bluuebunny/crossref_metadata_2025_split huggingface dataset:
British Society for Cutaneous AllergyOral presentationsCD01 Isobornyl acrylate in nail cosmetics
Authors: Xie Fangyi , Sansom Jane , Sinha Aparna 
Published: June 2024

Abstract
We present two cases of patients with allergic contact dermatitis to acrylates from gel nail kits, containing isobornyl (meth)acrylate (IBA). IBA has been associated with contact allergic dermatitis from medical devices, namely insulin pumps and continuous glucose-monitoring devices. However, it has not previously been reported with nail cosmetics. We examined commercially available nail cosmetics to look for the presence of IBA. We compiled the ingredients of the top 10 search results from four online sources (Amazon, Boots, Look Fantastic, Nail Polish Direct) for ‘gel nails’. We looked for ingredients in the initial website, the official product website and the safety data sheet, or emailed the company where the information was not available. One patient was a 23-year-old woman who was a keen recreational acrylic, gel and press-on nail user, with a 6-year history of a blistering rash in the periungual region and fissuring of the finger pulps. She had positive patch test reactions to multiple acrylates: 2-hydroxyethyl methacrylate (HEMA), 1,4-butanediol dimethacrylate, 1,6-hexanediol diacrylate, triethylene glycol diacrylate, diethylene glycol diacrylate, ethyl methacrylate, ethyl acrylate, methyl methacrylate, 2-hydroxyethyl acrylate and IBA. The second patient was a 45-year-old woman with chronic atopic dermatitis who had recently developed a facial flare after using gel nails. She had positive patch test reactions to diethylene glycol diacrylate, methylisothiazolinone and methylchloroisothiazolinone. Both patients used commercial gel nails containing IBA. Thirty-two of 40 (80%) products were gel nail polishes, and the rest were two each (5%) of gel-like polish, gel nail tips, stick-on gel nails and topcoat. Twenty of 40 (50%) products had no ingredients listed on the commercial website, of which six (30%) had no further information on the official product website or on the initial websites. All products contained at least one acrylate. IBA was in eight of 34 (24%) products, of which four were in the isobornyl methacrylate form. The most common acrylates were acrylate copolymers (17 of 34, 50%), HEMA (13 of 34, 38%), 2-hydroxypropyl acrylate (10 of 34, 29%), di-HEMA trimethylhexyl dicarbamate (6 of 34, 18%), hydroxyethyl acrylate (6 of 34, 18%) and trimethylolpropane triacrylate (5 of 34, 15%). The incidence of acrylate allergic contact dermatitis has risen due to the increasing popularity of salon and nonoccupational use with home ultraviolet light devices to cure monomers. Limitations of the study include only online searches, which may miss common products in salons or stores. We wanted to highlight the presence of IBA in commercially available nail cosmetics, given the recognized cross reactions and cosensitizing potential of acrylates.
CD03 Watch out! Allergic contact dermatitis to acrylates in a smart watch
Authors: Davies Anna , Stone Natalie 
Published: June 2024

Abstract
A 15-year-old girl with long-standing atopic dermatitis and hay fever presented to the patch test clinic with an atypical distribution of eczema over the trunk, elbows and perioral skin. Close examination additionally revealed a well-defined patch on the dorsal left wrist, at the exact site of her Apple smart Watch. She was a competitive swimmer and gym user. Her medications were tranexamic acid, topical steroids and emollients. Testing to the British Society for Cutaneous Allergy standard, medicaments, facial, oral, metals and acrylate series (applied on day 2) showed positive reactions to methylisothiazolinone (day 2+, day 4++), methylchloroisothiazolinone/methylisothiazolinone (MCI/MI) (day 2+, day 4++), benzophenone-3 (day 2−, day 4+), benzophenone-4 (day 2−, day 4+), sodium benzoate (day 2−, day 4+), benzoyl peroxide (day 2−, day 4+), isobornyl acrylate (day 2+), ethylene glycol dimethacrylate (day 2+) and hexanediol diacrylate (day 2+). The benzophenones were of current relevance to her sun protection factor-containing emollient. Sodium benzoate was present in her shower gel and shampoo, as well as her favourite Vimto squash. Benzoyl peroxide was of unknown relevance and MI/MCI was thought to be of past relevance. The acrylates, in particular isobornyl acrylate, were postulated to be of current relevance to her Apple Watch. Since avoiding the allergens, including the Apple Watch, her eczema has significantly improved, specifically clearing at the wrist and perioral skin. Our patient had no known previous acrylate exposure, in particular no history of using gel or acrylic nails. The Apple product website declares that many of their products contain trace amounts of acrylates and methacrylates. Knowledge that acrylates are a common cause of allergic contact dermatitis (ACD) in diabetic devices, and strong clinical suspicion about the watch, prompted us to test with the acrylate series. There are two previous reported cases of Apple Watch ACD, both attributed to nickel (Levian B, Chan GC, Adler BL. Out of REACH: allergic contact dermatitis to nickel in an Apple Watch. Contact Dermatitis 2024; 90: 99–101; Ko WC, Yu J. Nickel allergy elicited by an Apple Watch. Dermatitis 2022; 33: e11–12). Nickel is mentioned on the Apple product website, but that states that release levels are low. Interestingly in one case the dimethylglyoxime spot test was negative (Levian et al.) and the acrylate series was not tested. Our patient tested negative to nickel. There are many reported cases of ‘irritancy’ caused by smart watches; however, most have not been patch tested to the acrylate series. To our knowledge this is the first case suggesting acrylate ACD caused by a smart watch. We encourage others to test with the acrylate series in similar future cases.
CD04 The dermal–dental nexus
Authors: Hussain Fazleenah Ajmul , Williams Jeremy , Godwin Alison , Yesudian Paul Devakar 
Published: June 2024

Abstract
Allergic contact dermatitis (ACD) from acrylates is frequently observed in occupational settings, particularly among dental workers, nail technicians and beauticians. In the last 2 decades, there has been a shift in the types of products causing ACD related to acrylates, transitioning from conventional sources like dental materials, glues, sealants, adhesives, paints and printing inks, to increasing prevalence in nail cosmetics. Recent studies indicate that 64% to &gt; 80% of reactions to acrylates were related to cosmetic nail products. In dermatological practice, patients undergo patch testing for oral reactions following dental procedures involving acrylates. In these patients, previous nail acrylate sensitization is thought to play a role. Systemic contact dermatitis (SCD) refers to a condition where sensitization via the skin leads to subsequent reactions to the same or crossreacting allergens systemically. Recognizing the significance of this phenomenon, we conducted a survey among dental workers in the UK to gauge their awareness of this association. We received 49 responses, of which 39 (80%) were from general dental practitioners. Our cohort was highly experienced, with 21 (43%) having &gt; 20 years’ experience. Most respondents (31, 63%) were from Wales, and 30 (61%) spent &gt; 75% of their time working with the NHS. Overall, 26 (53%) responders reported that 5 to 10 patients a day required acrylate as part of their treatment, while 14 (29%) stated that they use it in fewer than 5 patients a day seeking dental treatment. In total, 34 (69%) did not routinely enquire about patients’ past allergy or sensitivities to nail acrylates before undertaking acrylate-related dental procedures. One responder asked this routinely and two (4%) responders felt that there was no evidence for this. Nineteen (39%) expressed uncertainly about encountering oral reactions following exposure to dental acrylates in patients with nail acrylate allergy as they were not aware of this association. Seventeen (35%) did not experience any such reaction, while eight (16%) encountered this, albeit rarely. In total, 32 (65%) were unaware that nail acrylate sensitization could lead to oral reactions following dental acrylate exposure, and a significant majority (47, 96%) had never received education on this association. The survey underscores a lack of awareness among dental practitioners regarding the potential for SCD causing oral reactions after nail acrylate sensitization. Given the relevance of these findings, it is imperative to incorporate this knowledge into dental undergraduate curricula.
CD05 Consort allergic contact dermatitis to occupational acrylates
Authors: Khan Yasmin , Latheef Faheem 
Published: June 2024

Abstract
A 52-year-old woman presented to dermatology with severe widespread dermatitis, characterized by spongiosis on a recent skin biopsy. Despite thorough investigation, a definitive cause remained elusive. The patient underwent patch testing with the baseline, photopatch, anti-infective, excipient, cosmetic, textile, fragrance and acrylate series. Patch testing revealed multiple positive 3+ blistering reactions to various acrylates: 2-hydroxyethyl methacrylate, 2-hydroxypropyl methacrylate, ethylene glycol dimethacrylate, 1,4-butanediol dimethacrylate, 1,6-hexanediol diacrylate, tetrahydrofurfuryl methacrylate, tetraethylene glycol dimethacrylate, butyl acrylate, ethyl acrylate, 2-hydroxyethyl acrylate and triethylene glycol diacrylate. The patient lacked any direct exposure to acrylates through common sources such as gel, shellac or acrylic nails; dental materials; dressings or bone cement. Further inquiry revealed that the husband’s profession was in windscreen repairs, where he routinely handled resins containing acrylates, which he would wipe on to his work overall. It emerged that the transfer of resin onto his clothing, subsequently laundered alongside the patient’s own clothes, likely facilitated sensitization. Analysis of the husband’s work-related resin products confirmed the presence of several acrylates implicated in the patient’s patch test reactions. Given the severity of her symptoms, including blistering reactions, a consort allergic contact dermatitis (CACD) to occupational acrylates was strongly suspected. Following counselling on allergen avoidance strategies, the patient consciously avoided close contact with her partner’s work clothing and began laundering her garments separately. Remarkably, this intervention led to complete resolution of her symptoms. CACD, also referred to as connubial contact dermatitis, is a recognized phenomenon wherein one develops allergic reactions to allergens originating from another individual. A recent systematic review reported a female predominance (62.8%) in cases of CACD, with partners or spouses being the most common consorts (50.0%) (Lee J, Guo S, Dinalo J et al. Consort allergic contact dermatitis: a systematic review. Dermatitis 2022; 33: 181–6). Exposure from a partner’s occupation was noted in a subset of cases (14.6%), underscoring the relevance of occupational history in such presentations. A caregiving relationship was also frequently involved. This case represents the one of the first documented instances of CACD attributed to occupational acrylates. It highlights the need for comprehensive social and occupational history taking in dermatology settings. It underscores the importance of considering potential sources of allergen exposure from partners or dependants, particularly in cases with unusual clinical presentations.
CD06 Beryllium is back: a case of culinary contact dermatitis
Authors: Lee Pui Chi , Thompson Donna 
Published: June 2024

Abstract
Beryllium is a metal with physical properties including a great strength-to-weight ratio, making it stronger than steel. It is a useful material in many industries and is used in metal alloys. It is found in tools, dental and medical prostheses, and the aerospace industry. We report an unusual case of occupational hand dermatitis in a chef secondary to beryllium-containing tools. A 23-year-old woman with hand dermatitis was seen in our cutaneous allergy clinic for patch testing. She is right-handed and reported a 3-year history of blistering, erythema and cracking of the palms of both hands. A suspected source was the professional chef’s knives that she had purchased over 7 years ago and had been using daily. There was no past medical or surgical history of note, and no history of dental work. Patch testing was performed to the standard, cosmetics, rubber, metals, plants and woods series, with a positive reaction to only diallyl disulfide (1% in petrolatum) on day 2 (48 h). However, she later developed a new positive reaction on day 9 (216 h), confirmed to be beryllium sulfate tetrahydrate (1% in petrolatum). Her hand dermatitis improved with garlic avoidance, and the discontinued use of the utensils, often made with beryllium-containing alloys. At our centre, we have patch tested a total of 731 patients to beryllium in our extended metal series in the past 20 years. There were four other patients who patch tested positive to beryllium with association to occupation and medical prostheses. In one case it was felt that the copper beryllium alloy wires used in the flexible leads of their pacemaker were relevant. Beryllium is an uncommon cause of allergic contact dermatitis, with published case reports notably highlighting the tendency to late reactions, particularly occurring between day 7 and day 10 (Toledo F, Silvestre JF, Cuesta L et al. Contact allergy to beryllium chloride: report of 12 cases. Contact Dermatitis 2011; 64: 104–9). Such delayed reactions are often under-reported, as routine patch test readings are not performed after day 4 or day 7. Toledo et al. published a case series of 12 patients with positive reactions to beryllium chloride and suggested that readings between day 7 and day 10 can be useful whenever beryllium is patch tested. Our case reinforces the value of taking patch test readings beyond day 4 when specific metal allergies are suspected. It also demonstrates beryllium-containing utensils as a cause of culinary contact dermatitis and highlights these as an additional source of occupational exposure.
CD08 ‘If it’s not the hair maybe it’s in the air?’ A case of allergic contact dermatitis from airborne exposure to acrylates
Authors: Khan Yasmin , Latheef Faheem 
Published: June 2024

Abstract
A 38-year-old auditor was referred for patch testing for a suspected hair dye reaction following development of a florid eczematous reaction on her face after a hair dye appointment. This reaction predominantly affected her cheeks, with the left more so than the right, extending to just below her eye. She also had mild eye swelling. The description and photographs taken at the time were atypical for a hair dye reaction, and on further questioning she revealed she had been sat in close proximity to someone undergoing acrylic nail treatment during the aforementioned hair appointment. We undertook patch testing to our baseline, anti-infective, excipient, hairdressing, fragrance, acrylic nail, cosmetic, photopatch and perianal series. Positive results were observed for 14 acrylates found in acrylic nails, namely methyl methacrylate, 2-hydroxypropyl methacrylate, ethylene glycol dimethacrylate, triethylene glycol dimethacrylate, urethane dimethacrylate, bisphenol A dimethacrylate 2%, bisphenol A glycidyl dimethacrylate 2%, 1,6-hexanediol diacrylate, tetrahydrofurfuryl methacrylate, tetraethylene glycol dimethacrylate, butyl acrylate, ethyl acrylate, 2-hydroxyethyl acrylate, and triethylene glycol diacrylate. No reactions were observed to any hair dyes on patch testing. Skin prick testing for para-phenylenediamine (PPD) was also negative, excluding a type 1 allergy to PPD. She reported prior but infrequent use of acrylic nails, the last instance being over a year ago. It is therefore likely that the patient became sensitized through these exposures, leading to a pronounced reaction following subsequent airborne exposure to acrylates. An increasing incidence of allergic contact dermatitis (ACD) to acrylates has been noted, particularly among nail technicians and consumers. Although airborne contact dermatitis to acrylates is rare, it has been reported in occupational settings involving nail technicians and dental nurses, and in manufacturing. Facial dermatitis or dermatitis in exposed areas without direct allergen contact has been documented. Additionally, four cases of respiratory sensitization with acrylate-induced occupational asthma have been reported in conjunction with ACD. Respiratory problems were often alleviated with mask usage, but airborne contact dermatitis posed greater challenges, prompting job changes. Efforts to collect sensitizers using air pumps for vapours and filters for airborne aerosols have seen limited success. This unusual case underscores the diverse clinical presentations of acrylate sensitivity and emphasizes the importance of promptly detecting the allergen to prevent further exposure. Awareness of airborne allergic contact dermatitis to acrylates is useful in occupational disease reviews. Additionally, efforts should be made to minimize airborne methacrylate concentrations to reduce sensitization risk.
DS15 Lentigo maligna: mapping using confocal microscopy and the impact of multiple facial surgeries on patient quality of life
Authors: Leahy Marion , Laing Mary 
Published: June 2024

Abstract
Lentigo maligna (LM) can present with subclinical extension that may be difficult to define preoperatively and lead to incomplete excision and potential recurrence. Preliminary studies have used reflectance confocal microscopy (RCM) to assess LM margins. Knowing the margin prior to surgery allows for forward planning and enables the doctor to discuss the plan with the patient. The objectives of this study were (i) to evaluate the correlation of subclinical extension of LM defined by RCM compared with the gold standard of histopathology, and (ii) to assess the impact of multiple surgical excisions on a patient’s mental health and quality of life. This was a prospective study of patients with LM referred for surgery. RCM was performed at the clinically defined initial surgical scar, followed by staged RCM imaging of the ‘normal’ skin to define the exact margin of the lesion. Punch biopsies were then completed along the negative margin to ensure the accuracy of the results. Patients then completed a questionnaire detailing their knowledge of LM and the impact that multiple surgeries had on their life. Ten patients were included: five male and five female. All patients had undergone multiple surgeries without obtaining a negative margin. Ninety per cent had a facial lesion and 10% had a chest lesion. The mean largest diameter was 2.8 cm (range 0.8–5). Diagnostic accuracy for detection of residual LM using RCM was 97%. Histopathology correlation revealed that 96% of biopsies matched the RCM findings. All participants reported a negative impact on their quality of life. Eighty per cent of patients thought LM was melanoma. Fifty per cent of patients were not informed of the nonsurgical options. Twenty-five per cent of patients would not have opted for surgical excision if they had understood the extent of the surgery. In conclusion, providing optimal care for patients with LM requires a multidisciplinary approach. RCM is an useful tool to aid surgical planning and for managing patient expectations in LM.
DS18 Pre-Mohs biopsy survey (related specifically to basal cell carcinoma and biopsy prior to Mohs surgery)
Authors: Nassar Omar , Shah Dev 
Published: June 2024

Abstract
Mohs micrographic surgery (MMS) is a specialized surgical technique for removing locally invasive, high-risk skin cancers. MMS provides high cure rates with maximal preservation of unaffected tissue (Hanke CW. Frederic Mohs tribute. History of Mohs micrographic surgery. J Drugs Dermatol 2002; 1: 169–74; Brodland DG, Amonette R, Hanke CW, Robins P. The history and evolution of Mohs micrographic surgery. Dermatol Surg 2000; 26: 303–7). In contrast to standard excision, in which only a small portion of the margins is evaluated, in MMS, specimens are cut in horizontal sections that allow the evaluation of the entire peripheral and deep margins of the tumour. This survey was conducted to gather different opinions about type of biopsies used before Mohs surgery specifically for basal cell carcinoma (BCC). The survey was sent to British Society for Dermatological Surgery members all over the UK. The survey aimed to investigate participants’ opinions in doing biopsies before Mohs surgery specifically for BCC. This includes the types of the biopsy they prefer, and how it affects the Mohs procedure, for example whether there is a specific type of biopsy that results in the need to take more deep levels during the Mohs procedure. Of the responses received, 60% were from dermatology consultants, about half of whom are Mohs surgeons. Overall, we found that about 50% do routine biopsy before Mohs, 65% prefer scoop biopsy or shave biopsy and only 10% do punch biopsy, while 15% do not mind the type of the biopsy. We were interested that 50% routinely do biopsies prior to Mohs, and of these at least 10% are punch biopsies, which we feel should be limited as they can induce a deep scar and result in more layers being taken during the Mohs surgery procedure in order to clear the scar.
DS21 Perils of a 3-mm punch biopsy
Authors: Victory Liana , Brady Ronan , Quigley Claire , Kevane Barry , Moloney Fergal 
Published: June 2024

Abstract
An 83-year-old woman underwent a 3-mm diagnostic punch biopsy from a Bowenoid patch on her right cheek. Her medical background was significant for invasive cholangiocarcinoma and she was on active treatment with gemcitabine under the care of oncology. In terms of anticoagulation she was on aspirin 75 mg as a preventative measure. Unfortunately, the patient developed ongoing bleeding from the biopsy site and presented to the emergency department. She was reviewed in the emergency department, the wound was sutured and haemostasis was noted. Over the next few days, she had progressive bleeding from the biopsy site. A plastic surgeon was consulted and the site was examined, cauterized and resutured. During the procedure haemostasis was achieved. The patient was discussed with haematology, and tranexamic acid for 3 days was recommended and aspirin was held. Routine bloods and a coagulation screen were sent. It was noted there was an isolated prolongation of the activated partial thromboplastin time. A diagnosis of acquired factor VIII deficiency was made following a coagulation screen in the department. She was transferred to the National Coagulation Centre for management and replacement of factor VIII. She was commenced on prophylactic FEIBA (anti-inhibitor coagulant complex) intravenous three times per week. Acquired haemophilia A is a rare but severe autoimmune bleeding disorder caused by circulating autoantibodies that inhibit the coagulant activity of factor VIII. It is more frequent in older patients and is associated with several conditions such as malignancies, the postpartum period, autoimmune diseases and drug exposure. This is a rare presentation; however, it highlights the risks involved with even minor dermatological surgical procedures and the importance of consenting patients for these possible complications.