bluuebunny/crossref_metadata_2025_split huggingface dataset:
BC02 Role of platelet-rich plasma in atrophic acne scars along with microneedling and subcision
Authors: Bhargava Shashank 
Published: June 2024

Abstract
Atrophic acne scarring is one of the most common sequel of acne vulgaris. The objective of this study was to evaluate the role of platelet-rich plasma (PRP) as adjunctive therapy to a combined subcision and needling treatment in severe (grade 4) atrophic acne scarring. In total 78 patients with grade 4 atrophic acne scars were randomly divided into two groups with 39 patients each: group A underwent three sessions of subcision and microneedling, while group B had three treatments of subcision, needling, and topical application of PRP. The sessions were repeated every 4 weeks. Scar grading was assessed 6 months following the final session. The participant’s assessment of treatment response was also considered. Scar improvement by ≥ 50% was reported significantly more often by patients in group B than in group A (P = 0.025). There were 11 patients from group B who improved by two grades, in comparison with only three from group A. The physician’s evaluation of improvement correlated with the patients’ own assessments: 50% of patients in group A and 67% in group B showed improvement of 25–49% and 50–74%, respectively. The mean duration of downtime was shorter among patients in group B than in group (21.1 vs. 32.9 h, respectively). Icepick scars showed the least improvement when compared with other variants of atrophic scars. In conclusion, PRP definitely works as an adjuvant modality to treat atrophic acne scars.
BC06 A systematic review of social media and Melanotan, the ‘Barbie drug’
Authors: O’Mahony Sarah , Connolly Archie , Collins Aoibhin , Alhunay Talal , Edgar Katie , Hynes Madeline , Tobin Anne Marie 
Published: June 2024

Abstract
Melanotan, a term referring to both Melanotan I (MT1) and Melanotan II (MT2), is a synthetic analogue of the endogenous hormone, α-melanocyte-stimulating hormone (α-MSH). Although the compound is unregulated and unlicensed, it is commonly exploited for its ability to produce a sunless tan. Melanotan has recently regained notoriety through social media platforms such as TikTok, a video-sharing online platform. The substance gained traction on TikTok, where the hormone is known as the ‘vacation peptide’. MT2 is an illicit substance sold on websites such as www.trutan.net, in gyms and in aesthetic clinics. The ‘Barbie drug’, MT2 promises to suppress appetite and thus induce weight loss, increase libido and produce an artificial tan that does not wash off. Recent increases in social media use have demonstrated positive correlations with body dissatisfaction. As a result, one can see how, in a world where social media has been demonstrated to cultivate body dissatisfaction, a seemingly quick-fix solution may prove attractive. MT2 is injected subcutaneously or administered intranasally via nasal sprays to produce increased skin pigmentation in the user via stimulation of melanocytes. From baking in the sun, to messy applications of temporary tans, and the now declining popularity of sunbed use, this new method of achieving a darker complexion surfaced incidentally. Initially researched for their photoprotective properties and their potential to reduce skin cancer, these synthetic hormones were found to have the desirable effects that are now sought after by self-proclaimed Instagram ‘influencers’ and fitness models. Despite being structurally different compounds, both are α-MSH analogues; α-MSH is a nonselective full agonist that targets melanocortin receptors. MT1 and MT2, in turn, act as relatively nonspecific agonists at melanocortin receptors. MT1 is more structurally like α-MSH and maintains its high affinity for the melanocortin 1 receptor (MCR1), while MT2 has an increased affinity for melanocortin 4 receptors (MCR4). This explains the increased pigmentation effects of both analogues, while MT2 also has additional sexual effects due to the role of MCR4 in sexual behaviour and erectile function. This systematic review aims to explore the impact of social media on Melanotan consumer perception through qualitative analysis. Four relevant studies were included in this systematic review. The results revealed that social media is a driving force in unlicensed Melanotan sales. Additionally, it was made clear that very few social media posts show Melanotan in a negative light, despite its deleterious adverse effects. From a perspective of safety, the results of this study outline a need for increased awareness of the negative aspects of Melanotan throughout social media platforms.
PD02 Sunscreen database app
Authors: Parkin Donna , Kayamkhani Surayyakhanam , Ayer Jean 
Published: June 2024

Abstract
Sunscreens play a pivotal role in the effective management of photodermatoses by safeguarding the skin against harmful ultraviolet radiation, thereby mitigating the onset or exacerbation of symptoms. However, complications arise when individuals develop allergies to sunscreen filters and other formula constituents. Navigating the process of finding a suitable sunscreen that offers adequate protection without triggering adverse reactions can often be challenging. Careful scrutiny of product labels is vital for individuals with known allergies. However, deciphering ingredient information can be difficult due to the small print size and complex chemical names. To address this, we present the development of an innovative sunscreen database designed to help healthcare professionals to identify appropriate sunscreens for patients with sunscreen allergies in a clinical setting. The Sunscreen database has been developed using Power Apps. The application has two interfaces, one for administrators and one for guest users. Administrators are granted access to add, edit and delete sunscreens and ingredients in the existing dataset. Various data fields are provided, including the sunscreen name, sun protection factor, star rating, ingredients, ultraviolet filters, formulation date, and company details. The home page displays a table of all sunscreens we have populated the database with. Filter and search options using simple drop-down menus provide a customized list of sunscreens, facilitating easy access to sunscreen information and quick and accurate decision making. The app allows groups to be assigned to ingredients with several names, which keeps the ingredient list simple. Moreover, if an ingredient from a group is selected for filtering out of the sunscreen dataset, all the remaining ingredients in that group will be automatically selected as well. This saves time and effort that would otherwise be spent manually selecting each individual ingredient in a group. Currently, the app can only be used by clinicians within the Northern Care Alliance, as the current system is set up for data integrity and security. External use may be permitted, but at this early stage, access must be granted from the IT department and their email added as a guest into the trust network. The aim of this project is to provide clinicians with a tool that generates printable, personalized recommendations for this patient group, especially for those who have confirmed allergies following formal patch testing. By providing patients with an allergen-free list of sunscreens, the app empowers them to make informed choices about the sunscreen products they use.
CD13 Effect of ciclosporin on serum inflammatory cytokines in patients with allergic contact dermatitis due to the weed Parthenium: a preliminary study
Authors: Verma Kaushal , Mohan Braj , Sharma Alpana 
Published: June 2024

Abstract
Allergic contact dermatitis due to the weed Parthenium is common in India, resulting in high morbidity and significant impact on quality of life in these patients. The allergic response is primarily mediated by a T helper 1 response, and various inflammatory cytokines have been implicated in the pathogenesis of the disease, as well as disease activity. We evaluated the effect of ciclosporin on inflammatory cytokines and disease activity in patients with Parthenium dermatitis. Adult patients with a clinical diagnosis of Parthenium dermatitis, confirmed on patch test, were included in the study. The severity of the disease was determined in each patient using Clinical Severity Score (CSS) and serum proinflammatory [tumour necrosis factor (TNF)-α, interleukin (IL)-17 and IL-6] and anti-inflammatory cytokines [IL-10, transforming growth factor (TGF)-β]. The patients were treated with ciclosporin 2.5 mg kg−1 per day for 12 weeks or until complete remission of the disease. The cytokine levels and disease severity were reassessed following treatment. The study had 35 patients (28 male and 7 female; age range 32–80 years, mean 56.0, SD 11.1), with a disease duration of 1–30 years (mean 10.7, SD 7.8). The pretreatment CSS of these patients ranged from 12.8 to 78.3 (mean 41.7, SD 16.3). The proinflammatory cytokines (TNF-α, IL-6 and IL-17) showed a decreasing trend following ciclosporin treatment. The levels of TNF-α decreased from a mean (SD) 4.0 (9.4) pg mL−1 to 1.4 (1.8) pg mL−1 (P = 0.05); IL-6 from 47.2 (34.7) pg mL−1 to 26.1 (17.6) pg mL−1 (P = 0.005) and IL-17 from 154 (163) pg mL−1 to 75.6 (73.2) pg mL−1 (P = 0.10), with statistically significant changes for TNF-α and IL-6 but not for IL-17. Serum levels of the anti-inflammatory cytokine IL-10 increased from 4.20 (1.20) pg mL−1 to 3.40 (1.10) pg mL−1 (P = 0.05), which was also statistically significant, but serum TGF-β values remained largely unchanged, going from 0.40 (0.27) pg mL−1 to 0.30 (0.23) pg mL−1 (P = 0.08). The mean CSS decreased from 41.7 (16.3) to 1.5 (5.2) (P &lt; 0.001) following treatment. The changes in inflammatory cytokine levels seem to correspond with change in CSS and clinical disease activity. Therefore, this study has shown that the proinflammatory cytokines TNF-α, IL-17 and IL-6 decreased significantly, while the anti-inflammatory cytokine IL-10 increased following ciclosporin therapy in patients with Parthenium dermatitis, with a significant decrease in CSS and excellent control in disease activity.
DS09 Nasalis myocutaneous island pedicle flap for nasal defects after Mohs surgery: a case series and video demonstration
Authors: Aslam Arif 
Published: June 2024

Abstract
The technically difficult superiorly based nasalis myocutaneous island pedicle flap has been described as a useful repair option for distal nose defects after Mohs surgery. Both the bipedicle and single pedicle modification have been described. With the use of a video demonstration the author demonstrates the method of preparing, raising and executing the single pedicle nasalis sling flap, with pre- and postoperative results of representative cases. The author also describes his 6-year experience with this flap with pearls on how to execute it for the best results.
DS10 Postoperative complications after two-stage interpolated flap repairs for nasal defects after Mohs surgery
Authors: Aslam Arif 
Published: June 2024

Abstract
Dermatologists perform more flaps after skin cancer surgery than all other specialties. This study evaluated complications after interpolated flap repairs (forehead and cheek–nose) of the nose after Mohs surgery. This was a single-surgeon prospective study of 64 patients undergoing two-stage interpolated flap repairs over a 6-year period. Complications such as bleeding, infection, flap necrosis and hospitalization were reported. Seventeen patients experienced complications after flap placement, and six after the flap division and inset. The most common complication after the flap was created was bleeding, with infection being the most common after takedown. This study shows that two-stage flap repairs for the nose after Mohs surgery can be safely performed in a hospital outpatient setting under local anaesthesia.
DS23 Evaluation of American Joint Committee on Cancer and alternative tumour classification systems for primary penile squamous cell carcinoma
Authors: O’Connell Katie , Thomas Jacob , Murad Fadi , Sonpavde Guru , Mossanen Matthew , Clinton Timothy , Xu Antonio Ji- , Spiess Phillippe , Rossi Anthony , Schmults Chrysalyne 
Published: June 2024

Abstract
Survivorship overlap exists among patients classified according to the American Joint Committee on Cancer (AJCC) 8th edition tumour (T) staging system for penile squamous cell carcinoma (PSCC). At present, the AJCC 8th edition guidelines for PSCC stratify T1 tumours by the presence or absence of perineural invasion (PNI) and lymphovascular invasion, and the degree of differentiation. T2 and T3 tumours are stratified based on the anatomical depth of invasion into the corporal structures, with T4 tumours invading into the scrotum, prostate or pubic bone. This study evaluates the current performance of PSCC AJCC T staging and compares it to an alternative. Different combinations of tumour risk factors were evaluated in terms of distinctiveness (prognostic groupings without overlapping confidence intervals) to determine a new system with the best risk stratification. These characteristics have been set forth by the AJCC to describe the ideal staging system. An alternative staging system was developed from a previously published cohort of 265 patients with PSCC. Tumours were staged via the alternative and AJCC T staging systems. Predictions of metastasis and disease-specific death (DSD) were compared. The alternative and AJCC systems were compared regarding distinctiveness, homogeneity and monotonicity. Three independent predictors of poor outcomes were included in the alternative PSCC T staging system: PNI, poor differentiation, and invasion into corporal structures. In the alternative system, T1 represents 0 risk factors (RF), T2 is 1 RF, T3 is 2 RF, and T4 is 3 RF. The alternative system was superior to AJCC staging in detecting tumours at risk for metastasis (C-statistic: alternative 67% vs. AJCC 63%) and DSD (C-statistic: alternative 74% vs. AJCC 72%). Homogeneity and monotonicity were similar. For alternative T1 disease, the 5-year cumulative incidence of metastasis was 9% and risk of death 5%. The risk of metastasis climbed to 24%, 42% and 74% for alternative T2, T3 and T4 cases, respectively, and 21%, 33% and 60% for DSD. The alternative PSCC T staging system appears to have superior distinctiveness. External validation of the alternative staging system against the AJCC stage should be undertaken. Alternative T1 N0 disease may benefit from nodal staging given the 9% risk of metastasis. Alternative T2/T3/T4 N0 PSCC carries a significant risk of metastasis and death and merits further study for optimal management.
DP07 Diagnostic implication of skin biopsy for a rare neurodegenerative disorder
Authors: FitzGerald Holly , Ardakani Nima Mesbah 
Published: June 2024

Abstract
Neuronal intranuclear inclusion disease (NIID) is a rare neurodegenerative disorder characterized by eosinophilic hyaline intranuclear inclusions in various cells of the central nervous system and extranervous system, including the skin and subcutis. This case report details a 67-year-old man presenting with progressive short-term memory impairment, paranoia, anxiety and bladder dysfunction, leading to a diagnosis of NIID. It emphasizes the utilization of skin biopsy as a diagnostic tool beyond dermatological conditions. NIID is a slowly progressive neurodegenerative disorder associated with diverse clinical manifestations. Despite its heterogeneity, characteristic eosinophilic hyaline intranuclear inclusions in nervous system cells and other organs define the disease. Clinical presentations include pyramidal and extrapyramidal symptoms, dementia, ataxia, autonomic dysfunction, convulsions and neuropathy. A 67-year-old man presented with progressive short-term memory loss, daytime somnolence, paranoia, nocturia and incontinence. Clinical examination revealed a Montreal Cognitive Assessment score of 21/30, with significant points lost in delayed recall. Magnetic resonance imaging indicated increased diffusion-weighted imaging signal at the corticomedullary junction and cerebral hemisphere, suggestive of NIID. Two axillary skin punch biopsies were performed, showing occasional eosinophilic intranuclear inclusions in the nuclei of the epithelial cells lining the sweat glands. These intranuclear inclusions were strongly positive for p62 (ubiquitin) immunostain. In addition, p62-positive intranuclear inclusions were identified in the nuclei of adipocytes, endothelial cells lining dermal and subcutaneous blood vessels, and stromal fibroblasts. NIID is an unusual disease entity with varied clinical phenotypes, including infantile, juvenile and adult-onset forms. The age of onset and dominant symptoms further classify patients. Challenges in antemortem diagnosis historically limited understanding, with postmortem dissection being the primary diagnostic method until 2011. The discovery of intranuclear inclusions in skin biopsies, specifically ubiquitin-positive inclusions in sweat gland cells, adipocytes and fibroblasts, has revolutionized NIID diagnostics. Skin biopsy, although invasive, is preferable to other methods in terms of accessibility, acceptability, complication risk and sensitivity. This case report underscores the significance of skin biopsy in diagnosis beyond dermatological conditions. Further research is needed to enhance understanding, elucidate the pathogenesis, and develop targeted treatments for this complex neurological disorder. Ongoing efforts in research will contribute to a clearer clinical picture and improved management strategies for individuals affected by NIID (Pang J, Yang J, Yuan Y et al. The value of NOTCH2NLC gene detection and skin biopsy in the diagnosis of neuronal intranuclear inclusion disease. Front Neurol 2021; 12: 624321).
DP09 (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.
PA13 A hair’s breadth from misdiagnosis
Authors: Kearney Nicola , Stefanovic Nicholas , Murray Gregg , Molloy Kevin , Watchorn Richard 
Published: June 2024

Abstract
A 15 year-old boy presented with a 2-year history of patches of hair loss on his body, and skin changes. Initial examination revealed scattered erythematous patches with associated follicular accentuation and concurrent nonscarring alopecia, predominantly affecting his limbs. His background included acne, gynaecomastia and exercise-induced asthma. His only regular medication was a salbutamol inhaler. Punch biopsies from the left shin and right arm demonstrated mild acanthosis of the epidermis with slight hyperkeratosis, focal parakeratosis and minimal spongiosis with occasional lymphocyte exocytosis. The initial biopsies were reported as nonspecific changes of lymphocytic folliculitis with spongiosis. Following clinicopathological review a diagnosis of alopecia mucinosa was considered. Further histopathological review confirmed spongiosis in the superficial to midpart of the hair follicle. Additionally noted was exocytosis of lymphocytes, which displayed subtle cytological atypia marked by nuclear irregularity and slight enlargement, and immunohistochemistry indicated a predominance of CD4+ T cells, raising the possibility of mycosis fungoides. Subsequent incisional biopsies were performed for T-cell clonality studies using the BIOMED-2 protocol and were polyclonal. Expert external histopathologist opinion was sought and this supported a diagnosis of folliculotropic mycosis fungoides (FMF), a condition rarely described in paediatric patients. The patient had patch-stage disease of his arms and legs with follicular accentuation and his modified Severity-Weighted Assessment Tool (mSWAT) score was 3.9. He had no lymphadenopathy or B symptoms. He was initiated on mometasone furoate 0.1% and his current management plan is for observation for clinical response and for further investigations, including lymphocyte subsets and high-throughput sequencing of the T-cell receptor, which are awaited. Although T-cell gene receptor rearrangement studies indicated polyclonality, their sensitivity is estimated at 50–70%. Based on the clinical and histological features the patient was diagnosed with stage IA FMF. FMF is characterized histologically by atypical CD4+ T lymphocytes that surround and infiltrate the hair follicles (folliculotropism) and should be considered in lesions resembling keratosis pilaris but in an unusual distribution and/or in clusters. Epidermotropism is typically absent in FMF, and concomitant follicular mucinosis is frequently observed. Paediatric follicular MF is rare, but this case highlights that in cases of suspected alopecia mucinosa, even in paediatric patients, a diagnosis of FMF merits careful consideration (Reiter O, Amitay-Laish I, Oren-Shabtai M et al. Paediatric mycosis fungoides – characteristics, management and outcomes with particular focus on the folliculotropic variant. J Eur Acad Dermatol Venereol 2022; 36: 671–9).