bluuebunny/crossref_metadata_2025_split huggingface dataset:
P045 An international Delphi consensus to define a clinically appropriate definition of disease modification for plaque psoriasis
Authors: Eyerich Killian , Krueger James , Stahle Mona , Schakel Knut , Conrad Curdin , Gniadecki Robert , Puig Luis , Scoble Thomas , Williams Nick 
Published: June 2024

Abstract
In moderate-to-severe psoriasis, biologic therapies have achieved high levels of complete skin clearance and maintenance of this response over several years for many patients. However, questions remain as to how the disease can be controlled, brought into remission, or modified. Current definitions and measurement of disease modification are of limited utility in a clinical setting. This work acknowledges that the rapidly developing therapeutic landscape for plaque psoriasis brings into focus the question of potential for disease modification. Our objective was to achieve consensus on a definition of disease modification that can be applied within a clinical setting. In May 2021, a literature review on the topic of disease modification in psoriasis was conducted using the PubMed database. Search terms included but were not limited to ‘disease modification’, ‘disease progression, ‘disease interception’, ‘treatment target’, ‘drug therapy’, ‘biomarker’ and ‘drug-free remission’. Following the review, a panel of experts in psoriasis care from across Europe and North America convened in October 2021. Employing Delphi methodology guided by an independent facilitator, the panellists identified six main topics of focus. These topics were discussed, and 35 statements were developed and used to inform an online Delphi survey. This was distributed through a convenience sampling method to 97 healthcare professionals specializing in psoriasis care across Europe and North America. Respondents were offered a four-point Likert scale to indicate their responses. Completed surveys were anonymously collated and analysed by the independent facilitator. The results were then shared with the expert panel to determine conclusions. Stopping criteria for consensus rounds were defined as a 3-month period to collect responses, a minimum of 50 responses within this timeframe, and 90% of statements passing the threshold for consensus. The a priori threshold for consensus agreement was set at 75% and was further defined to be ‘very high’ at ≥ 90%. In total 63 responses (65% response rate) were received. Consensus was achieved for 32 statements and was not achieved for three statements. Given the high level of agreement with the statements, and that the stopping criteria were met, a second round of testing was not performed. The authors offer a definition of disease modification for plaque psoriasis that could be utilized in a clinical setting: ‘A sustained improvement in the disease course of plaque psoriasis resulting from a change in pathophysiology that minimizes the need for treatment.’ To determine the strength of this definition, the next step will be to test it within a real-world clinical setting.
P048 Immunosuppression and vaccination: a cross-specialty survey on current practices
Authors: Lim Chris Puo Nen , Maliampurakal Akash , Saunders Jayne , Paton Elaine , Drummond Angela 
Published: June 2024

Abstract
According to the 2018 General Medical Services contract in Scotland, the responsibility for vaccination delivery has shifted from general practitioners to secondary care. Dermatologists working in NHS Scotland now have an active role in recommending vaccinations for their patients who are on immunosuppressants. This recommendation is outlined in the Green Book published by the UK Health Security Agency. Currently, dermatology patients on immunosuppressants are required to receive the pneumococcal vaccine before starting treatment and every 5 years thereafter. However, this requirement is not included in the patient group direction produced by Public Health Scotland. As a result, individual prescriptions for the vaccination are needed, which adds to the workload on the services. Our objective was to assess current vaccination practices for patients on systemic medications across multiple specialties (dermatology, rheumatology, gastroenterology) in our local health board. We developed an online questionnaire, which was iteratively refined and distributed between June and August 2023 to clinicians working in dermatology, rheumatology, and gastroenterology locally, as well as other dermatology units in Scotland through the Scottish Dermatological Society. The questionnaire aimed to gather information on clinicians’ recommendations regarding influenza, pneumococcal and COVID-19 vaccines for patients taking various immunosuppressants, including methotrexate, ciclosporin, azathioprine, mycophenolate mofetil, fumaric acid esters, apremilast, biologics, and Janus kinase inhibitors. In total 64 responses were obtained: from dermatology (44 of 64, 69%), rheumatology (8 of 64, 13%) and gastroenterology (12 of 64, 19%). Most respondents in dermatology (68%) and rheumatology (88%) were consultants or associate specialists, while 50% of the respondents in gastroenterology were specialist trainees. Almost all respondents across the three specialties recommended vaccinations routinely in their clinical practice. The majority of respondents recommended yearly vaccinations against influenza. There were mixed responses on recommendations regarding pneumococcal vaccinations, with varying frequencies between yearly and 5-year intervals. A significant proportion of respondents were unsure of the latest COVID-19 vaccine recommendations. Free-text comments revealed an interest in the project and the need for standardization of vaccination recommendations. A review of the Green Book highlighted the following recommendations for patients on immunosuppressants: annual influenza vaccine, one-off pneumococcal vaccine unless in high-risk groups (asplenia, splenic dysfunction, and chronic kidney disease) and booster COVID-19 vaccines during seasonal campaigns. In conclusion, we highlight the variations in vaccination practices among these three specialties, and the importance of standardization in vaccination recommendations.
P058 Healthcare disparity affecting delayed diagnosis in acral lentiginous melanoma
Authors: Wu Xinxin , Lesch Samantha , Griffin Julia , Silberstein Peter 
Published: June 2024

Abstract
Acral lentiginous melanoma (ALM) is a rare subtype of cutaneous malignant melanoma that arises in patients with minimal correlation to ultraviolet radiation exposure, unlike many other melanoma subtypes (Arrington JH 3rd, Reed RJ, Ichinose H, Krementz ET. Plantar lentiginous melanoma: a distinctive variant of human cutaneous malignant melanoma. Am J Surg Pathol 1977; 1: 131–43). The 5-year overall survival rate for stage I disease is 98%, which can drop as low as 10% for stage IV. A concerning trend in diagnosis has shown that many patients present with this disease later in the disease process and are thus subject to high morbidity and mortality. Of additional concern is that ALM disproportionately affects non-White populations. A previous Surveillance, Epidemiology and End Results study (n = 1724) reported that Black patients, on average, presented with more advanced disease than their White counterparts (Huang K, Fan J, Misra S. Acral lentiginous melanoma: incidence and survival in the United States, 2006–2015, an ana­lysis of the SEER registry. J Surg Res 2020; 251: 329–39). This calls into question the role of socioeconomic inequities in the stage of disease at which patients are diagnosed. A retrospective cohort study of 3683 patients diagnosed with stage I and stage IV ALM between 2004 and 2020 in the National Cancer Database was compared via binary logistics regression to determine factors associated with later diagnosis. On multivariate analysis, Black race and male sex were associated with later stage at diagnosis (P = 0.001 and P &lt; 0.001, respectively). Population density, insurance status, facility location, education level, income status, age and Hispanic status did not have statistically significant associations with patients diagnosed with stage I vs. stage IV ALM. These results illustrate that Black male patients disproportionately face disparities in the diagnosis of this subtype of melanoma. This study highlights the need for continued research on ALM and the factors that affect its prompt recognition, diagnosis and treatment.
P060 An analysis of eye colour and iris pattern as a risk factor for skin cancer in immunosuppressed renal transplant recipients
Authors: Leahy Marion , Laing Mary 
Published: June 2024

Abstract
Renal transplant recipients (RTRs) are at increased risk of keratinocyte skin cancers, with a tendency to have multiple, aggressive and difficult-to-treat tumours. The eye and the skin share the same embryological ectoderm. Iris pattern has recently been reported as a predictive risk factor for skin cancer in nonimmunosuppressed Southern European and Irish populations. Our aim was to analyse whether an individual’s iris pattern is an independent risk factor for the development of keratinocyte carcinoma in RTRs. Iris patterns of 110 RTRs were evaluated using the Simionescu visual three-step technique (iris periphery, collarette and iris freckling). Established risk factors for skin cancer in patients with transplants were recorded as confounding factors. This was an observational cross-sectional study. Among the 110 RTRs, 31 participants had skin cancer. In the skin cancer group, iris periphery was blue/grey in 74% (P = 0.053, odds ratio 2.5), the collarette was light brown in 57% (P &lt; 0.004) and iris freckles were present in 55% (P = 0.04). Dark brown and blue collarettes were observed in controls. Binary logistic regression analysis showed that light brown collarette is a significant independent risk factor for skin cancer (odds ratio 4.54, confidence interval 1.56–10.6, P = 0.02). Within this RTR population a blue iris periphery, light brown collarette and presence of freckling confer an independent risk for skin cancer. Iris pattern is a useful tool for identification of transplant patients at risk of skin cancer and an easy-to-use technique for risk evaluation in this cohort. This is the first study to investigate iris pattern and skin cancer risk in RTRs.
P064 Prevention is better than cure: acitretin and chemoprevention
Authors: Hussain Fazleenah Ajmul , Yesudian Paul Devakar 
Published: June 2024

Abstract
Solid organ transplant recipients (SOTRs) have an increased incidence of cutaneous malignancy, especially nonmelanoma skin cancers (NMSC), where the risk is estimated to be up to 65 times higher than that of the general population. A 10-fold increase in mortality has been reported for NMSC in SOTRs. There are currently no guidelines on chemoprevention of recurrent keratinocyte tumours (KTs) in patients with or without transplants, leading to variation in clinical practice. We undertook an online survey analysing acitretin use for NMSC chemoprevention among British dermatologists. The questionnaire was distributed through email to dermatologists in the UK. We received 52 responses, of which 37 (71%) were from consultants. Most responses came from dermatologists practising in Scotland (34, 65%). The cohort was highly experienced, with 20 (38%) having &gt; 20 years’ dermatology experience and 13 (25%) responders having 11–20 years’ experience. Overall, 24 (46%) saw fewer than five SOTRs in their clinic in a month and 20 (38%) saw hardly any. In nontransplant patients, 26 (50%) dermatologists prescribed acitretin for recurrent KTs, whereas 13 (25%) did not. The preferred dosing was 10 mg for the majority (29, 60% of those with data). Prescribers (n = 25, 53%) commenced patients on acitretin after they developed at least two to five KTs; one prescriber started acitretin after development of at least one KT. In the SOTR group, acitretin was prescribed after development of recurrent KT and not pre-emptively; 10 mg was the preferred dose for majority (22, 47%). For both SOTRs and nontransplant patients, acitretin was prescribed indefinitely by 31 (63%) responders. Interestingly, 17 (35%) dermatologists did not prescribe acitretin in SOTRs and 10 (20%) did not prescribe acitretin in either SOTRs or nontransplant patients. Thirteen (25%) did not prescribe acitretin in nontransplant patients with recurrent KT. Side-effects of acitretin were not severe enough to lead to discontinuation according to 16 (35%) responders. Some commented that adverse events were patient and dose dependent, and by minimizing the dose of acitretin, they reduced side-effects. In total, 47 (92%) provided regular photoprotective advise to patients with recurrent KTs. Overall, 49 (94%) did not encounter patients with skin of colour with recurrent KTs in their practice. To our knowledge, this is the first survey assessing the practice of acitretin use in chemoprevention in both transplant and nontransplant patients. Our survey suggests discrepancies in practice among dermatologists prescribing acitretin in SOTRs and nontransplant patients. More than one-third did not prescribe acitretin in SOTRs with recurrent KTs. There is good evidence that acitretin reduces the incidence of KT in SOTRs, and hence its use should be encouraged in this cohort.
P065 Attitudes and practices of patients with inflammatory bowel disease towards skin cancer risk and sun protection
Authors: Herlihy Maeve , Blake Eve , Courtney Garry 
Published: June 2024

Abstract
Skin cancer is the most common form of cancer in Ireland, with over 13 000 new cases diagnosed annually. People with inflammatory bowel disease (IBD) may be at higher risk of skin cancer. A meta-analysis performed on more than 170 000 patients diagnosed with IBD found that patients with IBD had a 37% higher risk of developing melanoma than expected in the general population (relative risk 1.37, 95% confidence interval 1.10–1.70). This increased risk was independent of IBD treatment. Additionally, many of the treatments used for IBD involve supressing or altering the immune system. Immunosuppression is a risk factor for all types of skin cancer, and cutaneous malignancies in immunocompromised patients tend to behave more aggressively compared with those in the general population. The British Association of Dermatologists has published preventive guidelines for patients on immunosuppression, but specific gastroenterology recommendations are lacking. Prevention and early detection are therefore of paramount importance. Our aim was to assess knowledge of skin cancer risk factors and photoprotective behaviours in an Irish cohort of at-risk patients with IBD. A questionnaire was given to patients attending our IBD clinic. Clinical data were recorded including diagnosis, immunosuppressants, skin cancer risk factors and photoprotective behaviours. In total, 87 patients (52% women) with IBD (63% Crohn disease, 35% ulcerative colitis) were included. All participants were White, with 77% recorded as having fair or very fair skin. Most patients (97%) were on treatment for their IBD (66% on biologics, 25% on immunomodulators). Over one-third of participants (35%) were unaware of an increased skin cancer risk associated with IBD. Four patients had a history of skin cancer, two of which were melanoma. Half of patients (48%) had been sunburnt in the last year, and 36% had more than 10 burns in their lifetime. In total, 57% of patients reported a history of blistering sunburn and 22% of patients had used sunbeds. Knowledge of skin cancer risk factors and worrisome features was generally good, and the majority of our cohort (74%) always wore suncream abroad. However, less than half wore suncream frequently in Ireland (37%) or when it is cloudy (22%), and also did not take other important measures, such as reapplying suncream every 2 h (43%), or wearing a hat (26%) or protective clothing (32%). Our study highlights gaps in the education of our IBD cohort regarding skin cancer risk and prevention, and suggests that primary prevention of skin cancer in this IBD cohort is suboptimal. Ideally, educational interventions to enhance patient awareness and encourage adequate photoprotection and skin self-surveillance should be undertaken and assessed.
P073 Prevalence, mortality and healthcare resource use for generalized pustular psoriasis compared with plaque psoriasis in England: a population-based cohort study
Authors: Frysz Monika , Patel Smit , Li Marie , Griffiths Christopher , Warren Richard B , Ashcroft Darren 
Published: June 2024

Abstract
Generalized pustular psoriasis (GPP) is a rare, chronic inflammatory skin condition that is potentially life-threatening. Accumulating evidence suggests that GPP is distinct from the more common plaque psoriasis in terms of aetiology and clinical and dermatological features. The aim of this study was to describe the epidemiology, comorbidities, mortality and healthcare resource use (HCRU) in patients with GPP compared with those with plaque psoriasis in England. A retrospective cohort study of the Clinical Practice Research Datalink (CPRD) Aurum database linked with hospital and mortality data, between 2008 and 2019, was conducted, and HCRU between 2015 and 2019 was calculated. Prevalence rates, comorbidities and survival rates were estimated for GPP and plaque psoriasis. Diagnoses were based on CPRD medical codes and International Classification of Diseases 10th Revision codes (L40.1 for GPP, and L40.0 for plaque psoriasis). In total, 373 patients with GPP (62.5% female) and 224 223 patients with plaque psoriasis (49.4% female) were identified. The mean age (SD) was 55.9 years (18.6) for GPP, and 48.5 years (19.1) for patients with plaque psoriasis. A higher proportion of patients with GPP had at least one comorbidity, compared with plaque psoriasis (76.4% vs. 55.9%, respectively). From 2008 to 2019, the prevalence rates per 100 000 persons ranged from 1.61 to 3.0 for GPP, and from 1771 to 1904 for plaque psoriasis. In total, 78 of the 373 (20.9%) patients with GPP died during the study period, compared with 20 771 of 224 223 (9.3%) patients with plaque psoriasis. Compared with plaque psoriasis, survival rates were lower for patients with GPP, particularly those who were over 55 years old and those with a history of at least one comorbidity. Overall, 297 patients with GPP and 181 925 with plaque psoriasis were included in HCRU analysis. Hospitalizations, outpatient visits and accident and emergency visits were more frequent in patients with GPP compared with plaque psoriasis (78% vs. 47%, 92% vs. 75% and 71% vs. 52%, respectively). Our results support previous findings that GPP is a distinct disease from plaque psoriasis with a different epidemiology. Compared with plaque psoriasis, patients with GPP had higher mortality and were found to have higher disease burden, demonstrating a high unmet need in this patient group. The study was supported and funded by Boehringer Ingelheim. Boehringer Ingelheim was given the opportunity to review the manuscript for medical and scientific accuracy, as well as intellectual property considerations.
P079 The lifetime risk of vitiligo across sociodemographic groups: a UK population-based cohort study
Authors: Eleftheriadou Viktoria , Ahmed Alia , Nesnas John , Nagra Ranjit 
Published: June 2024

Abstract
The lifetime risk for vitiligo has not previously been estimated using large-scale population data. It is also not clear how the lifetime risk for vitiligo differs by sex, ethnicity and levels of socioeconomic deprivation. We aimed to estimate the lifetime incidence of vitiligo in the UK, overall and across sociodemographic subgroups. Incident cases of vitiligo were identified using a large database (Optimum Patient Care Database) of routinely collected primary care records in the UK between 1 January 2004 and 31 December 2020. Lifetime incidence of vitiligo was estimated at age 80 years using modified time-to-event models, adjusted for competing risk of death, with age as the timescale. Lifetime incidence was estimated for the study population overall and stratified by ethnicity, sex and deprivation. We identified 9460 adults and children newly diagnosed with vitiligo during the study period. The overall cumulative lifetime incidence in the population was 0.92% at age 80 years [95% confidence interval (CI) 0.90–0.94]. Lifetime incidence was similar in female (0.94%, 95% CI 0.92–0.97) and male patients (0.89%, 95% CI 0.86–0.92). There were substantial differences in lifetime incidence across ethnic groups: Asian (3.58%, 95% CI 3.38–3.78), Black (2.18%, 95% CI 1.85–2.50), mixed (2.03%, 95% CI 1.58–2.47), other (1.05%, 95% CI 0.94–1.17) and White ethnicity (0.73%, 95% CI 0.71–0.76). There were also substantial differences in the lifetime incidence across sociodemographic subgroup, with higher lifetime risk in the most deprived quintile (1.25%, 95% CI 1.20–1.31) compared with the least deprived quintile (0.81%, 95% CI 0.77–0.86). However, these differences appear to result from a higher proportion of people from non-White ethnicities in the lower socioeconomic subgroups. In post hoc analysis when restricting the sociodemographic analysis to those of White ethnicity only, the socioeconomic differences were negligible. Our estimates of lifetime incidence suggest that 1 in 109 people will develop vitiligo over their lifetime. Clinicians should be aware of the markedly increased incidence of vitiligo in people of non-White ethnicity, in particular for those of Asian ethnicity (1 in 28 people). The negative impact of vitiligo on mental health, work and healthcare utilization highlights the importance of monitoring people with vitiligo to identify those who need additional support. The study protocol for this retrospective observational study was registered a priori with ClinicalTrials.gov (identifier: NCT06097494). This research was sponsored by Pfizer. Project management, medical writing and statistical support were provided by Momentum Data, UK, and funded by Pfizer.
P081 A highly selective Janus kinase 1 inhibitor, ivarmacitinib ointment, for the treatment of atopic dermatitis: results from a phase II study
Authors: Li Baoping , Goh Joshua S H , Wang Duoqin , Xu Jinhua , Goh Aik Han 
Published: June 2024

Abstract
Atopic dermatitis (AD) is a pruritic chronic inflammatory skin disorder. Ivarmacitinib, a highly selective inhibitor of Janus kinase 1, potently suppresses cytokine signalling involved in AD pathogenesis. A randomized, double-blind, vehicle-controlled, seamless and adaptive-designed phase II/III study was conducted to evaluate the efficacy and safety of ivarmacitinib ointment in patients with AD. The results of phase II are reported here. The study was registered with ClinicalTrials.gov (NCT04717310). In total, 128 patients aged 18–65 years with mild-to-moderate AD were randomly assigned (1 : 1 : 1 : 1) to receive twice-daily topical ivarmacitinib ointment 2%, 1% or 0.5%, or vehicle for 8 weeks. Efficacy evaluation included Eczema Area and Severity Index (EASI), Investigator’s Global Assessment (IGA), Scoring of Atopic Dermatitis (SCORAD), Pruritus numerical rating scale (NRS) and Dermatology Life Quality Index (DLQI). At week 8, all three doses met the primary endpoint, mean percentage change of EASI from baseline. The results in the arms with ivarmacitinib 2%, 1% and 0.5% were −56.1%, −54.6% and −66.9% (P = 0.06, 0.08, 0.002, respectively), compared with vehicle (−40.2%). The ivarmacitinib 0.5% ointment group also achieved IGA response (IGA score of 0/1 with ≥ 2 points improvement from baseline) compared with vehicle. Other endpoints including SCORAD, NRS and DLQI all showed therapeutic benefit at week 8 in the ivarmacitinib ointment regimens. The ivarmacitinib ointment demonstrated good safety results and was well tolerated. In conclusion, ivarmacitinib ointment at 2%, 1% or 0.5% strength significantly improved signs and symptoms compared with vehicle and was well tolerated in adult patients with mild-to-moderate AD. This study was funded by Reistone Biopharma Co., Ltd.