bluuebunny/crossref_metadata_2025 huggingface dataset:
CPC05 A case of adult-onset en coup de sabre responsive to abatacept
Authors: Diong Sophie , Wynne Bairbre , McMenamin Mairin
Published: June 2024

En coup de sabre (ECDS) is a rare subtype of linear morphoea, located on the forehead or frontoparietal scalp. It is typically seen in children, with < 100 cases of adult-onset ECDS reported. The name derives from the characteristic scar that indents the skin and underlying structures. It can involve the dermis, subcutaneous tissue, muscle, bone and underlying structures, with resulting extracutaneous manifestations including neurological, ocular and oral complications. A 70-year-old female patient presented with a progressive, year-long history of forehead linear atrophy and induration manifesting along a decade-long vertical rhytid. Examination revealed a right paramedian linear atrophic depression with a violaceous rim. This extended posteriorly into her frontal scalp, with associated linear cicatricial alopecia, and inferiorly towards her orbital rim. Histopathology highlighted scarring alongside lymphocytic inflammation and focal subtle vacuolar interface change. Given both the clinical and pathological features, a diagnosis of ECDS was made. Magnetic resonance imaging of her brain revealed no skeletal or parenchymal abnormalities. Ophthalmology examination was normal. Given a history of progression, and the clinical appearance of active disease, immunosuppressive therapy was warranted. Abatacept 125 mg subcutaneously weekly was chosen over methotrexate given the presence of comorbid liver disease. An 8-month course was completed, improving the appearance of the lesion. No further activity has been noted 1 year off treatment. ECDS is a chronic autoimmune fibrosing condition of the skin and underlying tissue with the potential for significant disease-associated morbidity. There is currently no universal diagnostic test for ECDS and no pathological marker that correlates with disease activity. Histology often highlights a perivascular and periappendageal lymphocytic infiltrate, with vacuolar interface changes. All patients should undergo brain imaging to determine the extent of disease. While its aetiopathogenesis remains unknown, there is evidence to suggest that the early inflammatory stages are driven by the T helper (Th)1/Th17 pathway, while the Th2 pathway may be responsible for the fibrosis and damage observed later in the disease. This concept underpins the efficacy seen with abatacept, which inhibits T-lymphocyte activation. Abatacept is a lesser-recognized but important therapeutic option in our armamentarium for managing ECDS. Studies have shown a latency period of > 2 years between symptom onset and diagnosis, likely due to the rarity of this condition and reduced knowledge of adult-onset ECDS. Given the cutaneous and extracutaneous manifestation of this condition, this can have disastrous consequences. Increased awareness of adult-onset ECDS is important to allow for prompt diagnosis, investigation and management.
P012 A delayed diagnosis of neurofibromatosis type 1 during pregnancy
Authors: Dyer Alice , Papadakou Elena , Shah Anjnee
Published: June 2024

Neurofibromatosis type 1 (NF1) is a multisystem autosomal dominant disorder with a prevalence of 1 in 3500 live births. It is caused by mutation of a tumour suppressor gene NF1, located in the long arm of chromosome 17 (17q11.2). There is a 1 : 1 ratio for spontaneous vs. inherited mutations. Mutations resulting in the loss of function of neurofibromin leave cells susceptible to uncontrolled proliferation via overstimulation of protein kinase pathways by unchecked Ras proteins. The common cutaneous manifestations of NF1 – café au lait macules, neurofibromas and intertriginous freckling, appear in most patients by the age of 20 years. Neurofibromas typically first appear during puberty, resulting in questions regarding the role of steroid hormones. To support the hypothesis that steroid hormones contribute to neurofibroma development, we present a new diagnosis of NF1 following the eruption of neurofibromas in a 32-year-old woman during her first trimester of pregnancy. A patient presented in the third trimester of her first pregnancy, with a long history of four unchanged cutaneous papules affecting the right breast. During the first trimester these had increased in number, size and extent of distribution. The patient had no previous history of skin abnormalities, scoliosis, malignancy or developmental delay. There was no family history of NF1. Examination revealed over 50 skin-coloured papules in a segmental distribution involving the entire right arm, right chest and right thigh, as well as five café au lait macules involving the trunk. Histological analysis confirmed neurofibromas, supporting the NF1 clinical diagnosis, which was positive on genetic testing. The pregnancy progressed uneventfully. The patient’s mother subsequently tested positive for NF1 mutation without having any symptoms or signs. In vitro studies have demonstrated that up to 86% of cutaneous neurofibromas possess progesterone receptors; they have also found high levels of heterogeneity when examining the proliferation of NF1 cell cultures in response to steroid hormones. It is unclear why levels of steroid hormones at birth or during puberty are enough to trigger formation of neurofibromas in some patients but not others. This represents an important area for research regarding whether further tumour factors, such as epigenetics, may alter the response to environmental and genetic triggers. Consideration of NF1 as a diagnosis in people of all ages is essential, particularly in view of the increased risks it presents during pregnancy. Patients with NF1 are more likely to develop gestational hypertension, pre-eclampsia and intrauterine growth restriction. Appropriate prenatal counselling and imaging for detection of spinal soft tissue tumours prior to epidural use are additional important aspects of patient management. These were not possible for our patient due to her late diagnosis.
P020 Lentigo maligna: a vanishing act
Authors: Murphy Lisa , Hackett Caitriona
Published: June 2024

The abscopal effect is a phenomenon seen in the treatment of metastatic cancer, whereby the treatment of a tumour with radiotherapy results in the shrinkage of another tumour elsewhere in the body. We report the case of a biopsy-proven lentigo maligna that self-resolved in the setting of radiotherapy for a preceding malignant melanoma on the left chest. Our patient was a 57-year-old man who was originally referred to the clinic with a lesion on his left chest wall. His history was significant for sun exposure, as he had previously worked in the army, and had completed numerous army tours in Lebanon. He was reviewed in clinic, and the lesion was deemed clinically suspicious for melanoma. He was diagnosed with a superficial spreading malignant melanoma on his left chest wall in March 2019 (Breslow thickness 3.6 mm). Wide local excision was negative. A sentinel lymph node biopsy was also performed and this was positive (T3N1M0). He proceeded to have an axillary lymph node dissection. He completed 20 fractions of radiotherapy to his left axillary region in May 2021 and he was commenced on pembrolizumab with the oncology team in July 2021. On routine surveillance review in January 2022, he was noted to have an irregular-shaped lentigo on his right infraorbital cheek. Pigment clods and rhomboidal structures were seen, suggestive of lentigo maligna. An incisional biopsy was arranged, and histology was consistent with a lentigo maligna. He was referred to have this lesion excised. A mapping biopsy was performed in June 2022, and this did not show any evidence of lentigo maligna. He completed his immunotherapy treatment with pembrolizumab in May 2022. At a further follow-up review, the pigmented lesion was no longer clinically evident. It was agreed that an excisional biopsy should be performed to assess for any histological evidence of lentigo maligna. Once more there was no further evidence seen of lentigo maligna on histology. He was reviewed in clinic subsequent to this again, and the site was clear. It is our hypothesis that the lentigo maligna may have resolved due to the abscopal effect, as a result of his radiation treatment for the melanoma on his chest. We suspect that this response would also have been primed by the immunotherapeutic agent pembrolizumab, to help mediate this antitumour response.
P021 The diagnosis and management of pemphigus vegetans in pregnancy
Authors: Clancy Cornelius , Hussain Fawad , Pappa Elena
Published: June 2024

A 31-year-old woman, 16 weeks pregnant at presentation and with no prior medical history, presented to hospital with 2 months of progressive vegetative plaques of the perioral and nasal mucosa, and genital pruritus. After review by medical teams and initiation of treatment for pelvic inflammatory disease, her genital pruritus resolved. However, the patient re-presented to the emergency department 1 week later due to persistence of her facial lesions. Initial diagnoses considered included exuberant granulation tissue in response to infection, nasal papilloma prolapse, pyodermatitis–­pyostomatitis vegetans, and pemphigus vegetans. Due to concerns of facial disfigurement, a biopsy from the lower lip was completed. This revealed mild acantholysis, further confirmed by direct immunofluorescence, with intercellular deposition of IgG and C3 within the intraepidermal space, consistent with a diagnosis of pemphigus vegetans [Messersmith L, Krauland K. Pemphigus vegetans. In: StatPearls. Available at: https://www.ncbi.nlm.nih.gov/books/NBK545229 (last accessed 1 February 2024)]. Published case reports of pemphigus vegetans treatments were reviewed and the options discussed with the patient. Systemic treatment was declined due to associated risks with pregnancy, and instead topical management was initiated with a trial of triamcinolone injections over the course of several months, which significantly improved the patient’s physical appearance. Systemic treatment was initiated postpartum with oral corticosteroids, allowing disease remission with ongoing patient follow-up. This case highlights the diagnostic challenge in diagnosing rare conditions such as pemphigus vegetans in pregnancy, treating severe immunobullous disease during pregnancy, and the psychological impact of immunobullous disease.
P025 Community lesion imaging clinics for tele-triage of suspected skin cancer: implementation of a low-cost model in an NHS trust
Authors: Morgan Hannah , Greenish Huw , Shirwac Hafsa Faarax , Fleming Colin , Anderson Alexander D G
Published: June 2024

Across the NHS there has been a significant and sustained rise in referrals for suspected skin cancer, resulting in a capacity crisis in many NHS trusts. Teledermatology has been successfully used to triage suspected skin cancer referrals nationally, but often involves dedicated medical photographers and expensive equipment. The aim of this study was to report the initial results of tele-triage based on a low-cost community imaging lesion clinic (CLIC) service using dermatology staff and readily available equipment. CLICs were provided in a community hospital setting and staffed by band 3 healthcare assistants. A structured questionnaire was completed and data entered directly into a cloud-based software platform (Islacare, London, UK) using an iPad. The same iPad was used to capture a localizing shot, a close-up macro shot using a readily available clip-on macro lens and a dermoscopic image using a Dermlite DL4. Patients under 18 years of age, those referred with more than three lesions, and patients with genital lesions were excluded. Referral letters, questionnaire data and images were reviewed by a senior dermatologist within 48 h on the Isla platform. In total, 438 patients were reviewed (489 lesions) between August and November 2023. The male-to-female ratio was 1.08, with a median age of 72 years (interquartile range 62–80). Overall, 122 of 438 patients (27.9%) were discharged directly from triage, with advice returned to the referrer. An additional 91 of 438 (20.8%) were identified as suitable for direct listing for biopsy or simple excision. Four of 438 (0.9%) were referred to another specialty following triage, one of 438 (0.2%) had a delayed face-to-face assessment organized, one of 438 (0.2%) declined to participate in tele-triage and requested a face-to-face appointment, one of 438 (0.2%) experienced technical problems, and in one of 438 (0.2%) the site for review was not clear. A potential total of 218 of 438 (49.8%) face-to-face assessments were avoided. The average time for clinician review was 2 min 55 s per patient. Tele-triage using a low-cost CLIC was well tolerated, feasible and effective and resulted in a capacity increase of almost 50%. A significant proportion of patients were managed in a community setting without the need for travel to hospital. One further advantage was the creation of a consecutive series of images and metadata suitable for future study of diagnostic artificial intelligence algorithms or submission to a national dataset.
P030 Implementing the Edmonton Obesity Staging System: a cross-sectional study of the prevalence and management of obesity in a systemic therapies clinic
Authors: Tummon Olga , Gill Rebecca , Murphy Michelle
Published: June 2024

Registry studies from the UK and Ireland report the incidence of obesity among patients on systemic treatment for psoriasis as 40%. This is almost double the background population prevalence of obesity in the UK (26%) and Ireland (23%). Patients with higher body mass index (BMI) have poorer responses to systemic therapies. This study aimed to investigate the prevalence and management of obesity among consecutive patients attending dermatology systemic clinics. Weight and height were recorded, and a patient questionnaire was distributed. Patients identified as living with obesity were classified using the Edmonton Obesity Staging System (EOSS). The EOSS categorizes patients living with obesity into five stages based not solely on BMI but on the presence of obesity-related comorbidities; studies have shown the staging system correlates with clinical outcomes. The study included 113 participants. The median age was 49 years (range 19–79), and 57% (64) of participants were female. The most common diagnosis was psoriasis (77%, 88), followed by atopic dermatitis (16%, 19) and hidradenitis suppurativa (HS) (0.4%, five). Defining a BMI of ≥ 25 kg m−2 as overweight and ≥ 30 kg m−2 as obese, 38% (43) of patients were overweight and 45% (51) were living with obesity. The mean BMI was 31.4 kg m−2, with an SD of 7.3 (range 19.4–53.5). The mean BMI in patients with psoriasis was 31 kg m−2, with eczema 28 kg m−2 and HS 41 kg m−2. Of those living with obesity, 31% (16) fulfilled the requirements for EOSS stage 3, and 32% (37) met the criteria for EOSS stage 2. Hypertension at 31% (36) and mental health issues related to weight at 33% (38) were the two most common self-reported comorbidities. In total, 23% (26) of patients were being prescribed a biologic agent at an increased dose or frequency, and 92% (24) of these patients were either overweight or obese, reflecting the challenges of treating this patient cohort. Overall, 80% (41) of patients in the study classified as living with obesity expressed an interest in accessing medical management for their obesity, while 10% (n = 9) reported that a doctor had discussed obesity management options with them. This is the first study to implement an obesity staging system to examine patients with dermatological diagnoses. The results show that our patients on systemic therapies do not simply have high BMIs but also have physical and psychological consequences. New medical options for the management of obesity have the potential to help many of our patients and, in turn, improve their coexisting dermatological diseases. The EOSS is a valuable tool in time-poor environments to assess obesity and facilitate discussion of management options.
P033 Do suspected cancer pathway referrals to dermatology meet the NICE criteria for referral?
Authors: O’Neill Harriet , Sharma Maulina , Shahidullah Hossain
Published: June 2024

Suspected cancer pathway referrals to dermatology are increasing to an extent that is overwhelming services, yet only 6% of these receive a diagnosis of melanoma or squamous cell carcinoma [Cancer Waiting Times (CWT) urgent suspected cancer referrals: referral, conversion and detection rates. Available at: https://www.cancerdata.nhs.uk/cwt_conversion_and_detection (last accessed 5 February 2024)]. There is an urgent need to identify factors that might reduce inappropriate referrals and improve this conversion rate. We analysed 100 urgent suspected skin cancer referrals from primary care, received consecutively from 1 October. Data were extracted for referring healthcare practitioner, suspected diagnosis and whether the referral was judged to meet the NICE criteria for referral of suspected skin cancers. Only 68% (n = 68) of referrals met the NICE referral criteria for urgent suspected skin cancer. In total, 97% (n = 31) of the referrals that did not meet these criteria had an eventual diagnosis of a benign lesion or nonsignificant basal cell carcinoma (BCC); one referral judged inappropriate had the clinical outcome of a BCC on the nasal tip, which would have met the NICE criteria. Overall, 17% (n = 17) of referrals came from non-general practitioners (GPs) such as physician associates or advanced nurse practitioners. These referrals were less likely to be judged to meet the NICE referral criteria than those from GPs: 41% (n = 7) of non-GP referrals were deemed appropriate vs. 73% (n = 61) of referrals from GPs. Adherence to the NICE criteria for referring suspected skin cancers to dermatology is disappointing. Crucially, less than half of referrals from non-GPs met these criteria, compared with nearly three-quarters of those from qualified GPs. This raises the case for only accepting referrals for suspected skin cancer from qualified GPs. Our evidence suggests that such a stance could potentially lead to a 5% reduction in referrals overall. It is also significant that not one of the referrals deemed to be inappropriate on paper led to an eventual diagnosis of melanoma or squamous cell carcinoma. This suggests that triaging referrals at the pre-appointment stage with the option of querying or even rejecting referrals that do not meet NICE criteria would be low risk. This could potentially reduce urgent suspected skin cancer referrals by 32%.
P069 Familial malignant melanoma: CDKN2A mutation-positive family tree
Authors: Winter Sarah , Ashton Sally , Davies Hannah , Mughal Avad
Published: June 2024

The most common cause of inherited melanoma is mutations in the CDKN2A gene, which is a gene regulator of cell division. The risk of melanoma in carriers of this gene is 30% by 50 years and 67% by 80 years (Goldstein AM, Fraser MC, Struewing JP et al. Increased risk of pancreatic cancer in melanoma-prone kindreds with p16INK4 mutations. N Engl J Med 1995; 333: 970–5). Fortunately, germline mutation in the CDKN2A gene is believed to be rare in the population (Harland M, Cust AE, Badenas C et al. Prevalence and predictors of germline CDKN2A mutations for melanoma cases from Australia, Spain and the United Kingdom. Hered Cancer Clin Pract 2014; 12: 20). Those positive with the CDKN2A gene have associated risks of developing other malignancies such as lung, breast, brain and, in particular, pancreatic carcinoma. Pancreatic cancer is associated with smoking and alcohol-induced pancreatitis. To the best of our knowledge no study has mapped out an extensive CDKN2A mutation-positive family tree including second-degree relatives. We have mapped a family tree including first- and second-degree relatives, stemming from our index patient. She was the first in her family to be diagnosed with malignant melanoma, at the age of 33 years. She tested positive for the CDKN2A gene mutation, BRAF wildtype. Our patient had 10 first-degree relatives. To date, four of these relatives have been diagnosed with malignant melanoma. Her son was diagnosed with malignant melanoma at the age of 12 years and was also found to be positive for the CDKN2A mutation. Four of her other first-degree relatives have been diagnosed with other malignancies: lung adenocarcinoma, squamous cell carcinoma, breast cancer and chordoma. No diagnosis of pancreatic carcinoma has been made in a first-degree relative. There are 21 second-degree relatives, with only one confirmed malignant melanoma. Not all family members have been tested for the CDKN2A mutation, and confounding factors include lifestyle and sun exposure. However, this family tree clearly shows the spread of the condition through a family, with the mutation present in a non-Mendelian pattern. More cohorts need to be collected to accurately predict the risk of malignancy and correction of preventable factors. Being genetically tested for the CDKN2A mutation is beneficial for patients and their families as appropriate counselling can be provided. Patients would be better informed in continued skin self-examination, sun protection and risk of other malignancies.
P070 The epidemiology of skin cancer in Greater Manchester 2017–22: a retrospective cohort study using primary care records
Authors: Lai Lana Y H , Sim Ben W M , Farragher Tracey , McMillan Brian , McMullen Emma , Venables Zoe C , Yiu Zenas Z N
Published: June 2024

Skin cancer is the commonest cancer in the UK, with increasing incidence, creating a significant workload for dermatology departments. Greater Manchester is one of the most populous areas in the UK, and understanding the regional skin cancer trends is vital for healthcare service planning and public health interventions. The Greater Manchester Care Record (GMCR) holds data from 99.5% of general practices on > 3 million registered patients (Watkinson RE, Williams R, Gillibrand S et al. Ethnic inequalities in COVID-19 vaccine uptake and comparison to seasonal influenza vaccine uptake in Greater Manchester, UK: a cohort study. PLOS Med 2022; 19: e1003932). It was approved for research access for COVID-19 response analysis, which allowed this opportunity to understand the epidemiology of skin cancer in Greater Manchester. This retrospective observational cohort study of the GMCR included cases of basal cell carcinoma (BCC), cutaneous squamous cell carcinoma (cSCC) and malignant melanoma (MM) registered between January 2017 and December 2022. We calculated the crude incidence rate (IR) per 100 000 person-years by skin cancer type, age group and sex. To avoid duplication, we restricted cases to a timeframe of at least 2 weeks before a subsequent case was counted, based on expert advice and review of the data. The denominator was the summation of 1 year of follow-up for each registered patient as of December each year. We compared the IR from GMCR to the national cancer registry IR from the ‘Get Data Out’ skin initiative. We identified 42 370 cases of BCC, 7503 cSCC and 7924 MM between 2017 and 2022, with respective median (interquartile range) ages at diagnosis of 73.3 years (62.3–80.9), 73.6 years (62.2–81.9) and 62.0 years (49.1–73.8); the majority (> 87%) of the population was White. The IR ranged from the lowest at 185, 44 and 36 per 100 000 person-years in 2020 (coinciding with the early stages of the pandemic) to the highest at 265 (2022), 35 (2019) and 54 (2022) per 100 000 person-years for BCC, cSCC and MM, respectively. The incidence rate ratios (95% confidence interval) for 2020 vs. 2019 were 0.79 (0.76–0.81), 0.98 (0.91–1.06) and 0.87 (0.80–0.94) for BCC, cSCC and MM, respectively. The male-to-female ratio was around 1 for BCC and cSCC until age 70 years, after which there was an increasing male preponderance, while for MM the same divergence started at age 50 years. We report lower IRs for both BCC and cSCC compared with England, and a higher IR for MM. We present the epidemiology of skin cancer in Greater Manchester from a novel primary care dataset, showing reductions in IR during 2020 of 21%, 2% and 13% for BCC, cSCC and MM, respectively. We report a lower than expected IR of cSCC, which is a likely underestimate and requires further investigation.
P075 A retrospective review of isotretinoin treatment-related psychosexual health side-effects in a tertiary dermatology clinic
Authors: Mitsaki Kyriaki Stefania , Chawla Sumir , Merika Eirini
Published: June 2024

Isotretinoin is the gold-standard treatment for severe acne. Growing concerns about its association with psychiatric and sexual side-effects have led to the introduction of new monitoring requirements by the Medicines and Healthcare products Regulatory Agency. Herein we present pivotal real-world data on treatment-related psychosexual side-effects. The primary aim of this review was to evaluate mental health outcomes in terms of depressive symptoms and quality of life in patients treated with isotretinoin. Our secondary endpoint was to evaluate the effect of isotretinoin on sexual function. We conducted a retrospective cohort study of 167 consecutive patients who completed treatment with isotretinoin for acne vulgaris between 1 November 2019 and 31 October 2023. Patient Health Questionnaire-9 (PHQ-9) scores, Cardiff Acne Disability Index (CADI) scores and subjective symptom reports were collected at baseline and each follow-up until completion of treatment. We compared data on baseline characteristics, clinical and biochemical side-­effects and dosing regimens for patients who met the criteria for moderate or severe depression vs. those with mild or no depressive symptoms. Mean PHQ-9 and CADI scores improved significantly following isotretinoin completion compared with baseline (P < 0.05). Twenty patients (12.0%) met the criteria for moderate or severe depression at baseline. Of these, five patients were on antidepressive therapy and two patients experienced worsening of symptoms on isotretinoin. In total 11 patients (6.5%) met the criteria for moderate or severe depression at the final follow-up; nine of these had reported no or mild depressive symptoms at baseline. Logistic regression analysis did not identify potential risk factors for psychiatric adverse effects with isotretinoin, including no correlation with the average daily or total cumulative dose. We report no cases of suicidal ideation, suicide or erectile dysfunction. A single case of low libido was noted; however, symptoms were mild and did not warrant discontinuation of treatment. The mean follow-up duration after discontinuation of treatment was 209 days. Our analysis did not identify an association of isotretinoin with new-onset depressive symptoms or sexual dysfunction above the background prevalence. The findings support an overall favourable risk profile of isotretinoin at the population level, but the possibility of rare, idiosyncratic adverse events cannot be excluded.
P085 Efficacy and safety of 611 for the treatment of moderate-to-severe atopic dermatitis in adults
Authors: Zhang Jianzhong , Zhao Yan , Zhou Qinghong , Xu Yuyu
Published: June 2024

Atopic dermatitis (AD) is a chronic, recurring, inflammatory skin disease characterized by extensive rashes on the body, leading to symptoms such as persistent itching and exudation. There is still a need for safe and effective therapies to improve disease management for uncontrolled moderate-to-severe AD, as current treatments may not adequately control the disease. 611 is a novel monoclonal antibody that targets interleukin (IL)-4Rα. It can selectively bind to IL-4Rα, thereby obstructing the signalling pathways of both IL-4 and IL-13. This action aids in modulating immune function, offering potential relief for conditions such as AD and other related diseases. In this phase II study, the safety and efficacy of 611 was investigated in moderate-to-severe AD in adult patients. In total 93 patients were randomly assigned to three groups: group A received a loading dose of 600 mg of 611 followed by 300 mg every 2 weeks (Q2W), group B received a loading dose of 600 mg of 611 followed by 300 mg every 4 weeks (Q4W), and there was also a placebo group. The primary efficacy endpoint was the proportion of patients with Eczema Area and Severity Index (EASI) 75 response (≥ 75% reduction in score from baseline) at week 16. The results showed positive responses in primary and all secondary endpoints in adult patients with moderate-to-severe AD after treatment with 611. There was a significant difference between 611 and placebo in EASI 75 improvement, with a 60.0% response rate for 611 compared with 15.6% for placebo (P < 0.001). The percentage of patients achieving IGA 0/1 (Investigator’s Global Assessment score of 0 or 1, and ≥ 2-point reduction from baseline) also exhibited a significant difference in the groups receiving 611 or placebo, with rates of 35.5% and 9.4%, respectively (P < 0.05). The other endpoints, including EASI 90, EASI 50, and numerical rating scale reduction by ≥ 4 points, improved more in the groups receiving 611 than for placebo. Regarding safety data in the trial, treatment with 611 showed results comparable with placebo. 611 showed a positive effect in treatment of patients with moderate-to-severe AD in terms of efficacy and safety. 611 has potentially become a promising treatment product targeting IL-4Rα, following on from dupilumab.
P101 Sustained improvement in atopic dermatitis disease control and treatment satisfaction with dupilumab in clinical practice: 4-year follow-up results from the RELIEVE-AD study
Authors: Wang Zhixiao , Yang Min , Chao Jingdong , Martins Bruno , Chuang Chien-Chia , Shumel Brad , Sierka Debra , Carboni Margaret , Strober Bruce
Published: June 2024

Although atopic dermatitis (AD) typically affects children, it can persist into or start during adulthood. In the RELIEVE-AD study, which included adults with moderate-to-severe AD who initiated dupilumab in real-world clinical practice, results up to 3 years showed significant, sustained improvements in disease control, flares, skin symptoms, sleep, quality of life, and treatment satisfaction. We now report 4-year disease control, treatment satisfaction, and concomitant medication results from RELIEVE-AD. RELIEVE-AD is a single-arm, prospective, longitudinal patient survey study of adults with moderate-to-severe AD who were prescribed dupilumab, enrolled in the US dupilumab patient support programme. The patients had agreed to participate in online surveys at baseline and months 1, 2, 3, 6, 9, 12, 33–36 and 48. The outcomes presented here are (i) disease control [assessed by the six-item Atopic Dermatitis Control Tool (ADCT), with total score ranging from 0 to 24, with higher scores indicating less control, and score < 7 indicating controlled disease]; (ii) treatment satisfaction (seven-point Likert scale from ‘extremely satisfied’ to ‘extremely dissatisfied’) and (iii) reported days with no intense episodes of itching. Statistical significance was determined using generalized estimating equations to account for correlated data from the same patients. Among 698 patients who completed the baseline survey and started dupilumab, 353 (50.6%) completed the month 48 survey. At baseline, the mean age was 46.2 years, 61.7% were female, and common comorbidities included nonseasonal allergies (36.0%) and asthma (32.2%). The mean total ADCT score was significantly lower (P < 0.001) at all post-treatment initiation timepoints, decreasing from 15.8 at baseline to 3.7 at month 48. The proportion of patients with an ADCT total score < 7, indicating controlled disease, increased from 5.9% at baseline to 61.0% at month 1, then 77.4%, 80.7% and 80.5% at months 12, 33 and 48, respectively (all P < 0.001). The percentage of patients reporting no intense episodes of itching over the last week (0 days) increased from 3.2% at baseline to 61.2% at month 48 (P < 0.001). Patient satisfaction with AD treatments improved over time, with 84.9% of patients satisfied at month 48 (P < 0.001 for all timepoints during follow-up vs. baseline). A large majority of survey respondents at 4 years reported controlled disease, as well as fewer episodes of itching, and were very or extremely satisfied with their AD treatments. This research was sponsored by Sanofi and Regeneron Pharmaceuticals Inc. Medical writing and editorial assistance were provided by Rebecca Czolk, PhD, of Excerpta Medica, funded by Sanofi and Regeneron Pharmaceuticals Inc., according to the Good Publication Practice guideline.
P113 Ocular involvement and care provision in children with epidermolysis bullosa
Authors: Shatskikh Marina , Browne Fiona
Published: June 2024

Epidermolysis bullosa (EB) is a group of skin fragility conditions that result from defects in connective tissue proteins. Classification is based on the level of skin cleavage, with four major subtypes (Has C, Bauer JW, Bodemer C et al. Consensus reclassification of inherited epidermolysis bullosa and other disorders with skin fragility. Br J Dermatol 2020; 183: 614–27). Skin fragility is a cardinal feature of EB but mucosal involvement is highly variable depending on subtype. There are limited data evaluating ocular mani­festations of EB, associated management and related outcomes. The aim of this study was to assess ocular manifestations among children with EB attending the National EB Clinic and to compare management against current best practices [Chen VM. Eye care for EB patients: strategies to prevent blistering, scarring and vision loss. Lecture at the DEBRA Care Conference, 2018. Available at: https://www.debra.org/eb-care-tips/eye-care (last accessed 19 February 2024)]. This would provide a better understanding of patients’ needs, helping to identify gaps in care and develop strategies to support patients in obtaining care. We carried out a retrospective chart review, correlating patients’ genotype, phenotype, ocular symptoms and management of the same (access to ophthalmology and treatment adherence). Additionally we circulated a postal questionnaire to patients and carers. Records of 69 patients (52% female) aged 10 months to 22 years were reviewed. The average age at diagnosis was 1.7 years. Overall, 51% had EB simplex (EBS), 19% dominant dystrophic EB (DDEB), 17% recessive dystrophic EB (RDEB), 10% junctional EB (JEB) and 3% Kindler syndrome. In total, 38% of all patients had ocular involvement. Those most commonly affected had RDEB (35%) or JEB (23%). Patients with EBS (31%), DDEB (8%) and Kindler syndrome (4%) presented with mild ocular concerns including itch (27%), dryness (42%) or sticky eyes (27%). More severe ocular involvement presented as redness (12%), pain (19%), inability to open the eye (15%), excessive tearing (15%), blepharitis (8%), conjunctival or corneal erosions, ulcerations or scarring (27%), trichiasis (4%), astigmatism (4%), amblyopia (8%) and/or vision loss (35%), necessitating regular ophthalmology review. Only 36% of patients were referred to ophthalmology, either at diagnosis or at onset of symptoms. Of those, 16% attended annually, with follow-up for others generally limited to ‘as required’. Our results highlight gaps in care. Only a small proportion of patients are engaged with ophthalmology services; over 60% have never been formally assessed. Given the variability in the presentation and severity of eye disease, prompt ophthalmology review at the time of diagnosis is vital to manage symptoms and minimize long-term damage. A personalized approach to management is key to ensure that patients’ unique needs are met and outcomes improved.
BC01 Evaluation of effectiveness of fractional ablative CO2 laser and triple combination cream in the treatment of melasma: a randomized controlled study
Authors: Verma Kaushal , Patel Utpal , Bhari Neetu , Sethuraman G
Published: June 2024

Melasma is a common pigmentary disorder causing considerable cosmetic disfigurement and psychological distress. Treatment of melasma remains a challenge despite the availability of several therapeutic agents, due to its refractory and recurrent nature. Triple combination cream (TCC) consisting of hydroquinone (4%), tretinoin (0.05%) and fluocinolone acetonide (0.01%) is considered to be the first-line therapy for melasma. Ablative fractional lasers have been reported to be effective. We evaluated the effectiveness and safety of fractional ablative CO2 and TCC in melasma in a split-face randomized control study. Clinically diagnosed adult patients with symmetrical melasma were included in the study and were randomized to receive either fractional CO2 laser, once every 4 weeks plus TCC (group A), or TCC alone (group B) to either side of the face once daily for 12 weeks. The patients were evaluated every 4 weeks to determine treatment response and adverse effects, and were followed for another 12 weeks to determine relapse. There were 54 patients (19 male and 35 female; mean age 33.0 years, SD 7.7; age range 21–57 years). They had melasma for 0.5–15 years (mean duration 5.7 years, SD 3.5). Following treatment, the mean melanin index and modified Melasma Area and Severity Index (mMASI) scores decreased in both groups. The mean (SD) melanin index decreased from 46.5 (5.2) to 43.7 (5.6), P < 0.001, in group A, and from 47.0 (5.5) to 44.3 (5.5), P < 0.001, in group B. The mean (SD) mMASI decreased from 4.4 (1.8) to 2.8 (1.6), P < 0.001, in group A, and from 4.4 (1.9) to 3.2 (1.7), P < 0.001, in group B. The changes were statistically significant, but were comparable between the two groups (P = 0.47 and P = 0.20, respectively). However, improvement in Physician’s Global Assessment (PGA) was superior in group A vs. group B (60.8% vs. 39.1%, P < 0.001. Also, the mean (SD) patient self-assessment scores were 5.9 (2.0) and 4.6 (2.0) in group A and group B, respectively (P < 0.001) showing a better response in group A. There were no significant adverse effects. However, 67% of patients (34 of 51) had a relapse, with gradual increases in MI, mMASI, PGA and patient self-assessment scores in both groups during post-treatment follow-up. Therefore, the study has shown that fractional CO2 laser offers modest additional benefit and is safe in the treatment of melasma. Hence, further studies are required.
BC07 Hair oiling: a paradigm shift in the deep-rooted ritual from East to West
Authors: Hussain Fabliha , Dubash Faisal
Published: June 2024

For centuries, generations of African and South Asian women have continued the cultural practice of hair oiling. Pure coconut, castor, amla and argan oils have been used, typically as a prewash ritual. While there is limited clinical evidence on the role of hair oils in trichology, they remain both accessible and inexpensive with a relatively minimal risk profile. The continual rise of globalization and social media, and increased self-care awareness, are factors that have driven their popularity in recent years. The demonstrable shift in mainstream appeal for hair oiling in the West is evidenced by a surge in Google searches for hair oil routines, the emergence of trending social media hashtags such as #HairSlugging, and frequent features by popular media outlets such as Vogue and Grazia magazines. Deeply negative perceptions of the practice, previously held in the West, have undergone an unanticipated U-turn. As the cosmeceutical industry exploits this opportunity, the long-standing ritual has been repackaged to target the Western consumer. Advancements in manufacturing technology have resulted in the modernization of these ancient remedies, from pure oils and homemade blends of the past to more complex formulations that are lightweight, fragranced and more user-friendly. The now expansive hair oil market and widespread global uptake of the practice warrant clinician awareness and the ability to relay accurate evidence on the hair care practice. Benefits of regular hair oiling that are commonly claimed include treating hair loss, thinning and breakage. Studies have considered factors such as emollient effect, saponification, antimicrobial activity, ultraviolet protection and tensile strength. We reviewed the literature to examine the leading hair oils in current use, their biochemical profiles and potential therapeutic benefits. The results demonstrated that despite a plethora of carrier and essential oils in mainstream use, there is only evidence from a limited number of oils, for specific aspects of hair health. Greater evidence was observed for coconut-based hair oils, which demonstrate a protective role in prewash use, preventing increased hair porosity, providing colour protection and improving tensile strength, but not for hair growth. Randomized controlled trial evidence exists for rosemary oil, showing hair growth in androgenetic alopecia. We propose further comparative research of hair oils to delineate the evidence base for their use. This would help consumers differentiate between commercially labelled pseudoscientific benefits and any actual robust evidence base.
BH06 (P110) Comparative efficacy of low-dose oral minoxidil, topical minoxidil, and platelet-rich plasma with topical minoxidil in androgenetic alopecia: a randomized controlled trial
Authors: Janaani P , Kumaran Sendhil , Vinay K , Mehta Hitaishi , Sharma Vinod Kumar
Published: June 2024

Androgenetic alopecia (AGA) is conventionally managed with topical minoxidil, while platelet-rich plasma (PRP) and oral minoxidil present alternative options. Head-to-head trials are scarce, necessitating a comparative study. This randomized controlled trial aimed to compare the efficacy of low-dose oral minoxidil (2.5 mg once daily), topical minoxidil (5% twice daily), and PRP (four sessions, conducted every 4 weeks) combined with topical minoxidil 5% twice daily in individuals with AGA. Natural regulatory T cells (Tregs; CD4+ CD25high FOXP3+) reside within hair follicles, fostering the proliferation of hair follicular stem cells (HFSCs) through the NOTCH signalling pathway by elevating Jagged1 ligand expression. Additionally, the study explored the impact of these treatments on Treg cell populations – inducible Treg cells (CD4+ CD25low FOXP3+) and natural Treg cells (CD4+ CD25high FOXP3+) – and signalling molecules including cytotoxic T-lymphocyte-associated protein (CTLA)4, NOTCH and Jagged1. In total 66 male participants were randomly assigned to three groups of 22 patients each: oral minoxidil (Group 1), topical minoxidil (Group 2) and PRP with topical minoxidil (Group 3). Clinical and videodermoscopic assessments were conducted every 8 weeks, over 32 weeks. Treg cell populations and signalling molecules were analysed in skin biopsies (n = 5 from each group) obtained at baseline and 32 weeks. At 32 weeks, six (27%) patients each in Group 1 and Group 3, and three (14%) patients in Group 2 showed improvement in the grade of AGA. At 32 weeks, Group 3 significantly surpassed Groups 1 and 2 in increasing terminal hair density (P = 0.03 and P = 0.02, respectively). Group 1 had notably decreased vellus hairs compared with Group 3 (P = 0.02), and no significant difference was seen between Groups 2 and 3 (P = 0.2). Reduction in hair diameter diversity was observed with all three modalities, with earlier responses in Groups 1 and 3 (P < 0.01). A proportionate significant increase in natural Treg cells and a decrease in inducible Treg cells was observed at week 32 compared with baseline, without significant modality-specific differences: Group 1, mean 36.2 (SD 15); Group 2, mean 22 (SD 3.4); Group 3, mean 33.7 (SD 10); P = 0.31. A mean decrease in CTLA4 level and an increase in NOTCH and Jagged1 levels with a weakly negative nonsignificant correlation was observed in all three groups at week 32, with no modality-specific differences. Combining PRP with topical minoxidil achieved superior terminal hair density, while oral minoxidil exhibited an advantage in reducing vellus hair density. The study endorses low-dose oral minoxidil as an alternative to topical use and indicates the benefits of combining oral or topical minoxidil with PRP.
British Society for Cutaneous AllergyOral presentationsCD01 Isobornyl acrylate in nail cosmetics
Authors: Xie Fangyi , Sansom Jane , Sinha Aparna
Published: June 2024

We present two cases of patients with allergic contact dermatitis to acrylates from gel nail kits, containing isobornyl (meth)acrylate (IBA). IBA has been associated with contact allergic dermatitis from medical devices, namely insulin pumps and continuous glucose-monitoring devices. However, it has not previously been reported with nail cosmetics. We examined commercially available nail cosmetics to look for the presence of IBA. We compiled the ingredients of the top 10 search results from four online sources (Amazon, Boots, Look Fantastic, Nail Polish Direct) for ‘gel nails’. We looked for ingredients in the initial website, the official product website and the safety data sheet, or emailed the company where the information was not available. One patient was a 23-year-old woman who was a keen recreational acrylic, gel and press-on nail user, with a 6-year history of a blistering rash in the periungual region and fissuring of the finger pulps. She had positive patch test reactions to multiple acrylates: 2-hydroxyethyl methacrylate (HEMA), 1,4-butanediol dimethacrylate, 1,6-hexanediol diacrylate, triethylene glycol diacrylate, diethylene glycol diacrylate, ethyl methacrylate, ethyl acrylate, methyl methacrylate, 2-hydroxyethyl acrylate and IBA. The second patient was a 45-year-old woman with chronic atopic dermatitis who had recently developed a facial flare after using gel nails. She had positive patch test reactions to diethylene glycol diacrylate, methylisothiazolinone and methylchloroisothiazolinone. Both patients used commercial gel nails containing IBA. Thirty-two of 40 (80%) products were gel nail polishes, and the rest were two each (5%) of gel-like polish, gel nail tips, stick-on gel nails and topcoat. Twenty of 40 (50%) products had no ingredients listed on the commercial website, of which six (30%) had no further information on the official product website or on the initial websites. All products contained at least one acrylate. IBA was in eight of 34 (24%) products, of which four were in the isobornyl methacrylate form. The most common acrylates were acrylate copolymers (17 of 34, 50%), HEMA (13 of 34, 38%), 2-hydroxypropyl acrylate (10 of 34, 29%), di-HEMA trimethylhexyl dicarbamate (6 of 34, 18%), hydroxyethyl acrylate (6 of 34, 18%) and trimethylolpropane triacrylate (5 of 34, 15%). The incidence of acrylate allergic contact dermatitis has risen due to the increasing popularity of salon and nonoccupational use with home ultraviolet light devices to cure monomers. Limitations of the study include only online searches, which may miss common products in salons or stores. We wanted to highlight the presence of IBA in commercially available nail cosmetics, given the recognized cross reactions and cosensitizing potential of acrylates.