bluuebunny/crossref_metadata_2025_split huggingface dataset:
P084 The prevalence of inflammatory back pain in a secondary care psoriasis cohort
Authors: Phillips Alexandra , Eddison Joe , Sinha Aparna , Reilly Elizabeth 
Published: June 2024

Abstract
The articular manifestations of psoriasis are well recognized. While peripheral psoriatic arthritis is the most common form, patients with psoriasis are also more likely to have axial disease either through axial psoriatic arthritis or axial spondyloarthritis. Isolated axial disease may be missed by screening tools such as the Psoriasis Epidemiology Screening Tool (PEST) but can cause significant morbidity. In addition, the average diagnostic delay for axial spondyloarthritis is 8.5 years (Zhao SS, Pittam B, Harrison NL et al. Diagnostic delay in axial spondyloarthritis: a systematic review and meta-analysis. Rheumatology 2021; 60: 1620–8), and its association with psoriasis therefore presents an important screening opportunity within the dermatology clinic. This exploratory survey aimed to establish the prevalence of symptoms of inflammatory back pain (IBP) among a cohort of patients with psoriasis in secondary care to determine the unmet service need. Patients with a diagnosis of psoriasis seen in the dermatology department of a UK secondary care hospital between 1 March 2021 and 12 October 2023 (n = 1529) were identified through electronic clinical noting. Patients who had a mobile phone number recorded (n = 1516) received a text message inviting them to complete the National Axial Spondyloarthritis Society screening survey for IBP. The link remained open for 3 weeks and written consent was embedded within the questionnaire. Patients were then identified through their email address or by email contact to facilitate referral to rheumatology and the collection of additional clinical information. In total 355 responses were received, of which six patients did not provide consent, two patients entered duplicate responses and two patients did not have psoriasis. Overall, 30% (n = 103) reported having chronic back pain; 22% (n = 77) screened positively for possible IBP, of whom 47 were not known to rheumatology. Twenty-five patients provided identifying details allowing further analysis. The average Psoriasis Area and Severity Index score of those with possible IBP was 13.3 and the average Dermatology Life Quality Index was 16.4. The PEST score was recorded for seven patients and was positive for two of these. There is a high prevalence of possible IBP among our cohort of patients with psoriasis in secondary care. The majority of cases are not known to rheumatology, indicating a high potential unmet need. The PEST score was infrequently recorded and correlated poorly with the score for possible IBP, supporting the understanding that it is not an effective screening tool for axial disease. Use of a more sensitive screening tool for IBP may aid in identifying patients with psoriasis who also have axial PsA or spondyloarthritis and help facilitate earlier diagnosis and treatment.
P107 Updating the Assessment of the Psychological and Social Effects of Acne (APSEA) through factor analysis: developing the novel APSEA-3
Authors: Jones Georgina , Morgan Jim , Lau Eva , Latt Moe , Lee Natasha , El-Mansori Ibtessam , Layton Alison 
Published: June 2024

Abstract
Health-related quality of life is now recognized as an essential outcome to assess in acne trials and practice. Many patient-reported outcomes exist, including the Assessment of the Psychological and Social Effects of Acne (APSEA), which is an acne-specific measure (Layton AM, Seukeran D, Cunliffe WJ. Scarred for life? Dermatology 1997; 195: 15–21). APSEA was developed in 1990s and subsequently psychometric standards and methods have progressed. The purpose of this study is to conduct an updated psychometric analysis of the APSEA among a cohort of patients being treated for acne in routine clinical practice. Exploratory factor analysis (EFA), a method of classical test construction, was carried out (n = 993). To test the adequacy of the sample size for undertaking factor analysis, values for the Kaiser–Meyer–Olkin test and Bartlett’s test of sphericity were calculated, as well as Cronbach’s alpha. Following the EFA and generation of the proposed scales, the individual domains were calculated and transformed onto a scale of 0–100 by summing the items within the scale, dividing by the total possible score within that domain. A confirmatory factor analysis (CFA) was then undertaken using a new second dataset (n = 501) to test the factor conceptual framework, using MPlus 8.6 software (http://www.statmodel.com). Descriptive statistics and tests of internal consistency reliability and construct validity (concurrent) were also undertaken using a priori hypotheses and comparisons with the Dermatology Life Quality Index (DLQI) and Patient Health Questionniare-9 (PHQ-9). The EFA suggested a three-domain model (anxiety and depression, body image and self-esteem, and social functioning), which was confirmed in the CFA analysis whereby the goodness of fit indices all indicated good model fit (RMSEA = 0.038, CFI = 0.96, TLI = 0.96, SMR = 0.048). Cronbach’s alpha values exceeded 0.70, and item-total correlations exceeded 0.40 for all three domains, indicating good internal consistency reliability. All three APSEA domains were also positively correlated with the DLQI and the PHQ-9, indicating good construct validity of the tool. This EFA study has demonstrated the validity and reliability of a novel version of APSEA, which we have termed APSEA-3 to reflect the three unique domains it captures. Preliminary results show that the tool is responsive to change and useful for measuring the psychosocial impact of acne.
BH05 (P049) Best foot forward: awareness of melanoma of the foot among podiatrists
Authors: Nolan Brian , O’Connor Cathal , Murphy Michelle 
Published: June 2024

Abstract
Melanoma of the foot can masquerade as ulcerative conditions, congealed blood and trauma. Thus, even for experienced clinicians, diagnosis can prove challenging. There is a paucity of evidence about the role that podiatrists, who are routinely exposed to patients’ lower limbs, play in melanoma detection. The aim of this study was to assess the awareness and knowledge of melanoma among podiatrists, and to investigate whether podiatrists examine and assess suspicious pigmented lesions of the foot. An anonymous 18-question survey was designed assessing podiatrists’ knowledge of melanoma of the lower limb, and exposure to suspicious pigmented lesions. Ethical approval was granted by the local research ethics committee. This survey investigated the frequency of examination of suspicious pigmented lesions, insight into what constitutes a suspicious pigmented lesion, actions taken upon detection of such lesions, and suggestions for helping to improve early detection of melanoma. The survey was distributed anonymously by the national podiatrists’ association to 400 registered members over a 3-month period. The survey generated 247 responses (62% response rate, n = 400). Most podiatrists (81%) had over 20 years’ experience, and saw an average of 30 patients weekly. Over two-thirds (68%, n = 167) had been asked to examine suspicious pigmented lesions on the lower limb, of whom almost two-thirds (61%, n = 102) reported being frequently asked to examine suspicious pigmented lesions. Over two-thirds of podiatrists (71%, n = 175) reported identifying a lesion that they felt could represent melanoma, of whom 79% advised presentation to the general practitioner (GP), 8% advised dermatology review, 6% took photographs for skin-mapping, 6% contacted the patient’s GP directly, and one took a biopsy. Most (81.9%) did not receive subsequent feedback from the patients or GP. Just over a third (34.4%, n = 83) reported not feeling comfortable contacting a GP surgery directly to refer a patient, while 55.8% (n = 135) did not feel comfortable discussing sunscreen and photoprotection with patients. Most (81.7%, n = 196) did not feel they received satisfactory undergraduate education in melanoma. Suggestions for improving early detection of melanoma of the foot among podiatrists included enhanced undergraduate training, a clear referral pathway for podiatrists, and feedback from their referrals to GP or dermatologists. There is a concerning gap between the reported frequency of suspicious pigmented lesions in podiatry practice and the lack of formal training in melanoma detection and assessment. Improved training, clearer referral guidelines, and enhanced interprofessional communication strategies may improve early detection of melanoma of the foot among podiatrists.
BH11 A curious cause of ‘shrimp nail’
Authors: Kearney Nicola , Roche Muireann 
Published: June 2024

Abstract
A 25-year-old woman presented with a 7-year history of dystrophic great toenails, on a background of ulcerative colitis treated with the tumour necrosis factor (TNF)-α inhibitor, infliximab. The reported nail changes occurred after initiation of infliximab. Prior to review in the dermatology clinic, this patient had been treated with a year of oral antifungals without significant benefit. On examination, both great toenails were dystrophic with a stacked abnormal nail plate, particularly at the left great toenail, and had the appearance of ‘shrimp nail’. She was also noted to have a mild paronychia with some periungual ooze at the toenail of her right hallux. Her fingernails were normal. She was prescribed hydrocortisone plus miconazole to use for cuticular inflammation, and also had an avulsion of her left great toenail 8 months following the initial review, with very slow nail regrowth of approximately two-thirds over an 18-month period. A 32-year-old woman also attended our dermatology department with a history of psoriasis with associated psoriatic arthritis. She had been treated with apremilast for 2 years before being switched to the anti-TNF agent, certolizumab, as she was trying to conceive. Approximately 6 months following the initiation of this anti-TNF medication, the patient was noted to have dystrophic great toenails, most markedly at her left hallux, with a stacked abnormal nail plate. This patient’s nails also had the appearance of shrimp nails. She was referred for and is awaiting an avulsion of her left great toenail. These two clinical vignettes highlight cases of shrimp nail in patients who were newly commenced on anti-TNF medications. ‘Shrimp nail’, a rarely described entity, refers to a pronounced vertical curvature of the nail plate that resembles the back of a shrimp. It is caused by sequential onychomadesis that occurs before sufficient regeneration of the new nail is completed. Onychomadesis, related to spontaneous arrested growth of the nail matrix, has a multitude of causes including traumatic insults, systemic insults, local inflammation or infectious involvement of the nail matrix, and drug-induced arrest of nail matrix growth (Buttars B, Braswell MA, Huynh T et al. Congenital malalignment of the great toenail and onychomadesis in monozygotic twins. JAAD Case Rep 2021; 14: 1–3). To date, there are no cases in the literature that describe shrimp nail occurring in association with anti-TNF medication. Due to the development of shrimp nail within a number of months following the initiation of anti-TNF medication, coupled with an absence of traumatic insults to the nails, we contend that shrimp nail has occurred in these patients as an adverse effect of anti-TNF medication.
CD07 Let the games begin! Paediatric facial allergic contact dermatitis secondary to a gaming virtual reality headset
Authors: Akhtar Shaheen , Stone Natalie 
Published: June 2024

Abstract
A 13-year-old boy presented with an 8-year history of recurrent facial dermatitis. He had a history of atopic eczema and had developed intermittent swelling, redness and scaling of the face for several years, initially thought to be related to sunscreen exposure but more recently associated with prolonged time wearing his virtual reality (VR) headset. The distribution of the rash over the cheeks coincided with areas in contact with the headset rubber foam padding. Patch testing to the British Society for Cutaneous Allergy standard series, facial series, photoallergen series and a sample from the headset foam showed positive reactions to carba mix 3% (day 2+, day 4++), methylchloroisothiazolinone with methylisothiazolinone (MCI/MI) 0.02% (day 2+, day 4+), methylisothiazolinone (MI) 0.2% (day 2+, day 4+), 2-bromo-2-nitropropane 0.5% (day 2+, day 4+), methyldibromoglutaronitrile 0.3% (day 2−, day 4+), benzisothiazolinone 0.1% (day 2+, day 4+), propolis (day 2−, day 4+) and the patient’s own VR headset sample as is (day 2+, day 4+). Carba mix was felt to be relevant to the sponge rubber headset padding, which was also positive on testing. 2-Bromo-2-nitropropane was of current relevance to use of a facial ‘cooling spray’ containing this preservative. The other reactions were of unknown relevance. Avoidance of the headset led to complete resolution of symptoms. The VR company has since provided a cover for the padding, which has allowed our patient to wear the device without flaring his skin. The UK has one of Europe’s largest gaming markets, with projections indicating a surge in video game users from 51.2 million in 2023 to an estimated 57.6 million by 2027. Approximately 56% of the UK population engages in gaming, with most notably the demographic aged 16–24 years reporting 88% engagement in video games, and 68% of individuals aged 7–18 years owning gaming consoles. VR headsets are currently utilized by only 1% of children aged 3–15 years, hindered by the substantial price tag of £1420 for some VR headsets. However, the availability of more affordable alternatives will drive increased usage. Virtual meetings and working from home are becoming commonplace, widening potential exposure to VR headsets in the workplace. Gaming controllers are reported to cause ACD, as well as ‘PlayStation thumb’, with desquamation, lichenified hyperkeratotic papules and fissures on the lateral aspect of the thumbs. PlayStation palmar hidradenitis manifests with discrete, erythematous, tender nodules over the finger pulps and the palmar aspects of both hands, caused by repeated trauma while gaming. To our knowledge, ACD caused by a VR headset has not been previously reported. We would like to highlight this potential new source of ACD to the gaming and wider working population.
DS14 Not all dimples are simples
Authors: Sankey Sana , Ailenei Elena , Amarasena Chalani , Thomas Suraj , Preena Dhulsan , Gahir Daya , Paul Manju 
Published: June 2024

Abstract
We discuss four cases of orofacial fistulas presenting via the skin cancer pathway over 12 months. The predominant morphological presentation of the lesions was dimpling on the skin. The time to presentation ranged from 6 to 24 months. All patients required surgical input from the maxillofacial team. Case 1 is a 76-year-old man referred with a 2-year history of a lesion under the left submandibular area. Computed tomography (CT) of the neck revealed a dental apical cyst. The patient underwent a tooth extraction, leading to sinus resolution. Case 2 is a 58-year-old man who presented with a ruptured lesion on the left cheek, leading to recurrent discharges. The ultrasound scan (USS) revealed a sinus tract from a dental infection that had tracked to the skin. The sinus resolved after tooth extraction. Case 3 is a 54-year-old woman referred with a chronic, indented papule above the left nasolabial groove. USS examination revealed a heterogeneous lesion tracking deep into the subcutaneous tissue. An orthopantomogram identified a periapical infection of the upper-left third tooth. She underwent root canal treatment with resolution of the sinus. Case 4 is a 79-year-old woman with a 6-month history of a nonhealing discharging lesion in the left submental area. CT revealed soft-tissue thickening along the left mandible alveolar margin involving the buccal aspect, extending as a sinus to the skin surface and extensive osteoradionecrosis. Unfortunately, she succumbed to an unrelated illness and did not complete her treatment. An orofacial fistula, or sinus, is an abnormal connection between the oral cavity and the face’s surface. Despite its rarity, anyone can be affected regardless of age, sex or race. Dental issues cause most oral cutaneous fistulas and are often accompanied by inflammation. Chronic dental periapical infections and dentoalveolar abscesses are the most common culprits of intraoral and extraoral fistulas. The discharging points on the skin depend on the relationship between the muscle attachment and the site of the infection. These lesions may be mistaken for more severe conditions like squamous cell carcinoma or cysts, especially if ulcerated. Thus, careful examination of the oral cavity and dental history is crucial in diagnosis. Imaging tests like USS or CT can confirm the diagnosis. Treatment options involve antibiotics and dental treatment. Usually, fistulas present to dentists or surgeons, but occasionally they can be referred to the skin cancer clinics. A high level of suspicion is essential to achieve an early diagnosis and prompt treatment.
DS25 Complications after skin surgery
Authors: Sarto Rubiana , Balagopalan Anitha , Naseem Saadia , Sanapala Josephine , Pynn Emma 
Published: June 2024

Abstract
Dermatological surgery is associated with a low incidence of postprocedural complications (Amici JM, Rogues AM, Lasheras A et al. A prospective study of the incidence of complications associated with dermatological surgery. Br J Dermatol 2005; 153: 967–71). However, they can have a significant impact on healing, patient experience and cosmetic outcome. Our aim was to assess our incidence of postprocedural complications and to review associated risk factors, potentially enabling us to improve clinical practice and patient outcomes. Over a 2-week period in December 2023, all patients undergoing excision with primary closure, at any surgical site, were invited to take part. Twelve operators across three outpatient locations recorded operative details and gave out information sheets. Patients were surveyed 2 weeks after surgery through an online form or by phone regarding bleeding, antibiotic requirement, dehiscence and other issues. Case records were reviewed to obtain demographics and details of medications. In total 78 patients agreed to participate, of whom 70 responded to the survey: 71% were above 65 years old, and 51% were male. Thirteen patients (19%) reported postprocedural complications, most of whom (77%) were above the age of 65 years. The face was the most frequent site (38%). Bleeding was the most common complication, seen in seven participants (10%); only one was anticoagulated and four were treated for postoperative infection, which may have been the primary issue. Two experienced slight bleeding, whereas five (7%) needed further medical input. Five (71% of those with a bleed) had a recorded history of increased alcohol consumption, compared with 14% of those who did not bleed. Fifteen patients (21%) received prophylactic antibiotics, and five different individuals (7%) required postprocedural antibiotics in the community. Interestingly, four of these five (80%) reported concurrent bleeding. Dehiscence was described by five patients (7%), 23% of whom were smokers. Six patients were recorded as having ulcerated lesions, four of whom were given prophylactic antibiotics; of the other two, one developed dehiscence and one infection. Our study identified bleeding as the most common postprocedural complication, with significant events in 7%. The most frequent documented risk factor was not anticoagulation as expected but alcohol intake; however, high use of antibiotics in this group suggests association with or primary diagnosis of infection. Limited by our relatively small sample size, we would like to expand this study to a larger group to further explore the clinical significance of these risk factors. We advocate continuing to educate patients regarding risk of bleeding postprocedure, with awareness of the potential effect of alcohol.
DP19 Intraepithelial metastatic melanoma mimicking gastric signet ring adenocarcinoma in situ
Authors: Wong Jo-Yve , Carless Jonathan , Holte Kristofer , Houghton Joe , Kelly Paul 
Published: June 2024

Abstract
Melanoma is the most common tumour to metastasize to the gastrointestinal tract. We present an exceptionally rare case of metastatic melanoma presenting as a gastric metastasis with atypical endoscopic findings and subtle histological findings mimicking signet ring adenocarcinoma in situ and neuroendocrine cell hyperplasia. A 78-year-old patient with a remote past history of pT2b acral lentiginous melanoma of the great toe was referred to gastroenterology with weight loss and anorexia. An oesophagogastroduodenoscopy (OGD) demonstrated focal thickening of the gastric folds. Biopsy from the thickened area demonstrated a focally confluent, lentiginous intraepithelial proliferation of cytologically bland, amelanotic, small cells that was confined to gastric glands. These cells were suspected to be melanocytic in nature because of the presence of periglandular mild melanin incontinence. The melanocytes stained strongly with SOX10, S100, HMB45, melan-A and PRAME immunohistochemistry. Despite examination at levels there was no lamina propria invasion or nodule formation. Given the patient’s clinical history a diagnosis of metastatic melanoma was favoured over a primary gastric melanoma. Soon after OGD the patient developed dyspnoea. A computed tomography (CT) scan demonstrated bilateral pulmonary emboli with thrombus extending from the renal vein into the vena cava. This also demonstrated lytic lesions in the T12 and L1 vertebra and para-aortic lymphadenopathy, both of which were fluorodeoxyglucose avid on positive emission tomography (PET) CT. No gastric lesion was identified on PET CT. Metastatic melanoma presenting as a gastric intraepithelial lesion is incredibly rare, and to our knowledge this is only the second such reported case. However, this is the first case to be examined with a negative PET CT scan, demonstrating a lack of sensitivity of radiological investigations in identifying metastatic melanoma with this growth pattern. This in situ pattern of metastasis to the stomach is potentially more common than previously recognized and is deserving of wider attention.
PA24 Concomitant Crohn disease and scurvy: an unusual presentation revealing nutritional challenges
Authors: Pacheco Matheus Alves , Sarto Rubiana , Lima Fernanda Ramos Paes , Wegner Christine Aparecida , Rosa Ariel Cordova , Di Giunta Funchal Gabriella , Martini Athos 
Published: June 2024

Abstract
This case report presents a 15-year-old boy newly diagnosed with Crohn disease (CD), currently under treatment with prednisone and azathioprine. The patient was admitted to the hospital due to diffuse abdominal pain, diarrhoea and fever. Remarkably, after 5 days of hospitalization, he developed purpuric lesions on his wrists, abdomen and lower limbs. Dermoscopic examination of the cutaneous petechiae revealed an intriguing finding: whitish hair follicles exhibiting a distinctive ‘corkscrew’ hair pattern surrounded by a haemorrhagic violaceous halo. This dermoscopic profile strongly suggested the presence of scurvy. Histological analysis provided further insight, demonstrating perifollicular haemorrhage and interstitial extravasation of red blood cells. While nutritional deficiencies are commonly linked to CD, vitamin C deficiency is less frequently identified and reported, despite its prevalence. The challenge lies in the potential overlap of symptoms between active CD and scurvy, making the diagnosis of vitamin C deficiency more elusive in patients with CD. This case underscores the importance of considering vitamin C deficiency in the differential diagnosis of cutaneous manifestations in individuals with CD. Clinicians should be vigilant in identifying such nutritional deficiencies to ensure timely intervention and prevent complications associated with scurvy.