bluuebunny/crossref_metadata_2025_split huggingface dataset:
P047 Dermatology Life Quality Index used as a standard in validation of 101 quality-of-life instruments: a systematic review
Authors: Vyas Jui , Johns Jeffrey , Abdelrazik Yasmina , Ali Faraz M , Ingram John R , Salek Sam , Finlay Andrew Y 
Published: June 2024

Abstract
Over the last 30 years many new quality-of-life measures have been described in dermatology; a critical aspect of their validation is demonstrating correlation with an instrument measuring a similar construct. The aim of this systematic review was to analyse peer-reviewed publications describing use of the Dermatology Life Quality Index (DLQI) in validation of other patient-reported outcome (PRO) and quality-of-life (QoL) measures. Seven databases were searched for papers published between January 1994 and December 2022 for articles containing data using DLQI in validation of other PRO or QoL measures. Methodology followed the PRISMA guidelines. The protocol was prospectively registered in PROSPERO. Of 1717 screened publications, 122 articles including 33 969 patients from 34 different countries with 38 diseases met the inclusion criteria. The DLQI was used in validation of 80 different dermatology-specific QoL measures, mostly disease specific, and of 21 generic measures. Of these studies, 42 were cross-cultural adaptations, 112 were single arm, 100 were cross-sectional, 18 were longitudinal and six were randomized controlled. DLQI was used for 14 known-group, 10 construct, 101 convergent, 10 concurrent, 10 divergent/discriminant and three criterion validity tests using the Mann–Whitney U-test (2), Spearman’s correlation (80), Pearson’s correlation (25) and Student’s t-test (1). The DLQI was used in responsiveness analysis in 13 studies. This review identified widespread use of DLQI in validation of other dermatology PRO and QoL measures, which confirms the central role DLQI plays in instrument development and validation across dermatology and beyond. The use of the DLQI by so many developers of other instruments has provided a common standard for comparability.
P092 Bidirectional association between alopecia areata and herpes zoster: a nationwide population-based study
Authors: Li Chia-Lun , Ma Sheng-Hsiang , Tai Ying-Hsuan , Dai Ying-Xiu , Chang Yun-Ting , Chen Tzeng-Ji , Chen Mu-Hong 
Published: June 2024

Abstract
Alopecia areata (AA) is the most common cause of immune-mediated alopecia. Due to the autoimmune nature of AA, researchers have investigated its potential links with infectious diseases. Herpes zoster (HZ) is one of the most common infectious diseases encountered in clinical practice, with a lifetime risk of 30%. However, only a few studies have reported a potential association between AA and HZ. This nationwide, population-based cohort study aims to explore the bidirectional relationship between AA and HZ, using data from the National Health Insurance Research Database (NHIRD) of Taiwan between 1997 and 2013. Individuals aged ≥ 10 years with a diagnosis of AA or HZ were included. Both AA and HZ diagnoses were confirmed by board-certified dermatologists on at least three occasions. For every patient with AA or HZ, 10 matched controls were randomly selected. These individuals were matched for age, sex, monthly income and residence. The primary outcomes assessed were new-onset HZ for patients with AA and new-onset AA for patients with HZ. Using a Cox regression model with adjustment for potential confounders, we assessed the risk of HZ in patients with AA, and vice versa. The cumulative incidence of disease was analysed using Kaplan–Meier survival curves with log-rank tests. In study 1, we included 9072 patients with AA and 90 720 matched controls. In study 2, we included 31 570 patients with HZ and 315 700 matched controls. Compared with controls, patients with AA had a 3.93-fold [95% confidence interval (CI) 3.42–4.52] increased risk for HZ, while patients with HZ had a 5.20-fold (95% CI 4.21–6.42) increased risk for AA. Both associations remained significant after stratification by sex and age. The 15-year cumulative incidence of HZ in the AA group was significantly higher than in the controls, and vice versa (P &lt; 0.001). Furthermore, patients with AA had 4.97-fold (95% CI 2.55–9.68) and a 3.42-fold (95% CI 2.55–4.59) elevated risk for HZ ophthalmicus (HZO) and HZ with nervous system complications, respectively, in comparison with controls. Patients with HZO and HZ with nervous system complications exhibited 3.85-fold (95% CI 1.43–10.4) and a 5.00-fold (95% CI 3.42–7.32) increased risk for AA, respectively, compared with controls. We also found that patients with AA had a significantly younger age at HZ diagnosis compared with controls (40.6 vs. 50.6 years, P &lt; 0.001). Our study revealed a bidirectional association between AA and HZ. Clinicians should remain vigilant regarding this link in both patient cohorts.
P102 Cutaneous noninfectious manifestations of chronic granulomatous disease: a prospective study
Authors: Keshavamurthy Vinay , Dev Anubha , Aggarwal Ridhima , Vignesh Pandiarajan , Rawat Amit , Chatterjee Debajyoti , Dogra Sunil 
Published: June 2024

Abstract
Dermatological manifestations in chronic granulomatous disease (CGD) include skin infections and sterile cutaneous inflammatory lesions. The objective of this study was to assess the clinical and histopathological features of noninfectious skin lesions in patients with CGD. This was a cross-sectional observational study from January 2022 to June 2023, carried out at a tertiary care centre. Forty-eight patients with CGD who were registered in the paediatric immunology clinic were screened for cutaneous noninfectious lesions during their routine follow-up. We describe the frequency of cutaneous noninfectious lesions among patients with CGD, along with their clinicodemographic and histopathological features. Noninfectious inflammatory skin lesions were present in 11 of 48 (23%) patients with vCGD. The mean age of this cohort (n = 11) was 19.8 years (SD 5.2). Centrofacial papulopustular lesions and erythematous infiltration involving the nose and the perinasal area (nose sign) were observed in 5 of 11 patients. Five patients presented with yellowish-orange, discrete, papular lesions involving the face and trunk, mimicking acne-like eruptions. Two patients had lesions of hidradenitis suppurativa. Histopathological examination revealed ill-formed granulomas with a mixed inflammatory infiltrate in the patients with facial lesions, while three patients with acneiform eruptions showed well-formed granulomas. The median age at onset of symptoms of CGD (48 vs. 7 months, P = 0.005; difference between groups 35 months, 95% confidence interval 12–78) and the median age at diagnosis of CGD (150 vs. 48 months, P = 0.008, difference between groups 72 months, 95% confidence interval 22–132) were significantly higher in patients with CGD who developed noninfective, inflammatory skin lesions compared with those without such skin lesions. The proportion of patients with NCF1 mutation was significantly higher in patients with noninfective inflammatory skin lesions (73% vs. 27%, P = 0.011). No correlation was seen between the type of skin manifestation and pathogenic mutation. In conclusion, inflammatory noninfectious cutaneous lesions can occur in CGD in the form of perinasal infiltrated papules and pustules (nose sign), as well as acne­iform lesions, and can be clues towards clinical diagnosis.
P106 Clinical outcomes and quality of life in a cross-sectional study of patients with moderate-to-severe psoriasis treated with bimekizumab in routine clinical practice
Authors: Wicker Gemma , Tredwell Amanda , Topliffe Joanne , Smith Maureen , Vistenia Jason 
Published: June 2024

Abstract
Psoriasis is a chronic, systemic, immune-mediated disease that is associated with severe comorbidities including depression, psoriatic arthritis and cardiovascular disease. As a result, psoriasis impacts on patient wellbeing and quality of life. Biologic therapies are highly effective for psoriasis; however, 11–35% of patients do not respond to their first treatment within the first year. Bimekizumab is a humanized monoclonal antibody that neutralizes the activity of the proinflammatory cytokines interleukin-17A and interleukin-17F, which are pivotal in developing psoriasis. This study assessed changes in disease severity and health-related quality of life in patients with psoriasis who were treated with bimekizumab in routine clinical practice. This cross-sectional study included adult patients with psoriasis who were attending routine clinical practice visits at five hospitals in the UK. Patients may have received prior therapy for psoriasis, and all were subsequently treated with bimekizumab. In total, 66 patients were included in the study; 35 (53%) were women, the mean age was 47.1 years (SD 15.5), the mean duration of disease was 19.6 years (SD 9.9) and the mean body mass index was 31.2 kg m−2 (SD 6.4). At baseline, the majority of patients (38 of 62, 61%) had extensive or widespread psoriasis, and 23 of 58 (40%) had psoriatic arthritis. Seven patients (11%) were treatment naive to biologic therapy, 55 of 65 (85%) had not responded to previous biologic therapy, and 43 of 65 (66%) had received adalimumab. After initiation of bimekizumab, there was a substantial improvement in disease severity at week 16. The mean Psoriasis Area and Severity Index (PASI) at baseline was 17.1, and no patients had a score of 0; the mean PASI at week 16 was 1.7, and 20 of 52 patients (38%) had a score of 0. This improvement in PASI was accompanied by an improvement in quality of life (Table). Qualitative data reported by patients indicated that treatment with bimekizumab improved their daily lives and decreased psychological stresses. In this study, bimekizumab reduced the severity of psoriasis and improved patients’ quality of life and overall wellbeing. These results indicate that bimekizumab should be considered for the treatment of patients with severe psoriasis where rapid and significant clearance of psoriasis is clinically appropriate, including treatment-naive patients and those resistant to previous biologic therapy. Medical writing support was funded by UCB; the study was conducted independently of the sponsor.ParameterPatientsBaselineWeek 16PASI scoreaMean (SD)17.1 (7.3)1.7 (4.1)Median (range)14.8 (4–43)0.5 (0–27)DLQI scorebMean (SD)20.2 (6.1)3.6 (5.4)Median (range)20.0 (10–33)1.0 (0–25)Psoriasis Area and Severity Index: baseline, n = 65; week 16, n = 52. Dermatology Life Quality Index: baseline, n = 64; week 16, n = 51.
Poster presentationsBC04 Clinical efficacy of oral tranexamic acid in lichen planus pigmentosus: case series
Authors: Bhalla Mala , Arora Astha , Kalia Aashali 
Published: June 2024

Abstract
Lichen planus pigmentosus (LPP) is a rare pigmented variant of lichen planus first described in India in 1974. It has an insidious onset and predominantly affects the photoexposed areas of darker skin phenotypes. The blue grey pigmentation is of great cosmetic concern and extremely difficult to treat. Various topical agents have been tried without much success, probably because the pigment is deeper in the dermis. The aim of this study was to assess the clinical efficacy of oral tranexamic acid 250 mg twice daily in LPP. In total 10 consecutive patients clinically diagnosed with LPP were included. A detailed history was taken to ascertain the onset and any possible risk factors. A skin biopsy was done in the patients who consented, to establish the histopathological diagnosis. All the patients were started on oral tranexamic acid 250 mg twice a day after excluding the risk factors for coagulopathy along with strict photoprotection. No other topical treatment was given. All patients were assessed for improvement in the pigmentation every 4 weeks until 12 weeks according to the following scale: no improvement (0%), mild improvement (0–25%), moderate improvement (26–50%), good improvement (51–75%) or very good improvement (76–100%). Photographs were taken and the patient’s satisfaction was also noted. Six of the 10 patients consented for biopsy and their histopathology was consistent with LPP. At the 4-week follow-up, four patients showed mild improvement, four had moderate improvement and two had good improvement. All the patients showed improvement and fading of pigment. Oral tranexamic acid seems to be effective in LPP, but more studies are required to establish the optimum dose and duration of treatment.
BH03 Do patients with afro-textured hair who are experiencing hair loss feel understood by their dermatologists? A cross-sectional study
Authors: Amoafo Emma , Baker Holly , Akhras Victoria 
Published: June 2024

Abstract
Providing good-quality care for skin and hair conditions in patients with skin of colour is an important area of dermatology. This study aims to analyse patient perceptions of their dermatology experience with hair loss and caring for afro-textured hair. We also examined whether they were signposted to the British Association of Dermatologists patient information leaflet (BAD PIL) ‘Caring for Afro-textured hair’ [British Association of Dermatologists. Caring for Afro-textured hair. Available at: https://www.bad.org.uk/pils/caring-for-afro-textured-hair (last accessed 19 April 2024)]. Patients with afro-textured hair attending a consultation for hair loss between 2020 and 2023 were included. Patients consented to participating in an anonymous online survey. A Google form was emailed to participants between December 2023 and January 2024, with responses recorded. A link to the BAD PIL was attached to the survey. Seventeen patients responded. Of these, 59% did not receive a diagnosis prior to seeing a dermatologist. In total, 71% of patients did not fully understand the cause of their hair loss and commonly used social media (53%), online websites (41%, including 18% using the BAD website) and family and friends (35%) to seek information about hair loss. Social media (35%) and family and friends (29%) were the most common forms of seeking information regarding caring for their hair. After seeing a dermatologist, 13 patients (76%) received a diagnosis. Fourteen patients (82%) were offered a biopsy, which 12 underwent. Overall, 29% of patients believed their dermatologist understood their hair loss very well, 24% somewhat well, 35% not very well and 6% not at all. Most patients (63%) had the same understanding about their hair loss after their consultation, and half of patients (47%) did not gain any confidence about managing their hair loss. Patients are more likely to refer to the BAD website after seeing a dermatologist (35%). However, only five patients (29%) were signposted to the BAD PIL during their consultation. Overall, 41% of patients found the leaflet somewhat or very helpful. Patients expressed that their consultation was more beneficial when they were seen by a doctor with afro-textured hair, and were disappointed when signposted to leaflets that featured hair loss in non-afro-textured hair. Others feel saddened because there is ‘no cure’ and current management has not helped. This study highlights the challenges that patients with afro-textured hair face in the management of their alopecia. There appears to be a perception that dermatologists do not fully understand hair loss in afro-textured hair, unless they have such hair themselves. Further education to dermatology colleagues is imperative to improve patient care and satisfaction. The BAD PIL is a useful signpost, which can be more reliable than patients relying on social media for advice.
Poster presentationsBH07 Intralesional vitamin D as immunotherapy for palmoplantar and periungual warts: how effective is it?
Authors: Bhargava Shashank 
Published: June 2024

Abstract
Warts are a viral infection of the skin caused by human papillomavirus, occurring in the form of verrucous growths over the surface of the skin. Incomplete removal or local recurrence of the infection is the disadvantage with the currently available local tissue destructive therapies. Newer therapy, such as intralesional immunotherapy with purified protein derivatives, offers the advantage of taking care of the viral infection not only at treatment site but also at remote sites, and also offers lifelong immunity. The current study was conducted on 40 patients of all ages with palmar, plantar and periungual warts. After clinical examination, patients were given 0.1–0.2 mL of vitamin D intralesionally in the largest wart at intervals of 3 weeks for three sessions. Patient assessment in follow-up visits was done with clinical photographs and by filling in pro formas for effects and side-effects. Complete clearance was seen in 31 patients (78%), partial clearance in 5 (13%) and no clearance in 4 (10%). There was variation in response in different morphological types of warts, with 100% clearance in plantar and palmar warts, and 70% clearance in periungual warts. In conclusion, intralesional vitamin D is useful in all types of warts; it can be used as a valuable first-line treatment in difficult-to-treat sites like palmoplantar warts and periungual warts.
BH16 Central centrifugal cicatricial alopecia and fibroproliferative disorders: exploring the association with uterine leiomyomas
Authors: Bala Laksha , Tsang Christie , Agarwal Vani , Elshimy Noha 
Published: June 2024

Abstract
Central centrifugal cicatricial alopecia (CCCA) is a type of scarring alopecia, which typically starts on the crown and progresses in a centrifugal manner. It predominantly affects women of African descent and often has devastating psychosocial implications. The pathogenesis of CCCA is not fully understood and therapeutic options are limited. It has been proposed that CCCA is a fibroproliferative disorder (FPD) with persistent, low-grade inflammation resulting in end-stage fibrosis. People of African descent are at increased risk of FPDs including uterine leiomyomas (ULs), possibly due to the protective effect of profibrotic alleles against helminthic infections (Dina Y, Okoye GA, Aguh C. Association of uterine leiomyomas with central centrifugal cicatricial alopecia. JAMA Dermatol 2018; 154: 213–14). There are only eight publications to date that explore the potential link between CCCA and ULs. A retrospective cohort study found that Black women with CCCA have nearly five times increased odds of ULs, compared with Black women without CCCA (Dina et al.). Fibroproliferative genes (e.g. platelet-derived growth factor and collagen genes I and III) are upregulated in areas of scalp affected by CCCA, compared with unaffected scalp in the same patients, with an overlap in pathogenic mediators with other FPDs including atherosclerosis and hepatic fibrosis (Aguh C, Dina Y, Talbot CC Jr, Garza L. Fibroproliferative genes are preferentially expressed in central centrifugal cicatricial alopecia. J Am Acad Dermatol 2018; 79: 904–12). These findings may help identify future therapeutic targets to treat CCCA. Current approaches use anti-inflammatory medications to halt disease progression. However, unlike other scarring alopecias, patients with CCCA often have minimal visible scalp inflammation, despite worsening fibrosis and hair loss. Hence, particularly for patients who do not improve with anti-inflammatory treatments, antifibrotic agents may play a therapeutic role in the future, with medications such as losartan and statins demonstrating potential for halting CCCA progression. We conducted a retrospective cohort study among patients with CCCA presenting to our tertiary-centre hair clinic, using Black women with lichen planopilaris (LPP) as a comparator group (n = 20). We found that 80% of Black women with CCCA had reported ULs, compared with 50% of Black women with LPP. In light of this potential association, dermatologists should be encouraged to screen for symptoms of ULs, alongside other FPDs, and counsel patients regarding potential comorbidities associated with CCCA. This may allow for prompt diagnosis of life-altering comorbidities and significantly ameliorate patients’ quality of life.
PD06 (P035) Quantifying the mutation burden of a therapeutic course of narrowband ultraviolet B (UVB) to help inform on the carcinogenicity of narrowband UVB
Authors: Coltart George , Fowler Joanna , Sood Roshan , Lai Chester , Nadarajah Noeline , Jones Philip , Healy Eugene 
Published: June 2024

Abstract
Narrowband ultraviolet B (NB-UVB) is recommended by NICE as a treatment for chronic plaque and guttate psoriasis that cannot be controlled with topical therapies. However, ultraviolet radiation is a carcinogen that causes DNA mutations in the skin, and in some cases results in skin cancer development. To date, there have been no studies determining how many mutations develop in human skin as a result of a therapeutic course of NB-UVB, and therefore we investigated the mutation burden of NB-UVB in the current study. Although whole-exome or whole-genome sequencing and target-enriched sequencing can detect mutations in large clones of mutated skin cells, these approaches do not detect mutations occurring only in single skin cells, hence we used a novel type of sequencing called Nanorate sequencing (which can identify mutations occurring in just a single molecule of DNA) in this study. We obtained 6-mm punch biopsies of normal skin (buttock and/or forearm) before and after a course of UV from patients (n = 16) undergoing NB-UVB treatment for psoriasis. Epidermis was microdissected from the dermis and the epidermal DNA was sequenced using Nanorate sequencing. DNA from venous blood underwent whole-genome sequencing as germline control for accurate identification of mutations in the epidermal samples. The numbers of DNA mutations were compared between the skin samples taken before and after NB-UVB in order to quantify the mutation burden attributable to the course of NB-UVB. Minimal erythema doses ranged from 0.3 to 0.9 J cm−2 and the total dose received during the course of NB-UVB ranged from 14.8 to 133 J cm−2. There was a significant rise in the number of mutations in buttock and forearm skin due to the NB-UVB treatment, with median increases in single-base substitutions per megabase of 1.09 SBS/Mb (P = 0.001) and 3.77 SBS/Mb (P = 0.0098) in buttock and forearm epidermis, respectively. The change in number of mutations secondary to NB-UVB treatment was predominately due to UV signatures SBS7a and SBS7b, with the DBS1 (CC&gt;TT mutations) double-base substitution signature also identified in buttock and forearm skin samples. Comparison of the increase in mutation burden from NB-UVB with the mutation burden in keratinocyte cancers indicated that, for more susceptible patients, a course of NB-UVB therapy contributed as much as one-sixteenth of the total mutational burden of a cutaneous squamous cell cancer.