bluuebunny/crossref_metadata_2025_split huggingface dataset:
BG06 Patient perspectives on living with multiple actinic keratoses: a qualitative study
Authors: Drumm Ciara , Moloney Aoife , Moriarty Blaithin , Lally Aoife 
Published: June 2024

Abstract
Actinic keratoses (AKs) are chronic recurrent erythematous scaly lesions that appear most commonly on sun-damaged skin. Although many AKs will regress, up to 16% will progress to cutaneous squamous cell carcinoma. Therefore, field treatment is advised. Due to the long-term recurrence rates with the current available treatments and the need for repeated courses of treatment, there may be a substantial burden on patients. In this qualitative study, we aimed to understand the challenges experienced by patients with multiple AKs. Purposive sampling was used to recruit patients with a history of multiple AKs to two patient focus groups. To facilitate discussion, only 10 patients were invited to attend each focus group. Six patients were able to attend the first focus group and seven the second patient focus group, with circumstances such as personal or family illness resulting in four patients missing the first focus group and three the second. The first focus group was unscripted, unstructured, and conducted by the lead investigator and a cancer specialist nurse. The discussions that arose during the first focus group were then used to guide and structure the second focus group. An interview guide was developed by the lead investigator and reviewed by a consultant dermatologist. The second focus group was semistructured to allow flow of discussion and was conducted by the lead investigator and two specialist nurses. This focus group was audio-recorded with written and informed consent from all participants and then transcribed and analysed using Gioia methodology on NVivo software (version 12; QSR International, Doncaster, Australia). This research adopts constructivist ontological and subjectivist epistemological assumptions, which recognize that patients have unique experiences, values and preferences that should be considered in their treatment choices. Four themes and 16 subthemes were identified through analysis of the transcript. The first theme, physical and emotional impacts, was subdivided into impact on mood, living with uncertainty and recurrence, insecurity and coping mechanisms. The second theme focused on the impact of the COVID-19 pandemic and covered access to care, reduction in functioning and loss of support. The third theme refers to patient support and experience and explored individualized treatment, neglected examination areas, lack of reassurance, awareness campaigns and the benefits of sharing personal experiences. The final theme looked at communication and information through patient empowerment and understanding, individual variations in treatment, accessibility of information, evidence-based information, and the communication gap. The burden and impact of AKs is poorly understood. This qualitative study explores the experiences, concerns and priorities of patients with multiple AKs, and may assist development of shared decision-making pathways for this group.
PA02 A case series of refractory, paediatric atopic dermatitis effectively treated with dupilumab in combination with abrocitinib
Authors: Fong Wei Chern Gavin , Win Kaung Htet Hla , Lopes Rhea , Kanji Alpa , Ravenscroft Jane , Tang Ting Seng , Flohr Carsten 
Published: June 2024

Abstract
A range of systemic treatment options are available for children with atopic dermatitis (AD) who do not respond to standard topical therapy. However, real-world data have revealed a subset of patients who remain significantly affected despite treatment with all of the available topical and systemic therapies, including novel therapeutic agents such as dupilumab and Janus kinase (JAK) inhibitors. To achieve disease control, these individuals may require novel approaches such as utilizing systemic treatments in combination. However, there is insufficient published evidence about the efficacy and safety of this approach. We present three paediatric cases with severe refractory AD who required combined systemic therapy with dupilumab and abrocitinib to achieve adequate disease control and improvement in quality of life. The third patient had coexistent extensive alopecia areata, which also responded well to treatment. These individuals had exhausted all conventional systemic therapies, and had undergone treatment with both dupilumab and abrocitinib individually and in various combinations with methotrexate. However, despite this, they continued to experience inadequate disease control and significant adverse effects. It was only when the combination of dupilumab and abrocitinib was introduced that they finally achieved noticeable and sustained improvements in AD control. The heightened observed efficacy of dupilumab and abrocitinib in combination may be attributed to the inhibition of interleukin-4 and interleukin-13 at two separate stages, at the receptor (dupilumab) and intracellularly (abrocitinib). Furthermore, an additional advantage of this combined regimen is that JAK inhibitors, with their broader mechanism of action, may attenuate cytokines implicated in comorbid diseases such as dupilumab-related eye disease, seen in our first two cases, and alopecia areata in our third case. In conclusion, the concurrent use of dupilumab with abrocitinib represents a potentially effective and tolerated therapeutic approach for children with severe, refractory AD who exhibit inadequate control with other treatments. Larger studies are warranted to ascertain the long-term efficacy and safety of this treatment strategy.
PA11 An indolent course of paediatric primary cutaneous γ/δ T-cell lymphoma
Authors: Deng Pierce , Polcari Ingrid , Miller Daniel 
Published: June 2024

Abstract
A 16-year-old girl with a history of antinuclear antibody (ANA) positivity, Raynaud phenomenon, arthralgias and night sweats presented to our paediatric dermatology clinic for relapsing and remitting tender subcutaneous nodules on the trunk and extremities over the past year. The nodules arise spontaneously within a couple of days and resolve over a few days or up to a month later without overlying skin changes or ulceration. At one time, she had six nodules altogether, but typically she has one to four nodules that come and go every month. Prior rheumatology evaluation had considered systemic lupus erythematosus; however, multiple repeated autoimmune serologies had returned negative, including repeat ANAs, extractable nuclear antigen antibody panels, and DNA double-stranded antibodies. Physical exam at the initial dermatology visit demonstrated a single small deep subcutaneous nodule on the left buttock. Inflammatory panniculitis was suspected and a biopsy was considered, but it was ultimately deferred given that the present nodule was very deep and already resolving. The patient returned to clinic a year later given continued formation of subcutaneous nodules. An incisional punch biopsy from her right flank was performed, which revealed a subcutaneous, predominantly lobular infiltrate of mostly CD3-positive T cells with prominent atypia, high Ki-67 labelling, significant positivity on T-cell receptor δ immunostaining and cytotoxic markers, and a positive T-cell gene rearrangement study. These findings were consistent with primary cutaneous γ/δ T-cell lymphoma (PCGD-TCL). The patient was subsequently referred to haematology and oncology. Peripheral blood smear, positron emission tomography scan, and bone marrow biopsy were reassuring, with no evidence of haemophagocytic syndrome or malignancy. Treatment with methotrexate was initiated and the patient experienced some mild improvement initially; however, the nodules soon returned to the same frequency and intensity as before. Interestingly, she did report resolution of her night sweats since starting methotrexate. Currently, she is seeking additional expert opinions with consideration for a repeat biopsy, as well as second-line therapies such as ciclosporin, mycophenolate or bexarotene. PCGD-TCL is a rare lymphoma of γ/δ T cells that usually presents with generalized subcutaneous nodules or ulceronecrotic plaques, and is classically associated with a poor prognosis. The apparent indolent course in this patient supports the notion that PCGD-TCL may be more heterogeneous than traditionally described, and a subset of PCGD-TCL follows a more indolent course analogous to the α/β phenotype of subcutaneous panniculitis-like T-cell lymphoma. This case also highlights a rare paediatric presentation of PCGD-TCL and the often overlapping clinical and microscopic features of the panniculitic cutaneous lymphomas with lupus panniculitis.
PA12 Fats and figures: how abnormal lipids unravel the truth
Authors: Teoh Yee Ping , Gold Adam , Yesudian Paul D 
Published: June 2024

Abstract
Oral isotretinoin is the most effective treatment for severe acne vulgaris. However, its use may be limited by adverse drug reactions, including hyperlipidaemia. A 22-year-old man with a 2-year history of severe nodulocystic acne involving the face, chest and back was commenced on low-dose prednisolone and isotretinoin. His acne did not respond as expected to the isotretinoin. Baseline screening of lipids, and liver function tests were unremarkable. Lipid monitoring during therapy revealed progressively worsening hyperlipidaemia with a peak low-density lipoprotein cholesterol (LDL-C) of 10.6 mmol L−1 (normal &lt; 3.0 mmol L−1), triglycerides 4.1 mmol L−1 (normal &lt; 2.0 mmol L−1) and reduced high-density lipoprotein cholesterol (HDL-C) of 0.2 mmol L−1 (normal &gt; 1.0 mmol L−1). Biochemists intervened, suspecting possible familial hypercholesterolaemia. On further questioning, the patient admitted to self-administering multiple anabolic steroids and testosterone, as well as consuming high-protein supplements. Laboratory testing revealed markedly elevated testosterone levels, above the laboratory limit &gt; 52 nmol L−1 (normal range 9.0–31.0 nmol L−1). The differential diagnoses for isolated high LDL include familial hypercholesterolaemia and hypothyroidism. However, the combination of very low HDL and high LDL cholesterol suggests secondary aetiologies such as exogenous testosterone or anabolic steroid use in young men. In older individuals, multiple myeloma or haematological cancers can similarly present, although LDL is often normal in cancer. The underlying aetiology of anabolic-steroid-induced lowering of HDL is thought to be mediated via an increase in activity of hepatic triglyceride lipase (HTGL), an enzyme that facilitates catabolism of HDL. HTGL stimulates breakdown of HDL particles, significantly decreasing HDL-C levels. However, the mechanism behind the adverse effect of anabolic steroids on increased LDL-C levels remains to be completely elucidated. Previous case reports reveal that there may be unintentional ingestion of anabolic steroids that have been added to consumer products like whey proteins. Conversely, patients may not disclose substance use without direct questioning. This case highlights important considerations for interpreting and managing abnormal lipid profiles in patients receiving isotretinoin treatment for acne. Unexplained markedly elevated LDL-C, especially accompanied by very low HDL-C, should prompt evaluation of testosterone levels, as it may indicate undisclosed exogenous testosterone or anabolic steroid use.
PA19 The importance of a paediatric biopsy service in dermatology departments: a service evaluation
Authors: Wells Helena , Ramesh Raakhee 
Published: June 2024

Abstract
Access to paediatric skin biopsy services in dermatology departments varies widely. A timely skin biopsy can result in a quicker diagnosis for the family and child and hence swifter management, which is crucial for a paediatric dermatology service to run efficiently. Some services may be reliant upon assistance from other specialists, such as the plastic surgeon, to perform these procedures, which are sometimes preformed unnecessarily under a general anaesthetic. This can complicate the patient pathway, resulting in breaks in continuity of care and delays to investigations. Overall, there is a paucity of published data on skin biopsies in children, particularly on the indications and spectrum of diagnoses. We performed a service evaluation of our paediatric biopsy service at a busy district general hospital, to understand the role and importance of this service. We have a total of four paediatric dermatologists, who have regular clinics and theatre lists. We collected data retrospectively on paediatric biopsies performed between April 2020 and March 2023 (a 35-month period). Nearly all patients attending for a biopsy had clinical images taken. In total 71 biopsies were performed on children during this timeframe. Most patients were aged between 11 and 15 years (61%), with 7% aged 16–18 years, and the remainder aged &lt; 10 years (32%). There was an even sex distribution, with 35 male patients and 36 female patients. A variety of procedures were performed, with punch biopsies (30%) and excision biopsies (24%) being the most common type. Regarding the body site, 17% of procedures were performed on the head and neck, and 8% on the scalp. In total, 41% were performed on the limbs, and 32% on the torso or abdomen. The biopsies were categorized as lesional or inflammatory. Forty-six biopsies (65%) were performed for lesions, of which pyogenic granuloma was the most common cause (15%), alongside spitz naevus (11%). Twenty-five biopsies (35%) were performed for inflammatory conditions, including folliculitis decalvans (1%), ichthyosis (1%), lymphangioma circumscriptum (1%) and confluent and reticulated papillomatosis (1%), alongside many other pathologies. Of lesional biopsies, 37 (80%) had the correct diagnosis listed prior to the procedure and 9 (20%) were incorrect. Of the inflammatory pathologies, 17 (68%) were correct, and 8 (32%) incorrect. This demonstrates the importance of the biopsy in identifying the diagnosis. Our data demonstrate the importance of a paediatric dermatology biopsy service offered at all sites where paediatric dermatology is undertaken, to aid in the diagnosis and management of paediatric patients in a timely fashion.
PA25 Sleep disruption in caregivers of infants with atopic dermatitis
Authors: O’Connor Cathal , O’Halloran Kate , Irvine Alan D , Murray Deirdre , Hourihane Jonathan , Murphy Michelle , Boylan Geraldine 
Published: June 2024

Abstract
Atopic dermatitis (AD) commonly presents in infancy and is characterized by dermatitis, itch and sleep disturbance. The burdens of disease and treatment in AD are very high. Caregivers of infants with AD are loaded with provision of medical care, emotional distress and sleep disruption. The aim of this study was to assess the sleep of parents of infants with AD in the first year of life by comparing them with parents of healthy age-matched control infants, using both quantitative and qualitative measures. Parental sleep and infant sleep were quantitatively assessed using the Pittsburgh Sleep Quality Index and Brief Infant Sleep Questionnaire at 6, 9 and 12 months. Data on infant AD severity and infant itch were collected using the Eczema Area and Severity Index and a numerical rating scale. Detailed interviews were conducted at 12 months with 10 parents of infants with AD. There were 31 cases and 32 controls. Mothers of cases slept less than mothers of control infants at all timepoints: 6.3, 6.8 and 6.7 h at 6, 9 and 12 months (vs. 7.1, 7.3 and 7.5 h). Sleep onset latency was longer for mothers of infants with AD at 6 months (27.1 vs. 12.8 min, P &lt; 0.05) and 12 months (20.8 vs. 12.6 min, P &lt; 0.05). Sleep efficiency was worse for cases at all timepoints. Fathers had longer sleep onset latency and worse sleep efficiency than controls at 9 months. Themes regarding parental sleep disruption included the relationships between AD severity, itch and sleep disruption; bedtime routine; daytime loss of function; impact on parental relationship, infant bonding and family planning; sleep futility; and strategies to cope with sleep disruption. Mothers, but not fathers, of infants with AD experience significant sleep disruption in the first year of life. Factors that affect parental sleep include infant AD severity and itch.
BI19 SCAR: more than just a mark on the skin
Authors: Carroll Emma , Leahy Marion , Dhonncha Eilis Nic 
Published: June 2024

Abstract
Drug-induced hypersensitivity syndrome (DIHS) is a severe and potentially life-threatening condition characterized by a delayed onset of hypersensitivity reactions, occurring days to weeks after exposure to a causative drug in predisposed individuals. Here, we present the case of a 34-year-old female patient with DIHS that demonstrated an uncommon response to initial high-dose immunosuppression. The patient was admitted to hospital with an erythematous, maculopapular rash affecting the abdomen and chest, having undergone three cycles of ipilimumab/nivolumab immunotherapy for pT4a N1 malignant melanoma of the anal canal. The rash rapidly progressed to involve 90% of the body surface area within a matter of days. Concurrently, blood investigations revealed an acute liver injury and thyrotoxicosis. Notably, eosinophil levels were within normal limits. A skin biopsy displayed features consistent with DIHS, including interface dermatitis and basal vacuolar degeneration. Initial management involved intravenous high-dose methylprednisolone and mycophenolate mofetil following guidelines for acute liver injury. However, the patient’s skin deteriorated further and became dusky, despite high-dose immunosuppression. Her liver function also continued to decline. Following discussion with the hepatology unit, it was determined that the patient exhibited an atypical resistance to significant doses of immunosuppression, posing a unique challenge in the management of DIHS. After literature review and discussion with a DIHS specialist, treatment was transitioned to ciclosporin. Remarkably, within days of ciclosporin initiation, the patient demonstrated notable improvement in both cutaneous manifestations and liver function. This case underscores the complexity in managing DIHS, particularly when confronted with an unexpected lack of response to conventional high-dose immunosuppressive regimens. Currently there is a lack of formal clinical guidance regarding the management of complex cases of DIHS. This case highlights the challenges posed to clinicians when faced with such scenarios.
BI23 ‘Not so, my Lord; I am too much i’ the sun.’ Sun protection behaviours and awareness among an immunosuppressed neurology cohort
Authors: McFeely Orla , Tuohy Orla , Griffin Laoise , Yong Ji Fung , Cozman Anita , Durack Alana , O’Connell Michael , Paul Lyndsey 
Published: June 2024

Abstract
The effect of immunomodulatory medications in the development of skin cancer was first reported over 50 years ago in the context of transplant recipients. Immunosuppressant medications used to treat autoimmune conditions, such as inflammatory bowel disease and multiple sclerosis, have been implicated in the development of nonmelanoma skin cancer. While there are reports emphasizing the need for skin cancer awareness among immunosuppressed gastroenterology patients, the same cannot be said of a high-risk neurology cohort. We aimed to explore the sun protection behaviours and knowledge of an outpatient immunosuppressed neurology population. We distributed anonymous questionnaires to patients prescribed immunomodulatory treatments in a dedicated multiple sclerosis clinic. Baseline demographics including sex and age were collected, as well as underlying diagnosis, name and duration of immunosuppressant treatment, history of previous skin cancer and sun protection measures undertaken. Of the patients who were included in this study, the median patient age was 32 years and all patients were female. The median time of prescribed immunosuppressive treatment was 4 years. Half of the patients reported performing self-skin examinations and no patient had undergone healthcare professional skin examinations. All patients reported factor 50 sunscreen use and 33% of patients reported sunscreen application year round. Overall, 66% of patients were uncertain of sinister skin changes to look for. No patient had a prior history of skin cancer. In total, 33% of patients were actively seeking a tan, with a further 33% describing sunbed use. This study highlights that sun protection measures and skin cancer awareness are lacking in this immunosuppressed neurology cohort. Consequently, these patients practise suboptimal sun protection measures. To the authors’ knowledge, this is the first study emphasizing the need for further education regarding safe sun habits among this population.
BI27 New-onset hidradenitis suppurativa secondary to combination therapy with programmed cell death ligand -1 inhibitor atezolizumab and vascular endothelial growth factor inhibitor bevacizumab
Authors: Fagan Nicole , Victory Liana , Pender Emily , Kirby Brian , Alsharqi Ali 
Published: June 2024

Abstract
Hidradenitis suppurativa (HS) is a chronic inflammatory condition characterized by recurrent inflammatory nodules and abscesses thought to develop via follicular occlusion, a disrupted microbiome and subsequent inflammation and follicular rupture. A 50-year-old man with no prior history of skin disease was referred from hepatology with a 3-month history of recurrent inflammatory nodules of the axillae and bilateral groin. He had been diagnosed with advanced metastatic segment II/III hepatocellular carcinoma and portal vein thrombosis on a background of cirrhosis 7 months previously. He received palliative radiotherapy for T12/L1 spinal metastases and endoscopic banding of grade 2 oesophageal varices. Concomitant treatment with the programmed cell death ligand (PDL)-1 inhibitor atezolizumab and bevacizumab, a vascular endothelial growth factor (VEGF) inhibitor, was commenced 1 month postdiagnosis. After 2 months of combination immunotherapy, the patient reported the development of recurrent inflammatory nodules and abscesses. Examination was consistent with HS Hurley stage II. Of note, the patient had no other risk factors for HS including smoking, sex, family history, comorbidities or raised body mass index. Immune checkpoint inhibitors are associated with a myriad of cutaneous toxicities. Anti-PDL-1-induced HS has been described with nivolumab with an upregulation of the interleukin-17 axis postulated as a mechanism [Ayoubi N, Gerhardt AC, Hennessy K et al. Hidradenitis suppurativa secondary to nivolumab. J Am Acad Dermatol 2022; 87 (Suppl.): AB171]. The occurrence of new-onset HS in patients on checkpoint inhibitors supports the concept of HS as a primary inflammatory disease. Cases of HS have also been reported with sunitinib, a VEGF inhibitor (Montero-Vilchez T, Bueno-Rodriguez A, Salvador-Rodriguez L et al. Could vascular endothelial growth factor inhibitors induce hidradenitis suppurativa? Report of three patients with renal cancer treated with sunitinib. Dermatol Ther 2020; 33: e13306). Although the exact culprit drug in this patient’s case cannot be definitively stated, given the effect that HS has on quality of life, the association of HS with both PDL-1 and VEGF inhibition should be noted along with prompt referral to a dermatologist and initiation of appropriate treatment.