bluuebunny/crossref_metadata_2025_split huggingface dataset:
PD10 Objective evaluation of sunscreen in a patient with solar urticaria
Authors: Gajebasia Sareena , McMullan Alexandra , Patullo Laura , Eadie Ewan , Ibbotson Sally 
Published: June 2023

Abstract
Sunscreens are an important part of photoprotection for patients with photodermatoses, such as solar urticaria (SU). Despite long ultraviolet (UV)A and visible wavelength photosensitivity in many patients with SU, sunscreens can still be beneficial (Beattie PE, Dawe RS, Ibbotson SH, Ferguson J. Characteristics and prognosis of idiopathic solar urticaria: a cohort of 87 cases. Arch Dermatol 2003; 139:1149–54). However, unlike the objective assessment of photosensitivity by monochromator phototesting, formal evaluation of sunscreens’ effects is more challenging. We report a 32-year-old man with a 2-year history of immediate-onset photosensitivity, confirmed as SU on monochromator phototesting, with an action spectrum of UVB, UVA and visible light (305–460 nm). He had been using Nivea Sun SPF (sun protection factor) 50+ (Beiersdorf) and reported that this increased his tolerance of natural light from 10 to 60 min. Based on the sunscreen constituents, we were surprised to hear that it was so effective as there was no mineral constituent. Therefore, we evaluated his SU photosensitivity by UVA testing using a metal halide source [Honle UVASPOT 400 T; 24.09 mW cm−2; minimal urticaria dose (MUD) &lt; 0.13 J cm−2] through his own sunscreen and, for comparison, Dundee Cream Beige (Tayside Pharmaceuticals) and LaRoche Posay Mineral One shade 01 (L’Oreal), both of which contain reflectant titanium dioxide. Three areas, measuring 15 × 10 cm, were marked out on his back and 0.15 mL of one sunscreen was applied to each. Each area was then irradiated through a Daavlin template using multiples (1×10) of the MUD and sites were observed for 30 min. As he was so severely photosensitive, none of the sunscreens affected the threshold MUD, but we noted delay in the induction of SU. Dundee Cream Beige offered minimal photoprotection, with urticaria occurring at 10 min vs. 5 min without sunscreen at 1 × MUD. LaRoche Posay SPF delayed the onset of SU to 30 min, and the reaction was less intense at 1 × MUD. However, the most marked effect was with his own Nivea SPF 50+. Urticaria induction was delayed to 30 min at 1 × MUD and was less intense, but it was also delayed to 15 min and less intense at a dose of 4 × MUD, confirming his impression that this sunscreen was of clinical benefit. We highlight this case to show how photodiagnostic testing can be employed to evaluate objectively the sunscreen effects in patients with photosensitivity. Conventionally, it is assumed that titanium dioxide-based products, such as the Dundee creams, are required in patients with longer UVA/visible light sensitivity, but with refinements in the development of new sunscreen products, this may not necessarily be the case.
PD12 An audit of the photodynamic therapy service at the Birmingham Skin Centre
Authors: Khan Taherah , Dalal Fatima , Thomson Michelle 
Published: June 2023

Abstract
Photodynamic therapy (PDT) is licensed in the UK for treating at least one nonmelanoma skin cancer and premalignant lesions. The PDT is a service offered at our centre but is anecdotally underutilized with no up-to-date outcome measures. The aim was to audit the PDT service at the Birmingham Skin Centre against the 2018 British Association of Dermatologists and British Photodermatology Group PDT guidelines, and make recommendations for improvement. Retrospective data were gathered on consecutive patients treated with topical PDT between 12 March 2019 and 28 August 2022 at the Birmingham Skin Centre and compared with the recommended audit points in the national guidelines. A clinician survey was conducted to assess service awareness, satisfaction and referral process. Thirty-four patients received topical PDT during the specified time period; two patients were excluded from data analysis as the last treatment fell within the 3-month assessment period (n = 32). Differentiation between ambulatory and standard PDT was not recorded. Treatment was licensed in all cases (n = 32): actinic keratosis (AK; n = 18), squamous cell carcinoma (SCC; n = 7) in situ, superficial basal cell carcinoma (BCC; n = 4), nodular BCC (n = 1) and other (n = 2). Clearance assessment at 3 months was recorded in 21 of 32 cases; accounting for this, the clearance rate for AK, SCC in situ and superficial BCC at 3 months after last treatment was 52% (n = 11/21; guideline recommendation ≥ 75%). Eleven of 32 patients treated for SCC in situ and superficial BCC within the data set were due 12-month clearance assessment. Four of 11 patients had clearance assessment recorded. Accounting for this, the clearance rate for SCC in situ and superficial BCC at 12 months after last treatment was 50% (n = 2/4; guideline recommendation ≥ 75%). No patient had an individual pain-management plan documented. Patient satisfaction of the service was recorded in 9% (n = 3/32) of cases; of these, 67% (n = 2/3) of patients were ‘very satisfied’ and 33% ‘satisfied’. Patient satisfaction of cosmetic result was recorded in one case as ‘excellent’. The PDT was a popular treatment method among the clinicians surveyed. Some clinicians asked for PDT-based teaching. The general consensus supported online referrals and documentation. The PDT is used for licensed indications and popular with clinicians in our department. Clearance rates at 3 (52%) and 12 (50%) months are below the national guideline recommendation of 75%. Limited documentation across audit points limits interpretation of clearance rates, patient satisfaction and adverse effects. We plan to implement a new standardized digital referral and documentation system to improve the service.
PS01 Prevalence of baseline anxiety and depression in patients attending a tertiary virtual acne service
Authors: Vincent Rosie , Hutchison Eliza , King Natalie , Shipley Debbie 
Published: June 2023

Abstract
Evidence suggests that the prevalence of depression and suicide in those with acne is higher than in the general population. There have also been case reports of suicide in patients taking isotretinoin for acne, although there is a lack of evidence to suggest a true causality. We know that many people with acne and acne scars struggle with impacts on emotions, social/daily activities, study, work and relationships. A prospective cohort study was undertaken, including 150 consecutive new patients in our acne clinics from 7 December 2021 to 5 July 2022 as part of a service evaluation. This project was registered with our local research and innovation team. We captured a snapshot of the demographics of our patients, including baseline Generalised Anxiety Disorder Assessments (GAD-7), Patient Health Questionnaires (PHQ-9) and pre-existing mental health problems. Mean age was 26 years (range 17–46). Sixty-four per cent of patients were women and 36% were men. Thirty per cent of patients reported a previous/current mental health problem, the most common being anxiety (19.3%) and depression (18.0%). The most common medications taken previously or currently were sertraline (4.0%) and propranolol (4.0%). Initial PHQ-9 scores ranged from 0 to 29 points: 49.1% had a score of ≥ 5; 29.1% a score of ≥ 10; and 18.2% a score of ≥ 15. As a comparison, in July–August 2021, the prevalence of depression (classified as a PHQ-8 of ≥ 10) was 32% in women and 20% in men aged 16–29 years in the UK. Rates of depression in our patient cohort were therefore similar to those in the general population in this age group. Interestingly, in the general population, 17% of those aged ≥ 16 years experienced depression during this time. This is significantly higher than the prepandemic prevalence rate of 10%. Initial GAD-7 scores in our cohort ranged from 0 to 21 points: 58.7% had a score of ≥ 5; 30.3% a score of ≥ 10; and 11.0% a score of ≥ 15. As a comparison, in September–October 2021, an estimated 28% of those 16–29 years old experienced moderate–severe anxiety in the UK (GAD-7 equivalent to ≥ 10), and the prevalence was higher in women. Anxiety levels were therefore similar in our cohort compared with the general population. The prevalence of anxiety and depression is high in young adults, which has increased with the COVID-19 pandemic, and the prevalence in our acne cohort is similar to that of the general population of a similar age. It remains that those with moderate–severe acne, regardless of what treatment is received, should be screened and monitored for anxiety and depression.
PS11 Dupilumab for moderate-to-severe atopic dermatitis: transformative changes in quality of life and low burden of treatment — a mixed-methods study
Authors: Porter Emma , O’Connor Cathal , Murphy Michelle 
Published: June 2023

Abstract
Moderate-to-severe atopic dermatitis (AD) has a significant impact on quality of life (QoL). The emergence of biologic agents has changed the treatment landscape for those with severe disease. Adult patients on biologic treatment for moderate-to-severe AD were invited to complete written questionnaires during scheduled clinical care. Questionnaires prompted reflection on QoL before and after treatment with dupilumab. Dermatology Life Quality Index (DLQI) and Burden of Treatment (BoT) scores were simultaneously assessed. Charts were retrospectively reviewed with respect to prior treatments, duration of biologic treatment, adverse events and clinical severity scoring. Statements were assessed qualitatively to identify common themes. Twenty-one patients participated in the study. The median age of participants was 38 years. Most (n = 14; 67%) were men. All patients were on subcutaneous dupilumab 300 mg, for a median duration of 10 months (range 3–61). Thirteen patients had trialled one immunosuppressant agent prior to commencing dupilumab, and five had failed two or more agents. Three had contraindications to immunosuppression. Median DLQI prior to commencing biologic treatment was 22 (range 9–30, SD 5.5), improving to 2 (range 0–11, SD 3.1) at the time of study participation. Median Eczema Area and Severity Index scores were 30.2 before dupilumab and 6.4 at the time of participation. Median BoT scores on dupilumab were low (range 0–3/10) across all domains, including burden related to emollients, topical steroids, injections, cost and scheduling of appointments. Themes identified in patients’ descriptions of prebiologics QoL included embarrassment, low self-esteem, anxiety, poor quality of social relationships, sleep disturbance, perceived loss of autonomy, loss of time, frustration with health services, high financial costs, negative childhood memories and hopelessness about the future. All patients described dramatic improvements on dupilumab. Themes included the disappearance of itch, confidence reacquisition, improved relationships, the ability to sleep, enjoyment of activities, freedom of clothing choice, greater free time, improved daily functioning, liberation from topical steroids and reclaiming control. Three patients (14%) reported disappointment with incomplete clearance, all relating to persisting facial dermatitis. Six patients (29%) reported side-effects on dupilumab, all described as mild eye symptoms, which did not affect QoL. This study highlights the profound impact of dupilumab therapy for moderate-to-severe AD on physical, psychological and social functioning. The transformative life changes described by patients on biologic treatment are compelling. Side-effects described were minor and more tolerable than with conventional immunomodulatory treatments, with a low burden of treatment in all patients.
PS13 Meeting the care needs of transgender patients in dermatology
Authors: O’Mahony Sarah , Tobin Anne Marie 
Published: June 2023

Abstract
Transgender persons are a diverse group whose gender identity differs from the sex recorded at birth. Some, but not all, choose to undergo medical treatment to align their physical appearance with their gender identity. It is important that clinicians understand the specific medical issues relevant to this population. Transgender individuals are at an increased risk of experiencing health inequalities, such as anxiety and depression, in addition to their own individual healthcare needs. It is important that staff in the healthcare setting are prepared to care for this population, to ensure the best patient outcomes. An understanding of transgender terminology and the experience of gender dysphoria is key. Improving the quality of care will reduce health disparities commonly faced by the transgender population. In our department, we have encountered difficulty in maintaining accurate gender identity data. We describe a case of a transgender woman attending the outpatient dermatology services for treatment of hidradenitis suppurativa and acne vulgaris. In addition to management of their dermatological conditions, there are issues with mislabelling in their chart. This includes the use of outdated labels and the inability to update their current forename from their original forename under their medical record number and on the patient information system. Electronic health records (EHRs) are the cornerstone in managing accurate patient information in hospitals. Healthcare institutions should have the capacity to collect accurate and up-to-date gender identity data, and gender-related demographic fields. However, the utility of gender identity fields in retrospectively identifying transgender patients, which is important for clinical care, as well as population health management, remains unknown. Clinic operations, EHRs, clinic culture, clinic environment, resource availability and staff education are all characteristics of healthcare clinics that can be improved to better facilitate high-quality dermatological care for transgender patients. In addition to basic demographic details, transgender individuals may face unique dermatological needs. Exogenous hormones affect hair and sebum production. Hormonal therapy leads to drastic skin alterations, impacting on sebum production, hair growth and acne, all of which may become a dermatological concern for transgender patients. Dermatologists have the opportunity to not only improve transgender patient care, but also their experience of healthcare. It is imperative that EHRs can provide accurate gender identity data and correct name use to close the gap in inequality in transgender population healthcare.
BT02 Use of teledermatology in the 2-week wait pathway: 5 years of positive data
Authors: Elias Jennifer , Synan-Jones Hannah , Singh-Raghunath Rakhi , Vlachou Christina , De Silva Bernadette 
Published: June 2023

Abstract
Our teledermatology service was started in 2018 to facilitate the dermatology department’s move offsite and allow for the continuation of inpatient care digitally without the need for increasing staff levels or cross-site working. Its implementation also allowed for efficient adaptation and use throughout the COVID-19 pandemic and recovery following this period. Alongside these aspects, teledermatology has become integral in the department’s rapid-access 2-week wait (2WW) capacity. The pathway involves patients attending the department and undergoing a nurse-led review with upload of the history alongside macroscopic and dermoscopic photographs to the platform for consultant review and management. The platform conforms to all aspects of the British Association of Dermatologists’ teledermatology guidelines and is hosted on the National Health Service’s Health and Social Care Network. Of almost 4000 2WW referrals assessed by digital teledermatology between 2018 and the present, no referrals have been rejected for poor quality, only 1% required urgent face-to-face review with a consultant, 32% were discharged, 53% were booked in for a minor surgical procedure of which half were suspected to be cancer or precancer and performed urgently, and 14% were booked for routine review due to risk factors such a multiple moles and need for a full skin check. Our consultants can assess 40 patients on the digital platform in a 4-h period, and the overall cost is approximately half of a face-to-face clinic, including admin. Of all 2WW referrals, general practitioner diagnosis has remained quite constant, with 30% of lesions thought to be malignant melanoma (MM), 36% squamous cell carcinoma (SCC) and 3% basal cell carcinoma (BCC); in the remaining 31%, no diagnosis was made. Of those referred for surgery by the dermatology consultants, the clinical diagnosis was BCC in 20%, SCC in 22% and MM or MM in situ in 6%; the remainder was thought to be precancerous, atypical naevi or other. We have continued to demonstrate through audit that the clinicopathological correlation in the digital teledermatology clinic is as good as face-to-face clinics for lesion diagnosis because of the quality of the history and images. Our most recent satisfaction survey in 2022 showed 96% patient satisfaction with the initial teledermatology assessment; of those booked for a procedure, 88% strongly agreed that all concerns were addressed prior to surgery. All patients would recommend the service to friends and family. With nearly 5 years of data and continuous evaluation, we have shown the effectiveness of a well-designed, connected digital system in supporting our service without duplication of effort by clinicians or prolongation of the patient’s journey.
BT03 (P63) Effectiveness of an image-analysing artificial intelligence-based digital health technology to diagnose nonmelanoma skin cancer and benign skin lesions
Authors: Marsden Helen , Palamaras Ioulios , Kemos Polychronis , Greenhalgh Jack 
Published: June 2023

Abstract
Squamous cell carcinoma (SCC) and basal cell carcinoma (BCC) are common types of nonmelanoma skin cancer (NMSC). The DERM-003 study was a prospective multicentre single-arm masked study that aimed to demonstrate the effectiveness of an artificial intelligence-based digital health technology (AI-DHT) to identify SCC, BCC and premalignant conditions in dermoscopic images of suspicious skin lesions. Patients with at least one suspicious skin lesion that was suitable for photography were eligible. Each lesion was photographed with three smartphone cameras (iPhone 6S, iPhone 11 and Samsung 10) with a dermoscopic lens attached. Each image was assessed by the AI-DHT. A clinical diagnosis was made by the dermatologist, and histopathology results were obtained for biopsied lesions. The AI-DHT output was compared with the histopathology diagnosis, and the area under the receiver operating characteristic curve (AUROC) was calculated. Secondary endpoints included other diagnostic measures and assessment of premalignant lesions. Altogether, 572 patients (49.5% women, mean age 68.5 years, 96.9% Fitzpatrick skin types I–III) were recruited from four UK National Health Service trusts, providing images of 611 suspicious lesions. There were no exclusion criteria relating to skin type. In total, 592 lesions had images from all three cameras available; only one lesion had no images available. Altogether, 395 lesions had a histopathology result. Forty-seven biopsied lesions were diagnosed as SCC and 184 as BCC. The AUROCs for images taken by the iPhone 6S was 0.88 [95% confidence interval (CI) 0.83–0.93] for SCC and 0.87 (95% CI 0.84–0.91) for BCC. For the Samsung 10, the AUROCs were 0.85 (95% CI 0.79–0.90) and 0.87 (95% CI 0.83–0.90), and for the iPhone 11, they were 0.88 (95% CI 0.84–0.93) and 0.89 (95% CI 0.86–0.92) for SCC and BCC, respectively. Using images taken on the iPhone 6S of biopsied only lesions, the sensitivity in detecting SCC and BCC was 98% (95% CI 88–100) and 94% (95% CI 90–97), respectively; the specificity was 38% (95% CI 33–44) and 28% (95% CI 21–35), respectively; the positive predictive value was 17% (95% CI 16–19) and 59% (95% CI 56–61), respectively; and the NPV was 99% (95% CI 95–100) and 81% (95% CI 70–89), respectively. All 12 lesions diagnosed as Bowen disease were classified correctly by the AI-DHT. Of the 61 lesions diagnosed as actinic keratosis, 52 were correctly classified of the 22 lesions diagnosed as dysplastic, and 18 were correctly classified by the AI-DHT. All 16 lesions diagnosed as melanoma were classified as such by the AI-DHT. The AI-DHT has the potential to support the diagnosis of NMSC and premalignant lesions.
BT07 Creation of a skin lesion image pipeline: key steps in developing a mobile application with DICOM® fields and metadata
Authors: Chin Gillian X M , Coon Andrew , Wilde Chris , Muthiah Shareen , Morton Colin , Fleming Colin 
Published: June 2023

Abstract
A key issue facing artificial intelligence (AI) for dermatology is the lack of standardization around capture, transfer and storage of skin images and clinical data. To assist systematic capture of clinical data, we developed a nationally agreed proposed minimum dataset, based on Digital Imaging and Communications in Medicine (DICOM®) standards. Subsequently, we collaborated with an established image management system (IMS) supplier, Waba [supported by grants from our local National Health Service (NHS) innovation department], to incorporate these fields into a dermatology-specific mobile application (app), facilitating real-time capture and data transfer. We describe our steps in developing this app. The app integrates with the national Patient Administration System (SCI Store), allowing retrieval of real-time patient demographics linked to hospital or Community Health Index number. Each care episode captures a standardized dataset, including lesion views, clinical information and consent level. On episode completion, datasets are securely transferred to the IMS via WiFi or GPRS signal, following a fully auditable pathway. The IMS is a web-based app developed on a Microsoft Structured Query Language server, which allows authenticated users to access our trust’s centralized repository of nonradiological images. Adherence to industry-standard data storage format, patient safety reporting and specific access rights ensure compliance with Caldicott recommendations and data protection standards. For AI research, we are exploring conversion of datasets into DICOM format. Close collaboration between software developers and end users, including clinical photography, dermatology and general practice, was essential for app design. We worked on design architecture through fortnightly technical meetings, scheduled to progress development in months 1–8. Installation and functionality testing was performed in months 9 and 10, followed by comprehensive user testing in months 10–12. Live app test-of-change rollout was performed in months 13–16, with continued usability refinement during this period. To develop a standardized minimum dataset, we conducted a consensus exercise with the British Association of Dermatology AI working group. Based on DICOM standards, a comprehensive international standard for medical imaging, this could improve the quality, availability and interoperability of data for AI development. In summary, we have developed an app to standardize the capture, transmission and storage of skin lesion images and associated metadata. By collaborating with an industry partner with NHS experience, iterative user-led design and national engagement for standard-setting, we believe this is a useful step toward a national UK skin database for training and validating AI systems. Future work is planned to evaluate the output of this data pipeline.