2023

Dermatologists consider topical corticosteroids (TCS) to be the first-line active treatment for most inflammatory skin disorders, including eczema. Well-known adverse effects can usually be avoided by careful prescribing. However, widespread public antipathy to TCS, sometimes amounting to steroid avoidance and phobia, can impair patient care. This fear is largely independent of steroid potency, even though there can be up to a 100-fold difference between the mildest and the most potent products. National Institute for Health and Care Excellence guidelines refer to the World Health Organization’s four-level grading system (mild, moderate, potent and very potent), but information about potency is never found on TCS packaging and rarely in patient information leaflets (Haider Z, Proctor A, Moss C. Potency of topical steroids should be clearly labelled on all packaging. Br J Dermatol 2023; 188:427–8). We surveyed parents and carers to investigate their knowledge and understanding of steroid potency. A SurveyMonkey® questionnaire was promoted by the National Eczema Society on social media, and by Eczema Outreach Support in a newsletter to supporters in January 2023. Of 984 responses received, 25% were from parents or carers of children with eczema. Of these, 97% knew that TCS could have different strengths (potencies), but 44% did not know how many different grades there were, with only 20% correctly answering four. Despite this, 77% of respondents felt ‘somewhat confident’ or ‘very confident’ that they knew how strong their cream was, but of those who were ‘very confident’, 29% did not know how many potency grades there were. Follow-up questions revealed that of those who had used these specific TCS, 93% knew that hydrocortisone is mild, but only 48% correctly identified Fucidin H as mild. Only 54% correctly identified DermovateTM as very potent. When asked ‘Where would you look to find out how strong your steroid creams and ointments are?’ most (69%) answered ‘on the packaging’. Ninety-seven per cent were in favour of clear potency labelling on all steroid creams and ointments. Sixty-two respondents provided free-text comments that were analysed thematically: 51% expressed confusion about TCS or a need for more information; 18% complained that general practitioners were not sufficiently knowledgeable; 20% voiced concerns about TCS, some vehemently, and most citing ‘topical steroid withdrawal’; 11% were positive about TCS and the information provided, two of whom used the ‘Aron regimen’. Several responses indicated confusion between percentage concentration (stated on the tube) and potency. These findings confirm the clinical impressions that parents of children with eczema have limited understanding of potency and need clearer information on the tube and packaging.
PA22 Topical tacrolimus management of chronic recurrent skin reaction to mauve stinger jellyfish envenomation
Authors: West Cavan , Alessandrini Virginia , Gass Julia K
Published: June 2023

Chronic skin eruptions may follow the acute reaction to envenomation by some jellyfish, the incidence and management of which are not well described. We describe management with topical tacrolimus of a chronic eruption following envenomation by Pelagia noctiluca (‘mauve stinger’), one of the most common stinging jellyfish in the Mediterranean Sea. An 8-year-old girl was stung on the arm by a P. noctiluca in Menorca, Spain. First-aid measures with vinegar and topical antihistamine were administered, and the discomfort settled within 24 h. Five days later, the sting site became increasingly painful and itchy, with superficial ulceration and arm swelling. A second sting site on the lower leg reacted in a similar manner. She was systemically well. She was treated with oral co-amoxiclav, fusidic acid and betamethasone valerate 0.1% cream, and nonadhesive dressings. She initially responded well, but was required to continue the use of potent topical steroid after 3 weeks, as the symptoms recurred within 48 h of halted application. The use of topical tacrolimus cream 0.03% achieved symptom control when used in a slowly weaning regime over 3 months, with a brief flare of skin symptoms around the time of contracting COVID-19. She has now been asymptomatic for 12 months, and the sting site is a maturing scar. Envenomation reactions to jellyfish of the phylum Cnidaria (including P. noctiluca) are the result of varying pathophysiological mechanisms. The tentacles and bell of P. noctiluca carry toxin-releasing epithelial organelles called nematocysts. When triggered, the stinging apparatus fires, injecting thousands of mineralized spine-covered tubules and toxins such as porins [Yanagihara AA, Wilcox C, Smith J, Surrett GW. Cubozoan envenomations: clinical features, pathophysiology and management. In: The Cnidaria, Past, Present and Future (Goffredo S, Dubinsky Z, eds). Cham: Springer, 2016; 637–52]. Acute tissue damage and inflammation are caused by physical trauma and venom effects. Vinegar used at the time of a sting may permanently prevent discharge from unfired and noninjected nematocysts. Hot-water immersion for 30 min inactivates venom, and topical steroids reduce inflammation. The delayed and prolonged skin response (presenting after the primary reaction to envenomation), as in our case, is likely to be an immunological response to the retained, embedded nematocyst structures and may include granulomatous reactions, and eventually scarring. Optimal acute first-aid measures (as above) are thought to reduce incidence of late skin sequelae. This report highlights the successful use of topical tacrolimus immunomodulation for an established delayed reaction.
PA24 Abnormal interferon signature in a patient with chilblain lupus
Authors: Oldham Jaimie , O’Toole Edel
Published: June 2023

A 5-year-old girl of Sri Lankan ancestry with no history of parental relatedness presented with the clinical features of chilblain lupus. This was particularly florid over her dorsal fingers, toes and the soles of her feet with areas in keeping with panniculitis on her calves and an epidermal naevus on the right side of her trunk. There was no ulceration or necrosis. Her parent reported occasional fevers and palpable lymph nodes in her neck. She also has bilateral astigmatism and mild valvular and supravalvular pulmonary stenosis. Blood tests showed a persisting mild transaminitis, an antinuclear antibody of 1 in 160 and a negative double-stranded DNA. She had a skin biopsy that showed supporting features for chilblain lupus. A lymph node biopsy showed nonspecific changes. The clinical suspicion was of a mild form of Aicardi–Goutières syndrome (AGS), and a genetic panel was performed that included TREX1, RNASEH2B, TMEM173 and SAMHD1 (all negative). The common mechanism behind these conditions is a type I interferonopathy. We sent blood on a research basis for RNA extraction and testing of her interferon (IFN) gene signature (IGS), which came back as abnormal (11.895; cutoff score of 2.758); she had normal expression of neutrophil-associated genes. This IFN score is on par with patients who have confirmed AGS or STING-associated vasculopathy with onset in infancy. An IGS is derived from the expression of IFN-regulated genes. A raised IGS has not only been reported to be useful as a biomarker in many rheumatic diseases, but is also used to help identify type I interferonopathies where genetic testing has not identified any clear pathogenic mutations (Crow YJ, Stetson DB. The type I interferonopathies: 10 years on. Nat Rev Immunol 2022; 22:471–83). National Institute for Health and Care Excellence guidelines allow for treatment of interferonopathies with baricitinib in patients with two documented high IFN gene signatures, which is our current plan for this patient.
PD07 Sun exposure and associated risks in 17 countries: UK results
Authors: Passeron Thierry , Dreno Brigitte , Puig Susana , Goh Chee L , Lim Henri W , Ly Fatimata , Kang Hee Y , Morita Akimichi , Ocampo Candiani Jorge , Schalka Sergio , Wei Liu , Le Floc’h Caroline , Kerob Delphine , Krutmann Jean
Published: June 2023

Primary and secondary prevention of skin cancer varies considerably from one country to another. This survey investigates knowledge and behaviours regarding sun exposure in the UK. This UK survey (n = 1000) was conducted online from 28 September to 18 October 2021 and was part of a worldwide survey (n = 17 001) conducted in 17 countries (five continents). Automated selection from the Ipsos online panel ensured samples of 1000 individuals in each country fit the quotas method based on sex, age, employment status and country regions. Data covered demographics, phototype, exposure habits and practices, and knowledge and understanding of risks. The population comprised 49% men [mean (SD) age 46.6 (15.7) years]; 61% were of skin phototypes I–II. Seventy-six per cent of Britons stated that a tanned skin looks attractive vs. 72% worldwide. Seventy per cent of Britons indicated that a tan gives a healthy look, a different perception compared with worldwide (64%). Most Britons were aware of sun-related skin health issues, a better awareness compared with worldwide (94% vs. 88%). Sixty-one per cent did know that sun protection is useful when the weather is overcast, a similar knowledge as worldwide (61%). Furthermore, 15% indicated it was safe to expose themselves without protection when already tanned, a better knowledge than worldwide (23%). In terms of photoprotection, 15% said they protected themselves from the sun all year round, a lower score compared with worldwide (23%). In detail, Britons were more likely to put sunscreen on their face (71% vs. 60%), on their hands, neck and ears (64% vs. 52%), and on the arms, legs and chest (69% vs. 55%) compared with the global population. However, Britons were less likely to try to stay in the shade (73% vs. 77% worldwide) or avoid midday sun exposure (53% vs. 66%). Of those who applied sunscreen, 69% applied it only once or twice a day – a slightly better practice compared with the worldwide average (74%). In terms of knowledge, 71% did not understand the difference between ultraviolet (UV)A and UVB vs. 70% worldwide. Although the risks of sun exposure are widely recognized, sun protection practice is inadequate. This survey provides insight into the need for additional photoprotection education in the UK.