bluuebunny/crossref_metadata_2025_split huggingface dataset:
P088 Physician-assessed effectiveness, patient-reported outcomes, and safety in adult and adolescent patients with atopic dermatitis treated with dupilumab: real-world insights 1 year into the GLOBOSTAD multinational prospective observational study
Authors: Ferrucci Silvia M , Calzavara-Pinton Piergiacomo , Murrell Dédée F , Fougerousse Anne-Claire , Karlová Iva , Lapeere Hilde , Holzer Gregor , Al-Ahmad Mona , Chu Chia-Yu , Foti Caterina , Pérez-García Bibiana , Petrova Anastasia , Wu Jiangming , Ardeleanu Marius , Bosman Kwinten 
Published: June 2024

Abstract
Real-world studies complement randomized controlled trials (RCTs) by providing data from a more heterogeneous population treated in a normal practice environment. In several RCTs, dupilumab has demonstrated robust efficacy with acceptable safety in patients with moderate-to-severe atopic dermatitis (AD). The main objectives of the ongoing GLOBOSTAD study (NCT03992417) are characterizing the patient population treated with dupilumab, their AD treatment patterns, long-term effectiveness, and safety of dupilumab in the real world. The GLOBOSTAD 5-year, multinational, prospective, observational study enrolled patients aged ≥ 12 years with moderate-to-severe AD. Patients received dupilumab based on country-specific prescribing information, and assessments were performed at baseline, 3 months (± 1 month), 6 months (± 2 months) and 12 months (± 2 months). The data are reported as observed for the enrolment/safety (n = 955; data cutoff March 2023) and follow-up (n = 903) populations. In total, 758, 863 and 705 patients completed at least one follow-up assessment at 3, 6 and 12 months, respectively, with a mean (SD) treatment period of 11.7 (1.2) months. The mean (SD) Eczema Area and Severity Index (EASI; &gt; 21 = severe; ≤ 7 = mild/no disease) at baseline was 25.1 (12.8). During the study, ≥ 75% (EASI 75) and ≥ 90% (EASI 90) reductions in mean EASI scores from baseline were observed in 66.2% and 35.6% of patients at 3 months, 74.6% and 42.4% at 6 months, and 81.0% and 55.8% at the end of the observation period (12 months), respectively. The patient-reported mean (SD) weekly average pruritus numerical rating scale (NRS, range 0–10) at baseline was 6.3 (2.2). A three-point and four-point improvement from baseline or a score of 0 in pruritus NRS was observed in 66.9% and 57.1% of patients at 3 months, 73.6% and 64.1% at 6 months, and 79.0% and 70.3% at 12 months, respectively. Of the follow-up population, 67.4% achieved an absolute pruritus NRS score of ≤ 3 at 3 months, 76.4% at 6 months, and 80.3% at 12 months. Adverse events considered related to dupilumab that led to permanent discontinuation occurred in 2.4% of patients. Patients enrolled in the GLOBOSTAD study achieved rapid improvements in AD signs and symptoms on initiating dupilumab treatment, which were sustained until the end of the 1-year observation period. Safety was consistent with the known dupilumab safety profile. This research was sponsored by Sanofi and Regeneron Pharmaceuticals Inc.
P094 Oral tofacitinib monotherapy for the management of moderate-to-severe alopecia areata in children and adolescents: a retrospective analysis of 36 cases
Authors: Mehta Hitaishi , Mahajan Rahul , De Dipankar , Handa Sanjeev 
Published: June 2024

Abstract
Alopecia areata (AA) poses a significant challenge in the paediatric population, with limited treatment options. Oral tofacitinib has emerged as a promising modality, with case reports and small series suggesting safe and effective use in children with AA. This retrospective analysis sought to expand the knowledge base around tofacitinib’s role in managing AA in the younger population and to provide valuable insights into challenges encountered when faced with no responsive to treatment. This retrospective chart review spanned from January 2021 to December 2023 and included 36 patients aged ≤ 16 years with moderate-to-severe AA [Severity of Alopecia Tool (SALT) score &gt; 25], who received ≥ 6 months of oral tofacitinib therapy. The treatment response was defined as ≥ 75% reduction in SALT score (SALT 75) at 6 months. Other outcome measures of interest included times to attain SALT 50, SALT 75, SALT 90 and SALT 100, and incidence of adverse events. In total 36 patients were included, with a mean age of 10.1 years (SD 3.8, range 3–16), with 17 male and 19 female patients. AA subtypes included patchy (19%), ophiasis (17%), subtotalis (28%), totalis (8%) and universalis (28%). The mean SALT score at baseline was 73.1 (SD 26.7). The mean duration of oral tofacitinib treatment was 8.69 months (SD 3.17, range 6–16). SALT 50 was achieved by 26 patients, with an equivalent number attaining SALT 75. Additionally, 24 patients reached SALT 90, while 19 patients reached SALT 100. The mean (SD, range) durations in months to achieve SALT 50, SALT 75, SALT 90 and SALT 100 were 2.81 (1.16, 1–6), 4.08 (1.69, 1–8), 5.71 (2.14, 3–10) and 6.74 (2.35, 3–12), respectively. Ten of the 36 patients (28%) were classified as nonresponders. Nonresponders exhibited a higher median total duration of illness, higher baseline SALT score, and higher incidence of atopy and nail involvement compared with responders. Adverse events were noted in nine patients, with two cases necessitating treatment discontinuation due to adverse events. Among those not showing a response, three patients each underwent a transition to combination therapy of oral steroids with methotrexate and topical immunotherapy with diphenylcyclopropenone. Notably, regrowth was observed in two patients from the former group, while none from the latter group experienced similar positive outcomes after the therapeutic strategy shift. Limitations of the study include the retrospective nature and small sample size. This comprehensive analysis enriches the existing literature on the role of tofacitinib in paediatric AA, addressing gaps in approved treatments and providing valuable guidance for clinicians navigating the challenges of nonresponsiveness in this vulnerable population.
P103 Clinical clues for frontal fibrosing alopecia: a case series describing prominent, depressed forehead veins
Authors: Bala Laksha , Tsang Christie , Agarwal Vani , Elshimy Noha 
Published: June 2024

Abstract
Frontal fibrosing alopecia (FFA) is a lymphocytic, scarring alopecia characterized by progressive frontotemporal hairline recession, most frequently in postmenopausal women. It is considered a subtype of lichen planopilaris, given the shared histopathological findings of perifollicular lymphocytic infiltration and fibrosis. FFA is a recently reported entity and one of the most common causes of cicatricial alopecia worldwide. Its pathogenesis is not well understood, with immune dysregulation, and hormonal, genetic and environmental factors all postulated to play a role. Clinical features include the characteristic bandlike frontotemporal scarring hair loss, perifollicular hyperkeratosis and erythema (active inflammation), the ‘lonely hair’ sign (terminal hairs within a band of alopecia), loss of eyelashes and eyebrows, and facial lesions (most commonly papules). Visible vascular abnormalities with prominent and/or depressed forehead veins are a much less recognized entity, with only three publications to date reporting this finding (Heymann WR. Vascular abnormalities in FFA, artificial intelligence and Winston Churchill. Dermatol World Insights Inquiries 2023; 5: Aug 23). We present a case series of 15 patients with FFA presenting to our tertiary centre hair clinic, who displayed prominent and/or depressed forehead veins. To the unsuspecting clinician, visibility of frontal veins may mistakenly be attributed to steroid atrophy (in patients receiving corticosteroid treatment). Instead, it has been hypothesized that FFA itself may be responsible. The pathogenesis of FFA involves concentric perifollicular fibrosis, thought to culminate in fibrous tract formation and progressive vertical contraction with dermal constriction. This may be more marked around vasculature, resulting in the characteristic appearance of frontal veins in FFA. Steroids may exacerbate this process, but are not thought to be pathogenic (Vañó-Galván S, Rodrigues-Barata AR, Urech M, Jiménez-Gómez N et al. Depression of the frontal veins: a new clinical sign of frontal fibrosing alopecia. J Am Acad Dermatol 2015; 72: 1087–8). Therapeutic approaches for FFA largely focus on suppression of inflammation driving perifollicular fibrosis. Common therapies include topical corticosteroids or calcineurin inhibitors, corticosteroid injections, and systemic therapies such as oral tetracyclines or hydroxychloroquine. Prominent vasculature in FFA can be challenging to treat, with one study supporting the use of Nd:YAG laser as a potentially safe and effective treatment. The reason for the presence of prominent, depressed forehead veins in FFA and, indeed, the preferential targeting of follicles along the frontal hairline in this disease remains unknown and merits further research. Nevertheless, this clinical sign may serve as a helpful diagnostic tool for the perceptive dermatologist.
P108 Acne as an adverse effect of upadacitinib treatment for atopic dermatitis in adults and adolescents: a systematic review of short-term analysis
Authors: Sarto Rubiana , Dornelas Luana Baptistele , Monteiro Sara Baldé , Ricardo Naína Oliveira 
Published: June 2024

Abstract
Atopic dermatitis (AD) is a chronic, recurrent, immune-mediated inflammatory skin disease characterized by eczema and intense itching. There are many drugs used in patients with AD, but none of them is preferential. In this context, upadacitinib, an oral Janus kinase inhibitor, has been suggested for AD treatment. However, acne has been described as a potential adverse effect of this drug. We aim to compare the incidence of acne among patients treated with upadacitinib and placebo through randomized clinical trials (RCTs) in adolescents and adults with moderate-to-severe AD. The PubMed, Scopus and Cochrane databases were used to search for RCTs comparing upadacitinib and placebo in adolescents and adults with moderate-to-severe AD. The outcome assessed was acne. We included four RCTs: Measure Up 1 and Measure Up 2 (together abbreviated here as MUp), AD Up (ADUp) and Rising Up (RUp). These involved 2855 patients allocated to receive placebo, upadacitinib 15 mg or upadacitinib 30 mg. Of these patients, 269 had acne as an adverse event. The follow-up period was 16 weeks. Acne was predominant in the upadacitinib 30-mg group (19.8% in RUp, and 15.2% in MUp + ADUp). Patients aged 18–40 years were the most affected by acne, especially those in the upadacitinib 30-mg group. The body area most affected by acne was the face in all groups and studies (placebo: 80% in RUp and 89.5% in MUp + ADUp; upadacitinib 15 mg: 83.3% in RUp and 96.4% in MUp + ADUp; upadacitinib 30 mg: 94.4% in RUp and 96.2% in MUp + ADUp). The most common presentation of acne was as inflammatory papules (placebo: 100% in RUp and 84.2% in MUp + ADUp; upadacitinib 15 mg: 83.3% in RUp and 91.7% in MUp + ADUp; upadacitinib 30 mg: 88.9% in RUp and 8.4% in MUp + ADUp). There were two episodes of medication discontinuation due to acne, each in the RUp study in the upadacitinib 15-mg and 30-mg groups. Our ana­lysis suggest that acne as an adverse effect was more intense in the upadacitinib 30-mg group in all studies. Also, the face was the most common site of manifestation, and the most common presentation was as papules.
BH12 A case of reverse ageing phenomenon of the hair secondary to vitamin B supplementation
Authors: Amoafo Emma , Rao Archana 
Published: June 2024

Abstract
An 80-year-old woman is known to the dermatology department with darkening of previously grey hair. She was initially referred to the dermatology department for scalp pruritus. Her past medical history included atrial fibrillation and heart failure. Regular medications included furosemide, omeprazole, ferrous fumarate, and over-the-counter supplements, namely vitamin B, vitamin D, zinc, magnesium, cod liver oil, glucosamine and chondroitin. Examination of the scalp revealed erythema, scaling and crusting on the crown with no alopecia. Initial blood tests revealed normal full blood count, renal function, liver function, thyroid function, vitamin D and iron studies, and a raised vitamin B12 level. The scalp pruritus was attributed to seborrhoeic dermatitis and was treated successfully with topical steroids and antifungal shampoo. Changes in hair colour have been described in the literature. Overnight white hair has been attributed to alopecia areata. Conversely, darkening of hair has been reported secondary to vitamin B supplementation. Vitamin B has been reported to repigment grey or white hair in both premature and age-related achromotrichia. Hair repigmentation can begin as early as within 1 month of supplementation. A 2020 review of the literature suggests that vitamin B supplementation is only useful to reverse hair greying where there was underlying vitamin B deficiency initially (Yale K, Juhasz M, Atanaskova Mesinkovska N. Medication-induced repigmentation of gray hair: a systematic review. Skin Appendage Disord 2020; 6: 1–10). The mechanism for hair greying and repigmentation with vitamin B supplementation is incompletely understood, but some authors have hypothesized a ‘free radical theory of ageing’. This is where the production of free radicals increases while endogenous defence mechanisms decrease with age. It has been suggested that the antioxidant properties of orally ingested B vitamins in targeting these free radicals may explain the reverse ageing phenomenon (Trüeb RM. Oxidative stress in ageing of hair. Int J Trichol 2009; 1: 6–14). Other medications that have been reported to cause reverse ageing of the hair include thalidomide, lenalidomide, adalimumab, acitretin, etretinate, prednisone, ciclosporin, cisplatin-based chemotherapy, interferon-α, psoralen, latanoprost, erlotinib, imatinib, tamoxifen, levodopa, clofazimine and captopril (Yale et al.). Further studies and trials into this unique phenomenon could prove extremely beneficial to a society that is significantly focused on antiageing.
BH17 A case of talquetamab-induced onychomadesis with associated palmoplantar keratoderma and desquamation
Authors: Quigley Claire , Qassabi Al Mutasim Al , Murphy Lisa , Long Amy , Timoney Irene , Barry Rory , Diong Sophie , O’Gorman Susan 
Published: June 2024

Abstract
Herein we present the case of a 59-year-old woman who presented to our department with shedding of nails on all 10 fingers and toes, as well as desquamation of the skin on the palms of her hands and soles of her feet. She had a background history of relapsing refractory multiple myeloma and had not responded to multiple other lines of therapy. However, she had biochemical and clinical remission of her multiple myeloma with a new monoclonal antibody agent, talquetamab. She presented to our clinic with significant nail and skin changes that occurred 2 weeks into treatment with talquetamab. She reported shedding of the nails on all 10 fingers and toes, with recurrent cycles of regrowth and shedding. She also reported increased thickened scale and peeling of the skin on the palms of her hands and soles of her feet. Examination revealed onychomadesis of all nails and toenails as well as palmoplantar keratoderma and desquamation. Talquetamab is a bispecific monoclonal antibody targeting human CD3 surface antigen, and GPRC5D tumour-associated antigen. It was approved as a conditional monotherapy for relapsing refractory multiple myeloma in August 2022. In trials, nail-related adverse events occurred in 57% of patients receiving talquetamab and skin-related adverse events occurred in 67% of recipients. To our knowledge, there has been only one other case report of onychomadesis described in relation to talquetamab therapy. It is postulated that the target protein GPRC5D is also present in nails, with talquetamab treatment leading to nail matrix arrest and subsequent nail shedding. These changes have impacted on our patient’s quality of life, including affecting her manual dexterity. Treatment with ultrapotent topical steroids has provided only modest benefit.
PD09 Delving deeper into sunburn
Authors: Christou Evangelos A A , Kerr Alastair , Lehmann Alan , Sarkany Robert , Fassihi Hiva , Ibbotson Sally H 
Published: June 2024

Abstract
A 25-year-old woman was referred to a tertiary photodiagnostic service following ‘severe sunburn’ after minutes of sun exposure on an overcast day. She described a prickling sensation on exposed forearms and later developed erythema, vesicles and large unilocular blisters, requiring attendance at accident and emergency and a burns unit. The episode resolved over weeks with exfoliation, but no scarring. With hindsight, she reported five other severe episodes since the age of 7 years, requiring accident and emergency visits and bandaging, so had avidly avoided the sun. She was medically well, on no medications, with no personal or family history of skin cancer. Skin examination was normal, with no skin dyspigmentation or lentigines. Monochromator phototesting showed mild delayed ultraviolet (UV)B and UVA2 sensitivity, with enhanced responses at 48 h. UVB TL-01 minimal erythemal dose, broadband UVA provocation testing, sunscreen photopatch testing, connective tissue disease screen, human leucocyte antigen typing, plasma and red cell porphyrins were normal or negative, and vitamin D levels were markedly deficient. Biopsy of an abnormal phototesting site revealed apoptotic keratinocytes, lymphocytic infiltrate and dermal oedema. Due to the severity of the ‘sunburn’ episodes, functional DNA repair studies were performed and could not rule out xeroderma pigmentosum (XP), although they excluded XP-variant. Genotyping showed homozygosity of an ERCC4 pathogenic variant [NM_005236.2(ERCC4): c.1135C&gt;T (p.Pro379Ser)], consistent with XP complementation group F (XP-F). XP-F is a rare form of XP and is significantly underdiagnosed due to its often milder clinical manifestations. Our case is the fourth case of XP-F that is reported in the UK, and shares similar characteristics with the other three published cases (Fassihi H, Sethi M, Fawcett H et al. Deep phenotyping of 89 xeroderma pigmentosum patients reveals unexpected heterogeneity dependent on the precise molecular defect. Proc Natl Acad Sci U S A 2016; 113: E1236–45). Notably, the identified pathogenic variant has an allele frequency of 0.3%, suggesting that around 10 individuals per million could be homozygous for this variant, equivalent to roughly 600 cases of XP-F currently in the UK. This case raises the importance of not underestimating ‘sunburn’ – attending accident and emergency with severe episodes following relatively minor sun exposure should be a red flag, requiring consideration of DNA repair diseases, even in the absence of any other features of XP. Moreover, it underscores the need to refer patients with abnormal photosensitivity to a specialist photodiagnostic service for comprehensive assessment and, where required, to the national XP service. It is likely that there is a significant number of ‘easy sunburners’, who are not currently recognized as having XP-F due to underdiagnosis, so we wish to raise awareness of this important condition.
PD14 Trends, knowledge and practice on sunscreen use in patients referred via the suspected cancer pathway: a multisite survey
Authors: McAllister Lucy , Ifan Erin , Hiranput Siwaporn , Yesudian Paul Devakar 
Published: June 2024

Abstract
Sunscreens are widely accepted as a safe and effective method for reducing skin cancer incidence and addressing photoageing and sun-induced pigmentary changes. Market research indicates a worldwide increase in sunscreen sales; however, real-world data on consumer understanding, selection and use of these products remain scarce. A questionnaire was distributed to patients attending clinics in five hospital sites after referral for suspected skin cancers. Data collected included demographics, occupation and previous dermatological diagnosis. Sunscreen use, sun protection factor (SPF), ultraviolet star rating, presence of a visible light filter, and frequency and anatomical areas of application were also recorded. Understanding of SPF definition was assessed using a multiple-choice question. Data were analysed using SPSS software (IBM, Armonk, NY, USA), and a χ2-test was applied to identify associations between patient characteristics and sunscreen use. In total, responses were received from 126 patients; 54 (43%) were male and 72 (57%) female. The most frequent age category was 61–70 years (n = 31, 25%) and, where data on skin type were captured, Fitzpatrick types I and II were most prevalent (n = 62, 84%). Of the responses regarding employment, 16 (29%) worked in outdoor occupations. Overall, 63 patients had no prior dermatoses (49%). Of the 126 respondents, 97 stated regular use of a sunscreen product, which was significantly associated with female sex: χ2 (1, n = 126) = 14.4, P &lt; 0.001. No relationship was identified between age or occupation and sunscreen use. Products were applied in sunny weather (n = 76, 66%), rather than daily. SPF 50 was the most frequent factor used (n = 39, 41%). In total, 84 (87%) did not know whether their product contained a visible light filter. The scalp was a frequently missed site of application (n = 17, 16% applied to the scalp). Approximately half of responses (n = 47, 53%) reported the correct definition of SPF. Evidence suggests that those with previous cutaneous malignancy tend to be better educated on SPF properties of sunscreen than the general population. However, there are very limited data available on understanding of visible light blockage. In this survey only 13% knew whether their sunscreen contained a visible light filter, which confers major advantages in reducing hyperpigmentation and photoageing. As ultraviolet vs. visible light protection varies between products, targeted education may enable better choices. Men are statistically more likely to develop skin cancers, yet they underutilize sunscreens, frequently omitting high-risk sites for carcinogenesis, which our findings corroborate.