bluuebunny/crossref_metadata_2025_split huggingface dataset:
Poster presentationsPA10 Hidradenitis suppurativa and trisomy 21: a case series
Authors: Murphy Lisa , Tobin Anne-Marie 
Published: June 2024

Abstract
It has long been postulated that there is a link between hidradenitis suppurativa (HS) and Down syndrome (DS); however, there are limited data in the literature examining the disease trajectory for these patients and the underlying mechanism. We performed a multicentre retrospective chart review to assess whether there is a particular phenotype of HS associated with patients with DS. Nine patients were included in total. The average age of presentation among our cohort was 17.4 years. Overall, 44% of patients had a raised body mass index, 22% had a positive family history for HS and none of the patients currently smoked. Most patients (89%) had trialled at least one oral antibiotic for their HS. The results of our review suggest that DS would appear to be an independent risk factor for developing HS. It would also appear to have an earlier age of presentation and to occur independently of the traditional risk factors for developing HS. It is hypothesized that trisomy 21 contributes to a genetic dysregulation that predisposes patients to this condition. This supports the findings suggested by similar studies.
PA14 An interesting case of congenital syphilis
Authors: Muttoni Elisabetta , Beattie Paula 
Published: June 2024

Abstract
Congenital syphilis occurs due to transplacental transmission of Treponema pallidum from mother to fetus during pregnancy or rarely during childbirth. Intrauterine infection can result in a variety of presentations ranging from asymptomatic infection to cutaneous and visceral changes and even stillbirth and perinatal death. We present the case of a 15-week-old infant with congenital syphilis presenting with a persistent rash, organomegaly, haematological abnormalities and epistaxis. The patient was a 15-week-old male infant seen by the general paediatricians at the age of 6 weeks with a widespread nonspecific exanthematous rash, which was initially felt to be a viral exanthem due to a preceding episode of bronchiolitis. However, the rash persisted, and after developing bilateral epistaxis he attended hospital and was found to have hepatosplenomegaly, confirmed on ultrasound scan, and a markedly raised white cell and lymphocyte count along with low haemoglobin and platelet count. While he was under the haematology team, dermatology were asked to review the patient. He was noted to have small brownish–pink plaques over the fingers and knuckles and scattered throughout the body, bluish macules on the legs, and peeling on the soles. He was also noted to have a flattened nose and sounded congested. A diagnosis of congenital syphilis was suggested and he was referred on to the infectious disease team. Investigations showed he was positive for T. pallidum polymerase chain reaction on rectal and mouth swabs and urine sample, but not in cerebrospinal fluid. He has completed a 10-day course of intravenous benzylpenicillin. In the postnatal period, congenital syphilis can present with haematological, visceral and cutaneous manifestations. The most common early signs, which present at birth or appear in the first 2 years of life, include hepato­splenomegaly, rash, fever, rhinitis (snuffles) and generalized lymphadenopathy. Leucocytosis and thrombocytopenia are also recognized (Woods CR. Congenital syphilis – persisting pestilence. Pediatr Infect Dis J 2009; 28: 536–7). Penicillin is the gold-standard treatment for syphilis as resistance of T. pallidum to penicillin has never been reported (Peeling RW, Mabey D, Kamb ML et al. Syphilis. Nat Rev Dis Primers 2017; 3: 17073). Patients who are allergic to penicillin should be treated with doxycycline or ceftriaxone. It is important to consider congenital syphilis as a potential differential in any infant who presents with a rash, organomegaly and haematological abnormalities such as the case we present, and we hope to increase awareness to facilitate early diagnosis and prompt treatment.
PA29 A case of atypical herpes zoster in an immunocompetent infant with congenital melanocytic naevi
Authors: Johnston Sarah , Honan Alison 
Published: June 2024

Abstract
An immunocompetent 6-month-old child presented with a striking bandlike inflammatory eruption. She was systemically well with no apparent symptoms. Her only medical history was of congenital melanocytic naevi. Brain imaging had not yet been requested. She was exposed to chickenpox at 4 weeks old but had no clinical evidence of primary varicella infection. The patient’s mother had chickenpox in childhood. The patient had crops of grouped vesicles on erythematous bases, on her abdomen and left midback extending onto the left flank. Although perceptibly thoracic dermatomal, the plaques crossed the midline. She also had a large congenital melanocytic naevus overlying the left thoracic region with a number of smaller naevi on her scalp, chest and back. Herpes varicella zoster was confirmed by viral swab. The patient was treated with oral aciclovir and has had complete resolution. Subsequent magnetic resonance imaging confirmed neurocutaneous melanosis. Herpes zoster (HZ) is a segmental eruption due to reactivation of latent varicella zoster virus (VZV) from sensory dorsal ganglia. HZ is typically a painful condition affecting older adults or immunocompromised individuals. Infantile HZ is rare, with an estimated incidence of 0.2 per 1000 person-years in 0–5 year olds (Kurlan JG, Connelly BL, Lucky AW. Herpes zoster in the first year of life following postnatal exposure to varicella-zoster virus: four case reports and a review of infantile herpes zoster. Arch Dermatol 2004; 140: 1268–72). Most cases occur due to intrauterine VZV exposure or early postnatal exposure. Primary infection before 12 months increases the risk of HZ, due to immune system immaturity and less sustained cell mediated immunity. Maternal antibodies can alter primary infection to a subclinical form. Infantile HZ tends to be milder and not associated with complications such as postherpetic neuralgia. Therefore, there is no consensus on whether antiviral treatment is required. Infantile HZ is likely underestimated due to the milder presentation, subclinical primary infections and assumption that maternal antibodies provide protection. Case reports describe vesicles slightly outside the primary dermatome, but to best of our knowledge there are no case reports of eruption crossing the midline. This case highlights the importance of considering HZ as a differential in vesicular eruptions in infants. It highlights the differing presentation where lesions can be asymptomatic and less typically dermatomal. As an additional learning point, this case emphasizes the role of imaging in the presence of large congenital melanocytic naevi to aid diagnosis and prognostication. Early imaging can avoid sedation and increases the sensitivity of detecting melanosis prior to brain myelination in late infancy (Jakchairoongruang K, Khakoo Y, Beckwith M, Barkovich AJ. New insights into neurocutaneous melanosis. Pediatr Radiol 2018; 48: 1786–96).
PA30 Unilateral naevoid telangiectasia: a case series
Authors: Forde Karina , Burrows Nigel 
Published: June 2024

Abstract
Unilateral naevoid telangiectasia (UNT) is characterized by unilateral, linearly arranged telangiectasia in a blaschkoid or dermatomal pattern, most frequently involving the cervical dermatomes. It can be congenital but more frequently is acquired. It is thought to occur as a result of somatic mosaicism, with cutaneous lesions being unmasked under conditions of elevated oestrogen, such as puberty, pregnancy, alcoholism, hormone treatment and liver disease. There is conflicting evidence as to whether affected skin has increased levels of oestrogen receptors compared with unaffected skin. We report a case series of three adolescents who presented to our paediatric dermatology clinic with acquired UNT. Patient one was a 14-year-old boy who presented with a 9-month history of linearly arranged telangiectasia in a blaschkoid distribution along the left arm, forearm and dorsum of hand. Dilated capillaries with surrounding pallor indicating vascular steal phenomenon were evident. Systemic exam was unremarkable. Patient two was a 13-year-old girl referred with a 2-year history of telangiectasia across the left chest and upper back. Clinical exam revealed punctate telangiectasia with surrounding halos distributed in a C4, C5 and C6 dermatomal distribution on the left chest and back, along with a larger well-circumscribed telangiectatic patch on the left posterior shoulder. Clinical exam was otherwise normal. Patient three was a 15-year-old boy referred with a 1-year history of diffuse telangiectasia involving the right chest and arm. Clinical exam demonstrated pinpoint telangiectasia with surrounding halos distributed in a blaschkoid pattern across the right anterior chest with sharp midline cutoff. There was further subtle linearly distributed involvement of the right arm extending to the base of the right thumb. In all three cases liver and thyroid function tests were normal. Patients one and three were discharged with reassurance and patient two was referred for laser therapy due to concerns regarding cosmesis. This case series illustrates the typical presentation of acquired UNT presenting in adolescents, typically around onset of puberty. Although acquired UNT has been reported in association with liver and thyroid disease, previous case series have reported an absence of associated disease in adolescents presenting with UNT, mirrored in our cohort. Clinical diagnosis is appropriate, and no other investigations are indicated in the absence of additional features of concern. Although UNT is reportedly rare, it is likely under-recognized and under-reported. It is therefore important to be familiar with the presentation and natural history of the condition, so that appropriate reassurance can be given to patients and their families.
BI37 Efficacy of psoralen plus ultraviolet A therapy for the treatment of chronic cutaneous graft-versus-host disease: a retrospective study analysis from a tertiary care centre
Authors: Sadhwani Monal , Kulkarni Vinay 
Published: June 2024

Abstract
Cutaneous graft-versus-host disease (GVHD) is a well-recognized complication, occurring in 60–80% of patients after allogeneic bone marrow stem cell transplantation (BMSCT) (Garbutcheon-Singh KB, Fernández-Peñas P. Phototherapy for the treatment of cutaneous graft-versus-host disease. Australas J Dermatol 2015; 56: 93–9). The chronic type manifests as either a lichenoid or sclerodermatous form. Phototherapy is an effective treatment option as it works by immunomodulatory effects. We retrospectively reviewed eight cases of chronic cutaneous GVHD. All the patients had undergone allogeneic BMSCT for an underlying haematological disorder at a tertiary care centre in western India. Each patient was administered phototherapy with ultraviolet (UV)A radiation twice a week. All of them received 8-methoxy­psoralen at a dose of 0.6 mg kg−1 as a photosensitizer, 2 h prior to UVA therapy. The percentage improvement in body surface area involved was calculated at the end of therapy and results were analysed using SPSS. Also, the doses of steroids and immunosuppressants were tapered while the patient was on phototherapy. A total of eight patients were enrolled in the study; five (63%) were male (63%) and three (38%) were female. The mean age at the time of presentation was 37.75 years. Five patients (63%) had lichenoid GVHD, while the other three cases (38%) had sclerodermatous type GVHD. Six patients had undergone allogeneic BMSCT for leukaemia, while one patient had myelofibrosis and one case was diagnosed with Diamond–Blackfan syndrome. The mean time to develop GVHD after bone marrow transplant was 9.5 months and the mean body surface area involved at the time of diagnosis was 50.6%. There was more than 50% improvement in five cases (63%) after an average of 36.3 sessions of psoralen plus UVA (PUVA), while one case (13%) relapsed after achieving complete remission. One patient (13%) was lost to follow-up as he was not able to visit the hospital frequently for twice-weekly sessions. One patient (13%) died while on PUVA therapy owing to relapse of leukaemia. Generally, all the patients tolerated PUVA well, except two patients who experienced nausea after taking psoralen, one patient with dizziness after PUVA therapy and one patient who complained of pigmentation of skin over the extremities. The percentage reduction in the dose of steroids before and after phototherapy was also found to be statistically significant. We conclude that PUVA therapy is an effective nonaggressive modality for treating chronic cutaneous GVHD, especially the lichenoid form. It offers a major advantage of an immunosuppressive sparing effect as well as a good safety profile.
DE02 Mentoring tomorrow’s dermatologists: establishing a mentorship scheme for junior doctors interested in dermatology
Authors: Winter Sarah , Ashton Sally 
Published: June 2024

Abstract
Mentoring is a powerful tool for personal and professional development (Burgess A, van Diggele C, Mellis C. Mentorship in the health professions: a review. Clin Teach 2018; 15: 197–202). It is strongly advocated by the Royal College of Physicians. Several mentorship schemes have been created for doctors interested in competitive specialities. Dermatology remains one of the most competitive specialties, yet to the best of our knowledge, there are no mentoring schemes for junior doctors interested in dermatology in the UK. The aim of our project was to successfully launch a dermatology mentorship scheme to help mentees take control of their own career journey, while enabling mentors to build on their leadership skills. In 2022, a pilot dermatology scheme was created in Cardiff, matching foundation and core trainees to dermatology registrars. There were six delegates in the pilot. With the success of a pilot, where 100% of delegates felt that the scheme was beneficial to their career and progression, the mentorship scheme was expanded to include the whole of South Wales. The scheme was advertised through junior doctor groups on Facebook and through postgraduate medical education centres for mentees. In total, 23 delegates signed up to the 2023 scheme: 12 mentees and 11 mentors. A virtual mentoring workshop was held for all delegates and this was well received. Delegates were also provided with a mentoring contract to use. Initial survey results showed that 100% (n = 12) of mentees felt they had not yet been exposed to enough potential mentors at work or at medical school. Overall, 92% (n = 12) stated that they did not yet have a mentor-like figure, 67% (n = 8) of delegates stated that not having a scheme available was one of the reasons for not having a mentor, and 82% (n = 9) of the mentors wanted to develop their leadership skills through the scheme. Informal feedback has been overwhelmingly positive. Formal feedback will be welcomed in May 2024 to make improvements to the scheme for the following year. Our project shows that there is demand for mentorship in dermatology. We hope that the successful establishment of our scheme paves the way for mentorship schemes to be set up locally to help inspire and support the next generation of dermatologists.
DE07 Dermatology Dungeons and Dragons: simulation in dermatology education
Authors: Lawlor Kate , Mughal Avad 
Published: June 2024

Abstract
It has been shown that dermatology is poorly understood among medical students and doctors of all grades (Chiang YZ, Tan KT, Chiang YN et al. Evaluation of educational methods in dermatology and confidence levels: a national survey of UK medical students. Int J Dermatol 2011; 50: 198–202). A scoping review within dermatology showed better learning effects when the interventions activate students, involve feedback, and are built on case-based learning (Bernges F, Zielbauer S, Weberschock T, Ochsendorf F. Teaching dermatology to medical students: a scoping review of published interventional studies. J Dtsch Dermatol Ges 2022; 20: 1077–87). Unlike more rigid direct case-based teaching, simulation learning allows the student to help build the zone of learning and explore areas of education that may not have previously considered. A novel approach is currently being utilized with year 3 medical students. There are approximately 12 students in each 2.5-h session. They are split into three or four groups, with students with previous dermatology experience allowed to ask fewer questions and those with no previous dermatology experience allowed to ask unlimited questions. Each group is asked to roll a 10-sided die to choose their case. They are then given a clinical scenario that includes a brief history and clinical photographs. The facilitator acts as the patient answering the students’ questions. The clinical scenarios cover the commonly encountered conditions in dermatology. When the students reach a certain point in the decision-making process, they again roll a die to determine the outcome of that choice. This demonstrates the element of chance and multiple potential outcomes in real-life decision making within clinical practice. The students can come up with any of many appropriate management plans, but their success is left up to chance. The crucial step is that the students then follow up that case again and evaluate the consequences of their decision making and the rationale for success or failure. This can be repeated as many times as the session allows, and other students learn from watching their colleagues. The students are provided with feedback forms at the end of the session to gain insight into the positive and negative aspects and whether they felt the session improved their knowledge of diagnosing and managing dermatology conditions. Feedback has been consistently positive including, ‘That is the best teaching I have ever had’. The freedom to make errors is vital and allows the student to reach the highest level of Maslow’s hierarchy. The consequences then ground this in learning.
GD03 (P095) Ten cases of scabies successfully treated with topical ivermectin
Authors: Oldham Jaimie , Sahota Anshoo , O’Toole Edel , Cunningham Malvina 
Published: June 2024

Abstract
Scabies is an increasing problem in the UK with a surge in cases reported by dermatologists and the media. It is intensely itchy and caused by the highly contagious mite Sarcoptes scabiei. There are many theories regarding the increased prevalence, including global warming, increased poverty, reduced treatment availability and resistance. The standard treatments in the UK include topical malathion, topical permethrin and oral ivermectin. All have had significant supply issues as reported by the British Association of Dermatologists. There have also been concerns of permethrin resistance. Oral ivermectin is expensive, with four tablets listed at £116.84 in the British National Formulary (BNF). Finally, oral ivermectin is not licensed in children weighing &lt; 15 kg (although data seem to suggest this is safe). One option that is less used but reported is topical ivermectin. This was in the 2018 Cochrane review looking at the efficacy of topical permethrin, and oral and topical (as 1% lotion) ivermectin. This showed no difference in efficacy and few or mild adverse events. These findings are also replicated in recent studies and there are case reports of topical ivermectin to treat neonatal scabies that seems resistant to permethrin. In our centre, we have used topical ivermectin (as the 10 mg g−1 cream Soolantra) to treat 10 patients, with great success. The first was a 14-month-old child who weighed 9.2 kg. She had previously had three courses of permethrin and two courses of malathion with ongoing signs and symptoms of scabies, including burrows. The entire family had been treated every time and the entire family (except this patient) was treated with oral ivermectin during the final treatment before topical ivermectin. The patient was treated top to toe with two applications of topical ivermectin cream 1 week apart, with resolution after one application. Subsequently we have had success using the same protocol to treat a 21-year-old man (with no response to four courses of permethrin) and his 53-year-old mother (with no response to three courses of permethrin). We have also treated a 31-year-old man, a 48-year-old man and his partner (all of whom had not responded to one course of permethrin), and a 68-year-old man and his family who had no previous treatment. We have had no adverse effects and no treatment failures. We report on 10 patients who we treated successfully with topical ivermectin. Topical ivermectin provides an exciting option for treatment and, of note, one tube is listed at £27.43 in the BNF, making it significantly cheaper than the oral alternative.
GD07 Skin neglected tropical diseases and global health: migration and integration beyond borders
Authors: Parajuli Niraj 
Published: June 2024

Abstract
Skin neglected tropical diseases (NTDs) are a group of diseases that present with cutaneous manifestation. There are at least 12 listed diseases included in the list of skin NTDs by the World Health Organization. Among these, some diseases are typically present more commonly in certain geographical locations compared with others. For example, leprosy is more common in the Asian subcontinent and Buruli ulcer in the African region. In this new world with easy global reach due to the ease of travel, skin NTDs are not restricted only to the tropics. Despite the propensity of these diseases to occur in the tropics and among poorer populations, they can be diagnosed in clinics globally. Therefore, all global dermatologists should have a good knowledge of these conditions wherever they are located. So, should we start on a global health topic for all skin NTDs? Travel data from Nepal showed that 3.48 million passengers travelled internationally from Nepalese airports, which included 1.93 million departures and 1.55 million arrivals. Similarly, a total of 105 million passengers arrive in the UK each year. This unrestricted massive travel between countries poses a huge risk of infectious diseases transferring from their countries of origin in the tropics to European countries. Moreover, mutation of the vectors and climate change have made it possible for certain diseases to adapt to colder climates. Leprosy, scabies, cutaneous leishmaniasis and resistant dermatophyte infection are commonly seen in Nepal. All of these diseases can present with varied clinical presentations. So, due to global travellers, diseases of the tropics may not remain only diseases of the tropics, which has been shown in recent years. Can this be an opportunity for a mutual learning experience between countries of the tropics and Europe? The tropics could learn from research conducted in the Western world, and both can work together in controlling NTDs.