bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical Assessment of Subjective Visual and Haptic Vertical Norms in Healthy Adults
Authors: van der Waal Charlotte , Saeys Wim , Truijen Steven , Embrechts Elissa 
Published: June 2024

Abstract

Background and objective
Accurate verticality perception is essential for daily life activities, such as correctly estimating object orientation in space. This study established normative data for the subjective visual vertical (SVV) and subjective haptic vertical (SHV) using the portable and self-constructable modified Bucket test and Rotating-Column test. Additionally, the contribution of age, sex, and starting position of the line/ column on SVV and SHV accuracy were evaluated.

Method
This study, part of the PRECISE project (ClinicalTrials.gov ID NCT05978596), was conducted following the STROBE guidelines. Healthy adults without visual/neurological/vestibular disorders were recruited. Subjective visual vertical and SHV accuracy were described in terms of constant errors (i.e., mean deviation from 0° [true vertical] respecting its direction), unsigned errors (i.e., mean deviation from 0° irrespective of direction), and variability (i.e., intra-individual standard deviation).

Results
Sixty participants were evaluated (mean age: 41.14 [SD = 16.74] years). Subjective visual vertical constant errors between −2.82° and 2.90°, unsigned errors up to 2.15°, and variability up to 1.61° are considered normal. Subjective haptic vertical constant errors ranged from −6.94° to 8.18°, unsigned errors up to 6.66° and variability up to 4.25°. Higher ages led to higher SVV unsigned errors and variability. SHV variability was higher in females compared to males. Certain starting positions led to higher SVV and SHV constants and SVV unsigned errors.

Discussion
Normative data are provided for affordable, self-constructable, and portable SVV and SHV tools. These norms are consistent with more sophisticated equipment and can be used to distinguish between normal and abnormal values.
CPC04 An atypical case of vasculitis: when immunosuppression is not the answer
Authors: Celebi Perin , Sherlock Hannah , Hawari Rand , Abid Maaz 
Published: June 2024

Abstract
Cutaneous vasculitis has a wide range of recognized causes, including drugs, autoimmune diseases, infection and malignancy. The management depends on the underlying cause, but the mainstay of treatment for severe disease is typically immunosuppressive agents such as corticosteroids. This case report discusses an unusual presentation and cause of small vessel vasculitis, and the challenges faced in diagnosis. A 53-year-old woman with a background history of renal sarcoidosis presented to dermatology with a 6-month history of a painful nodular and nonblanching purpuric rash on her lower legs. The clinical impression of cutaneous sarcoid was managed by increasing her prednisolone and later her azathioprine. However, despite this, her rash progressed into a bullous and necrotic ulcerating vasculitic eruption. An incisional biopsy was performed due to the atypical appearance of the rash, and the level of pain, which was not in keeping with cutaneous sarcoid or a usual vasculitic eruption. Sections of skin showed prominent epidermal necrosis, with focal blisters containing numerous dead keratinocytes. There were occasional viable keratinocytes showing intranuclear viral inclusions most in keeping with herpes infection. The underlying dermis showed prominent perivascular inflammation and fibrinoid necrosis of the superficial and deep blood vessels, even extending into the subcutaneous fat with areas of fat necrosis. Occasional leucocytoclastic debris was seen in the superficial blood vessels with numerous extravasated red blood cells. These histological features are in keeping with fulminant leucocytoclastic vasculitis with atypical herpes infection. Varicella zoster serology was positive, confirming the rare diagnosis of atypical fulminant herpes vasculitis. The patient improved on intravenous aciclovir 5 mg kg−1 and continues on a longer-term prophylactic oral dose. Atypical presentations of vasculitis are challenging to diagnose, resulting in delayed management and increasing the risk of postherpetic neuralgia. We aim to discuss this and other cases in the literature to improve awareness of this rare but important presentation, which, contrary to other vasculitides, should not be treated with immunosuppression.
CPC08 Two fatal cases of fulminant, rapidly progressive interstitial lung disease secondary to MDA5 dermatomyositis
Authors: Shareef Narin , Natkunarajah Jana 
Published: June 2024

Abstract
Anti-MDA5 dermatomyositis (DM) is a rare systemic autoimmune condition associated with clinically amyopathic DM and rapidly progressive interstitial lung disease (RP-ILD). It is associated with unique skin features including cutaneous ulceration, eyelid oedema, palmar papules and mechanic’s hands. We present two challenging cases of anti-MDA5 DM with atypical skin manifestations, complicated by RP-ILD, which unfortunately resulted in death in both patients. The first case is a 47-year-old Egyptian woman who initially presented with erythema and burning sensation of the fingertips, thigh rash, arthralgia, joint swelling, dry cough and reduced exercise tolerance. She was diagnosed with undifferentiated inflammatory arthritis and possible amyopathic DM and started on methotrexate and systemic steroids. An autoimmune panel showed weakly positive rheumatoid factor but negative antinuclear antibodies, extractable nuclear antigen, dsDNA, antineutrophil cytoplasmic antibodies and anti-Jo1. Subsequently she presented to accident and emergency with worsening breathlessness and productive cough and was admitted to the intensive care unit, treated for pneumonia. A high-resolution computed tomography (CT) scan was reviewed at a tertiary multidisciplinary team, showing an RP-ILD picture, most likely due to MDA5 DM. She was started on pulsed intravenous methylprednisolone and transferred to a tertiary centre for extracorporeal membrane oxygenation (ECMO) and consideration of rituximab. Unfortunately, she died shortly after. She demonstrated positive anti-MDA5 serology. The second case is a 60-year-old Chinese woman who initially presented to ophthalmology with left-eye oedema and was diagnosed with preseptal cellulitis. Subsequently, she presented again to accident and emergency with fatigue, unintentional weight loss, and reduced mobility. She was cachectic with ulcerating skin lesions on her shoulders and hips. Initial CT of the chest–abdomen–pelvis showed patchy consolidation in both lungs, with nodularity and ground-glass changes. She developed pyrexia and mild hypoxia and was treated for bilateral pneumonia. During admission, fasciculations in her upper limbs and tongue prompted a neurology review. Nerve conduction studies demonstrated myopathic changes. Creatine kinase was elevated, and magnetic resonance imaging of the lower limbs confirmed diffuse oedema. Concurrently, she was noted to have mechanic’s hands and Gottron papules. She developed severe type 1 respiratory failure, requiring transfer to intensive care. Repeat CT imaging showed worsening bilateral consolidation and ground-glass changes, with pleural effusions. Her rapidly progressive respiratory failure in the context of likely DM prompted urgent referral to a tertiary centre for ECMO and aggressive immunosuppression. Unfortunately, she died 3 weeks later. Autoantibody testing confirmed positive anti-MDA5 and Ro52 antibodies.
P002 Inflammatory vitiligo with raised borders: a rare case of pseudolymphoma mimicking hypopigmented mycosis fungoides
Authors: Daruish Maged , Grossmith Cecilia , Taibjee Saleem 
Published: June 2024

Abstract
A 51-year-old woman was referred to our department with a mildly itchy persistent rash that had started 3 years earlier on the back of her thighs, leaving pale skin as it progressed. She noted worsening of the rash during winter months. There was a history of psychological stress preceding the onset of the rash. Clinical examination revealed bilateral symmetrical annular hypopigmented patches with erythematous and slightly scaly raised edges. Symmetrical patches of depigmentation were also seen on her forearms. An incisional biopsy from the left posterior thigh, including the hypopigmented centre and adjacent erythematous rim, revealed unremarkable epidermis corresponding to the hypopigmentation, while the advancing edge showed interface changes with a bandlike lymphohistiocytic infiltrate and prominent lymphocytic exocytosis. The lymphocytes were positive for pan T-cell markers (CD2, CD3, CD5, CD7), with relatively equal CD4 and CD8 populations. Melan-A indicated reduced density of melanocytes. There was no evidence of clonality on T-cell receptor (TCR) gene rearrangement studies. Punch biopsy from a depigmented patch on the right forearm was unremarkable on haematoxylin and eosin sections. However, melan-A indicated that the epidermis was completely devoid of melanocytes. The diagnosis of inflammatory vitiligo with raised borders (IVRB) was made. IVRB is a rare subtype of vitiligo that typically presents with a raised erythematous, scaly and pruritic edge surrounding depigmented patches. Differentiating IVRB from hypopigmented mycosis fungoides can be challenging, both clinically and histologically, due to the prominent lichenoid infiltrate with epidermotropism and the predominance of CD8+ lymphocytes that can be found in both. Helpful clues include the characteristic erythematous border, as well as lack of clonality on TCR gene rearrangement studies in IVRB (Gomez-Moyano E, Vera-Casaño A, Gamero AH et al. Inflammatory vitiligo or hypopigmented mycosis fungoides? J Pediatr Hematol Oncol 2010; 32: 338–9). Melanocytes and epidermal melanin are more likely to be preserved in hypopigmented mycosis fungoides [El-Darouti MA, Marzouk S, Azzam O et al. Vitiligo vs. hypopigmented mycosis fungoides (histopathological and immunohistochemical study, univariate analysis). Eur J Dermatol 2006; 16: 17–22]. Clinicopathological correlation is crucial to make the distinction.
P026 Teledermatology from the other side: a clinical photographers’ perspective
Authors: Uthayakumar Aarthy , Searle Tamara , Elshimy Noha 
Published: June 2024

Abstract
Teledermatology has transformed the way we deliver our skin cancer service, with medical photographers playing a vital role in our trust. We sought to further streamline our existing teledermatology service and explore challenges faced by the photography team. Our teledermatology model involves patients directly attending the hospital for a professional photography appointment before consultant triage of the lesion(s). After observing teledermatology photography lists with detailed photographer feedback, 1 week of teledermatology clinics across all three sites of the trust were analysed. Referral type, discrepancies between the general practitioner (GP) referral and photos taken, and chaperone availability were explored, in addition to the referral pathway and patient information supplied. In total 122 teledermatology patients were included. Photographers highlighted difficulties with patients requesting lesions not specified on the GP referral to be photographed, and not having sufficient information prior to their teledermatology appointment, making it often difficult to manage expectations. Furthermore, due to minimal staffing, the availability of chaperones was often limited. In 19% of cases there was a discrepancy between the GP referred lesion and photograph taken, which was due to additional lesions being photographed (35%), patients having multiple moles (22%), and unlikely suitability for teledermatology and no GP referral being present (17%). Improvements have been implemented at different levels along the teledermatology pathway to further streamline the service and reduce some of the pressures faced by our clinical photographer colleagues. Modifications to the GP suspected skin cancer pathway referral make it clearer which patients are suitable for teledermatology, and request a mandatory lesion and locator photograph. The triage process has been altered to improve robustness, with an additional triage step to minimize patients inappropriate for teledermatology being booked in, such as those with more than three lesions, genital lesions and patients on stretchers. Patient information has been clearly displayed in the medical photography department, highlighting that only the referred lesion can be photographed, and a paper copy of the teledermatology patient information leaflet is provided to highlight the next steps to the patient. This minimizes questions directed at the photographers and aids management of patient expectations. Finally, a protocol for medical photographers has been implemented to standardize teledermatology images taken, with changes to include polarized and nonpolarized dermoscopy. With these changes we have minimized the challenges faced by our clinical photography colleagues, whose perspective and experience of a successful teledermatology service is critical, and we believe this should be explored in order to make meaningful improvements.
P051 The what, how and why of basal cell carcinoma: natural progression and surgical intervention
Authors: Lam Mun Wai , Wells Helena , Gibbs Heidi , Zhao Andrew , Tso Simon , Wernham Aaron 
Published: June 2024

Abstract
Basal cell carcinomas (BCCs) are slow-growing keratinocyte tumours. During the COVID-19 pandemic, the British Association of Dermatologists and British Society for Dermatological Surgery recommended deferment of surgical treatment for BCCs by 3–6 months unless they were causing significant symptoms or were at higher risk of growth. The deferment of surgical treatment for BCCs provided an unexpected opportunity to evaluate the natural history of BCC evolution given the paucity of evidence and conflicting outcomes of published literature. This study evaluated the natural progression of BCCs while awaiting surgical intervention, to better understand their natural growth and development. We also examined whether delays in surgery had implications on clinical outcomes. Patients with a suspected diagnosis of BCC, who had a surgical procedure planned between February and April 2023, were included in the data collection. Retrospective analysis was performed on the data, including waiting time for surgery, subtype of BCC, the size of the lesion, the location of the lesion, the planned and actual surgery performed and the patients’ symptomatology. Fifty-five patients, with a total of 70 lesions, were included in this analysis. Fifty lesions were found on the face and the others were on the trunk or limbs. The mean sum of BCC size was 91.7 mm2, while a larger mean size of BCCs of 119 mm2 was found on the trunk and limbs compared with the face (mean size 80.8 mm2). Twenty per cent of the cases had a larger procedure than originally planned at the time of booking. A regression ana­lysis showed 0.36 mm2 in growth on average (P &lt; 0.002), and 0.0045% (P &lt; 0.002) each day since presentation. Both values are statistically significant. A positive relationship between growth and time between presentation and surgical appointment (multiple R of 0.36) was demonstrated. The top three symptoms reported include itching (39%), crusting (36%) and bleeding (30%). In conclusion, our data reveal that while awaiting a surgical intervention, a BCC is likely to increase in size. Patients can therefore end up with larger and more complex procedures than originally planned. The symptoms experienced by patients should also be taken into consideration when planning surgery. Traditionally BCCs are not prioritized on a dermatology surgical list, compared with other skin cancers, but our findings demonstrate that a delay in surgical intervention can result in larger procedures being performed, and as a consequence increased morbidity to patients with greater impact on their quality of life.
P056 Reflectance confocal microscopy and basal cell carcinoma: is it time to embrace the new technology?
Authors: Nicholls Isabelle , Baloch Hina , Garioch Jennifer , Fadhil May 
Published: June 2024

Abstract
Reflectance confocal microscopy (RCM) is a noninvasive technique for in vivo examination of the skin. In vivo RCM can be used to diagnose basal cell carcinoma (BCC) noninvasively. Previous studies have demonstrated that RCM is an accurate technique for the diagnosis of BCC. RCM has the advantage that it is noninvasive and provides the diagnosis within a few minutes. By contrast, the current standard of care requires an invasive biopsy, taking several days before the result is available, and is costly and can result in sampling errors. We provide a snapshot of how we have integrated RCM into our service, and how it has reduced the number of biopsies, resulting in significant cost savings and shortening patients’ pathways. Sixty-three patients with suspected BCC of the head and neck were referred to our RCM clinic in January, February and March 2023. A diagnosis of BCC was made by RCM in real time in 89% of cases (56 of 63). Confirmation of the diagnosis of BCC in clinic facilitated discussion with the patient at the same outpatient attendance with regards to treatment, without the need for an additional outpatient visit. Overall, 11% of patients (seven of 63) suspected of having a BCC, whose diagnosis could not be confirmed by RCM, required a biopsy that confirmed the diagnosis of BCC. The median turnaround time for the biopsy result was 12 days. The cost of a punch biopsy in our hospital is £330 per patient, of which £176 is attributable to histopathology costs. Following the diagnosis of BCC, 73% (46 of 63) were referred directly for Mohs surgery, 12% (eight of 63) had conventional excision, 5% (three of 63) were referred for radiotherapy, and 10% (six of 63) were managed conservatively. We have shown that integrating RCM into our dermatology service has negated the need for biopsy in 89% of head and neck BCCs referred to the RCM clinic. RCM has resulted in shortening of patients’ pathways, it has reduced the pressure on our histopathology service, it has lessened the risk of false negative biopsies due to sampling errors, and it has produced significant cost savings. The diagnosis of BCC by RCM is a simple skill to acquire and allows the clinician to make the diagnosis with a few minutes. For patients, it is a more acceptable method of diagnosing BCC without recourse to biopsy. For the wider NHS, it has the potential for significant cost savings.
British Hair and Nail SocietyOral presentationsBH01 (P087) The British Hair and Nail Society present a review of our national grand round of challenging hair disorders and the benefits to the wider British Association of Dermatologists membership
Authors: Sharma Sonia , Bryden Alyson , Clayton Nicola , Farrant Paul , Mowbray Megan , Holmes Susan , Therianou Anastasia , Al-Nuaimi Yusur , Meah Nekma , Asfour Leila , Takwale Anita 
Published: June 2024

Abstract
The British Hair and Nail Society was formed in 2011. We currently have 133 members and invite them to submit challenging cases of hair disorders to our grand round (with relevant history, histopathology and photographs) for review by our expert hair panel. This comprises consultants with hair expertise from around the UK, and together we aim to address the referrers’ queries relating to diagnosis, treatment or both. We appreciate the complexity of hair disorders and the limited number of specialist hair clinics around the country, and therefore we have recently offered the opportunity for all British Association of Dermatologists (BAD) members to submit cases once a year. The aim of our review is to present the types of complex hair disorders that have been referred to our dedicated national hair-­related grand round and showcase some of the most educational cases. The hair disorders grand round began in 2018 and since then a total of 26 hair cases (10 children and 16 adults) have been submitted from various regions. The main aims of referral include diagnostic expertise (n = 4), aid with treatment plans (n = 8) or both (n = 14). The median age of patients was 33 years (range 4–75). There were 14 female and 12 male cases. The regions of referral include Oxford, Brighton, Manchester and Scotland. There were equal numbers of scarring alopecia (n = 13) and nonscarring (n = 13) cases. The most common nonscarring hair condition was alopecia areata (n = 6), with the possibility of other concurrent hair conditions (n = 1) or an underlying genetic disorder (n = 3). The most common diagnosis of scarring alopecia was folliculitis decalvans (n = 6). The diagnosis was altered in 10 cases (38%). Examples of some of our rare diagnoses include keratosis follicularis spinulosa decalvans, genetic hypotrichosis and scalp dermatomyositis. We reviewed cases of recalcitrant disease such as folliculitis decalvans, and novel therapeutics were suggested such as the use of naltrexone, utilizing photodynamic therapy after removing crusts, and even the use of manuka honey and cannabinoid oil. Our grand round has recommended independent funding requests in three cases and supports applications from clinicians for their patients with complex conditions. We hope our presentation showcases to the wider BAD members the value of our national hair disorders grand round in supporting complex diagnostic and therapeutic decisions, as well as offering support for clinicians in the form of individual funding request submissions or trialling novel therapies, which may have limited evidence. We welcome any future submissions.
BH14 Bald-faced lies: a qualitative review of misinformation on alopecia
Authors: Finnegan Paula , O’Connor Cathal , Murphy Michelle 
Published: June 2024

Abstract
Hair loss, or alopecia, is a major issue worldwide, and can be associated with negative psychological effects. Patients often use the internet and social media to research health-related issues. Health misinformation can confuse patients and have a negative impact on decision making, leading patients to search for illogical ‘causes’ and seek groundless ‘cures’. A PubMed literature search was performed, using the terms ‘alopecia’ AND ‘misinformation’ OR ‘disinformation’ OR ‘conspiracy theory’, alongside a Google search using combinations of these terms. Further searches were also performed on social media platforms including Instagram, TikTok, X (formerly Twitter) and Facebook. Four papers were deemed to be appropriate for inclusion. Common myths highlighted on social media included false causes of hair loss, criticism of conventional hair loss treatments, recommendation of alternative hair loss treatments (including for chemotherapy-induced hair loss) and unhelpful haircare practices. False causes of hair loss included hat wearing, sun exposure, excess washing or brushing, use of gelatin-containing hair products, excess testosterone, and sexual intercourse. Many posts criticized conventional alopecia treatments, including minoxidil, topical steroids, finasteride and Janus kinase inhibitors. Several alternative treatments were promoted online, often as ‘natural’ supplements, such as zinc, iron, biotin, and various oils and extracts. Certain common haircare practices were discouraged or recommended online, such as hair brushing and hair straightening. All healthcare professionals, including dermatologists, are responsible for actively combatting health misinformation.