bluuebunny/crossref_metadata_2025_split huggingface dataset:
P087 The British Hair and Nail Society present a review of our national grand round of challenging hair disorders and the benefits to the wider British Association of Dermatologists membership
Authors: Sharma Sonia , Bryden Alyson , Clayton Nicola , Farrant Paul , Mowbray Megan , Holmes Susan , Therianou Anastasia , Al-Nuaimi Yusur , Meah Nekma , Asfour Leila , Takwale Anita 
Published: June 2024

Abstract
The British Hair and Nail Society was formed in 2011. We currently have 133 members and invite them to submit challenging cases of hair disorders to our grand round (with relevant history, histopathology and photographs) for review by our expert hair panel. This comprises consultants with hair expertise from around the UK, and together we aim to address the referrers’ queries relating to diagnosis, treatment or both. We appreciate the complexity of hair disorders and the limited number of specialist hair clinics around the country, and therefore we have recently offered the opportunity for all British Association of Dermatologists (BAD) members to submit cases once a year. The aim of our review is to present the types of complex hair disorders that have been referred to our dedicated national hair-related grand round and showcase some of the most educational cases. The hair disorders grand round began in 2018 and since then a total of 26 hair cases (10 children and 16 adults) have been submitted from various regions. The main aims of referral include diagnostic expertise (n = 4), aid with treatment plans (n = 8) or both (n = 14). The median age of patients was 33 years (range 4–75). There were 14 female and 12 male cases. The regions of referral include Oxford, Brighton, Manchester and Scotland. There were equal numbers of scarring alopecia (n = 13) and nonscarring (n = 13) cases. The most common nonscarring hair condition was alopecia areata (n = 6), with the possibility of other concurrent hair conditions (n = 1) or an underlying genetic disorder (n = 3). The most common diagnosis of scarring alopecia was folliculitis decalvans (n = 6). The diagnosis was altered in 10 cases (38%). Examples of some of our rare diagnoses include keratosis follicularis spinulosa decalvans, genetic hypotrichosis and scalp dermatomyositis. We reviewed cases of recalcitrant disease such as folliculitis decalvans, and novel therapeutics were suggested such as the use of naltrexone, utilizing photodynamic therapy after removing crusts, and even the use of manuka honey and cannabinoid oil. Our grand round has recommended independent funding requests in three cases and supports applications from clinicians for their patients with complex conditions. We hope our presentation showcases to the wider BAD membership the value of our national hair disorders grand round in supporting complex diagnostic and therapeutic decisions, as well as offering support for clinicians in the form of individual funding request submissions or trialling novel therapies, which may have limited evidence. We welcome any future submissions.
P098 Association between air pollution and incidence of psoriasis: a nationwide population-based case–control study
Authors: Li Chia-Lun , Ma Sheng-Hsiang , Wu Chun-Ying , Lyu Ying-Syuan , Chang Yun-Ting , Ao Chon-Kit , Wu Chen-Yi 
Published: June 2024

Abstract
Air pollution (AP) is an alarming public health crisis worldwide. Common ambient pollutants include sulfur dioxide (SO2), carbon monoxide (CO), ozone (O3), coarse particulate matter (PM10), fine particulate matter (PM2.5), and nitrogen dioxide (NO2). Although previous studies have shown that AP has been associated with various cardiovascular, respiratory and inflammatory diseases, the relationship between AP and psoriasis remains unknown. This nationwide, population-based case–control study aims to explore the relationship between AP and incident psoriasis, using data from the National Health Insurance Research Database of Taiwan between 2012 and 2018. Patients with newly diagnosed psoriasis were included, which was confirmed by board-certified dermatologists or rheumatologists on at least three occasions. Exclusion criteria included patients with a diagnosis of psoriasis before 2012, patients under 20 years of age in 2012, or incomplete AP data. For each patient with psoriasis, four controls were matched considering age, sex, urbanization level, index date and comorbidities. AP data were retrieved from 73 general air quality monitoring stations operated by the Taiwan Environmental Protection Administration. Exposure to air pollutants (SO2, CO, O3, PM10, PM2.5 and NO2) was analysed in the 5 years preceding psoriasis diagnosis and in controls. The mean pollution levels were further divided into four quartiles (1 = lowest and 4 = highest) to assess the dose–response effect. A conditional logistic regression model was used to assess the association. Our study included 45 093 patients with psoriasis and 180 372 matched controls. No significant intergroup difference was found in age, sex, urbanization level or comorbidities. After adjusting for age, sex, urbanization, index date and comorbidities, the second and third concentration quartiles of CO exposure were associated with a decreased psoriasis incidence [adjusted odds ratio (aOR) 0.94, 95% confidence interval (CI) 0.91–0.97; and aOR 0.91, 95% CI 0.89–0.94, respectively), while the third concentration quartile of PM10 (aOR 1.05, 95% CI 1.02–1.08) and the second concentration quartile of PM2.5 (aOR 1.08, 95% CI 1.04–1.11) were associated with a slightly increased incidence of psoriasis. Using a model incorporating all air pollutants, we found that the levels of PM10 (quartile 4: aOR 1.09, 95% CI 1.03–1.16), PM2.5 (quartile 2: aOR 1.08, 95% CI 1.04–1.13) and NO2 (quartile 4: aOR 1.14, 95% CI 1.05–1.23) were associated with a slight increase in the incidence of psoriasis. Our study shows that although exposure to certain PM10, PM2.5 and NO2 levels was significantly associated with incident psoriasis, the increased risks were trivial, with no dose–response relationship.
P109 Association between air quality index and the risk of rosacea: a nationwide population-based cohort study
Authors: Ma Sheng-Hsiang , Wu Chun-Ying , Li Meng-Chieh , Ho Hsiu J , Ao Chon-Kit , Wu Chen-Yi 
Published: June 2024

Abstract
Air pollution is associated with several inflammatory skin disorders. However, the association between air quality and rosacea remains unclear. Our objective was to investigate the association between air quality index (AQI) and the incidence of rosacea. Overall, 21 709 479 participants without rosacea before 2008 were recruited from the Taiwan National Health Insurance Research Database. The long-term average AQI value for each participant was acquired from the Taiwan Air Quality Monitoring System Network and was calculated from 1 January 2008 until the diagnosis of rosacea, withdrawal from National Health Insurance, or 31 December 2018. We observed a significant association between AQI and the incidence of rosacea, with each unit elevation in AQI increasing the risk of rosacea by 5%. Compared with the quartile 1 group, the quartile 2, 3 and 4 cohorts exhibited 1.82-fold, 4.48-fold and 7.22-fold increased risks of rosacea, respectively. Additionally, exposure to PM2.5, SO2 and CO increased the risk of rosacea, whereas exposure to PM10 was associated with a lower risk. Limitations of this study include its retrospective design and involvement of participants mainly from Taiwan. Additionally, some potential confounding factors may not have been accessible in the database. This study supported a significant dose–response relationship between AQI and the incidence of rosacea.
P111 A retrospective analysis of cutaneous sarcoidosis
Authors: Hiranput Siwaporn , McAllister Lucy , Shing Stacey Li Hi , Damani Namiz , Abdalla Doaa , Yesudian Paul Devakar 
Published: June 2024

Abstract
Sarcoidosis is a multisystem granulomatous disorder of uncertain aetiology, manifesting with cutaneous features in one-third of affected individuals. We retrospectively reviewed medical records of patients with a clinical diagnosis of cutaneous sarcoidosis in dermatology departments within our region. Sixty-five patients were identified. The mean age at presentation was 49 years (range 28–75), with increased prevalence in women (44, 68%). Twenty-six patients (40%) had localized disease affecting a single anatomical location, three of which were within tattoos. Thirty-nine (60%) had involvement of at least two anatomical locations. Limbs were the most frequently affected site (41). Other affected areas were the face (32), torso (25), scalp (9) and neck (5). Plaques were the most common morphology, seen in 26 cases, followed by papules (23), nodules (23), patches (6), erythema nodosum (4), annular (3), ulceration (3) and subcutaneous nodules (3). The colours of lesions were erythematous (37), yellow–orange–brown (22), violaceous (9) and skin coloured (5). All patients had biopsy-proven noncaseating granulomas; 60 patients had this confirmed on skin biopsy and five patients from other organs. In total, 41 patients (63%) had systemic sarcoidosis. Twenty-four of those with systemic sarcoid osis (59%) had cutaneous signs as their first presentation of sarcoid osis. Pulmonary sarcoidosis was diagnosed in 36 (55%), with relevant findings on chest X-ray, computed tomography of the thorax and/or pulmonary function tests. Of these, 22 patients did not report respiratory symptoms. Other organs involved were eye (6), joint (6), extrapulmonary lymph nodes (5), liver (4), cardiac (3), central nervous system (2) and renal (2). Lymphopenia was detected in 14 (22%) and anaemia in six (9%) patients. Twenty-three (35%) had elevated serum angiotensin-converting enzyme (ACE) levels. Four patients with elevated serum ACE levels did not have systemic sarcoidosis. Twenty-two of 41 patients with systemic sarcoidosis did not have elevated serum ACE levels. Complete resolution of skin lesions was observed in 32 patients. Management included watchful monitoring (8), potent or superpotent topical steroids (11), short courses of prednisolone (3), antimalarials (3), intralesional steroids (2), methotrexate (1), tofacitinib (1), and treatments initiated for systemic sarcoidosis including long-term prednisolone (3) and adalimumab (1). Our study highlights a lack of correlation between clinical features of cutaneous disease and systemic involvement. We found no association between biochemical profile and severity of sarcoidosis, or disease progression. It underscores the importance of maintaining a high index of suspicion and conducting thorough investigations for early detection of extracutaneous disease, as patients with extensive systemic sarcoidosis may be asymptomatic.
BH09 Mycophenolate mofetil in the management of lichen planus pigmentosus in a woman with frontal fibrosing alopecia
Authors: Htwe Su , Holmes Susan 
Published: June 2024

Abstract
A 50-year-old woman of south Asian descent presented with a 4-year history of hair loss, itching and follicular prominence at her frontal hairline, in association with increasingly sparse eyebrows and loss of body hair. She was otherwise well and on no medication. Clinical examination revealed typical features of frontal fibrosing alopecia (FFA), with associated papules on the forehead. In addition, striking hyperpigmentation was evident over the forehead, face and neck. This was felt to be in keeping with FFA-associated dyspigmentation–lichen planus (LP) pigmentosus. Initial management was lymecycline 408 mg once daily, tacrolimus 0.1% ointment twice daily plus mometasone furoate 0.1% two times weekly to the neck, and pimecrolimus cream twice a day to the face, as well as a sun protection factor 50 sunscreen. Hydroxychloroquine was avoided initially due to the potential side-effect of altered skin pigmentation with this drug. While the hairline recession remained unchanged, the pigmentary changes worsened despite treatment and affected areas became increasingly itchy. Lymecycline was stopped and hydroxychloroquine 200 mg once daily was started. After 12 months, the cutaneous pigmentation continued to worsen and was extending onto the arms and torso. A trial of low-dose isotretinoin (20 mg once daily) was considered as this has been reported to be of benefit in LP pigmentosus. However, after 6 months, there was no improvement. A trial of mycophenolate mofetil 500 mg twice daily was then commenced. After 3 months of treatment, skin itching had settled and no new areas of hyperpigmentation were noted. After 9 months, there had been a significant improvement in skin pigmentation, which has been maintained. The extent of frontal hairline recession has remained stable. While FFA was initially described exclusively in postmenopausal White women, it has since been reported in Hispanic, African, Afro-Caribbean and Asian individuals, premenopausal women, and men. Dyspigmentation associated with FFA has largely been a feature observed in patients with darker skin types, and it is not clear whether this pigmentation is part of the spectrum of FFA in individuals with darker skin or whether LP pigmentosus is occurring coincidently with FFA in patients with darker skin types. Low-dose isotretinoin has been reported as being of benefit in LP pigmentosus but was ineffective in this case. Mycophenolate mofetil is also reported to be of benefit in the management of LP pigmentosus, and led to a significant improvement in both pigmentation and itch in this case. This case highlights the therapeutic benefit of mycophenolate mofetil in in LP pigmentosus associated with FFA.
PD08 Normal phototests in five patients with Bloom syndrome
Authors: Bakr Farrah , Duncan Mhairi , Naik Harsha , Sarkany Robert , Lehmann Alan , Mohammed Shehla , Fassihi Hiva 
Published: June 2024

Abstract
Bloom syndrome (BS) is a rare autosomal recessive disorder characterized by abnormal growth, skin changes, immunodeficiency, insulin resistance and diabetes, impaired fertility, and a significantly increased risk of cancer from an early age, commonly leukaemia. It is caused by variants in the BLM gene, encoding the DNA repair enzyme RecQL3 helicase, resulting in chromosome instability, excessive homologous recombination, and a greatly increased number of sister chromatid exchanges (SCE), pathognomonic of the syndrome. In the literature, patients with BS are frequently reported to be photosensitive. Although the skin is typically normal at birth, there are reports of marked and recurrent erythema following sun exposure, resulting in progressive facial telangiectasia and poikiloderma. The facial rash is commonly in a butterfly distribution across the nose and cheeks and is thought to be further exacerbated by sun exposure. Over time, the rash can also appear on the dorsum of the hands and forearms. In order to better characterize the photosensitivity reported in the literature, all patients with BS in a specialist unit were assessed by a photodermatologist and underwent phototesting. There were five children (three male, two female; age range 7–15 years) with a confirmed diagnosis of BS based on abnormal SCE and detection of pathogenic variants in the BLM gene. Two of the children had skin phototype I–II (ethnicity: Scotland, Poland) and three had phototype IV (ethnicity: one from Pakistan, two from India). None of the children described severe and exaggerated sunburn reactions despite sunny holidays abroad. On examination, there were no facial skin changes, specifically no evidence of telangiectasia or poikiloderma. Following monochromator and solar simulated irradiation, all five had normal immediate and 24-h responses. There were no delayed reactions. In summary, we present five cases of BS without the characteristic finding of photosensitivity, supported by normal phototesting. This is unlike the severe and exaggerated sunburn reactions following minimal sun exposure seen in other DNA repair disorders such as subtypes of xeroderma pigmentosum and trichothiodystrophy. This is the first time that photosensitivity in BS has been objectively assessed, and these phototest findings call into question the idea that photosensitivity is a cardinal feature of this disease entity. Nevertheless, in view of the known increased risk of nonmelanoma skin cancer in patients with BS from their early 30s, regular skin surveillance and sensible sun protection measures remain the mainstay of the dermatological management of these patients.
PD13 A UK single-centre prospective audit and clinical experience of developing an ultraviolet B phototherapy service using 308-nm excimer pulsed light for inflammatory skin disease
Authors: Mohammed Haya , Vilenchik Victoria , Banner Alexandra , Keith Daniel 
Published: June 2024

Abstract
Phototherapy is commonly recognized as a convenient treatment modality for inflammatory skin diseases (ISDs). It has seen significant technological advancements over the last 2 decades. With variable success, high running costs and demand for trained professionals, treatment outcomes in ISDs using cabinet phototherapy are limited. Due to its high efficacy and safety profile, 308-nm excimer pulsed light (EPL) represents an exciting and practical option in moderate-to-severe ISDs that are treatment resistant and difficult to reach, where only affected areas are targeted and overall fewer patient visits are required for clearance than with conventional phototherapy. A prospective single-centre cohort study was conducted on 36 patients with ISDs treated with EPL, including psoriasis (n = 14), palmoplantar pustular psoriasis (n = 6), vitiligo (n = 2), necrobiosis lipoidica (n = 3), vitiligo (n = 2) and dermatosis (n = 9). The number of sessions required ranged from 4 to 18, with a maximum fluence between 250 and 850 mJ cm−2 among patients. The primary outcome involved assessing lesions post-EPL treatment using Physician’s Global Assessment (PGA) scores including ‘much better’, ‘better’, ‘no difference’ or ‘worsened’. Secondary outcomes included occurrence of complications and comparison of Dermatology Life Quality Index (DLQI) scores before and after EPL. At the end of each completed EPL treatment course, lasting an average of six sessions in total, and requiring an average maximum fluence of 350 mJ cm−2, 72% (n = 26) of patients achieved clearance and were found to have ‘much better’ or ‘better’ lesion outcomes when reviewing PGA scores. A significant reduction in post-EPL DLQI in 28% (n = 10) of patients was also found, with an average score reduction by 4. No complications were reported in 94% of patients (n = 34), with minor post-EPL burn found in 6% of patients (n = 2) but high overall patient satisfaction. In conclusion, our study contributes further supporting evidence to the scarce dermatological literature surrounding the successful use of EPL as a powerful treatment modality in inflammatory skin disease, especially if recalcitrant. Large studies including randomized controlled trials are necessary to help validate these promising results and determine optimal dosing regimens, long-term efficacy and patient satisfaction.
DS03 Survey of dermatological surgical training in the UK
Authors: Webber Lucy , Barlow Richard , Bray Adam 
Published: June 2024

Abstract
Skin cancer incidence is rising annually in the UK, creating a substantial surgical burden. The dermatology training curriculum stipulates the need for regular supervised surgical lists with increasing independence throughout training to help address this growing demand. We distributed an electronic survey to dermatology trainees via the British Association of Dermatologists and British Society for Dermatological Surgery to evaluate current dermatological surgery training in the UK. The survey focused on training experience, satisfaction, and procedural competence to identify areas for improvement. Overall, 79 out of approximately 280 trainees responded (28.2%), of whom 64 (82%) were based in England, 8 in Wales (10%), 5 in Scotland (6%) and 1 in Northern Ireland (1%). Twelve deaneries within England were represented. The majority worked full time (56 trainees; 71%), and 76% of respondents were female. Twelve respondents were CESR trainees (15%) and three were clinical fellows (4%), with the remainder distributed from ST3 to ST6. In total, 59 respondents (76%) had surgical exposure within dermatology or allied surgical specialties before entering the training programme. Fifteen respondents (19%) reported having a supervised surgical list prior to starting training, defined as a consultant, senior dermatologist or equivalent observing their list. Around one-half of trainees (45, 53%) first received surgical supervision during their ST3 year, and 20.3% (16 trainees) had never received direct surgical supervision. Of these respondents, more than one-third (38%, six trainees) were at ST5/ST6 level. Overall, 65% (50 trainees) received intermittent direct supervision during their training, influenced by factors such as departmental staffing and prioritization of service provision; 68% of respondents (54 trainees) reported seeking additional hands-on surgical opportunities to fill gaps in their training. In total, 20% (16 trainees) felt that the procedural curriculum was unachievable within their training programme, and 29% of ST6 trainees (6 of 21) reported an inability to perform excision biopsies on the head and neck unsupervised. Dissatisfaction with surgical training was expressed by 35% (27 trainees). While our response rate limits the ability to draw definitive conclusions, our survey highlights significant intra- and interdeanery disparities in dermatological surgical training. A striking 86% of trainees (68) expressed the need for more consistent supervision to maintain and develop their surgical skills. Trainees call for clearer curricular guidance on surgical exposure and supervision, and national standardization of training to enhance surgical proficiency among the future consultant workforce.