bluuebunny/crossref_metadata_2025 huggingface dataset:
P21 Facial papules in an immunocompromised patient
Authors: Carty Kieran , Eustace Karen , de Barra Eoghan
Published: June 2023

A 29-year-old man presented with a 6-week history of clustered facial papules. Of note, he had a diagnosis of HIV 5 months previously and was on maintenance antiretroviral treatment. His initial CD4 count was 5, which increased to 38, and his viral load was now no longer detectable. He had also been treated for cytomegalovirus reactivation, pneumocystis pneumonia and suspected mycobacterium infection for the previous 3 months. He had ongoing symptoms of malaise, fevers, weight loss and nausea, along with abnormal liver function tests and a raised C-reactive protein. A bone marrow trephine showed noncaseating discrete small granulomas; Grocott and periodic acid–Schiff (PAS) stains were negative. Prior to his dermatology review, the papules were initially perioral and he had been treated with empiric valaciclovir for suspected herpes simplex virus (HSV) but with no resolution. Testing for HSV DNA and syphilis was negative. On examination, there were clusters of small nontender, well-circumscribed papules (some umbilicated), distributed on the forehead, cheeks, and cutaneous and mucosal lips. A diagnostic punch biopsy was taken of one of the characteristic papules. Histological examination demonstrated a dense dermal infiltrate of histiocytes with focal non-necrotizing granuloma formation. Interspersed neutrophilic microabscesses and occasional eosinophils were present. PAS stain for fungi confirmed the presence of numerous thick-walled spherules, many with a single distinct nucleus, with some showing binucleation, consistent with fungal organisms located within the histiocytes in the dermis. Differential diagnosis included histoplasmosis, cryptococcosis, blastomycosis and coccidiomycosis. He was commenced on intravenous liposomal amphotericin B for disseminated endemic mycosis while awaiting definitive diagnosis. Formal identification by panfungal polymerase chain reaction of skin tissue was positive for Histoplasma capsulatum and itraconazole was added. The diagnosis was consistent with disseminated histoplasmosis with cutaneous involvement. The lesions resolved completely over 4 weeks, with some residual hyperpigmentation remaining. Histoplasma capsulatum is a dimorphic fungus found in soil and the droppings of bats and birds. Infection is through spore inhalation, with most patients being asymptomatic. It is more prevalent in temperate and tropical climates. Disseminated histoplasmosis occurs mostly in immunocompromised individuals and can be fatal if left untreated. Although endemic to specific world regions, disseminated histoplasmosis should be considered in immunocompromised patients presenting with atypical cutaneous findings, even in regions of low prevalence.
P25 Considering the burden of scabies alongside a mass drug administration treatment programme in an indigenous community in northern Australia
Authors: Cox Victoria , Dowden Michelle , Williams Crystal , Engelman Daniel , Yan Jennifer , Ralph Anna , Currie Bart , Francis Joshua
Published: June 2023

Scabies is estimated to affect 455 million people worldwide and is one of 20 neglected tropical diseases recognized by the World Health Organization (WHO). It is caused by a parasitic mite infestation that is hyperendemic in low-resource regions, and the disease burden in northern Australia is believed to be among the highest in the world. However, few recent prevalence assessments have been conducted in northern Australia and it is not known whether historical assessments are still representative of the disease burden. Therefore, it is difficult to advocate for the allocation of government funding and resources without accurate information on the burden of disease. Considering the effectiveness of an ivermectin-based mass drug administration (MDA) treatment programme in northern Australia is important to explore a control strategy, following successful large trials conducted in the Pacific and recommendations from the WHO. The aim was to consider the burden of scabies and other skin conditions in an indigenous community in northern Australia, from undertaking a simplified skin assessment of all consenting community residents. An observational cross-sectional study design was used for this purpose. Five field teams covered different regions in Maningrida. The teams were comprised of a medical practitioner from the investigative team who worked alongside a local healthcare worker and an Aboriginal healthcare worker. All community residents who gave verbal consent were administered ivermectin, or topical permethrin cream if ivermectin was contraindicated, as part of a MDA programme, which was locally developed and implemented by the Mala’la Health Service. Simplified skin examinations (n = 1306) were conducted in Maningrida during Healthy Skin Week from 14 to 18 November 2022, with verbal consent from 99% of community residents approached for recruitment to undergo a simplified skin assessment and administration of ivermectin as part of the MDA treatment programme. The point prevalence for scabies was 25.2% (330 individuals). Ninety-three people (7.1%) were diagnosed with impetigo, and approximately 40% of community residents had evidence of skin disease. No study participants were diagnosed with crusted scabies. Scabies is endemic in indigenous communities in northern Australia. This was the first prevalence assessment to be conducted in the Northern Territory since the East Arnhem Healthy Skin Project, which concluded in 2007, and the first MDA treatment programme conducted by an aboriginal medical service as a local health intervention. The consideration of effective rapid mapping and regional control strategies is essential to tailor a public health response that addresses the high burden of skin disease in northern Australia.
P31 Trial design to improve inclusion of patients from ethnic minority backgrounds
Authors: Bishop Liam , Smith Isabelle , Gilberts Rachael , Nixon Jane , Wittmann Miriam
Published: June 2023

The ALPHA trial was a UK National Institute for Health and Care Research-funded, multicentre, prospective, adaptive, two-arm parallel group randomized controlled trial. Consenting participants with severe chronic hand eczema (CHE) were randomized on a 1 : 1 basis to receive either alitretinoin or immersion psoralen + ultraviolet A in conjunction with concomitant topical corticosteroids, emollients and patient education. Different skin types might respond differently to phototherapy due to different pigmentation, so it was important to recruit an ethnically diverse patient group. This was reflected in the design and analysis of the trial. ALPHA included a substudy where photographs were taken in a subgroup of randomly selected consenting participants and used as a disease-assessment quality-assurance check. Following a discussion with the Trial Steering Committee patient representative, a protocol amendment was implemented so that all consenting participants of an ethnic minority background would be selected for the substudy to assess any differences by skin type. The minimization algorithm was amended to incorporate the skin type as a minimization factor to ensure balance between the treatment groups in terms of skin colour and incorporated as a covariate in the primary analysis. ALPHA recruited 441 participants between October 2015 and June 2021, of which 49 (11.1%) were participants from ethnic minority background (13% was the national average in 2011, and 18% was the national average in 2021). In total, 95.2% (n = 373/392) of White participants and 92% (n = 45/49) of participants from ethnic minority backgrounds provided consent to have photographs taken as part of ALPHA. A total of 113 (30.3%) consenting White participants were selected for the photographic substudy, and 36 (80%) ethnic minority participants were selected. The presentation will report on the agreement between assessors in terms of photographs by skin type. Details of disagreement between photographs will be explored through the use of other disease-assessment measures that provide extra detail on the clinical symptoms that may not be visible on a photograph. Through increased awareness of the importance of different skin types, the trial was adapted to ensure ALPHA recruited a proportion of participants from ethnic minorities similar to the proportion of people from ethnic minority backgrounds in the UK. As a result, the trial was an example of adapting trial design to acknowledge the differences across ethnic groups, and to lead to improved research outcomes for patients from ethnic minority backgrounds. We will conclude the presentation with some practical recommendations for equality, diversity and inclusion in dermatological clinical trials.
P32 Impact of the COVID-19 pandemic on health equality in malignant melanoma diagnosis
Authors: Lau Kenny , Cheng Huan , Hussain Rima
Published: June 2023

Difficult access to care during the COVID-19 pandemic has led to a delay in some disease diagnoses. The pandemic has exacerbated pre-existing health inequalities, and the most deprived population has often been the most disproportionately affected. In this study, we investigated the impact of COVID-19 on the volume and pattern of melanoma diagnosis, to evaluate whether there is an association with the socioeconomic status of the population. Cases with newly diagnosed cutaneous melanoma from January 2019 to December 2021 were identified in a specialist multidisciplinary team-held database. Breslow thickness, pathological disease stage, patient demographics and postcodes were reviewed. In the 3-year study period, there was a total of 1910 cases. Compared with 2019 prepandemic data, there was a 31% reduction (P = 0.03) in melanoma cases diagnosed in 2020 and a 10% reduction (P = 0.09) in 2021. In 2020, stage 4 cases had a 46% increase (P = 0.031). In 2019, 7% of the most deprived population had stage 4 disease at diagnosis, which increased to 21% in 2020 (P = 0.02). COVID-19 has caused a dramatic reduction in the volume of melanoma diagnoses and an accompanying upstage of disease. Among the most deprived population in our region, they are three times more likely to receive a stage 4 diagnosis vs. before the pandemic. This suggests that the barrier to health care secondary to the pandemic is most apparent to the deprived population and probably caused a delay in cancer diagnosis among this group of patients. Health policy needs to be put in place urgently to address this health inequality, to minimize the prognostic impact on the population.
P36 A cross-sectional patient survey in a tertiary hidradenitis suppurativa clinic
Authors: Mathew Libin , Aziz Sally , Kattach Leila , Shah Aadarsh , Rashidghamat Ellie
Published: June 2023

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease that affects approximately 0.8% of the UK population. A survey was carried out among patients attending a tertiary HS clinic with the aim of better understanding the management of HS in primary care, and identifying the prevalence of associated risk factors. A total of 212 of the 552 patients (38.4%) invited chose to participate. The length of time patients had experienced symptoms before consulting their general practitioner (GP) was variable with 33.8% (n = 63) of participants reporting symptoms for 3–10 years and 26.3% (n = 49) experiencing symptoms for > 10 years. The majority of patients were given a diagnosis in secondary care (n = 103; 55.4%) and 28.5% (n = 53) by their GP. In primary care, treatments prescribed included topical treatment and antimicrobial washes (n = 107; 65.2%). Just over half (n = 84; 51.2%) were prescribed short and extended courses of antibiotics. Looking at lifestyle factors, 31.5% (n = 52) were current and 27.9% ex-smokers (n = 46). The majority (n = 108; 65.5%) identified themselves as being overweight, with 67.8% (n = 112) wanting to lose weight. Almost a third of patients (n = 107; 64.5%) did not carry out exercise regularly (defined as cardiovascular exercise three times weekly). Eighty per cent (n = 132) of patients reported that they had not received any psychological support for HS, either from primary or from secondary care. This study highlights that only a small proportion of patients with HS were diagnosed by their GP, with the majority receiving a diagnosis from their secondary care physician. A self-reported lack of confidence by GPs in diagnosing HS has historically been highlighted. Despite this lack of confidence, this study demonstrates good adherence to existing UK recommendations for the initial treatment of HS when the diagnosis is made. The negative effects of lifestyle factors on HS, such as smoking and obesity, are well recognized. Despite this, over half of patients in this study who were current smokers had not been offered referral to a smoking cessation service. This study underscores the need to screen for depression and anxiety in patients with HS and improve access to psychology services. This patient self-reported study gives an insight into the importance of providing holistic care for patients with HS. As GPs gain confidence in the diagnosis and initial management of HS, an awareness of associated lifestyle changes and comorbidities can further enhance the holistic care of patients with HS in primary care.
P43 Patient tolerability of adalimumab biosimilar therapy in dermatology and rheumatology: real-world experience from a large tertiary centre
Authors: McGuire Arlene , Guard Sarah , Topping Karen , Smith Catherine , Mahil Satveer , Barker Jonathan , McGrath Conn , Fox Hannah , Moorhead Lucy
Published: June 2023

Adalimumab is widely used in the treatment of immune-mediated inflammatory diseases. It is the highest-spend drug in the National Health Service, costing more than £400 million annually. In 2018, adalimumab biosimilars became available, leading to substantial cost savings. However, patient tolerability of biosimilars remains underexplored. We evaluated the tolerability of adalimumab biosimilar therapy (Idacio®) in patients who were switched from Humira® in a large dermatology and rheumatology tertiary centre. We identified all patients issued with a prescription of Humira by dermatology [psoriasis and hidradenitis suppurativa (HS)] or rheumatology (rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis and Behçet disease) and analysed the number who switched to Idacio between January 2021 and March 2022. Patient electronic records were reviewed up to October 2022 to identify patients who switched back to the originator product and the documented reason for the switch. The primary outcome was the numbers of patients who were switched back from the biosimilar to the originator product. Of 769 patients issued with a prescription of Humira, 694 were switched to Idacio during the study period. Of these, 134 (19.3%) switched back to the originator product, 102 of whom (76.1%) remained on this during follow-up. The highest proportion of individuals switching back to the originator product was observed in the HS population (26.7%). The most common reasons for switching back were patient-reported loss of disease control (n = 63; 47.0%), injection pain (n = 51; 38.1%) or both (n = 10; 7.5%). The median time to switch back was 197 days (interquartile range 138–280). Of 694 patients prescribed Idacio, 32 (4.6%) were switched to an alternative biologic agent during the study period. Our experience with previous biosimilar switches within rheumatology and dermatology (etanercept, rituximab and infliximab) has resulted in few patients requiring a switch back to the originator. Our data indicate that around one in five patients in our study population switched back to the originator product. The higher proportion of patients citing injection pain may relate to the citrate excipient content or larger injection volume of the biosimilar Idacio. Loss of efficacy with time is well established with adalimumab, in part due to antidrug antibodies, and cannot be specifically attributed to the biosimilar. Switching may alter a patient’s confidence in the drug, which is particularly important when it may be a first-line therapy or the only approved biologic for a condition. Data on switch-back rates for other adalimumab biosimilars is required to understand how generalizable our findings are and the potential economic implications.
P45 An analysis of infantile haemangioma referrals and comparison with the infantile haemangioma European task force’s ‘infantile haemangioma referral score’
Authors: Fagan Nicole , Dhonncha Eilis Nic , Sadlier Muriel
Published: June 2023

Infantile haemangiomas (IHs) are common. Timely referral and treatment can minimize complications in high-risk lesions. The IH European Task Force developed the Infantile Haemangioma Referral Score (IHRes) in 2020 (Léauté-Labrèze C, Torres EB, Weibel L et al. The Infantile Hemangioma Referral Score: a validated tool for physicians. Pediatrics 2020; 145:e20191628). This is a simple, easy-to-access validated screening tool that can assist physicians in deciding which IHs to refer to an expert centre. The aim of this study was to assess the quality of IH referrals to a national care centre. Data were retrospectively collected from a random sample of patients over a 13-month period between January 2019 and February 2020. Fifty-six patients were included. Eighty-six per cent had a solitary haemangioma (n = 48); 52% of IHs were located on the head (n = 29). Sixteen patients (29%) were referred between 5 and 8 weeks of age (29%); five patients (9%) were referred before 5 weeks of age. The majority of referrals came from primary care (55%; n = 31). Seventy-three per cent of referrers did not specify the urgency of the referrals (n = 41); 59% were subsequently triaged as urgent by a consultant dermatologist (n = 33). Most referrals did not specify the size of the IH (43%; n = 24), if it was actively growing (48%; n = 27), ulcerated (93%; n = 52) or potentially function threatening (84%; n = 47). Nine per cent included a photograph of the lesion (n = 5). Seventy-five per cent of referrals satisfied the IHRes six major criteria or had scores > 4, warranting a referral (n = 42). Fifteen patients (27%) were started on propranolol at first appointment and a further 12 were monitored in a return appointment. Our results show that use of the IHReS tool could improve clinical outcomes by identifying children that require specialist referral earlier and facilitate easier triage of referrals.
P51 A national analysis of demographic features associated with spindle cell melanoma
Authors: Wu Xinxin , Al Kurnas Mohammed , Liu Adam , Silberstein Peter
Published: June 2023

Spindle cell melanoma (SCM) is a rare morphological subtype of melanoma, characterized histologically by atypical, spindled, malignant melanocytes (Weissinger SE, Keil P, Silvers DN et al. A diagnostic algorithm to distinguish desmoplastic from spindle cell melanoma. Mod Pathol 2014; 27:524–34). SCM often manifests as a broad metastatic illness, is frequently amelanotic and can arise nearly anywhere on the body, making diagnosis challenging (Xu Z, Shi P, Yibulayin F et al. Spindle cell melanoma: incidence and survival, 1973–2017. Oncol Lett 2018; 16:5091–9). Given the rarity of SCM, the epidemiology is not yet well explored. The National Cancer Database (NCDB) is a nationwide oncology outcome database for > 1500 commission-accredited cancer programmes in the US and Puerto Rico. This study aimed to investigate the demographic factors associated with patients diagnosed with SCM by analysis of the NCDB. A retrospective cohort analysis utilizing data from the NCDB from 2004 to 2020 included patients diagnosed with histologically confirmed SCM (n = 7556). Sociodemographic factors (sex, age, race, Hispanic status, insurance type, urban/rural designation, facility location, facility type, education, income, distance from residence to facility and Charlson–Deyo score) were analysed using Pearson χ2-tests, and multivariate analysis was performed via binary logistic regression. Since 2004, an average (SD) of 480.8 (63.7) cases have been diagnosed annually. Most patients were male (66.5%), White (97.6%), not Hispanic (95.2%) and insured by Medicare (56.3%) and lived in an urban area (98.5%). Mean (SD) age at diagnosis was 67.9 (14.5) years, with an average (SD) Charlson–Deyo comorbidity score of 0.3 (0.6) and a mean (SD) distance of 37.3 (113.4) miles from the patient’s residence to the hospital. The most common primary site for SCM was the skin of the upper limb and shoulder (22.6%), followed by skin of the scalp and neck (19.0%), skin of other and unspecified parts of face (17.9%), and skin of the trunk (17.3%). On multivariate analysis, males were more likely than females to be diagnosed at an older age [69.3 vs. 65.3 years, 95% confidence interval (CI) 0.979–0.990; P < 0.001], receive treatment at an academic facility (45.9% vs. 42.7%, 95% CI 1.018–1.270; P = 0.023) and have a Charlson–Deyo score of ≥ 3 (2.1% vs. 1.3%, 95% CI 0.374–0.924; P = 0.21). Given the lack of literature on SCM, this study serves as a valuable tool for understanding the demographic factors associated with the diagnosis. Future studies within the laboratory aim to determine the effect of these factors on overall survival with propensity score matching for other variables to identify disparities.
P53 Incidence of merkel cell carcinoma in the Republic of Ireland (1994–2019)
Authors: Doyle Claire , Blasco Marta Costa , McFeeley Orla , Beatty Paula , O’Mahoney Sarah , Murphy Lisa , Andrawis Madonna , Tobin Anne Marie
Published: June 2023

Merkel cell carcinoma (MCC) is a rare, aggressive, neuroendocrine cutaneous malignancy most commonly observed in those aged over 65 years. MCC is twice as common in males as in females and is 25 times more common in those with fair skin than in those with darker skin types. Solid organ transplant recipients have a 24-fold increased risk of developing MCC. There has been a 95% increase in the incidence of MCC in the USA from 2000 to 2013, with further increases predicted. The aim of this study was to investigate the trends of incidence of MCC in the Republic of Ireland. Age-standardized rates were calculated using the 2013 European standard population. There were 447 histologically confirmed MCCs diagnosed between 1994 and 2019. Forty-nine per cent of cases (n = 220) were in males. Median age was 80 years (range 15–19 to 95+). The median age for males was 78 years and the median age for females was 82 years. On average, there were seven cases of MCC diagnosed annually between 1994 and 1998 vs. 27 cases of MCC annually diagnosed between 2015 and 2019—almost a quadrupling of case numbers. The age-adjusted incidence rate of MCC for both male and females is detailed in Table 1. Previous literature has indicated that MCC is twice as common in males than in females. Our cohort differed in that there was a slight female predominance in patients diagnosed with MCC. This is in keeping with published literature from Northern European groups, which have also demonstrated a female predominance in MCC. While the absolute number of MCC diagnosed in Ireland has increased in both males and females, the age-adjusted incidence rate is increasing in males, but there has not been a significant change in females. Other Northern European groups have also demonstrated an increase in the incidence of MCC in males that was not observed in females. This study adds to the body of epidemiological data on MCC.Table 1Age-adjusted incidence rates of Merkel cell carcinoma (MCC)Cases of MCCAge-standardized rate (per 100 000 person years)SE95% confidence intervalMales1994–1999230.520.130.27–0.772000–2004210.370.080.21–0.532005–2009350.790.150.50–1.082010–2014661.190.160.88–1.502015–2019751.050.120.81–1.29Females1994–1999260.360.070.22–0.502000–2004440.670.100.47–0.872005–2009540.790.110.57–1.012010–2014450.570.090.39–0.752015–2019580.650.090.47–0.83
P66 Uptake of biosimilars for psoriasis: a drug utilization study from the British Association of Dermatologists Biologics and Immunomodulators Register
Authors: Phan Duc Binh , Bewley Anthony , Smith Catherine , Mackenzie Teena , Griffiths Christopher , Lunt Mark , Warren Richard , Yiu Zenas
Published: June 2023

Tumour necrosis factor-α inhibitors (TNFi) have revolutionized the treatment of moderate-to-severe psoriasis. Following patent expirations of TNFi originators, TNFi biosimilars became available, presenting the opportunity for significant reductions in drug costs. This observational cohort study aimed to describe the uptake of TNFi biosimilars for psoriasis treatment in the UK and Republic of Ireland (RoI). This study utilized data from the British Association of Dermatologists Biologics and Immunomodulators Register (BADBIR), a national pharmacovigilance register for patients with psoriasis on systemic treatments. We analysed biosimilar uptake trends over time in nine geographical regions of England, along with Wales, Scotland, Northern Ireland and the RoI. We assessed the incidence of switching to biosimilars in an originator-user cohort (switchers). Patients on originator infliximab, etanercept and adalimumab at the time originator patents expired entered the cohort on 1 February 2015, August 2015 and October 2018, respectively, and were followed up until 31 October 2021. Trends in biosimilar initiations were assessed in an adalimumab-naïve cohort who started adalimumab between 1 October 2018 and 31 July 2019 (starters). We assessed the associations between patient factors and originator-to-biosimilar switching and biosimilar initiation using a multivariable Cox regression model and a multivariable logistic regression model. In total, 4202 patients (209 on infliximab, 742 on etanercept and 3251 on adalimumab) were included in the originator-user cohort. For infliximab, etanercept and adalimumab, the cumulative incidence of originator-to-biosimilar switching increased with time to 14.8%, 23.6% and 66.6% after 3 years, respectively. Across geographical regions, 3-year switching rates varied from 0% (North East England, London, Scotland, Northern Ireland, RoI) to 43.7% (East Midlands) for infliximab; from 0% (RoI) to 40.4% (South West England) for etanercept; and from 12.5% (London) to 84.3% (North East England) for adalimumab. After switching to biosimilars, 2.8% of switchers cross-switched to other biosimilars, 1.1% switched back to the originator and 17.1% discontinued or switched to other biologic medicines. In total, 528 patients were included in the adalimumab-naïve cohort, of whom 67.8% started on biosimilars. Amgevita® and Imraldi® were the most commonly used biosimilars among adalimumab biosimilar switchers (56.8% and 39.1%, respectively) and starters (53.6% and 34.4%, respectively). Originator-to-biosimilar switching and biosimilar initiation were more common in patients who were male or had lower a Psoriasis Area and Severity Index at cohort entry. The uptake of biosimilars increased over time and varied considerably across the UK and RoI; adalimumab had the highest biosimilar uptake rate compared with other TNFi.
P69 Baseline characteristics of patients with physician-diagnosed hidradenitis suppurativa: results from a retrospective observational study using data from the Clinical Practice Research Datalink database
Authors: Shams Kave , Rashidghamat Ellie , Brown Annette , Pamies Paula , Ingram John R
Published: June 2023

Hidradenitis suppurativa (HS) is a difficult-to-treat, painful, chronic inflammatory skin disorder characterized by nodules, abscesses and skin tunnels. Delay in diagnosis increases disease severity and overall disease burden. In England, HS is associated with a high healthcare resource use, with an estimated prevalence of 1.2% in the general UK population (Ingram JR, Jenkins-Jones S, Knipe DW et al. Population-based Clinical Practice Research Datalink study using algorithm modelling to identify the true burden of hidradenitis suppurativa. Br J Dermatol 2018; 178:917–24). Improved understanding of HS patient profiles in England will help optimize patient care and treatment outcomes. This study aimed to characterize the patient profiles, journey, treatment pathways and treatment outcomes of patients with HS in England using data from the Clinical Practice Research Datalink database. Here, we present the baseline characteristics of patients with HS from this database. Overall, 39 860 patients with physician-diagnosed HS were identified from 1 January 2009 to 31 March 2021. The mean (SD) age at diagnosis was 34.49 (13.07) years, and the majority were female (73.8%). Twenty-seven per cent of patients were White, 7.5% were Asian, 5.0% were Black and 27.9% were of mixed race, while 2.1% were from other races and the race was unknown for 30.7%. Overall, 44.6% were current smokers and 12.7% were ex-smokers. Depression (31.7%), anxiety (21.5%) and acne (20.6%) were the most commonly reported comorbidities related to HS. Chronic pulmonary disease was reported in 26.2% of patients; this may, in part, be attributed to relatively high rates of smoking in the HS population. The most frequently prescribed medications prior to HS diagnosis were pain medication, especially ‘non-opioid’ analgesics (21.8%) and opioids (19.8%); oral antibiotics, particularly tetracyclines (15.7%); combined contraceptive pills (7.2%) and metformin (4.8%). Only a few patients (< 0.05%) received a biologic prior to their HS diagnosis for other chronic inflammatory conditions. The various comorbidities, including psychiatric, metabolic, cardiovascular, gynaecological and pulmonary and associated treatments, observed in this real-world study in England suggest that optimal management should involve a multidisciplinary approach to improve outcomes in patients with HS.
P75 Are ‘hypoallergenic’ personal care products truly safe?
Authors: Hiranput Siwaporn , Smith Lucy , Yesudian Paul Devakar
Published: June 2023

It is estimated that one-fifth of the general population may have allergic contact dermatitis (ACD) to common environmental allergens. Skincare companies are increasingly advertising their products as ‘hypoallergenic’, targeting consumers who seek personal care products (PCPs) that are less likely to cause an allergic reaction. However, there are no Food and Drug Administration standards to regulate the use of the term hypoallergenic, allowing manufacturers to use the term freely. We evaluated PCPs marketed as hypoallergenic from two health and beauty retailers in the UK for the presence of allergens in the British Society of Cutaneous Allergy (BSCA) baseline series. Product and ingredient lists were obtained from www.boots.com and www.superdrug.com in November 2022 using the term hypoallergenic in the search box. PCPs without the term hypoallergenic in the product description, unrelated products (plasters, jewellery, sanitary towels, tampons, clothing, facial brushes) and duplicates (same products in different sizes) were excluded. In total, 208 PCPs met the inclusion criteria: 47 (22.6%) were rinse-off and 161 (77.4%) were leave-on products. At least one substance from the BSCA baseline series was an ingredient in 79 (38.0%) PCPs. Of these, 54 (26.0%) had 1 potential allergen, 21 (10.2%) had 2, and 4 (1.9%) had 3 potential allergens from the series. The frequently encountered allergens were cetearyl alcohol and paraben mix, found in 42 (20.4%) and 37 (18.0%) of products, respectively. Other BSCA baseline series allergens identified in PCPs included 2-bromo-2-nitropropane-1,3-diol, lanolin, decyl glucoside, diazolidinyl urea, methylisothiazolinone, limonene and linalool. In addition, PCPs had chemicals that were related to and may cross-react with allergens in the BSCA baseline series. Parfum/fragrance, which can cross-react with fragrance mix I and II, was found in 85 (41.3%) PCPs. Sodium benzoate and/or benzoic acid, often used as preservatives in PCPs, were found in 66 (32.0%) products. Forty (19.4%) PCPs had ingredients that belong to the Asteraceae family and therefore may trigger an ACD in those with positive reaction to Compositae and/or sesquiterpene lactone mix. Twenty-three (11.2%) PCPs contained cetyl alcohol and/or stearyl alcohol, the two major components of cetearyl alcohol. Overall, 153 (74.3%) of 206 PCPs marketed as hypoallergenic contained BSCA baseline series allergens or ingredients that may cross-react with them. This highlights the need to increase public awareness and education about the potential dangers of purchasing ‘hypoallergenic’ PCPs.
P83 Biologic and Janus kinase inhibitor therapy outcomes for severe psoriasis in trisomy 21
Authors: O’Connor Cathal , Byrne Berbie , Roche Darren , O’Connell Garret , O’Connell Michael , Murphy Michelle , Bourke John , Lynch Maeve , Bennett Mary
Published: June 2023

Trisomy 21 (T21) is strongly associated with autoimmune disease, including psoriasis. Little is known about biologic outcomes for severe psoriasis in T21. T21-associated immune dysregulation has implications for efficacy, safety and drug survival of biologic medications. The aim was to review the outcomes of patients with T21 and severe psoriasis treated with biologic agents or Janus kinase inhibitors (JAKi) in our region. Patients were identified via databases of the regional dermatology departments in the province of Munster, Ireland. Information on demographics, comorbidities, previous and current therapies and response to therapies was retrospectively collated. Adequate treatment response was defined as a physician global assessment score of zero (indicating clear skin), or one (indicating almost clear skin). Twenty-one patients were identified (mean age 24.7 years). Most (76%) did not have a first-degree relative with psoriasis. One-third (33%) of patients had arthritis, but all children (n = 6) had arthritis. Ninety per cent (n = 18/20) of trials of tumour necrosis factor (TNF)-α inhibitors failed. Almost two-thirds (n = 7/11) of patients achieved adequate response with ustekinumab. All three patients treated with tofacitinib achieved adequate response following at least three biologic failures. The mean number of biologic/JAKi therapies received was 2.1, with an overall biologic/JAKi survival rate of 36%. Overall, 81% (n = 17/21) of patients required a switch from their index biologic treatment due to failure. The four patients who remained on their index biologic all received ustekinumab. In patients with T21 and severe psoriasis, failure of TNF-α inhibition is common, and ustekinumab therapy should be considered first line. There is an emerging role for JAKi.
P88 Higher socioeconomic status is associated with psoriasis
Authors: Dagan Or
Published: June 2023

The role of several environmental risk factors such as stressful life events, smoking and overweight as triggers for psoriasis has been undoubtedly validated. Recent inquiries regarding the association between socioeconomic factors and psoriasis yielded contraindicating observations, and this relationship remains unclear. The aim was to measure the association between psoriasis and socioeconomic status (SES). We carried out a nationwide population-based cross-sectional study that included all patients insured by the Clalit healthcare organization (n = 4 604 994). Univariable and multivariable logistic regression analyses were conducted to explore the association between psoriasis and SES while controlling for potential medical and habitual confounders. The study population included 129 855 patients with psoriasis and 4 475 139 controls. The mean (SD) age of patients with psoriasis was 51.53 (19.96) years, and the proportion of females was 51.5%. Higher SES was associated with an increased prevalence of psoriasis. In a fully adjusted model, people within the highest socioeconomic level were 1.43-fold more likely to have psoriasis than those with the lowest SES [95% confidence interval (CI) 1.39–1.48; P < 0.001]; people of medium SES were 1.2-fold more likely to have psoriasis than those of the lowest SES [95% CI 1.18–1.26; P < 0.001 (P-value for linear trend < 0.001)]. There is a positive correlation between SES and psoriasis prevalence. Further investigation is warranted to elucidate which biologic or behavioural factors contribute to these findings.
P89 Real-world effectiveness of guselkumab in patients with psoriasis with and without concomitant psoriatic arthritis: retrospective data from the British Association of Dermatologists Biologics and Immunomodulators Register
Authors: Shams Kave , Wang Xiayi , Gillespie Justin , Chauhan Bhavika
Published: June 2023

Guselkumab is a monoclonal antibody that inhibits interleukin (IL)-23 signalling by binding to its p19 subunit and is approved to treat adults with moderate-to-severe plaque psoriasis and active psoriatic arthritis (PsA). BADBIR collects UK and Eire real-world observational data and includes patients receiving biologic treatments for psoriasis, with PsA being one of the recorded comorbidities at the time of enrolment. Absolute PASI (aPASI) scores can be used to quantify treatment effectiveness in routine clinical practice, and it has been suggested that an aPASI ≤ 2 represents a relevant disease endpoint to inform treat-to-target psoriasis-management strategies. This retrospective analysis evaluated the 1-year, real-world effectiveness of guselkumab on aPASI response in patients with moderate-to-severe plaque psoriasis and the subset of patients with and without concomitant PsA within BADBIR. Analyses were carried out on data collected up to the September 2021 data cutoff. Data were obtained from patients who had initiated guselkumab treatment and had recorded measurements for aPASI at baseline and 12-month follow-up was analysed. Measures of treatment effect for psoriasis included mean aPASI response, as well as the proportion of patients achieving an aPASI score of ≤ 1, ≤ 2, ≤ 3 and ≤ 5. Incomplete data collection limited the sample size of patients available for analysis. Five patients receiving guselkumab were excluded due to stopping treatment prior to the 12-month cutoff. Stratified by diagnosis, 36 (30.8%) patients had a concomitant diagnosis of PsA vs. 81 (69.2%) who did not. In the overall guselkumab-treated cohort (n = 117), mean (SD) aPASI at baseline and the following 12 months of treatment were 11.85 (8.95) and 2.45 (4.24), respectively. Following 12 months of guselkumab treatment in the cohort of patients with psoriasis (without concomitant PsA), 48 (59.3%) achieved an aPASI ≤ 1, 56 (69.1%) an aPASI ≤ 2, 64 (79.0%) an aPASI ≤ 3 and 69 (85.2%) an aPASI ≤ 5. In the concomitant PsA group, 19 (52.8%) achieved an aPASI score of ≤ 1, 22 (61.1%) achieved an aPASI score of ≤ 2, 28 (77.8%) achieved an aPASI ≤ 3 and 30 (83.3%) achieved an aPASI ≤ 5. Over 50% of guselkumab patients achieved an aPASI ≤ 1 at 12 months, supporting the effectiveness of targeting IL-23 with guselkumab for the treatment of psoriasis over 1 year. These results demonstrate that comparable responses were achieved for the treatment of psoriasis with guselkumab in patients with and without a concomitant PsA diagnosis within a real-world cohort.
BC02 Efficacy and safety of picosecond Nd-YAG laser for tattoo removal in Asian patients: a way to look forward
Authors: Bansal Rohit , Sahu Priyadarshini
Published: June 2023

Picosecond neodymium-doped yttrium aluminium garnet (Nd-YAG) lasers have emerged as the leading technology for tattoo removal due to their shorter pulse lengths and are considered better than other nanosecond lasers. The aim was to study the efficacy and adverse effects of a picosecond quality-switched (QS) Nd-YAG laser in a case series of 15 Asian patients for tattoo removal. Fifteen patients with black- and blue-coloured tattoos were recruited for tattoo removal. All were treated with a 1064-picosecond QS Nd-YAG laser. A single session with one pass was performed using a spot size of 4 mm, a fluence of 0.5–1 J cm–2 and a frequency of 6–10 Hz. The parameters were adjusted based on the size and type of tattoo and the patient’s skin type. Patients were treated at 4–6-weekly intervals. The clearance of pigmentation and local reactions was evaluated based on clinical photographs and dermoscopy, done at each sitting. At the end, both patients and physician assessed the clearance of tattoo. For patient assessment, a visual analogue scale (VAS) was used. To assess the efficacy of laser treatment by the physician, the tattoo removal rate was scored on a 5-point (0–4) scale (4: ≥ 70% removal, excellent improvement; 3: ≥ 50% and < 70%, marked improvement; 2: ≥ 30% and < 50%, moderate improvement; 1: ≥ 10% and < 30%, mild improvement and 0: < 10%, no effect). Patients were asked to assess their satisfaction (0 = dissatisfactory, 10 = satisfactory) and pain (0 = no pain, 10 = worst pain) using the VAS. Clinical photographs were assessed both by the patients and the physicians. Four women and 11 men were included (aged 30–45 years). At the end of treatment, all patients had > 75% clearance and seven obtained almost complete clearance. Thus, all patients had an excellent response. The average patient-reported score for satisfaction was 8.2 and 2.5 for pain. The average score was 4.4 for the number of sessions. A few adverse effects, including erythema, blistering and crusting, were observed. Picosecond lasers allow for the most effective delivery of thermal radiation to tattoo particles through more specific photothermal and photomechanical effects than traditional nanosecond lasers. They also have an additional effect of minimizing the collateral damage to the surrounding dermis and epidermis. Thus, a picosecond laser is a safe and effective method for tattoo removal in Asian people.
BC04 Burden of treatment in severe acne vulgaris
Authors: Kiely Lisa , O’Connor Cathal , Almoosa Aysha , Dight Emer , Murphy Michelle
Published: June 2023

Acne vulgaris is a common skin condition resulting in a significant personal burden to patients. Although the burden associated with the disease itself has been well reported, there is a paucity of data examining the burden of treatment (BOT) in acne. We performed a prospective single-centre study in a tertiary dermatology department in Ireland. Patients attending the dermatology department for acne management were invited to complete a validated BOT questionnaire with additional qualitative components, modified for use in acne. Fifty patients responded to the questionnaire. Sixty-eight per cent (n = 34) of respondents were female and 32% (n = 16) were male; mean patient age was 22.6 years (range 16–45). Eighty-two per cent (n = 41) of patients were on isotretinoin at the time of the study, with a further 18% (n = 9) on oral antibiotic therapy. The average BOT for antibiotics was 4.5/10 (range 2.5–6.9), and for isotretinoin, it was 3.8/10 (range 0.69–6.9). The greatest challenges reported with topical treatment were skin sensitivity and dryness and the lack of efficacy. The greatest challenges reported with antibiotic therapy were side-effects, including gastrointestinal upset, limited efficacy and the requirement for long-term treatment. Xerosis was described as the greatest challenge associated with isotretinoin; however, 58% of patients believed their overall BOT was decreased with isotretinoin, with statements such as ‘I really wish I’d started on isotretinoin a very long time ago’ provided. Acne results in a significant physical and psychosocial burden to patients. Patients on isotretinoin rated the BOT of isotretinoin as less than that of antibiotics and topical therapies. Prescribers should be aware of the BOT of various treatments to optimize treatment for acne.
BG02 A case of Werner syndrome: undiagnosed progeroid syndrome presenting as female pattern hair loss
Authors: Elias Jennifer , Singh-Raghunath Rakhi
Published: June 2023

A 27-year-old woman of Pakistani heritage with a background of type 2 diabetes, hypertension, hypothyroidism, infertility and Achilles tendinopathy was referred to the dermatology department for diffuse hair loss. She had greying of the scalp hair from the age of 20 years and, on examination, there were signs of hair fragility and thinning. Biopsies showed female pattern hair loss. Topical minoxidil 5% twice daily was advised. At the consultation, it was noted that her facial features included a thin nose with micrognathia. She had dental implants and had undergone cataract surgery at 19 years of age. Scleroderma-like changes were noted on the face and over the distal joints, alongside axillary freckling and excessive lentigines for her age and skin type. She was of short stature and low weight, with a body mass index (BMI) of 15.4 kg m–2. There was thenar and hypothenar wasting and loss of gluteal fat. Her parents were consanguineous (first cousins). One of her brothers, who had similar facial features, died aged 30 years from osteosarcoma. The patient and her partner had undergone two unsuccessful cycles of in vitro fertilization following 5 years of failure to conceive naturally. Medication consisted of atorvastatin, Calcichew, levothyroxine, lisinopril, metformin, pioglitazone and repaglinide. Routine bloods and hormone profile were normal. Despite her age, BMI and statin treatment, blood lipids were raised and a liver ultrasound showed fatty changes. The dermatology department queried Werner syndrome and referral to a tertiary lipodystrophy clinic was made. The lipodystrophy genetic panel was completed. Homozygous null mutation at the WRN locus was found confirming a diagnosis of Werner syndrome. Werner syndrome is an extremely rare autosomal recessive form of progeroid syndrome first described by Otto Werner in 1904. The hallmark sign is the striking disproportion between the patient’s age and appearance. WRN encodes the eponymous WRN protein, a member of the RecQ-like DNA helicase family. The prognosis is unfavourable, with a mean survival of 54 years. Primary causes of mortality are cardiovascular disease and malignancy, with melanoma, thyroid cancer, osteosarcoma and soft tissue sarcoma being the most common forms. There is currently no specific treatment. Management is close multidisciplinary monitoring and treatment of associated conditions. A 2010 study of the Werner syndrome mouse model found vitamin C supplementation to be beneficial (Massip L, Garand C, Paquet ER et al. Vitamin C restores healthy aging in a mouse model for Werner syndrome. FASEB J 2010; 24:158–72). As the condition results in excess damage on ultraviolet exposure and a high risk of melanoma, as well as nonmelanoma skin cancers, an annual dermatology skin check is required.