bluuebunny/crossref_metadata_2025_split huggingface dataset:
Poster presentationsPD10 Photosensitivity diseases in children: 10 years’ experience from a tertiary photodiagnostic service
Authors: McKeever Jessica , Lesar Andrea , Ibbotson Sally H 
Published: June 2024

Abstract
Photosensitivity diseases are a wide-ranging group of disorders, with heterogeneity in diagnostic categories, characteristics and management. Photosensitivity at any age poses specific challenges, with adverse impact on quality of life being highly significant, and children are of particular concern (Rizwan M, Heylett AK, Richards HL et al. Impact of photosensitivity disorders on the life quality of children. Photoderm Photoimmunol Photomed 2012; 28: 290–2). Our aim was to review the clinical and photodiagnostic characteristics of 209 children (aged ≤ 16 years), assessed through a tertiary photodiagnostic service between 2013 and 2023. We conducted this retrospective study with Caldicott Guardian approval (CALDICOTT-2023-011) and the presenter, a final-year medical student, analysed clinical photodermatology notes and our in-house photodiagnostic database with support from senior clinical supervisors. The median age of presentation was 8 years (range 4 months to 16 years), with a male-to-female ratio of 1 : 1.2. Most patients were of skin phototype II (40.6%), with only five being phototype IV and two phototype V. The median time from onset of symptoms to assessment was 3 years (range 1 month to 14 years). Polymorphic light eruption (PLE) was the most prevalent condition, diagnosed in 50.4%. A range of other diagnoses were seen, with photosensitivity excluded in 7.3%. Of those who underwent monochromator phototesting (n = 180), abnormal results were detected in 29 patients (16.1%), and 27 of 128 patients (21.1%) tested had an abnormal ultraviolet B TL-01 minimal erythema dose. Of 128 patients who were photopatch tested, 27 (21.1%) showed positive reactions. Vitamin D levels were insufficient in eight (24%) of the 33 patients tested. Paediatric antinuclear antibodies were tested in 29% of patients, with 11 (18%) being positive (≥ 1 : 80), although lupus was diagnosed in only two cases. Of 109 patients tested for porphyria, 11 (10.1%) were positive, seven being diagnosed with erythropoietic protoporphyria. One patient was diagnosed with xeroderma pigmentosum (XP). Children’s Dermatology Life Quality Index (CLDQI) assessment was available in 69%, with a median score of 10 (range 1–29). This study provides detailed characterization of photosensitivity diseases in children seen through a national photodiagnostic service. While PLE was the most common diagnosis, a range of other diagnoses were seen, including lupus, porphyrias and XP, highlighting the need for such specialist services. The delays in diagnosis and severity of impact on quality of life are of concern and emphasize the importance of raising awareness of photosensitivity in children in primary care. Prompt diagnosis, psychological support and holistic care are identified aspects of service provision.
PD12 Roadmap on how to set up home handheld phototherapy in the National Health Service: implementation of evidence-based treatment in the ‘real world’
Authors: Eleftheriadou Viktoria , Francis Carla , Hale Joanne , Halpern James 
Published: June 2024

Abstract
Vitiligo is the most common pigmentary disorder, and affects around 0.4% of the population in the UK. Recently conducted, two large retrospective observational studies using the UK Clinical Practice Research Datalink and Hospital Episode Statistics databases demonstrated that adults with vitiligo have an increased risk of subsequently being diagnosed with new-onset depression (25%) and anxiety (23%). The studies also found that people with both vitiligo and a mental health comorbidity have increased use of primary care services and are twice as likely to have recorded time off work and unemployment. Interestingly, the majority of patients (85%) were not prescribed any vitiligo-related treatments within a year of diagnosis for vitiligo. Second-line treatment for vitiligo includes either whole-body or localized phototherapy. Traditionally, narrowband ultraviolet B (NB-UVB) is reserved for people with extensive vitiligo and is delivered in secondary care using full-body units, requiring regular hospital attendance. In the current National Health Service (NHS) crisis, many NHS dermatology departments offer phototherapy either to a very limited number of patients with vitiligo or not at all, due to constraints on phototherapy services. The British Association of Dermatologists guidelines recommend that limited vitiligo can be treated with handheld NB-UVB devices. This recommendation was based on the results of a large, pragmatic, randomized controlled trial of home handheld phototherapy combined with topical corticosteroid for people with active, limited vitiligo (HI-Light trial). The trial was completed almost 5 years ago; however, only one centre in Wales chose to continue with the home handheld phototherapy service on the NHS after the completion of the trial. A new, unique, national, tertiary, research and treatment centre for children and adults with vitiligo has recently been established in England. In our centre, we offer home handheld phototherapy to eligible patients, who are often referred from out of area, therefore making a combination of topicals and NB-UVB more accessible. We designed patient-facing literature, a special pro forma for vitiligo clinic, and several other documents to assist in safety assurance and quality improvement processes. We describe the pathway that we followed when establishing this new service in the NHS. We have trained 20 patients so far. We describe the safety and efficacy results of home handheld phototherapy combined with topical treatments such as calcineurin inhibitors and corticosteroids, as well as oral antioxidants. We hope that our roadmap will pave the way for a home handheld phototherapy service in other centres, which would make phototherapy more accessible for patients with a variety of skin diseases such as vitiligo, hand eczema and scalp psoriasis, among others.
CD09 Prevalence of contact allergy in patients with vulval dermatoses: a 10-year retrospective review
Authors: Khan Wajeeha , Akhter Shaheen , Stone Natalie , Chowdhury Mahbub M U , Katugampola Ruwani 
Published: June 2024

Abstract
Allergic contact dermatitis (ACD) is an important diagnostic consideration in the evaluation of patients presenting with vulval dermatoses. Although ACD coexisting with vulval dermatoses is uncommon, identifying and avoiding the allergens can have a positive impact on the management and quality of life of patients. The aim of this retrospective review of patch test data was to identify relevant allergens in patients presenting with vulval dermatoses in two specialist centres. Relevant data were extracted from electronic database and patch test departmental records between 2013 to 2023 from two specialist cutaneous allergy centres. Patch tests were performed in accordance with the International Contact Dermatitis Research Group and European Society of Contact Dermatitis guidelines. Patch test readings were performed on day 2 and day 4, and positive reactions were recorded. In total, 155 female patients with a mean age of 53.4 years were referred for patch testing. Vulval pruritus (37.5%) and vulval eczema (29%) were the two most common presenting complaints for patch test referral. All patients were tested to the standard and anogenital series, and some to extra series including medicaments, cosmetic, plants, acrylates, hairdressing and own products, depending on clinical history. Multiple allergens were identified including metals, topical drugs, fragrances, preservatives, cosmetic constituents and rubber additives. The most common clinically relevant allergens were fragrances (27.4%), preservatives (18.5%), textile dyes (4.5%) and medicaments (2.5%). Interestingly, 9.6% of patients were tested to the acrylate series, but none had a positive reaction. Fragrance allergy was prevalent in patients with a history of vulval lichen planus and lichen sclerosus. Numerous products were implicated in causing the dermatosis, including sanitary pads, wipes, shower gels and topical medications. Overall, 76% of patients noticed improvement after avoidance of relevant allergens. Patients with chronic vulval dermatoses are at increased risk of ACD and should be assessed for possible contact dermatitis. Patch testing is required to identify relevant contact allergens, the most common of which from our cohort include fragrances, preservatives, textile dyes and medicaments. These results are comparable with previous results reported by Woodruff and Vandeweege (Woodruff CM, Trivedi MK, Botto N, Kornik R. Allergic contact dermatitis of the vulva. Dermatitis 2018; 29: 233–43; Vandeweege S, Debaena B, Lapeere H, Verstraelen H. A systematic review of allergic and irritant contact dermatitis of the vulva: the most important allergens/irritants and the role of patch testing. Contact Dermatitis 2023; 88: 249–62). Patient education and follow-up are essential in optimizing treatment and preventing recurrence of vulval ACD.
Poster presentationsCD10 Gunpowder dermatitis: is there such a thing?
Authors: Moledina Zahra , Singh Kiran , Tewari Angela 
Published: June 2024

Abstract
We report a case of a 17-year-old boy who developed a facial rash on three consecutive occasions after firing a rifle. Patch testing to the British Standard Series was positive to cobalt chloride. Our patient described a clear history of the gun smoking and then him developing an itchy facial rash 2 h later.  Over the next few hours, he developed worsening facial erythema and swelling. This was treated with antihistamines and topical steroids and resolved. A few months later, he developed a similar rash with facial oedema when firing his rifle. After just under 2 h there was facial erythema and oedema, and erythematous papules could be seen on the wrists. This was again treated in a similar manner and resolved. There was no oral or laryngeal involvement. Moreover, a third time, when he was cleaning his rifle, he developed a similar rash a few hours later. There have been no episodes of the rash occurring outside of relation to the rifle. It was felt that this could represent a contact allergy to the potassium nitrate found in gunpowder that would rebound back from the butt of the rifle to enable bullets to be fired from the cartridge. Our patient used blanks, which also contain gunpowder but without the firing bullets. The patient was tested to the European Standard Battery only. At day 4, the patient developed a 2++ reaction to cobalt only. Cobalt chloride is a common metal known to cause a delayed hypersensitivity reaction, affecting approximately 1–3% of the population (Midander K, Werner P, Isaksson M et al. Cobalt nanoparticles cause allergic contact dermatitis in humans. Br J Dermatol 2023; 188: 278–87). It is used to line the barrel of some rifles to reduce erosion and barrel wear (De Rosset WS, Montgomery JS. Cobalt-base alloy gun barrel study. Wear 2014; 316: 119–23). It is thought that our patient experienced immediate contact urticaria with a secondary id reaction to the cobalt. We have counselled him on other cobalt-containing products. There are currently no published reports of hypersensitivity reactions to cobalt through the use bullet-containing rifles.
CD11 Techniques for patch testing interpretation in patients with skin of colour: a systematic review of the literature and textbooks
Authors: Selvendran Subothini Sara , Goldsmith Portia 
Published: June 2024

Abstract
By 2031, approximately 15% of the UK population will comprise individuals with skin of colour. Allergic contact dermatitis can result in significant morbidity, and patch testing is the gold standard to detect triggers. Under-representation of those with skin of colour in educational materials may contribute to false negative patch testing and underdiagnosis of contact dermatitis in this population. Our aim was to investigate the extent to which images of positive patch tests in individuals with skin of colour are represented in the literature. A systematic search of the PubMed database and the Royal Society of Medicine (RSM) electronic library from conception to date was conducted. This revealed 903 articles and 2034 resources, respectively. Screening titles and abstracts revealed that six articles on PubMed and one paragraph in an electronic book on the RSM database commented on patch testing in those with skin of colour. Of these, only one article on PubMed included images of positive patch test results in individuals with skin of colour. In our department, 60% of patients have skin of colour. We describe our techniques for patch test readings and present an example of how positive reactions can be missed. We recommend using a tangential light at a 45° to 90° angle to reveal any areas of skin that are papular. The skin under all the areas where patches have been applied should be gently palpated by running an index finger over the skin to assess whether they are raised or infiltrated. A 61-year-old Afro-Caribbean woman underwent patch testing. Positive patch test reactions to fragrance mix I, fragrance mix II, geraniol, citral, limonene and thiuram were observed. These were demonstrated through a cluster of vesicles and papules that were skin coloured rather than erythematous. The use of tangential lighting enabled visualization of the results and mitigated glare. In summary, our literature review has shown that there is an omission in textbooks and papers on the challenges of how to read patch tests in patients with skin of colour. There is a need to increase the awareness of the pitfalls of looking for skin erythema and how to use simple techniques such as tangential lighting and palpation to help detect positive patch test reactions. This information coupled with images should be in educational materials to prevent underdiagnosing contact dermatitis and healthcare inequalities for people with skin of colour.
CD14 Efficacy of narrowband ultraviolet B phototherapy vs. low-dose oral ciclosporin as second-line management in antihistamine-refractory chronic spontaneous urticaria: a noninferiority, randomized study
Authors: Roshini N , Mehta Hitaishi , Bishnoi Anuradha , Parsad Davinder , Kumaran Sendhil 
Published: June 2024

Abstract
Literature regarding the role of narrowband ultraviolet B (NB-UVB) phototherapy in the treatment of antihistamine-resistant chronic spontaneous urticaria (CSU) is scarce, and ciclosporin has established its role in management. We aimed to study the efficacy of NB-UVB phototherapy vs. low-dose oral ciclosporin in the management of chronic refractory urticaria (CRU), terms of change in Urticaria Activity Score (UAS), Urticaria Control Test (UCT), Chronic Urticaria Quality of Life (CU-QoL) and Angioedema Activity Score (AAS). In this randomized prospective noninferiority study, 50 patients were recruited who fulfilled the criteria of oral antihistamine-refractory CSU, namely 6 months of spontaneous urticaria with no response from three consecutive months of antihistamines, and steroid dependence. The patients were randomized to receive NB-UVB (group A) or ciclosporin 3 mg kg−1 (group B) for 90 days, with post-treatment follow-up of 90 more days. Patients were assessed fortnightly. The mean (SD) UAS7 decreased from baseline scores of 24.8 (8.2) and 27.1 (8.2) to 0.82 (1.47) and 0.28 (1.4) in group A and group B, respectively at the end of the 90-day treatment (P &lt; 0.001). These increased to 1.55 (1.74) and 4.13 (4.85) at day 180 in groups A and B, respectively (P = 0.01 and P = 0.002). The mean (SD) UCT scores increased from baseline 8.52 (2.8) and 8.24 (2.67) to 15.0 (1.7) and 15.9 (0.4) at day 90 (P &lt; 0.001), which decreased to 14.9 (1.0) and 14.1 (2.0) at day 180 in groups A and B, respectively (P = 0.03 and P = 0.001). The mean (SD) CU-QoL decreased from baseline scores of 26.8 (14.9) and 30.0 (14.9) to 3.4 (6.3) and 0.48 (2.0) at day 90 (P &lt; 0.001 and P = 0.002), which increased to 2.1 (2.3) and 4.9 (5.2) at day 180 in groups A and B, respectively (P = 0.09 and P = 0.001). The mean (SD) AAS7 scores decreased from baseline 2.0 (4.7) and 4.9 (8.2) to 0 (0) and 0 (0) at day 90 in both groups (P = 0.04 and P = 0.007). AAS7 scores remained at 0 through follow-up. Ciclosporin performed as a crisis buster, giving early and better control of CRU during the treatment period; however, disease relapsed promptly on stopping ciclosporin. On the other hand NB-UVB had more sustained suppression of CRU even during follow-up. Thus NB-UVB is an effective, safe, affordable therapeutic modality for steroid-dependent CRU. Our study had a small sample size and the results may not be representative of a bigger population.
CD16 Medical-grade manuka honey and a sugar-free manuka honey extract inhibit allergic IgE-induced mast-cell degranulation: potential role as an topical anti-inflammatory agent in atopic dermatitis
Authors: Abdelwahab Omar , Lwaleed Bashir 
Published: June 2024

Abstract
Mast-cell numbers and activity are both increased in atopic dermatitis (AD) lesions. AD is characterized by allergen–IgE–FcεRI-induced mast-cell activation, associated with allergic responses to specific types of foods or allergens. Medihoney® (MH) is a medical-grade manuka honey with strong antimicrobial properties. Recent reports also suggest it has anti-inflammatory properties via inhibition of histamine release by mast cells. In the present study, we investigated the anti-inflammatory effect of MH and a sugar-free manuka honey extract (EX) against allergic inflammation by studying its effect on mast-cell degranulation induced by IgE. LAD-2 human mast cells were preincubated overnight with 100 ng mL−1 of human myeloma IgE, then activated by 1% antihuman IgE for 40 min with or without 20-min preincubation with 4%, 2% and 1% of MH or EX. Degranulation was assessed by measuring release of the lysosomal enzyme β-hexosaminidase. Both MH and EX induced significant dose-dependent inhibition of IgE-induced mast-cell degranulation, culminating at 85% and 100% inhibition, respectively, at 4% concentration. In conclusion, MH and EX potentially inhibit allergic IgE-induced mast-cell degranulation. Aqueous preparations of MH and EX (applied topically) could potentially be useful as anti-inflammatory agents directed against the allergic inflammation involved in the pathophysiology of AD.
DS13 Pregnancy-associated melanoma: a UK-wide service evaluation
Authors: Lawlor Kate , Hadjieconomou Sofia , Katugampola Ruwani , Mills Caroline , Li Vincent , Rajan Suchitra 
Published: June 2024

Abstract
There are currently no guidelines in the UK regarding management of pregnancy-associated melanoma (PAM). It is estimated that one-third of women diagnosed with melanoma are of childbearing age and numbers are rising (Still R, Brennecke S. Melanoma in pregnancy. Obstet Med 2017; 10: 107–12). Melanoma can metastasize to the placenta. Therefore, a diagnosis of PAM complicates decisions regarding staging and treatment (Carter TJ, George C, Harwood C, Nathan P. Melanoma in pregnancy: diagnosis and management in early-stage and advanced disease. Eur J Cancer 2022; 166: 240–53). A UK-wide survey distributed to members of the British Society for Dermatological Surgery (BSDS) has shown 23 cases of PAM and we await data of up to 26 additional identified cases. The data collected on these cases demonstrate an average age of 33.2 years at the time of diagnosis, with a range from 22 to 46 years. The stage of pregnancy at the time of diagnosis ranged from 2/40 gestation to 11 months postpartum. The diagnosis was primary melanoma in 18 patients, with metastatic disease in five patients. Breslow thickness ranged from in situ melanoma to &gt; 4 mm. Fifteen patients underwent narrow and subsequent wide local excision during pregnancy. Two patients delayed their wide local excision until after pregnancy. Two patients underwent sentinel lymph node biopsy during pregnancy, one of whom also underwent an axillary lymph node dissection during pregnancy. Three patients had immunotherapy for stage 4 disease postpartum. One of these patients delivered at term, having being diagnosed with metastatic melanoma at 32 weeks. She is currently having palliative treatment for advancing metastatic disease. Another of these patients underwent an elective caesarean section at 35 weeks’ gestation in order to commence immunotherapy and is likely to need further adjuvant treatment after a relapse. The details of the obstetric outcome for the third patient are awaited, but it is known that the patient has died from complications of metastatic melanoma. The placenta was sent for histological examination for only one of the patients and it did not show any evidence of metastases. The baby had a full-skin examination after birth in four cases (in three patients on one occasion only), with none showing any abnormalities secondary to melanoma. Four of the patients have successfully completed follow-up. Fifteen patients are currently undergoing follow-up, including one who is having palliative treatment and one who is due to recommence on immunotherapy. Four patients have died from complications of melanoma. We await data on up to 26 additional cases of PAM to include in this study.
DS16 Incidence and management of pregnancy-associated melanoma in a district general hospital in the Southeast of England
Authors: Pearson Nicholas , O’Kelly Sara , Birnie Andrew 
Published: June 2024

Abstract
Melanoma is the most common malignancy during pregnancy (Driscoll MS, Martires K, Bieber AK et al. Pregnancy and melanoma. J Am Acad Dermatol 2016; 75: 669–78). Pregnancy-associated melanoma (PAM) is defined as any melanoma diagnosed during pregnancy or up to 1 year postpartum. PAM appears to have poorer outcomes than other melanomas (Byrom L, Olsen C, Knight L et al. Increased mortality for pregnancy-associated melanoma: systemic review and meta-analysis. J Eur Acad Dermatol Venereol 2015; 29: 1457–66). The pathophysiology of why this could be is incompletely understood. There are currently no guidelines on the management of PAM in the UK. This is part of a project to collect data nationally to identify features of PAM, and to determine potential diagnostic challenges due to pregnancy. Patients were identified from the paper notes of the skin cancer multidisciplinary meetings from a district general hospital in the south-east of England. This covered a catchment area of approximately 800 000 patients. To identify patients who were diagnosed with PAM, we investigated the cohort of patients who were registered as female and aged between 20 and 50 years, a commonly used definition in the literature. Details on the pregnancies and melanoma were obtained from the electronic medical records. Four years of data from multidisciplinary meetings were processed, from December 2019 to November 2023. During this period, there were 85 female patients of childbearing age who were diagnosed with melanoma. Six patients had PAM, five of whom were diagnosed postpartum. The Breslow thicknesses ranged from 0.3 to 2.2 mm. The patient who was identified perinatally did not have her treatment delayed due to the pregnancy, and there was no record of the placenta being sent for histology or the baby being given a full-skin examination. Regarding the outcome for these patients, when the data were collected in December 2023, five were currently under follow-up and one had completed follow-up. PAM is a relatively rare condition, but with maternal ages rising in the developed world, the incidence could be expected to increase. National data collection is therefore required to identify trends and associations to gain consensus on its management.