bluuebunny/crossref_metadata_2025_split huggingface dataset:
P078 Establishing diagnostic criteria for vulval lichen sclerosus (SHELLS): an international electronic-Delphi consensus study
Authors: Simpson Rosalind , Birchall Mike , Daniels Jane , Gran Sonia , Kirtschig Gudula , Thomas Kim 
Published: June 2024

Abstract
Lichen sclerosus (LS) is a chronic inflammatory condition mainly affecting genital skin. It causes distressing symptoms that impact daily quality of life, results in progressive anatomical changes and has a potential risk of cancer. There is no defined set of diagnostic criteria for vulval LS. As a result, vulval LS is often misdiagnosed and improperly treated. The objectives of this study were to reach international expert consensus on clinical diagnostic criteria for vulval LS. Between March and May 2023, a four-stage electronic-Delphi consensus exercise was conducted. In the first three rounds, participants were asked to rate the importance of a list of clinical criteria. Responses from round one were summarized and presented in rounds two and three, along with additional criteria suggested by participants. Any items that met the definition of consensus as ‘very important/critical’ or ‘not important’ were not voted on again in subsequent rounds. In round four, items that met agreement for ‘important but not critical’ were ranked in order of their importance. Consensus was defined a priori, and all rounds were conducted anonymously. In total 47 participants from 14 countries completed round one, with 42 (89%) retained by round three when consensus was determined. Round four was completed by 36 (77%) participants. Participants completing all four rounds predominantly included healthcare professionals (78%, n = 28) and patient support group representatives (19%, n = 7). In round one, 21 diagnostic features were voted on. Participants suggested an additional 10 features that were subsequently added to the round two survey. After three rounds, consensus was achieved for five diagnostic features: whiteness, itch, changes in anatomy, burying of the clitoral area, and improvement in response to topical steroids. There were also 12 features voted as ‘important but not critical’, and participants subsequently ranked them in the fourth round. Experts have agreed on five critical diagnostic features for vulval LS in adults, and an additional 12 features that may also be important. Future research should assess these features for diagnostic validity through a multicentre diagnostic test accuracy study.
P091 Surgical management of hidradenitis suppurativa: a 12-month review from a tertiary referral centre on the long-term outcomes of surgical intervention for groin, gluteal, perianal and genital disease
Authors: Hughes Sam , Ferrari Linda , Rashid Ellie , Steyn Mia 
Published: June 2024

Abstract
Despite numerous pharmacological advances in the management of hidradenitis suppurativa (HS), achieving adequate disease control remains challenging. This has led to an increased need for surgical intervention. Representing a tertiary referral centre, run in conjunction with a dedicated colorectal surgery team, we aim to highlight our experience of running a multidisciplinary service and the long-term outcomes achieved with surgical management, in conjunction with traditional medical management. Between October 2022 and October 2023, 28 patients underwent surgical debridement for groin, gluteal, perianal or genital disease. A retrospective cross-sectional analysis was then conducted, comparing their Hidradenitis Suppurativa Physician Global Assessment (HSPGA) scores both pre- and postoperatively. We evaluated the role of patient factors such as body mass index (BMI), smoking status, age at disease onset, number of sites involved and associated inflammatory bowel disease (IBD). Moreover, we assessed whether cotherapy with adalimumab, acitretin or dapsone affected the overall outcome. Within the evaluated 12-month timeframe, 28 patients underwent surgical debridement of groin, gluteal, perianal or genital disease. Most were men (68%), most currently or formerly smoked (75%), the mean BMI was 28.5 kg m−2 and an average of 3 individual body sites were affected. Six patients had associated IBD. At the time of surgery, all patients had an HSPGA score of 3 or above, with 86% having Hurley stage 3 disease. In regard to concomitant medical therapies, 13 were taking adalimumab and seven were taking acitretin. Notably, none of our patients had been prescribed long-term antibiotics. Operatively, all patients underwent debridement of complex fistula (two with the addition of a seton suture). In all cases, wounds healed by secondary intention and no skin grafts were performed. At the 4-month postoperative review, 59% of patients had a reduction in their HSPGA severity score (35% by 1 point and 24% by 2 points). There were no hospital readmissions, no documented postoperative complications and no evidence of disease recurrence. Our collaborative approach with colorectal surgery resulted in a significant reduction in disease severity, emphasizing the impactful role of surgical intervention alongside traditional medical management. This underscores the efficacy of our multidisciplinary service in achieving long-term positive outcomes for patients with complex disease.
P095 Ten cases of scabies successfully treated with topical ivermectin
Authors: Oldham Jaimie , Sahota Anshoo , O’Toole Edel , Cunningham Malvina 
Published: June 2024

Abstract
Scabies is an increasing problem in the UK with a surge in cases reported by dermatologists and the media. It is intensely itchy and caused by the highly contagious mite Sarcoptes scabiei. There are many theories regarding the increased prevalence, including hypotheses related to global warming, increased poverty, reduced treatment availability and resistance. The standard treatments in the UK include topical malathion, topical permethrin and oral ivermectin. All have had significant supply issues as reported by the British Association of Dermatologists. There have also been concerns of permethrin resistance. Oral ivermectin is expensive, with four tablets listed at £116.84 in the British National Formulary (BNF). Finally, oral ivermectin is not licensed in children weighing &lt; 15 kg (although data seem to suggest this is safe). One option that is less used but reported is topical ivermectin. This was in the 2018 Cochrane review that assessed the efficacy of topical permethrin, and oral and topical (as 1% lotion) ivermectin. This showed no difference in efficacy and few or mild adverse events. These findings are also replicated in recent studies and there are case reports of topical ivermectin to treat neonatal scabies that seems resistant to permethrin. In our centre, we have used topical ivermectin (as the 10 mg g−1 cream Soolantra) to treat 10 patients, with great success. The first was a 14-month-old child who weighed 9.2 kg. She had previously had three courses of permethrin and two courses of malathion with ongoing signs and symptoms of scabies, including burrows. The entire family had been treated every time and the entire family (except this patient) was treated with oral ivermectin during the final treatment before topical ivermectin. The patient was treated top to toe with two applications of topical ivermectin cream 1 week apart, with resolution after one application. Subsequently we have had success using the same protocol to treat a 21-year-old man (with no response to four courses of permethrin) and his 53-year-old mother (with no response to three courses of permethrin). We have also treated a 31-year-old man, a 48-year-old man and his partner (all of whom had not responded to one course of permethrin), and a 68-year-old man and his family who had no previous treatment. Our patients have not experienced any adverse effects and there have been no treatment failures. We report on 10 patients who we treated successfully with topical ivermectin. Topical ivermectin provides an exciting option for treatment and, of note, one tube is listed at £27.43 in the BNF, making it significantly cheaper than the oral alternative.
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

Abstract
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 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 &lt; 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.
P112 The British Hair and Nail Society present a review of our national grand round of challenging nail conditions and the benefits to the wider British Association of Dermatologists membership
Authors: Sharma Sonia , Fonia Athina , Mowbray Megan , Takwale Anita , Asfour Leila , Laheru Dhruvkumar 
Published: June 2024

Abstract
The British Hair and Nail Society (BHNS) was formed in 2011. We currently have 133 members and invite them to submit challenging cases of nail disorders to our grand round (with relevant history, histopathology and photo- graphs) for review by our expert nail panel. This comprises consultants with nail expertise from around the UK, and together we aim to address the referrers’ queries relating to diagnosis, treatment or both. We appreciate the com- plexity of nail conditions and the limited number of special- ists around the country with an interest in nail conditions. Therefore, we have recently offered the opportunity for all British Association of Dermatologists (BAD) members to submit cases once a year. The aim of our review is to pres- ent the type of complex nail conditions and queries that have been referred to our dedicated national nail conditions grand round and to showcase some of the most educational cases. The nail conditions grand round began in 2018, and since then a total of 21 nail cases (three children and 18 adults) have been submitted from various regions. The main aims of referral included diagnostic expertise (n = 7), aid with treatment plans (n = 3) or both (n = 9). Two cases were referred for help with the need for diagnostic nail biopsy. The median age of patients was 45 years (range 12−77). The cases involved 14 female and 7 male patients. The regions of referral include Gloucestershire, Reading, Cambridge and Scotland. The diagnosis was altered in nine cases (43%). The most common nail condition was psoriasis with nail involvement (n = 4), with the possibility of concurrent condi- tions such as chronic paronychia and subungual keratosis. In one of these cases where the extent of psoriatic nail disease was causing huge psychological burden for the patient, but their Psoriasis Area and Severity Index score was &lt; 10, we supported the application of an individual funding request for biologic therapy. Examples of some of our rare diagnoses include nailbed seborrhoeic keratosis presenting as leucox- anthonychia, and a nailbed myxoid cyst following osteoar- thritic degeneration in distal interphalangeal joints. We hope our presentation showcases to the wider BAD membership the value of our national nail conditions grand round in supporting complex diagnostic and therapeutic decisions, as well as offering support for clinicians in the form of independent funding request submissions or trialling novel therapies, which may have limited evidence. We welcome any future submissions.
BC03 Assessment of atrophic and hypertrophic photoageing in patients with basal cell carcinoma
Authors: Kelly Aine , Mathew Libin , Stefanato Catherine , Ali Faisal , Ayer Jean , Craythorne Emma 
Published: June 2024

Abstract
Two contrasting forms of clinically evident photoageing have been described – hypertrophic and atrophic. Recent studies postulate that hypertrophic photoageing, described as a leathery appearance with coarse wrinkles, may be protective and mitigate skin cancer. Conversely, atrophic skin ageing is described as translucent skin with telangiectasia and skin thinning and is thought to be associated with actinic damage and an increased incidence of skin cancer. Full-face photographs of 102 patients who underwent Mohs surgery for basal cell carcinomas of the cheek during 2018–2023 were selected, and their hypertrophic and atrophic photodamage scored by two dermatologists and a nonmedic independently (score of 0–8, in increasing severity). All histopathology from 102 patients was reviewed. Two of the 102 patients were omitted due to poor-quality slides. Solar elastosis was scored based on the percentage of dermis affected (grade 1 &lt; 50%, grade 2 50–90%, grade 3 100%). Epidermal thickness was measured from an inter-rete ridge region halfway along each specimen. In total, 53% of patients were female and 47% were male; 49% had Fitzpatrick skin type I, 49% type II, and 2% type III. Overall, 89% of patients did not smoke, 9% currently smoked and 2% formerly smoked. Only 3% of patients were immunosuppressed. Five patients (5%) had an atrophic score of 2, 29% of 4, 49% of 6, and 17% of 8. Overall, 22% of patients had a hypertrophic score of 0, 58% of 2, 18% of 4, and 1% of 6. Eighty-eight patients (88%) had a solar elastosis score of 3. Of the patients with severe solar elastosis 70% had an atrophic photoageing score graded as severe (6 or 8). There was no association between sex and atrophic photoageing score. There was an association between solar elastosis grade and atrophic photoageing score. The mean epidermal thickness was lower in patients with a higher atrophic photoageing score (sum of squares 43.6, P = 0.002). The mean epidermal thickness was lower in patients with higher hypertrophic photoageing scores; however, this result was not statistically significant. There was a discrepancy between atrophic scoring and a concordance for hypertrophic scoring between the dermatologist and nonmedical personnel. Epidermal thickness was reduced regardless of sex in both atrophic and hypertrophic photodamaged skin. Most patients in our study had significant solar elastosis in their dermis, although this appeared to be more severe in those with higher atrophic photoageing scores. We postulate that photoageing changes are complex but can be depicted clinically. It is unclear whether dividing patients into atrophic and hypertrophic categories can distinguish histological changes and overall skin cancer risk.
BH08 Evaluating quality-of-life measures for alopecia: a comparative analysis of Dermatology Life Quality Index and Hospital Anxiety and Depression Scale correlations with disease severity
Authors: Lim Chris Puo Nen , Holmes Susan 
Published: June 2024

Abstract
Assessing quality of life (QoL) is crucial in managing patients with alopecia areata (AA), but the optimal health-related quality-of-life (HRQoL) measures remain debated. This uncertainty has been highlighted by recent clinical trials of Janus kinase inhibitors for severe AA, which employed various tools to evaluate the impact of AA and treatment effects on patient QoL. Measures used included generic scores [e.g. Hospital Anxiety and Depression Scale (HADS) and EuroQol (EQ)-5D-5L] and AA-specific scores (e.g. Alopecia Areata Symptom Impact Scale and Skindex-16-AA). Despite the well-recognized psychological impact of severe AA, EQ-5D-5L-based cost-effectiveness models failed to demonstrate significant improvement post-treatment. The current study aimed to evaluate the usefulness of QoL scores [Dermatology Life Quality Index (DLQI) and HADS] routinely collected from patients attending a specialist alopecia clinic. As there is no gold-standard QoL measure for alopecia, we analysed whether there was a correlation between DLQI and HADS, and with clinician-rated disease severity. The influence of psychiatric history and patient age was also assessed. Quantitative data were evaluated using SPSS (version 29.0.1.0; IBM, Armonk, NY, USA) for descriptive and parametric analyses. In total, 179 patients were assessed (17 male, 162 female; age 15–78 years). The results showed moderate positive correlations between DLQI and HADS-D (depression; P &lt; 0.001), DLQI and HADS-A (anxiety; P &lt; 0.001), and DLQI and total HADS (P &lt; 0.001). DLQI correlated positively with clinician-rated disease severity (P = 0.003); however, no association was observed between HADS and clinician-rated disease severity scores. Patients with a pre-existing psychiatric history had higher DLQI (P = 0.03), HADS-D (P &lt; 0.001) and HADS-A scores (P &lt; 0.001). Patients with scarring alopecia tended to have lower DLQI scores, while patients with nonscarring alopecia had higher scores (P &lt; 0.006). There was a statistically significant relationship between DLQI and patients’ ages, with younger patients more likely to have ‘moderate’ or ‘very large’ DLQI (P &lt; 0.004). On the basis of these results, DLQI and HADS correlate moderately; however, only DLQI correlates with clinician-assessed disease severity. Patients with a psychiatric history and nonscarring alopecia tended to have higher scores, and younger patients tended to score more highly using DLQI. The impact of alopecia on patients is often severe; however, the best measure(s) of assessment is unclear. Although it has limitations, DLQI seems to be a reasonable QoL measure for patients with alopecia and correlates with clinician assessment of disease extent. However, further research is required to identify the most useful QoL tools for patients with alopecia, and disease registries will facilitate this work.
BH10 Unequal National Health Service wig provision: toupée or no toupée, that is the question?
Authors: de Brito Marianne , Johnson Amy , Schilling Sue , Asfour Leila , Levell Nick J 
Published: June 2024

Abstract
The psychological impact of alopecia on patients’ quality of life can be significant. Patients may experience loss of confidence, discrimination, social anxiety and other mental health disorders as a result. In the absence of effective and well-tolerated treatments available in the National Health Service (NHS) to treat the underlying cause of the alopecia, wigs can provide an opportunity for patients to live confidently, free of stigma and visible differences. The Alopecia UK Charter for Best Practice for Wigs Provision aimed to support fair and equitable wig provision across the UK, work that was supported by NHS England and NHS Improvement. We investigated wig provision across nonprivate patients in the UK via an online survey. We circulated a three-question, 1-minute survey to dermatology doctors and healthcare professionals seeing nonprivate patients within NHS trusts (England), health boards (Wales and Scotland) or health and social care trusts (Northern Ireland). This was via the Alopecia UK stand at the British Association of Dermatologists (BAD) Annual Meeting 2023, to the circulation of the British Hair and Nail Society membership and events, and via the BAD newsletter. We received 73 responses. Overall, for nonprivate patients with severe alopecia, most reported that wig provision would be straightforward (52%), but a large minority reported variable difficulty, due to patient or other factors (33%), and 5% reported it would be impossible. The remaining 10% did not know. There were respondents from all regions of the UK, with most from England: 59 (Northern Ireland: 2, Scotland: 3, Wales: 7, not stated: 2). The best-represented regions in England were the Midlands (14), the North West (14), North East and Yorkshire (10) and London (9), but there were responses from all regions. There was widespread variation in access to wig provision by different regions. All respondents from Scotland (3 of 3) and the South West (2 of 2) reported wig provision was straightforward, while all respondents from Northern Ireland (2 of 2) reported variable difficulty. At least 50% of the respondents from the East of England, London, Midlands, South East and North West reported wig provision was not straightforward. The findings of this survey reveal widespread variation in ease of access to wig provision throughout different regions of the UK. This demonstrates a lack of equality between patients with alopecia in different regions of the UK and impacts on patient choice. This goes against the Alopecia UK Charter for Best Practice for Wigs Provision. We hope that these findings will have implications at health policy level to improve and standardize access for all patients with alopecia who want and need a wig.