bluuebunny/crossref_metadata_2025 huggingface dataset:
153 Performance testing of cordless handheld vacuum cleaners
Authors: Li Hui-Jing , Lin Jason , Huang Sheng-Hsiu , Lin Chih-Wei , Chen Chih-Chieh
Published: June 2024

The cordless handheld vacuum cleaners market is expanding rapidly and is expected to reach $10 billion by 2027, raising concerns about indoor air quality. Despite growing demand, there is limited research into the aerosol emissions from these devices and their impact on respiratory health, which is a current concern for everyone. Our study aimed to investigate particulate matter (PM) emissions from these vacuum cleaners and identify the key factors contributing to such emissions. Two custom-built devices were designed to quantify upstream and downstream PM concentrations and suction pressure with and without filter cartridge and motor exhaust. We tested six popular cordless vacuum cleaner models under different conditions and found that filter cartridge sealing, motor design, and dust load can affect PM emissions. In contrast to previous research, brushless motors (manufacturer claims) do not necessarily emit fewer particles than brushed motors. We also found that some filter cartridges are not airtight and will cause PM concentration to rise significantly, especially under heavy load conditions. While leaking cartridges result in higher suction and clean air delivery rates, we still recommend regulating airtight filter cartridges due to elevated PM emissions. Our findings also suggest the need for regulations controlling motor assembly and design standards, not just motor type. For immediate mitigation, users should ventilate areas and use respiratory protection. Our work is a foundation for understanding the health risks of vacuum cleaner aerosol emissions and informs consumer choices and potential regulatory measures.
163 Validations of the sampling and analysis techniques for the co-existing airborne chemicals in occupational settings
Authors: Yu Ya-Lun , Tsai Shih-Wei
Published: June 2024

Nowadays, more harmful volatile organic compounds are found in the workplace and exposed to them has many adverse health effects. Various occupational exposure limits are available to protect workers’ health for toxic substances. Nevertheless, air sampling and analysis methods have also been developed to detect harmful substances. Regarding health risk assessment, compared with only knowing the concentrations of fewer substances, it’ll be more beneficial if we can detect multiple compounds simultaneously. Therefore, there’s a need to develop more comprehensive and convenient way to sample and analyze air samples. In this study, we established the qualitative and quantitative conditions of co-existing airborne chemicals through taking air samples by gas bags, followed by SPME extraction, solvent-free technique, and GC/MS analysis. The findings from validation procedure showed it provides convenient and sensitive method to determine various chemicals in workplace’s air concurrently.

To prepare known concentrations standard vapors, we used zero-air system and air sampling bags with the VOCs standard containing 54 different substances. Moreover, we used the micro-injection needle to inject 0.16mL liquid, which was 200μg/mL, into the bags, followed by vaporizing to produce vapor with the concentration of each VOC of about 1ppm. Carboxen-PDMS SPME fiber was selected in this study then adsorbed and extracted for 40 minutes.

The results showed 49 different VOCs can be identified, including benzene, toluene, ethylbenzene, o,p,m-xylene, etc. Besides, linear ranges and sample stabilities were also validated. Furthermore, the established method was applied to determine the airborne chemicals in hairdressing and nail salons.
175 The characteristic of aerosol emission from motors
Authors: Hsu Chao-chun , Chen Chih-chieh , Huang Sheng-Hsiu , Lin Chih-wei
Published: June 2024

A motor plays a crucial role in household appliances, such as fans, hair driers, cleaning robots and electric shavers. However, varies studies have showed that the motors inside the household appliances, such as vacuum cleaners and toy cars, generate the ultrafine particle, which have been proven to be harmful to human health. So, we will test the particle number concentration and particle size, and know about the main mechanisms by which motors generate particles. Ultimately, find an effective way to control motor-generated particles

We establish an experimental chamber with a volume of 2 liters. Test motor would be placed inside the chamber, and the chamber were supplied with particle free air to bring out the particles. We use a Condensation Particle Counter and a Scanning Mobility Particle Sizer to monitor the particulate concentration and particle size range over time. A brushed DC motor and a brushless DC motor with a rated output power of 64 W commonly used indoors, will be utilized for testing.

The results of mechanism experience indicate that both the brushes and the bearings generate particles through mechanical friction, and the particles generated through spark discharge are 100 times more numerous than those generated through mechanical friction. This suggests that spark discharge is the main mechanism for particle generation by the motor. At a rotational speed of approximately 10,000 RPM, the particle emission rate reaches as high as 3.4 x 107 #/sec.However, at 10,000 RPM, the particle emission rate of the brushless DC motor is only 2.2 x104 #/sec, about one-thousandth that of the brushed DC motor.
271 Distribution of Korean safety and health professionals from the perspective of gender equality
Authors: Park Jeongim , Choi Sohyeon , Sung Yeji , Chung Jinjoo , Choi Sangjun
Published: June 2024

Background

Gender equality in the workplace remains a challenge. This study aimed to investigate the gender gap of human resources in the field of occupational safety and health (OSH) in Korea.

Methods

Several national statistical data that can confirm the gender distribution of personnel in the OSH sector were reviewed. The gender distribution of industrial technical manpower statistics, professional certificate holders in the OSH field, and the status of the appointment of safety and health managers by industry was analyzed.

Results

The distribution of professionals in the OSH sector in Korea had a large gender gap with a small number of women. In particular, the proportion of women in the safety field was lower than that in the health field. In the younger age group, while the proportion of women is increasing, the gender gap tends to decrease.

Conclusions

Few data are available to understand the gender-related aspects of OSH professions. Nevertheless, our results provide basic information for initiating a discussion on the necessity of establishing gender-sensitive culture and policies in the OSH sector.
312 Diesel engine exhaust emissions occupational exposure in a mine per exposure group
Authors: Tully Claire
Published: June 2024

This survey was undertaken to evaluate exposure to diesel engine exhaust emissions (DEEE) measured as elemental carbon in Boliden Tara Mines underground employees working with mobile equipment during their working shift.

In this poster, 44 personnel samples were taken in the underground mine from personnel carrying out a number of tasks from Production, Development, Mine Services, Mechanical Maintenance and Electrical services during normal working activities primarily where diesel propelled mobile equipment was part of the task or job. Particulate samples were analysed for elemental carbon, organic carbon and total carbon using the NIOSH 5040 method. Gas meters readings were taken for nitrogen dioxide using the onsite instrumentation and docking and calibration station. The poster will detail the exposure per occupational exposure group. Survey was taken in March 2021.
60 Modular Exposure Models for OSH Risk Assessment in Chemical Safety – MEMORA
Authors: Schlüter Urs , Meyer Jessica , Dumke Carolin , Papagna Raffaella
Published: June 2024

Introduction

European chemicals legislation aims to provide the best possible protection for workers when handling chemicals. The regulation of substances, mixtures and products is based on reliable risk assessments. This includes assessing workplace exposure to chemicals, which requires information on, e.g., the route of exposure (dermal/inhalation) and the level and duration of exposure.

Methodology

Exposure assessment requires the use of models, as workplace exposure data are often not available. The practical application of models as well as validation and comparative studies in recent years have led to the conclusion that further development of models is necessary. Key factors include a more user-friendly, transparent design of the tools and the addition of a dermal exposure module. Experiences from other BAuA projects (e.g., ETEAM and SysDEA) provide important insights for model-improvement. The MEMORA-project aims to develop a user-friendly toolbox covering both inhalation and dermal exposure assessment. Existing BAuA tools are examined and improved based on scientific findings, additional models will be included and a systematic tiered approach will be developed.

Results/Conclusion

During the workshop, 4 speakers will present the ongoing developments of different projects within the MEMORA-project-bundle. The aim is to develop solutions to questions that have arisen during the projects. Therefore, the presenters are interested in feedback from the participants to allow for possible adjustments to the chosen approaches. The workshop is intended to support the development of the toolbox in order to tailor it as much as possible to the needs of its users (practitioners, regulators, academics, etc.).
158 Embracing climate change and an evolving world! Discover global OEHS perspectives in a world cafe conversation
Authors: Alban Ashton , Hiddinga Andrea , Farid Marina Zainal , Laszcz-Davis Chris , Marín David Rodríguez , Anya Ifeyinwa (Okafor)
Published: June 2024

Exacerbating novel and known occupational hazards, climate change is threatening the occupational setting and OEHS professionals are being forced to adapt to the quickly changing world. Faced with the question of how to minimize workers exposure to the hazards, many professionals are left wondering if there are others facing similar issues to collaborate with. In this workshop, OEHS professionals from around the world will participate in a world cafe by rotating through 5 tabletop conversations exploring the most pressing challenges addressing climate change exacerbated hazards in the occupational setting. Each table will be representative of a different region of the world and facilitated by an OEHS professional from that region. Facilitators will share their experiences and encourage others to share their experiences and ideas in addressing the hazards. Dialogue will promote collaboration, knowledge sharing that will leave participants with a network of support and new ideas to enact in their workplace. The concerns and ideas taken from the conversation will be used to develop a summary presenting the discussed major occupational hazards exacerbated by climate change and ideas to address occupational hygiene and worker health protection through the minimization of worker exposure to those discussed hazardous agents.
57 Occupational hygiene leadership skills: communicating effectively, emotional intelligence, and managing conflict
Authors: Erdman Joy , Booth Celia
Published: June 2024

Did you know that research conducted by Harvard University, the Carnegie Foundation and Stanford Research Center found that 85 percent of workplace success is attributed to people skills (also called soft skills), and only 15 percent of job success comes from technical (hard) skills? (Ref: https://stlpolished.com/eight-essential-soft-skills-for-career-success/). This professional development course (PDC) will help you hone your leadership people skills, with special emphasis on communicating effectively, emotional intelligence, and managing conflict.

Using a combination of lecture and group discussion, attendees will get the opportunity to compare good and bad leadership people skills, help each other solve work issues and develop a leadership people skills action plan.

If attendees desire, they will be allowed to submit one or more problems/questions prior to the course, but this will not be required. Input will be sanitized for confidentiality, as appropriate.

While we will be focusing on 3 people skills --Communicating Effectively, Managing Conflict, and Emotional Intelligence -- attendees will find that other skills, such as problem solving, managing teams, time management, adaptability, creativity, working well under pressure, etc., will be woven into the course.
135 Occupational hygiene practice ethics - “an ounce of prevention is worth a pound of cure”
Authors: McClellan Nancy
Published: June 2024

The OH profession typically attracts rather altruistic, well-intentioned scientists concerned with worker health and safety. More often than not OH professionals find themselves in the midst of ethical dilemmas simply because they lack the knowledge and tools to recognize potential dilemmas early in the process and/or struggle to methodically work through a dilemma to find an appropriate solution. This session will provide the practical knowledge and methodology for navigating our sometimes challenging profession. This course has a long history of very high ratings at past OH professional meetings because it is highly interactive, thought provoking, and fun.
141 Start with the end in mind: How to give compelling presentations!
Authors: Apthorpe Linda
Published: June 2024

As Occupational Hygienists we know that communication is an integral component of the work we do. In many circumstances, we only have limited opportunities to get our message across to implement change or to make important information stick. In these cases, your message delivery counts, and effective communication is essential.

You may need to deliver your message by standing in front of worker groups, OHS committees, management representatives or even delegates at an occupational hygiene conference!

This professional development workshop will help you to communicate your story and build your confidence in presenting. We’ll explore how to plan, design and prepare your presentation, and to engage your audience to get your message across.

There will information on presenter techniques, and plenty of tips and tricks including how to make an impact, how to improve your presentation and communication skills, how to build confidence and how to feel comfortable in presenting.

This workshop is for anyone who wants to improve their presentation preparation and skills to give compelling presentations.
281 Managing exposure to nanoparticles: Understanding the risk
Authors: Chouvet Martine
Published: June 2024

This session will outline the basic principles of nanoparticles. What is a nanoparticle? Learn the definitions and different vocabulary used in regulatory texts. How do they form? Naturally or manufactured, nanoparticles generation is either intentional or non-intentional and thus, difficult to spot. Where do we find them? Which industries are of concern? A lot of industries now are using nanomaterials intentionally for their physical and chemical properties, discover which ones and how you can get exposed to them within your processes. This CES will end with some insights on what are the health effects, biological interactions with the body and already known risks that has justified some legislations to put in place OELs for dedicated nanomaterials.
O04 How useful is chest X-ray in addition to routine QuantiFERON® in the detection of latent tuberculosis prior to biologics?
Authors: Kearney Niamh , Aslam Fawad , Boyd Grace , Boylan Natasha , Laverty Emma , O’Hare Rosie , Campbell Victoria , Hoey Susannah , O’Kane Donal
Published: June 2024

The British Association of Dermatologists (BAD) 2020 psoriasis biologics guidelines recommend routine screening for latent tuberculosis infection (LTBI) prior to treatment, using a QuantiFERON®/interferon-gamma-releasing assay (IGRA), with consideration of local policy on additional screening using chest X-ray (CXR). QuantiFERON® is highly sensitive (approximately 96%) in detecting LTBI, while CXR is both poorly sensitive and poorly specific. CXR is included as a baseline test on the BAD biologics 2014 checklist followed in our trusts. Northern Ireland has the lowest annual incidence of tuberculosis in the UK. The aim of this study was to assess the utility of routine CXR in addition to IGRA before commencing biologics. Patients in two of the five trusts in Northern Ireland receiving biologics that require LTBI screening were identified using trust dermatology biologics databases. Electronic records were reviewed, collecting information on demographics, CXR and IGRA results, and respiratory clinic outcomes. We identified 995 patients, 528 male (53.1%) and 467 female (46.9%), with a mean age of 49.2 years. In total, 685 patients had an IGRA, with 16 of 685 positive (2.3%) and 4 of 685 indeterminate (0.6%). In the four patients with an indeterminate result, just one had a subsequent positive IGRA (0.1%). Overall, 949 patients had a CXR, with 83 of 949 (8.7%) noted to have any abnormality. Twenty-six patients (2.7%) required follow-up imaging, including CXRs (n = 13), computed tomography (n = 10) and echocardiograms (n = 3). Just eight patients had features suggestive of TB on CXR (0.8%). When the χ2-test was used, patients were just as likely to have an abnormal CXR if they had a positive (1 of 16, 6%) or negative IGRA (59 of 666, 8.9%; P = 0.93). Twenty-three patients were referred to the respiratory clinic with a positive IGRA or CXR (2.3%), with 20 patients treated for LTBI (2.0%). Three patients were treated on the basis of a CXR result (0.3%), including two patients without an IGRA and one patient with a negative IGRA. Tuberculosis is uncommon in our dermatology population in Northern Ireland, with just 2% of patients in two trusts treated for LTBI prior to commencing a biologic. QuantiFERON® is a highly sensitive test, detecting LTBI in 1.7% of 665 patients tested in this study. CXR, in contrast, identified changes suggestive of LTBI in 0.8%, with 8.3% noted to have another incidental finding, resulting in a burden of additional imaging requirements. Routine CXR in this cohort did not provide additional diagnostic value in the detection of LTBI. QuantiFERON® alone could be considered sufficient for screening.
O06 Abatacept efficacy in severe refractory morphoea: experience from a specialized centre
Authors: Watts Sophia , Gardette Emma , Orteu Catherine
Published: June 2024

Our aim was to evaluate the efficacy and safety of abatacept in the treatment of severe refractory morphoea. We conducted a single-centre prospective cohort study at a national specialized scleroderma centre treating adult patients with morphoea. The patients included had severe disabling generalized plaque, pansclerotic or linear morphoea. Abatacept was started after failure of at least two standard systemic immune-modifying therapies (SIMTs), including intravenous and/or oral corticosteroids and methotrexate (MTX), mycophenolate mofetil (MMF), ciclosporin and hydroxychloroquine. Patients on abatacept were assessed at baseline and 6 and 12 months, employing validated scores: the Localized Scleroderma Cutaneous Assessment Tool (particularly the modified Localized Scleroderma Skin Severity Index, mLoSSI) to assess disease activity, and Dermatology Life Quality Index (DLQI) and Hospital Anxiety and Depression Scale (HADS) to assess disease impact. In total 30 patients, all female, with a median age of 57 years (range 22–84) are currently receiving abatacept: 18 patients for ≥ 6 months and 16 for ≥ 12 months. Of these, 57% have pansclerotic morphoea. Patients had not responded to oral and/or intravenous corticosteroids in all cases, and an average of 2.4 other SIMTs, most frequently MTX (93%) and MMF (70%). At abatacept initiation, 47% of patients continued on oral prednisolone, and 13% received intravenous pulsed prednisolone. Most patients (29 of 30) continued a maintenance SIMT, 23% of patients received concomitant MMF, 37% received MTX and 20% received both MTX and MMF. At 6 months, 15 of 18 patients had available data and the median improvement in mLoSSI was 37.7%; at 12 months, all patients had available data and the median improvement was 49.1%. The mean DLQI was 17.4 at baseline, 15.1 at 6 months and 12.4 at 12 months. The mean HADS anxiety score was 10.1 at baseline, 9.3 at 6 months and 8.2 at 12 months; the mean depression score was 9.6 at baseline, 9.3 at 6 months and 10 at 12 months. Three patients (10%) discontinued abatacept: two due to early side-effects in the first 3 months and one due to plateauing of response in very severe disease. There were no serious adverse events. Abatacept appears to be an effective and safe option for severe refractory morphoea. The high DLQI and HADS scores reflect the significant psychosocial impact of the disease and tend to remain high despite significant clinical improvement. A 2-year follow-up is now needed as the disease is slow to reverse and continuing improvement was observed at 1 year.
O07 Clinical and mycological profile of dermatophyte infections in England
Authors: Phan Khanh Linh , Chandler David
Published: June 2024

The aim of this study was to provide an update on the epidemiology and causative agents of dermatophyte infections in England. We analysed all samples of skin, hair and nail (n = 34 624) that underwent mycological examination (microscopy and culture) in a single diagnostic microbiology laboratory in South East England over a period of 17 years (2006–2023). Fungal culture was positive for 22.0% (n = 7601) of samples. Dermatophytes accounted for 89.4% (n = 6793) of these, and nondermatophyte moulds were isolated in 4.8% (n = 366). The dermatophyte most commonly isolated was Trichophyton in 99.3% (n = 6744), followed by Microsporum in 0.5% (n = 37) and Epidermophyton in 0.2% (n = 12). Within the Trichophyton group, 99.4% (n = 6703) were pure Trichophyton isolates, while 0.6% (n = 41) displayed a mixed growth of dermatophyte and nondermatophyte moulds. Onychomycosis of the toenails was the most common infection (n = 2472), predominantly affecting women, with a mean age of 48.3 years. Trichophyton rubrum was isolated in 82.7% of cases, with positive micro­scopy (fungal hyphae observed) in 44.5%. Onychomycosis of the fingers, while less frequent (n = 427), exhibited a similar demographic profile, affecting mostly women, with a mean age of 53.7 years. Other dermatophyte infections included tinea pedis (n = 400), tinea corporis (n = 204), ­tinea cruris (n = 90), tinea manuum (n = 58) and tinea faciei (n = 14). Trichophyton rubrum was the ­commonest cause of ­dermatophyte infection across all body sites, except for tinea capitis (n = 82), where Trichophyton mentagrophytes (30.5%), Trichophyton violaceum (19.5%) and Trichophyton tonsurans (15.9%) were the most common causative agents. Non-anthropophilic species (n = 158) caused infection across all body sites, although most commonly this manifested as tinea capitis (25.3%, n = 40) or tinea corporis (20.3% n = 32). Notably, these infections were found to occur in a younger age group, with 27.8% of cases in individuals < 10 years old, and were more common in female patients. Trichophyton mentagrophytes, a zoophilic dermatophyte, was the most prevalent non-anthropophilic species in this study. Over the 17-year period (2006–2023), T. ­mentagrophytes, Microsporum canis and T. tonsurans showed significant declines in prevalence of 95%, 90% and 86%, respectively. Conversely, T. rubrum, constituting 75% of all dermatophytes isolated in 2006, demonstrated a substantial increase, reaching a prevalence of 95% in 2023. There were no cases of Trichophyton indotineae. This study provides an overview of recent epidemiological trends in dermatophyte infections in England. Trichophyton rubrum is increasingly the commonest cause of dermatophytosis, and the nails are the most common site of infection. Infection with non-anthropophilic species is rare and has a distinct demographic profile. Awareness of local trends in the clinical and mycological profiles of dermatophyte infections is important to guide the management of individual cases and inform public health interventions.
O13 42 590 fewer skin tumours diagnosed in England during the 2020 COVID pandemic: greatest reductions in melanoma in situ, stage I melanomas and basal cell carcinomas
Authors: Srimudkul Omsin , Venables Zoe C , Levell Nick J , Mistry Khaylen , Van Bodegraven Birgitta
Published: June 2024

During the early COVID-19 pandemic, there was a decline in most cancer diagnoses. The aim of this study was to ascertain the extent and impact of this on skin cancer subtypes in England. This national retrospective cohort study identified all skin tumour cases diagnosed in 2019 and 2020 in England from the National Disease Registration Service ‘Get Data Out’ project. Incidence rate ratios (IRRs) with 95% confidence intervals (CIs) and Poisson regression analysis were used to compare crude incidence rates (CIR) per 100 000 person-years (PY) in 2020 vs. 2019. In 2019, there were 233 717 skin tumours registered in England; this reduced to 191 127 (IRR 0.81, 95% CI 0.80–0.81, P < 0.001) in 2020. A year prior to the pandemic, there were 15 355 (CIR 27.3 PY) melanomas, 7135 (CIR 12.7 PY) melanomas in situ, 48 112 (CIR 85.5 PY) cutaneous squamous cell carcinomas (cSCCs), 159 178 (CIR 283 PY) basal cell carcinomas (BCCs) and 363 (CIR 0.65 PY) Merkel cell carcinomas (MCCs). When comparing incidence rates for 2020 vs. 2019, significant reductions (P < 0.001) were seen in all tumours except MCC: melanoma (IRR 0.81, 95% CI 0.79–0.83), melanoma in situ (IRR 0.65, 95% CI 0.63–0.68), cSCC (IRR 0.94, 95% CI 0.93–0.96), BCC (IRR 0.78, 95% CI 0.78–0.79) and MCC (IRR 0.93, 95% CI 0.80–1.08). For melanoma by stage, there were 8940 (CIR 22.6 PY) stage I, 2441 (CIR 6.18 PY) stage II, 1004 (CIR 2.54 PY) stage III, 385 (CIR 0.97 PY) stage IV and 2187 (CIR 5.53 PY) stage ‘unknown’ in 2019. The IRR for 2020 vs. 2019 showed significant reductions (P < 0.001) for stage I (IRR 0.76, 95% CI 0.73–0.78) and stage ‘unknown’ melanomas (IRR 0.67, 95% CI 0.62–0.71), while changes were not significant for all other stages. During the 2020 COVID pandemic, there was a 19% reduction in diagnosed skin tumours in England. There was a differential impact between tumour types and stages, with the greatest reduction seen in melanoma in situ (−35%), stage I melanoma (−24%) and BCC (−22%), compared with MCC (−7%), cSCC (−6%) and stage II+ melanoma (+2%). The improvement to staging data in 2020 (−33% ‘unknown’ stage melanomas) limits interpretation, but these account for < 15% of cases of melanoma. It is hypothesized that symptomatic and slow-growing tumours were not prioritized by patients and/or clinicians, potentially resulting in worse patient outcomes and increased burden on health services. This indicates a need for more time to study the impact of delayed diagnosis on survival, better public education on skin cancer recognition, and improved service provision during national emergencies.
Clinicopathological CasesCPC01 An unexpected infection in dermatology outpatients: cutaneous diphtheria
Authors: Wells Helena , Hague Joanne , Roberts Claudia
Published: June 2024

A 29-year-old asylum seeker presented to the emergency department with abdominal pain and a 1-month history of bilateral crusted plaques on his shins, associated with night sweats and lethargy. On examination he had multiple crusty erythematous plaques on the lower limbs, with some scattered pustules. Full-body examination was otherwise normal, except for multiple palpable inguinal lymph nodes bilaterally. Investigations revealed normal bloods and also included chest X-ray, urinalysis and computed tomography of the urinary tract. A dermatology referral was made, and differentials included ecthyma, atypical mycobacterial infection, fungal infection, or an iatrogenic cause with secondary infection. The patient was planned for multiple punch biopsies to be sent for haematoxylin and eosin staining, and tissue and mycobacterial culture. Unfortunately, a skin swab was rejected. A punch biopsy sent for culture surprisingly demonstrated the growth of a Gram-positive rod, identified as Corynebacterium ­diphtheriae, which was toxin gene positive. Histology showed a vesicopustule within the stratum corneum and upper epidermis containing neutrophils. The patient was diagnosed with cutaneous diphtheria. Cutaneous diphtheria is the most common nonrespiratory manifestation of the disease and can occur as a primary infection or in a pre-existing wound (Rahim NRA, Koehler AP, Shaw DD, Graham CR. Toxigenic cutaneous diphtheria in a returned traveller. Commun Dis Intell Q Rep 2014; 38: E298–300). It presents with shallow rolled-edged ulcers with a grey membrane at any skin site, including the genitals. It is reported that diphtheria is most contagious in its cutaneous form, where ulcers act as a reservoir for infection, which can be spread via wound manipulation (de Benoist A, White JM, Efstratiou A et al. Imported cutaneous diphtheria, United Kingdom. Emerg Infect Dis 2004; 10: 511–13). Prior vaccination does not prevent infection but stops systemic symptoms. Although rare, cases of cutaneous diphtheria are increasing in the UK, especially in asylum seekers. This case was identified by the dermatology department, which can be the location of first presentation. Lesions are clinically indistinguishable from other cutaneous infections, and so diphtheria must be considered as a differential in high-risk individuals. Vaccination does not prevent infection, but merely reduces the severity of the disease course. This can have important implications for staff safety if not recognized early, as in our case multiple exposed members of staff were required to isolate, take prophylactic antibiotics and receive a booster vaccination following exposure.
CPC09 Two cases of late-onset dystrophic epidermolysis bullosa COL7A1 mutations
Authors: O’Higgins Lisa , Hynes Jason , Grechin Cristina , Hudson Andrew , Roche Muireann , O’Kane Marina
Published: June 2024

Epidermolysis bullosa pruriginosa (EBP) is a highly distinctive phenotype of dystrophic EB (DEB). It is characterized by pruritic hypertrophic papules, nodules and plaques usually on the lower extremities. Clinical findings are caused by mutations in the COL7A1 gene on chromosome 3p21.3, which encodes type VII collagen. It is a rare condition that was first described in the literature in 1994 in a series of eight cases (McGrath JA, Schofield OM, Eady RA. Epidermolysis bullosa pruriginosa: dystrophic epidermolysis bullosa with distinctive clinicopathological features. Br J Dermatol 1994; 130: 617–25). The condition usually presents in the neonatal period, during adolescence or early adulthood. There are < 100 documented cases to date (Kim WB, Alavi A, Pope E, Walsh S. Epidermolysis bullosa pruriginosa: case series and review of the literature. Int J Low Extrem Wounds 2015; 14: 196–9). Here, we present two cases of late-onset EBP. Case 1 is a 72-year-old woman with a 20-year history of a recalcitrant, pruritic violaceous eruption on her lower legs. Findings on biopsy were nonspecific, showing hyperkeratosis, mild epidermal spongiosis with a subepidermal split devoid of inflammatory cells. There was vascular proliferation in the superficial dermis and surrounding perivascular inflammation with an inflammatory infiltrate comprising lymphocytes, histiocytes and plasma cells. Differential diagnosis included venous stasis or DEB. Genetic sequencing was performed, revealing heterozygosity for a COL7A1 c.6007Gly>Arg mutation, confirming a diagnosis of autosomal dominant EBP. Case 2 is a 60-year-old woman who presented with pruritic coalescing nodules and papules. These had appeared initially on the buttocks and occipital scalp and subsequently developed on her wrists, elbows and lower legs. Hyperkeratotic toenails and a pincer nail on her left thumb were noted. A biopsy taken from her right thigh showed hyperkeratosis with acanthosis, and sub­epidermal cleavage containing mixed inflammatory cells. Genetic sequencing confirmed the heterozygous mutation IVS107–2delA in the COL7A1 gene, consistent with a variant of dystrophic EB highly suggestive of EBP. Both patients’ symptoms responded to dapsone. To our knowledge these mutations have not been reported elsewhere in the context of EBP. We highlight the potential for late onset of this rare condition, novel genetic mutations, and the role of genetic testing in situations of clinical uncertainty.
CPC13 BRAF mutated and morphologically Spitz naevi and tumours: a series of four cases
Authors: Daruish Maged , Goodyear Helen , Lemahieu Julie , Taibjee Saleem
Published: June 2024

The current World Health Organization classification of skin tumours (5th edition) indicates that melanocytic tumours of the Spitz pathway can be defined by mutually exclusive oncogenic drivers, including HRAS-activating mutations or kinase fusions. Accordingly, the term ‘spitzoid’ has been suggested for tumours that show morphological features of Spitz tumours but lack these defining molecular aberrations. Such neoplasms harbouring BRAF or NRAS mutations include a subtype of melanomas with confirmed risk of local recurrence and metastasis. In contrast, a recent study described a subset of Spitz-looking neoplasms with BRAF mutations and insufficient criteria for melanoma (Zhao J, Benton S, Zhang B et al. Benign and intermediate-grade melanocytic tumours with BRAF mutations and Spitzoid morphology. Am J Surg Pathol 2022; 46: 476–85). The term BRAF mutated and morphologically spitzoid naevi/tumours (BAMS) was proposed for such lesions. We present a series of four cases of BAMS. The patients ranged in age from 3 to 40 years; three were male and one was female. The clinical history varied from new growing moles to change within long-standing lesions, congenital in one instance. One lesion was submitted with the query of halo naevus. Anatomical sites included the abdomen, pubis, right buttock and left upper back. In one of our cases the clinical appearance, including starburst pattern on dermoscopy, was very suggestive of a pigmented Spitz naevus. All cases showed a predominantly epithelioid cytomorphology with accompanying melanophages. The cytoplasmic pigment was prominent in three cases. Three of the neoplasms were compound, with evidence of maturation with depth. The case described clinically as a changing congenital lesion had a mild degree of cytological atypia, a single superficial mitosis and focal PReferentially expressed Antigen in MElanoma positivity. In this case there was bridging of nests and lamellar fibroplasia, indicating overlapping features with Clark dysplastic naevus. Three cases had Kamino bodies. Immunostaining for BRAF V600E was positive in all cases. Overall, the histological findings in our cohort are in concordance with those reported by Zhao et al. Interestingly, BRAF mutations were also identified in another study of ‘Spitz naevi’, likely representing BAMS (Fullen DR, Poynter JN, Lowe L et al. BRAF and NRAS mutations in spitzoid melanocytic lesions. Mod Pathol 2006; 19: 1324–32). Further studies are necessary to characterize the BAMS group, including long-term follow-up. Recognition of this group of tumours is important to avoid melanoma overdiagnosis in the advent of ancillary immunohistochemistry and molecular testing in determining melanocytic lineage in day-to-day practice.
P004 Morphoea in a patient with clear cell renal cancer and lung metastases
Authors: Palaiologos George , Mavrogiorgos Anastasios
Published: June 2024

Morphoea (localized scleroderma) is an autoimmune fibrotic skin disease with an estimated prevalence of 200 per 100 000. Although the pathogenesis remains unknown, the disease is characterized by an initial T-cell-mediated inflammatory phase followed by localized fibrosis of the skin. Most cases of morphoea in patients with cancer occur after radiation therapy (65%), chemotherapy (8.5%) or immunotherapy–immune checkpoint inhibitor (ICI) therapy (5.7%). In two-thirds of cases of morphoea in patients with cancer, the mean time to onset of morphoea is 3.2 years after radiation, 1.7 years after chemotherapy, and 8 months (rapid manifestation of morphoea) after ICI immunotherapy. We present the case of a 65-year-old male patient with a history of clear cell renal carcinoma, who underwent surgical removal of his right kidney 5 years previously. Two years postoperatively, he developed a metastatic nodule in the right upper lobule of his lung. The patient was under treatment with pazopanib 800 mg per day for 15 months. Pazopanib is a tyrosine kinase inhibitor that blocks tumour growth and inhibits angiogenesis. The metastatic nodule disappeared but a new one appeared (computed tomography and magnetic resonance imaging). While the second metastasis remained stable and the patient was not undergoing any treatment, he developed the typical skin lesions of morphoea, with numerous sclerotic, or atrophic lesions with lilac ring, 2.5 years after the cessation of pazopanib. The diagnosis was confirmed by biopsy and he is currently under topical treatment with cortisone and calcineurin inhibitors. To date, several studies have reported sudden development of morphoea either before or after a brief interval following the diagnosis of malignancy. Scleroderma is characterized by immunological dysregulation, vasculopathy and hyperproduction of the extracellular matrix by activated fibroblasts. Endothelial inflammatory and mesenchymal cells produce cytokines, growth factors (interleukins 1 and 6 and tumour necrosis factor-α), connective tissue growth factor, and basic fibroblast growth factor. In our case study, we examined a patient with a localized type of scleroderma (morphoea) without confirming the markers for systemic involvement. Morphoea developed 5 years after the diagnosis of clear renal cell carcinoma and 2.5 years after the cessation of pazopanib – a tyrosine kinase inhibitor – so it should be considered a paraneoplastic phenomenon rather than a secondary effect of pazopanib cancer therapy.
P005 Painful palmar papules: a rare variant of a familiar dermatosis
Authors: Santhosh Parvathy , George Mamatha , Rajiv Shwetha V , Nandakumar Gopalapillai
Published: June 2024

A 52-year-old man presented with painful lesions over the palms for 10 days, associated with low-grade fever. The lesions were exquisitely painful and affected his activities of daily living. He had type 2 diabetes mellitus, managed with metformin and glimepiride. On examination, multiple, discrete, erythematous, tender papules of size 0.3 × 0.3 cm to 1 × 1 cm over both palms were noted. The fingertips were erythematous and tender. Blood investigations were unremarkable, except for a blood glucose level of 19.5 mmol L−1. Skin biopsy showed hyperkeratosis, spongiosis and dermal elastosis with necrobiotic collagen surrounded by histiocytes and lymphocytes, with occasional foreign-body giant cells. Alcian blue stain revealed abundant mucin deposition. A diagnosis of acute-onset painful acral granuloma annulare was made. He was treated with potent topical corticosteroids along with anti-inflammatory medications. The lesions subsided fully within 8 weeks, with residual peeling of skin. Granuloma annulare (GA) classically presents as asymptomatic to mildly pruritic, localized clusters of small papules that coalesce into annular and arciform lesions. The common variants are localized GA, generalized GA and subcutaneous GA. Perforating GA and patch-type GA are unusual. Palmoplantar, Blaschko linear, pustular and visceral variants are considered extremely rare. Although hands and feet are common sites of granuloma annulare, lesions of the classical type occur on the dorsal surfaces. Acute-onset acral painful GA is considered a rare and distinct variant, characterized by the sudden eruption of tender papules on the hands and/or feet, with or without scattered lesions on other sites. There may be associated systemic features like fever, malaise, arthralgia and diarrhoea, with elevated inflammatory markers. The condition was first described as a separate entity in 2006 (Brey NV, Malone J, Callen JP. Acute-onset, painful acral granuloma annulare: a report of 4 cases and a discussion of the clinical and histologic spectrum of the disease. Arch Dermatol 2006; 142: 49–54). Subsequently, there have been a few other reports. Histology of GA shows an interstitial or palisading pattern of granulomatous inflammation with collagen degeneration and mucin deposits. The more common interstitial pattern shows upper and mid-dermal histiocyte collections, scattered between and around collagen bundles and vessels. In the palisading pattern, a central zone of necrobiotic collagen is surrounded by palisading histiocytes. Treatments reported to be effective in acute-onset painful acral GA include topical, intralesional and systemic steroids and hydroxychloroquine. Painful lesions, palmar lesions and systemic features are unusual in GA. Associated systemic features and deranged blood parameters might prompt unnecessary investigations. Hence, the significance of clinicopathological correlation in the diagnosis of this entity needs to be emphasized.
P011 A case report of neonatal lupus erythematosus in a 3-month-old baby
Authors: Odekunle Ayomikun , El-Naes Raed , Hawwa Ahmed
Published: June 2024

Neonatal lupus erythematosus (LE) is an uncommon clinical condition caused by the transfer of anti-Ro/SSA or anti-La/SSB transplacentally from the mother to the fetus (Costa Cascais F, Fraga S, Sousa S, Pinto M. Neonatal lupus: a clinical challenge. BMJ Case Rep 2021; 14: e246590). The incidence of neonatal LE is about 1 in 20 000 live births, with female neonates twice as likely to be affected compared than male (Sukumaran S, Singh D. Cutaneous neonatal lupus erythematosus: a case report. Cureus 2022; 14: e22279). We report a case of neonatal LE in a 3-month-old male infant who presented with multiple annular erythematous lesions on his scalp and feet. A 3-month-old baby was referred by the general practitioner after multiple annular erythematous lesions were noted on his scalp and feet. He was delivered at term via a spontaneous vertex vaginal birth. The APGAR (appearance, pulse, grimace, activity and respiration) score was 9 at 1 min and 10 at 5 min. The birthweight was 3440 g. The mother had routine prenatal care for an uncomplicated pregnancy. The rashes were first observed at 4 weeks after delivery and were treated with co-trimoxazole cream; however, there was no response, which prompted a referral to the dermatology department. The infant was seen physically 3 weeks after the initial virtual review. There were erythematous annular rashes with slightly rolled edges on the scalp and soles of the feet. The remainder of the examination was normal. He was started on hydrocortisone–miconazole cream and reviewed again 6 weeks later, when the rash had faded considerably on the temporal sides of his scalp and resolved completely on his left foot. A differential diagnosis of fungal infection/granuloma annulare/resolving viral infection was considered. However, as the rash did not completely resolve after a further review 3 weeks later, the differential of neonatal LE was considered and screening for neonatal lupus was performed, which came back positive. Antinuclear antibody was positive (titre 360, speckled pattern), and anti-Ro/SSA antibodies were positive. He was prescribed clobetasone cream as treatment. Maternal serology was later checked, revealing anti-Ro/SSA, anti-La/SSB and high-titre antinuclear antibodies. However, the mother was completely asymptomatic. Preliminary cardiac and blood investigations by the paediatrician did not reveal any abnormality. Cutaneous involvement is usually self-limiting, though topical steroids may be needed in some cases. Cardiac involvement should be actively screened for, as pacemakers may be needed for atrioventricular block.
P013 Eruptive seborrhoeic keratoses in late-onset constitutional mismatch repair deficiency
Authors: Fostier William , Holt Georgie , Husain Akhtar , Tellez James , Wimmer Katharina , Martin Richard , Burn John , Gallon Richard , Rajan Neil
Published: June 2024

Constitutional mismatch repair deficiency (CMMRD) is a rare autosomal recessive condition typically diagnosed in childhood. It is caused by biallelic inheritance of pathogenic variants within the MLH1, MSH2, MSH6 and PMS2 genes (DNA mismatch repair pathway). It confers a high risk of cancer, with many patients developing brain, gastrointestinal or haematological malignancy in the first two decades of life. The cutaneous features of CMMRD share similarities with neurofibromatosis, with café au lait macules, Lisch nodules, neurofibromas and axillary/inguinal freckling reported. Herein, we report a case of a 31-year-old woman with colorectal polyposis and multiple primary cancers presenting with an eruption of seborrhoeic keratoses (SKs), consistent with the paraneoplastic sign of Leser–Trélat (LTS). Aged 23 years, the proband underwent a prophylactic subtotal colectomy for multiple adenomatous large-bowel polyps. During colectomy, analysis of an enlarged mesenteric lymph node revealed a synchronous diffuse large B-cell lymphoma. This was treated with excision and chemotherapy. When she was aged 24 years, an ampulla of Vater adenoma was excised. Aged 29 years, she developed triple-negative invasive ductal carcinoma of the breast, treated with surgery and chemotherapy. The proband also developed basal cell carcinoma on her forehead and the tarsal edge of her right eye at ages 28 and 31 years, respectively. Her family history revealed that her father died at age 33 years of colorectal cancer, while her mother died at age 60 years due to cerebral haemorrhage. Concurrently to the proband’s breast cancer diagnosis, cutaneous examination revealed widespread small skin-coloured and brown plaques, which were confirmed on biopsy to be SKs in a predominantly acral distribution, with sparing of the trunk. Immunohistochemical assessment of the SKs demonstrated loss of expression of PMS2, with loss of expression also seen in normal perilesional skin. Microsatellite instability (MSI) analysis of peripheral leucocyte DNA revealed high levels of constitutional MSI, indicative of CMMRD. Germline genetic testing revealed compound heterozygous pathogenic variants in PMS2, confirming the diagnosis. LTS is characterized by an eruption of SKs in association with concurrent development of cancers arising from the breast, lung and gastrointestinal tract. A putative mechanism is that tumour-secreted factors, such as epidermal growth factor, drive SK growth. The responsible tumour may be difficult to determine in patients with multiple primary cancers; however, temporally, the breast cancer in our patient was most closely linked to her presentation of LTS. This case emphasizes the importance of recognizing the sign of LTS, a novel feature in the context of CMMRD.