bluuebunny/crossref_metadata_2025_split huggingface dataset:
BI28 Invasive streptococcal infection in a patient with HIV
Authors: Diong Sophie , O’Rourke Michéal , Bergin Colm , Leonard Niamh , Wynne Bairbre , Ormond Patrick 
Published: June 2024

Abstract
A spectrum of severity exists in cutaneous infections with group A β-haemolytic streptococci (GABHSs), including life-threatening streptococcal toxic shock syndrome (STSS), which can follow minor trauma to skin or mucosa. We present a case of STSS with resultant necrotizing ecthyma-type infraorbital ulceration and necrotizing lymphadenitis in a patient with HIV. A 37-year-old Nigerian woman of no fixed abode presented with florid head and neck oedema, and vasopressor-dependent hypotension 1 day after accidental ocular inoculation with a camphor-based product, causing excoriation-induced microtrauma to periorbital skin. Of note, she had a background history of treated HIV infection, with undetectable viral load, and end-stage renal disease. Examination revealed generalized craniofacial swelling, with significant periorbital oedema, and bilateral infraorbital ulcers with discharge. Inflammatory markers were raised, with a C-reactive protein of 503 mg L−1. Multiorgan failure (MOF) was noted with a new mixed-pattern liver function derangement and an almost doubling in her baseline creatinine to 833 µmol L−1. Only a small area of epidermal loss (body surface area &lt; 1%) was noted under her chin. Blood cultures were negative, but infraorbital swabs alongside culture biopsy from the infraorbital ulceration yielded Streptococcus pyogenes, a GABHS. Histopathology highlighted ulcerated skin, dermal necrosis and subcutaneous abscesses. The patient was diagnosed with STSS. Intravenous immunoglobulin, systemic steroids and antimicrobials allowed for stabilization. Cutaneous findings were slow to resolve, and complicated by submandibular necrotizing lymphadenitis. Given a prior history of keloidal scarring, secondary intention healing was trialled for the deep infraorbital ecthyma-type ulceration. Unfortunately, almost 2 months after the initial episode, no improvement was seen. Further Pseudomonas superinfection perpetuated ulceration, and full-thickness skin grafting was required, with good cosmetic and functional outcome for our patient. STSS is a superantigen-driven disease secondary to an invasive infection, leading to massive stimulation of T cells via exotoxins, inducing a cytokine cascade causing shock and MOF. While GABHSs are frequent in patients with HIV, the occurrence of STSS is less than expected, likely related to T-helper-cell dysfunction. When GABHSs are observed the disease is frequently protracted. Our case likely comes as a result of our patient’s compliance with HIV treatment, and resultant virological suppression. Ecthyma, a further invasive form of GABHS involving the dermis, carries a risk of scarring. GABHS skin and soft tissue infections are known to be independently associated with homelessness. This compounded the existing challenges of this case, including host immunodeficiency factors and subsequent bacterial superinfection, leading to refractory infraorbital ulcers.
BI38 A rare case of acquired epidermodysplasia verruciformis
Authors: Murphy Lisa , Leonard Niamh , O’Gorman Susan 
Published: June 2024

Abstract
Epidermodysplasia verruciformis (EV) is a rare, genetic disease characterized by an increased susceptibility to infection with specific types of human papillomavirus. These patients also have a higher likelihood of developing malignant skin tumours. We report the unusual case of a 51-year-old female patient who presented with 7-month history of tender, verrucous papules and nodules on the dorsum of both her hands. Her medical history was significant for sero­negative arthritis and diabetes mellitus, and she was being treated with methotrexate for her arthritis. She had never had lesions similar to these in the past and there was no history of a cutaneous malignancy. A biopsy from a lesion on the right elbow demonstrated epidermal acanthosis and a prominent granular layer suggestive of viral aetiology, such as EV. Acquired EV typically occurs in immunosuppressed patients such as those who have had transplants or haematological malignancies. The lesions generally appear at sun-exposed sites such as the hands and arms, as was seen in this case. Treatment options include topical treatments such as cryotherapy and fluorouracil, or oral agents such as acitretin. Photoprotection advice is also imperative. This case highlights the importance of considering EV in patients who are immunosuppressed, who present with a significant number of viral warts that are resistant to treatment.
H17 Dermatology in times of famine
Authors: O’Malley Seán , Feighery Cliona 
Published: June 2024

Abstract
From the years of 1845 to 1852, the Great Famine (An Gorta Mór) ravaged the island of Ireland. A multitude of factors contributed to the eventual extent of its devastation; however, at its core was the widespread failure of the potato crop. The most destitute year came in 1847, and by 1852 Ireland’s population is estimated to have declined from 8.5 million to 6.5 million, with 1 million having emigrated and another million dead. Starvation was the principal cause of death for some of those who succumbed to the Great Famine, but the majority who died did so as a result of illnesses arising from the crisis, both infectious and nutritional, and not only their toll on physical health but the consequent social ramifications. In this manner, infestations and cutaneous manifestations of illness played a vital role in the eventual morbidity and mortality of the Irish famine. General fever was common, mostly originating from lice infestation of the skin, which flourished in deteriorating conditions in settlements. Two variants developed that broadly separated between social classes: recurrent fever in the poor who had previous exposure, known colloquially as ‘getting the cool’, and the more deadly typhus fever that killed many of the middle and upper classes, in particular those who attempted to help the sick such as doctors and priests [Geary L. Epidemic diseases of the Great Famine. History Ireland. Available at: https://www.historyireland.com/epidemic-diseases-of-the-great-famine/ (last accessed 29 February 2024)]. Smallpox arose in frequent epidemics, and the associated widespread pustular rash, crusting lesions and eventual scabbing offered an obvious visual cue of illness. With limited quality food available, nutritional deficiencies contributed too to the deathly appearance of those afflicted. Lack of vitamin B3 resulted in pellagra, with its associated dermatitis, and a dire lack of vitamin C gave rise to scurvy, whose ecchymosis became known in Irish as ‘cos dubh’ or black leg. With such a constellation of symptoms, it can be appreciated why there was misunderstanding and fear of the sick. This led to division in communities about the construction of fever hospitals. Some pleaded for their establishment to quarantine the sick, while others resisted for fear of contagion and, in instances such as in Fethard, County Tipperary and Belturbet, County Cavan, committed arson attacks against the hospitals. Many who did not succumb were left pauperized and ostracized by their communities, in no small part as a result of their cutaneous manifestations of a multitude of diseases.
H22 Artificial intelligence: whose brains were behind it?
Authors: Long Amy 
Published: June 2024

Abstract
Long considered futuristic, artificial intelligence (AI) has slowly but surely come to prominence in medical spheres over the last 90 years. Dermatology is poised to benefit from emerging AI technologies, with its inherent visual diagnostic methods and the increasing volume of digital photographic data underscoring its suitability for AI-augmented patient care. Algorithms have been around for centuries, but it was Alan Turing who was the first to formalize algorithm and computation in the 1930s, along with cracking the Enigma code during World War II. In 1943, the first artificial neural network of electrical circuits was modelled to simulate biological neurones in the brain, a concept crucial to the success of AI today. The term ‘artificial intelligence’ was first coined by John McCarthy in 1956 at Dartmouth College. Computer-aided diagnosis was first applied in the ana­lysis of pulmonary nodules detected in chest radiographs in 1963. MYCIN, Edward Shortliffe’s doctoral dissertation at Stanford University in the 1970s, was the first powerful use of AI, whereby a computer program correctly identified the causative bacteria in cases of bacteraemia and meningitis and even recommended antibiotic treatments. In 1998 the first Food and Drug Administration (FDA)-approved computer-aided diagnosis system was used in mammography. After the 2010s, a subfield of machine learning called deep learning emerged, and from then on AI flourished, creating meaningful applications across many fields, not least in dermatology. As dermatology is a morphological feature-dependent discipline, machine learning models are increasingly implemented as a diagnostic support tool using image analysis in areas including dermatopathology and skin cancer detection. MelaFind was the first FDA-approved digital cancer detection unit to identify melanoma, succeeded by Nevisense, and recently by DermaSensor, which was approved by the FDA in January 2024. The visual nature of dermatology lends itself well to transformative AI-augmented practice. Although in its infancy, with the correct government and regulation, AI has the potential to help practising dermatologists deliver better skincare.
PS01 (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

Abstract
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 &lt; 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.
SG03 A case of Bazex–Dupré–Christol syndrome (BDCS)
Authors: Reed Oliver , Schirwani Schaida 
Published: June 2024

Abstract
A 36-year-old man presented to the dermatology department in 2013 with a pink papule on his neck. He had no significant past medical history and took no regular medications. He was born with sparse hair and had milia on his face, neck and ears since childhood. His nonidentical twin daughters were born with milia confined to the head and neck. His mother and maternal aunt had histories of multiple basal cell carcinomas (BCCs), hypotrichosis and follicular atrophoderma and were subsequently diagnosed with Bazex–Dupré–Christol syndrome (BDCS). On examination, he had a superficial BCC on his right posterior neck, with prominent follicular atrophoderma affecting the dorsum of his hands, elbows and feet. He had milia on his ears bilaterally. The BCC was successfully treated with imiquimod 5% cream. The initial genetic testing was uninformative. He was subsequently lost to follow-up but presented again in 2021 with a BCC on his lower eyelid. In 2022 a pertinent paper was published in the British Journal of Dermatology by Liu et al. (Liu Y, Banka S, Huang Y et al. Germline intergenic duplications at Xq26.1 underlie Bazex–Dupré–Christol basal cell carcinoma susceptibility syndrome. Br J Dermatol 2022; 187: 948–61). This revealed new insights into the genetic aetiology for the syndrome, and hence the patient was contacted to consider further genetic testing. Whole-genome sequencing was performed, which identified the same duplications in noncoding sections of chromosome Xq26.1 as highlighted by Liu et al. BDCS is a rare X-linked dominant condition characterized by a triad of BCC, follicular atrophoderma and hypotrichosis. It may also be accompanied by milia, hypohidrosis and trichoepithelioma (AlSabbagh M, Baqi M. Bazex–Dupré–Christol syndrome: review of clinical and molecular aspects. Int J Dermatol 2018; 57: 1102–6). It has been previously thought that there is no single gene solely responsible for BDCS; however, in 2022, Liu et al. suggested that dysregulation of the gene ARHGAP36, resulting from duplications in noncoding sections of chromosome Xq26.1, might be implicated. ARHGAP36 is a flanking centromeric gene near the control hair follicular stem cell compartment (Liu et al.). Our case highlights the importance of considering BDCS as a differential diagnosis in patients presenting with early-onset BCC. Having a confirmed diagnosis enables tailored clinical management with early preventative measures and the opportunity for genetic counselling for future generations of affected individuals.
BT13 (P028) The importance of clinical metadata when triaging patients for face-to-face assessment and possible biopsy in a teledermatology pathway
Authors: Islam Shafiqul , Walls Joseph , Hall Per , Raza Haider , Gan John , Garcia Alba , Wishart Gordon 
Published: June 2024

Abstract
The 7-point checklist (7PCL) is recommended by NICE to select patients with pigmented lesions and possible melanoma for urgent referral. This research investigates the potential of using machine learning (ML) models that utilize patient metadata from a teledermatology pathway including 7PCL for suspicious skin lesion detection, and compares the performance gain for each meta-feature added with the 7PCL. We analysed clinical metadata from 53 601 skin lesions in 25 105 patients who attended private skin cancer diagnosis clinics in the UK between 2015 and 2022. For each lesion, we included the following meta-features: 7PCL (change of lesion size, shape, colour, lesion &gt; 7 mm, inflamed, oozing, itching), weighted 7PCL, Williams score characteristics (patient age, patient sex, natural hair colour, arm mole count, sunburn history, prior nonmelanoma skin cancer), the overall Williams score, prior melanoma, lesion location, lesion age, and whether this was a predominantly nonpigmented pink lesion. All lesions were categorized as suspicious (10%) or nonsuspicious (90%) by skin cancer specialists during telemedicine triage (cancer detection rate = 5%). All meta-features were used as ML model inputs to classify whether each input was associated with suspicious or nonsuspicious classes. This study integrates five ML models (naive Bayes, logistics regression, support vector machine, random forest, and multilayer perceptron) to detect suspicious skin lesions based on patient metadata. Firstly, we compared the ML model performance between the original 7PCL and weighted 7PCL in correctly identifying suspicious skin lesions. We then added each meta-feature with 7PCL and tabulated the performance gain. We utilized balanced accuracy, sensitivity, specificity and area under the curve as evaluation metrics. There were no significant differences observed in model performance between the 7PCL and weighted 7PCL (sensitivity 68.1%). However, the performance of the ML model was improved significantly for each added meta-feature, with the best performance gain (sensitivity 85.2%) observed when 11 meta-features (lesion pink, Williams score, lesion age, sunburn, patient age, Williams group, patient sex, hair colour, site of the lesion on the body, freckling tendency, and mole count) were added to the 7PCL. This research has identified the optimal subset of meta-features that improve ML model performance for categorizing suspicious skin lesions during telemedicine triage, compared with 7PCL alone. Fusing these high-performing meta-features with image modalities is likely to further boost the ML model performance for skin cancer detection, and they could also be used to modify current skin cancer referral guidelines. The study is funded and supported by Innovate UK and the private teledermatology pathway provider.
BT19 The rising dermatology advice and guidance pandemic: building a workforce group with nationally implantable solutions that led to significant improvements over a 10-week period
Authors: Thandi Charankumal Singh , Moss Jake , Andrews Margaret 
Published: June 2024

Abstract
Advice and guidance (A&G) has become more prominent in medicine and has been used across multiple specialties. It has been implemented by most dermatology departments, which tackle the challenge in different ways. Why is it so challenging? What can we do to fix it? How can it be more manageable? These are common questions that are asked by clinicians, managers and referrers. We conducted a multicycle quality improvement project at our hospital collating feedback from clinicians, managers and referrers. As part of this we identified multiple challenges and also had a list of solutions, many of which led to the following improvement. We formed an A&G focus group within the department with a registrar chairing the group and discussing solutions at an annual strategy meeting. The first method was identifying the challenges. The challenges included a high number of referrals, multiple duplicate referrals that were pending, poor-quality photographs including inadequate dermoscopy, and, concerningly, referral of pigmented lesions including melanomas without review within primary care with senior clinicians. Having collated this list of challenges we emailed around asking for each clinician’s feedback from the team that actively takes part in A&G. These responses were collated and are shown below. They led to the following significant improvements in the numbers of pending A&G dermatology cases in the hospital. Over a 10-week period during this project there was a 33.6% reduction in the number of pending referrals from a peak of 1075 cases. There was a 99.4% reduction in the number of days taken to respond to urgent cases, a 35.7% reduction in the number of days taken to respond to paediatric cases and a 83.3% reduction in the number of days taken to respond to adult A&G referrals. The solutions involved (i) ensuring A&G staff were given clear dedicated time within job plans, with each clinician having a set number of cases to do per month; and (ii) feeding back response times via the local integrated care board during meetings and signposting to correct referral pathways during responses (as a tool to reduce overall duplication). Future plans include holding a circuit breaker week and sending out generic criteria for advice and guidance at the end of each response, highlighting current response time and the avoidance of 2-week-wait lesions. Our model can be used nationally within any medical or surgical specialty and has the potential to lead to significant improvements. It can help to ensure that referrers are clear of the pathways, while making A&G more manageable.
BT32 Teledermatology service evaluation compared with standard face-to-face review for 2-week-wait skin cancer referrals
Authors: Byrne Niamh , Wong Charlotte , Khoo Andre 
Published: June 2024

Abstract
Teledermatology has been shown to be accurate in the diagnosis of skin cancer. The number of skin cancer referrals to secondary care has surged and dermatology departments are under increasing pressure to meet cancer pathway targets. The aim of this study was to compare service outcomes for teledermatology vs. conventional face-to-face review. We performed a retrospective review of adult patients referred by general practitioners for suspected skin cancer via the 2-week-wait pathway from August 2022 to February 2023. Patients were assessed either by conventional face-to-face appointment or via teledermatology. Teledermatology patients completed a questionnaire and were seen by a photographer in the community who took regional, macroscopic and dermoscopic images. The primary outcomes were times from referral to first clinical appointment and to surgery (if applicable), surgical intervention rate, and histological diagnoses (if applicable). Statistical analysis was performed using Prism software (GraphPad Software, La Jolla, CA, USA). Comparisons between groups were performed with the Mann–Whitney U-test and Fisher exact, as appropriate. P-values &lt; 0.05 were considered statistically significant. In total, 50 consecutive patients assessed by a single clinician via teledermatology were compared with 100 randomly selected patients assessed by the same clinician via face-to-face review. More than half of patients were female in both groups (52% teledermatology vs. 58% face-to-face). The teledermatology group was older ,with a mean age of 56.7 years (SD 18.5) vs. 40 years (SD 20.5), P &lt; 0.001. The median waiting time for a clinical appointment was slightly longer in the teledermatology group [16.5 days (SD 8.5) vs. 14 days (SD 5.4) for face to face (P &lt; 0.001)]. The median waiting time from receipt of referral to surgery was similar in both groups [38 days (SD 17.3) for teledermatology vs. 32 days (SD 12.5) for face to face (P = 0.4)]. The median waiting time from decision to treat to surgery was similar in both groups [21 days (SD 17.3) for teledermatology vs. 20 days (SD 11.7) for face to face (P = 0.9)]. There was no significant difference in the diagnostic biopsy/therapeutic excision rate (34% for teledermatology vs. 27% for face to face, P = 0.37), or in the proportion of benign, dysplastic and malignant lesions biopsied or excised (P = 0.75). Over one-third of patients reviewed by teledermatology were discharged without the need to attend hospital. In conclusion, this model of teledermatology offers a robust way to assess suspected cancer, with biopsy rates and eventual diagnoses comparable with conventional models. The use of professional medical photography may delay initial review, but higher-quality images are associated with improved diagnostic accuracy.