bluuebunny/crossref_metadata_2025_split huggingface dataset:
BI29 Crusted scabies: a complicated course in a renal transplant recipient
Authors: Duff Eimear , Lyons Daniel , Eustace Karen , Collins Sinead 
Published: June 2023

Abstract
A 55-year-old man of Nigerian origin was admitted with a 3-month history of a generalized rash that was intensely pruritic at night. He had received a renal transplant 1 year prior for end-stage kidney disease in the context of hypertensive nephropathy. His maintenance immunosuppressive regimen includes mycophenolate mofetil, tacrolimus and prednisolone. No household contacts were affected by itch. He had been treated with the topical scabicide permethrin cream in the community, resulting in a painful fissuring of the lower limbs that prompted presentation to the emergency department. Full skin examination revealed an extensive scaling eruption, with profuse skin shedding and lichenified fissuring of the lower limbs. There were also loosely adherent, grey, hyperkeratotic scaling plaques widely extending from the genitals to mid-thigh and posterior upper limbs, with involvement of the ear lobes. There was relative sparing of the acral areas. He was initially treated empirically with oral ivermectin, oral flucloxacillin and topical clobetasol propionate ointment and paraffin gel. A full blood count revealed a prominent eosinophilia. A punch biopsy later revealed a number of scabies mites. He was prescribed ivermectin as per the Centers for Disease Control guidelines for crusted scabies in immunosuppressed populations with oral ivermectin 200 μg kg–1 on days 1, 2, 8, 9, 15, 22 and 29. Supply issues in the community delayed his treatment course. Further topical antiscabietic therapy was deferred until tolerated. He was subsequently re-admitted with methicillin-sensitive Staphylococcus aureus bacteraemia with pyelonephritis of the transplant kidney. The prescribed treatment regime of oral ivermectin, a topical keratolytic cream and topical permethrin cream daily for 7 days was completed as an inpatient. This yielded complete resolution of his crusted lesions. He responded well to a prolonged course of intravenous flucloxacillin. This case illustrates the challenge of diagnosing scabies in richly pigmented skin, as well in the immunosuppressed host (in this case due to defective T-cell responses). Maintaining a high index of suspicion is essential in the context of unexplained itch in the immunosuppressed as they may present with atypical presentations. Such vigilance will improve the recognition and management of this uncommon, potentially life-threatening infectious complication of crusted scabies in the transplant population (Wang MK, Chin-Yee B, Lo CKL et al. Crusted scabies in a renal transplant recipient treated with daily ivermectin: a case report and literature review. Transpl Infect Dis 2019; 21:e13077).
CD07 Corticosteroids: a complex case of friend and foe
Authors: Fleming Sarah , Galimova Tatiana , Cunnimgham Louise , Eustace Karen 
Published: June 2023

Abstract
Hypersensitivity reactions to corticosteroids, either immediate or delayed, represent a clinical paradox as one would not expect such reactions to compounds with anti-inflammatory and immunomodulatory effects. We present the case of a 67-year-old patient referred to our service with three episodes of a delayed hypersensitivity reaction to steroids. The first episode occurred in 2016 when the patient was treated for a chest infection with amoxicillin and 5-mg prednisolone. Following 1 day of treatment, the patient developed a widespread erythematous rash. The patient remained systemically well, and the rash resolved over 3 weeks. Subsequently, the patient tolerated penicillin with no issues. In April 2019, following a bupivacaine and triamcinolone steroid injection to the shoulder and back for pain management, the patient developed a widespread erythematous rash. The patient denied any blistering or peeling of the skin and was systemically well. This rash took ∼3 weeks to settle. In August 2019, the patient had a dexamethasone injection to her back and subsequently developed a widespread erythematous pruritic rash. On this occasion, the patient reported symptoms of nausea and headache. The patient has avoided all steroids since 2019 and has developed no rashes. The patient had a negative skin prick test to bupivacaine under the care of immunology. Patch testing results showed positivity to 10/13 compounds tested in the corticosteroid series (Table 1). The patient had a negative patch test result to tixocortol-21-pivalate (0.1%) and to hydrocortisone-21-acetate (1%). In the fragrance series, the patient tested positive to one compound, Santalum album oil (sandalwood oil) 2%. Corticosteroids are classified into four groups (A, B, C and D), with the last subdivided into D1 and D2. A further classification proposed divides corticosteroids into three groups based on their structural characteristics. Allergic reactions to corticosteroids have been reported, with an estimated prevalence of 0.1–0.3%, with contact dermatitis to corticosteroids having a higher frequency (0.5–5%). Although not life-threatening, contact allergy to corticosteroids can have significant impacts on quality of life and on treatment.Table 1Corticosteroid series patch testing resultsHapten/compound%48 h96 hBudesonide0.01+/–+++Betamethasone-17-valerate1++Triamcinolone acetonide1++Tixocortol-21-pivalate0.1Alclometasone-17,21-dipropionate1+/–Clobetasol-17-propionate1++Dexamethasone-21-phosphate disodium salt1+Hydrocortisone-17-butyrate+/–+++Desoximetasone1+++Betamethasone-17,21-dipropionate1+++Methylprednisolone aceponate1+++Corticosteroid mix2.1++++Hydrocortisone-21-acetate1
CD10 (P75) Are ‘hypoallergenic’ personal care products truly safe?
Authors: Hiranput Siwaporn , Smith Lucy , Yesudian Paul Devakar 
Published: June 2023

Abstract
It is estimated that one-fifth of the general population may have allergic contact dermatitis (ACD) to common environmental allergens. Skincare companies are increasingly advertising their products as ‘hypoallergenic’, targeting consumers who seek personal care products (PCPs) that are less likely to cause an allergic reaction. However, there are no Food and Drug Administration standards to regulate the use of the term hypoallergenic, allowing manufacturers to use the term freely. We evaluated PCPs marketed as hypoallergenic from two health and beauty retailers in the UK for the presence of allergens in the British Society of Cutaneous Allergy (BSCA) baseline series. Product and ingredient lists were obtained from www.boots.com and www.superdrug.com in November 2022 using the term hypoallergenic in the search box. PCPs without the term hypoallergenic in the product description, unrelated products (plasters, jewellery, sanitary towels, tampons, clothing and facial brushes) and duplicates (same products in different sizes) were excluded. In total, 208 PCPs met the inclusion criteria: 47 (22.6%) were rinse-off and 161 (77.4%) were leave-on products. At least one substance from the BSCA baseline series was an ingredient in 79 (38.0%) PCPs. Of these, 54 (26.0%) had one potential allergen, 21 (10.2%) had two, and four (1.9%) had three potential allergens from the series. The frequently encountered allergens were cetearyl alcohol and paraben mix, found in 42 (20.4%) and 37 (18.0%) of products, respectively. Other BSCA baseline series allergens identified in PCPs included 2-bromo-2-nitropropane-1,3-diol, lanolin, decyl glucoside, diazolidinyl urea, methylisothiazolinone, limonene and linalool. In addition, PCPs had chemicals that were related to and may cross-react with allergens in the BSCA baseline series. Parfum/fragrance, which can crossreact with fragrance mix I and II, was found in 85 (41.3%) PCPs. Sodium benzoate and/or benzoic acid, often used as preservatives in PCPs, were found in 66 (32.0%) products. Forty (19.4%) PCPs had ingredients that belong to the Asteraceae family and therefore may trigger an ACD in those with positive reaction to Compositae and/or sesquiterpene lactone mix. Twenty-three (11.2%) PCPs contained cetyl alcohol and/or stearyl alcohol, the two major components of cetearyl alcohol. Overall, 153 (74.3%) of 206 PCPs marketed as hypoallergenic contained BSCA baseline series allergens or ingredients that may cross-react with them. This highlights the need to increase public awareness and education about the potential dangers of purchasing ‘hypoallergenic’ PCPs.
DP06 (P10) Blastic plasmacytoid dendritic cell neoplasm: two representative cases
Authors: Taneja Neha 
Published: June 2023

Abstract
Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a malignant proliferation of plasmacytoid dendritic cells, representing &lt;1% of primary cutaneous lymphomas. It most commonly presents in the skin and has a poor prognosis with median survival of 1 year. The fifth World Health Organization classification of haematolymphoid tumours encompasses two entities in plasmacytoid dendritic cell neoplasms: BPDCN and ‘mature plasmacytoid dendritic cell neoplasm associated with myeloid neoplasm’. We present two cases, one representing each subset. Our first case was a 58-year-old man who presented with an asymptomatic, rapidly progressive, skin coloured-to-ery­thematous and hyperpigmented firm papules, nodules and plaques over the trunk, upper limbs and face of 2.5 months’ duration. This was associated with loss of appetite, loss of weight and leucopenia (2180 cells μL–1). Skin biopsy revealed a grenz zone with pandermal infiltration by large cells with high nuclear:cytoplasmic ratio, vesicular nuclei and prominent nucleoli and frequent mitotic figures. Immunohistochemistry (IHC) was leucocyte common antigen (LCA)+ but CD3–, CD20–, myeloperoxidase (MPO)– and CD117–. Bone marrow biopsy showed a similar infiltrate of cells, but the peripheral blood smear and flow cytometry was within normal limits. Further IHC was CD4+, CD56+, CD43+ and CD123+, establishing a diagnosis of BPDCN, and the patient was initiated on the Hoelzer protocol with 80% clearance of lesions after two cycles of chemotherapy. The second case was a 60-year-old woman who presented with asymptomatic firm skin-coloured nodules on her scalp, trunk, extremities and oral mucosa, associated with a low-grade fever, fatigability, weight loss, generalized lymphadenopathy and hepatosplenomegaly of 4 months’ duration. Histopathology showed similar features to the first case, with IHC being negative for CD3, CD20, CD138 and MPO. However, cells were LCA+, CD4+, CD56+ and CD43+. Bone marrow showed 77% acute leukaemia blasts with a MPO+ result, establishing diagnosis of acute myeloid leukaemia, suggestive of a mature plasmacytoid dendritic cell neoplasm associated with myeloid neoplasm. To conclude, BPDCN is an aggressive neoplasm that commonly presents in the skin and should be suspected by dermatologists when screening IHC for lymphoid and myeloid cell lines is negative in a suspected case of leukaemia cutis. A panel of CD4/CD56/CD43/CD123 may be used to establish the diagnosis.
DP14 Going against the grain: eosinophilic dermatosis presenting as erythema gyratum repens
Authors: Ting Jason Siong Kai , Eisner Mark , Venkatesan Sowmya , Fatah Saman 
Published: June 2023

Abstract
Erythema gyratum repens (EGR) is a rare, paraneoplastic rash with a characteristic woodgrain appearance. It is heavily associated with malignancies, including lung, oesophageal and breast cancers. However, other conditions can mimic EGR, including leucocytoclastic vasculitis, immunobullous and papulosquamous conditions. We report an unusual presentation of eosinophilic dermatosis with an EGR-like pattern, not associated with malignancy. A 67-year-old woman presented with a 2-week history of a pruritic eruption on her legs. It initially started with three small circular erythematous macules on the right leg and one on the left leg. Over the course of a few days, the three macules evolved into large concentric annular patches simulating woodgrain, which raised the clinical suspicion of EGR. After a week, the patches began to blister with accentuation of some of the blisters on the edge of the annular patches. She denied any previous history of skin problems or changes in medication and was otherwise well with no systemic symptoms, including fever. In view of the almost 70% chance of an underlying malignancy, she was thoroughly investigated. Her full blood count, eosinophil count, liver function test, renal profile and serum C3 and C4 were normal. Skin basement membrane/desmosome antibodies and Borrelia burgdorferi IgG and IgM antibodies were also negative. Histology revealed prominent epidermal spongiosis with some corneal and intraepidermal vesicles that were cell-poor and contained only red blood cells. The underlying dermis showed prominent papillary dermal oedema with a brisk interstitial and superficial/deep perivascular mixed inflammatory infiltrate containing numerous eosinophils but no obvious flame figures. There was also eosinophil infiltration into the underlying subcutaneous fat. Direct immunofluorescence was negative. The histological pattern was that of an eosinophil-rich dermatitis with vesiculation; the history and morphology of the eruption were not compatible with bullous insect bites. An eosinophilic dermatosis such as eosinophilic cellulitis presenting with an EGR-like pattern was considered to be the most likely possibility for her presentation. Computed tomography of the neck, thorax, abdomen and pelvis, bidirectional endoscopy and mammography revealed no malignancies. She was treated with prednisolone 30 mg daily for 10 days with Elocon® ointment, and the eruption improved remarkably leaving postinflammatory colour changes that subsequently resolved. We would like to raise the awareness that an EGR-like pattern can be found in several other dermatoses, including eosinophilic dermatosis, and woodgrain pattern is not always equivalent to EGR or a high risk of associated malignancies (Table 1).Table 1Erythema gyratum repens-like dermatosesLeucocytoclastic vasculitisImmunobullousPapulosquamousBullous pemphigoidPsoriasisEpidermolysis bullosa acquisitaPityriasis rubra pilarisLinear IgA dermatoses
DP26 Syringocystadenocarcinoma papilliferum masquerading as squamous cell carcinoma
Authors: Applewaite Rona , Mehta Anisha 
Published: June 2023

Abstract
Syringocystadenocarcinoma papilliferum (SCACP) is a rare cutaneous adnexal neoplasm with ~30 cases reported. This case highlights the potential diagnostic and treatment challenges. A 52-year-old woman presented with a poorly differentiated carcinoma on the left parietal scalp which recurred 2 and 5 years following the original surgical excision. Initial biopsy of this lesion had shown syringocystadenoma papilliferum (SCAP) with associated syringoma, and a subsequent wider excision revealed suspected poorly differentiated squamous cell carcinoma (SCC) in the deeper dermis that was fully excised; however, the SCAP reached the margins. Excision 2 years later of the first recurrence showed similar histological features, and a second recurrence was excised twice to achieve histological clearance followed by postoperative radiotherapy. She remains tumour-free 2 years later. Upon retrospective review of all specimens, the initial primary tumour excision showed histological findings of a surface exophytic SCAP with mild nuclear enlargement, nucleoli and scattered mitotic figures. An infiltrative lesion was seen beneath this consisting of atypical ductal structures within a fibroblastic stroma. In deeper regions, there was more solid proliferation with some squamous differentiation, although scattered glandular units remained visible. However, the squamous component was predominant in future biopsies and even represented the sole morphological appearance in some. This culminated in the latest biopsy showing a poorly differentiated spindle cell tumour which, with immunohistochemistry (BerEP4-negative; cytokeratin, CK14−, CK5−, p63− and p53-positive; and high Ki67 index), was considered entirely to be a poorly differentiated SCC. Ultimately, this sequence of biopsies actually represented the rare diagnosis of SCACP, which demonstrated progressive squamous differentiation with each recurrence. A previous case published also reported SCACP transition to squamous differentiation (Zhang YH, Wang WL, Rapini RP et al. Syringocystadenocarcinoma papilliferum with transition to areas of squamous differentiation: a case report and review of the literature. Am J Dermatopathol 2012; 34:428–33). Despite the generally favourable prognosis reported, there have been a few cases of locoregional metastasis. Furthermore, recurrence up to 8 years after excision of the primary tumour has been reported (Castillo L, Moreno A, Tardío JC. Syringocystadenocarcinoma papilliferum in situ: report of a case with late recurrence. Am J Dermatopathol 2014; 36:348–52). We present a unique case of doubly recurrent SCACP managed with surgery and adjuvant radiotherapy which highlights the need for long-term follow-up. Furthermore, SCACP may pose a diagnostic challenge due to squamous differentiation of these tumours, which may result in incorrect or delayed diagnosis.
DS06 Does the content of patient information leaflets reflect real-life practice? A comparison of four patient information leaflets in Mohs micrographic surgery
Authors: Demirel Sibel , Affleck Andrew 
Published: June 2023

Abstract
In our experience, patients referred for Mohs micrographic surgery (MMS) often have unrealistic expectations, anticipating defects that are small in size and depth, and incorrectly describe the procedure as removal of skin cancer by ‘taking away thin slices’ or ‘skimming the skin layer by layer’. This observation prompted us to critically appraise four widely accessed online patient information leaflets (PILs) on MMS produced by the British Association of Dermatologists, the American Academy of Dermatology, Dermnetnz.org and the European Society of Micrographic Surgery. Our aim was to evaluate the wording used and propose evidence-based changes to help manage patients’ expectations. We focused on two core themes: (i) excision of tumour by MMS, including the number of stages, and (ii) cosmetic benefit of MMS over standard excision (SE). All of these PILs state the need for ‘stages’ to achieve margin clearance, with an initial margin of excision as low as 1 mm per stage mentioned in one PIL. The leaflets suggest cosmetic benefit and tissue preservation of MMS over SE, and one leaflet ranked this higher than other advantages offered by MMS. We feel that these points are overstated and better addressed with evidence-based facts. Studies have shown that 60% of cases of MMS are cleared in one stage; &gt; 90% of tumours are cleared within two stages, and the number of patients needing three or more stages is only 6% (Macfarlane L, Waters A, Evans A et al. Seven years’ experience of Mohs micrographic surgery in a UK centre, and development of a UK minimum dataset and audit standards. Clin Exp Derm 2013; 38:262–9). In our experience, a surgical margin of 1 mm is not feasible in MMS. There is no direct evidence that MMS improves cosmesis compared with SE (Brown AC, Brindley L, Hunt WTN et al. A review of the evidence for Mohs micrographic surgery. Part 2: basal cell carcinoma. Clin Exp Dermatol 2022; 47:1794–804). Cosmetic and functional outcomes are usually only relevant in high-risk sites (e.g. the central face H zone) and in certain high-risk tumours where wide local excision would be the alternative treatment. In conclusion, we propose that PILs in MMS should avoid using misleading language like ‘thin’ and ‘small’ when describing the procedure. Patient information leaflets should clarify that the vast majority of tumours are cleared after two stages rather than requiring multiple stages. Tissue sparing should not be highlighted as the main advantage of MMS, and patients should not be pledged small wounds and better cosmetic outcomes.
DS14 Same-day surgery promotes sustainability in dermatology
Authors: Costa Blasco Marta , Doyle Claire , Tobin Anne Marie 
Published: June 2023

Abstract
The healthcare sector is responsible for 4.4% of global greenhouse gas (GHG) emissions. To limit global temperature rise by 1.5 °C, as called for in the Paris Agreement, GHG emissions will need to be significantly reduced. As climate change has been labelled the greatest threat to global health in the twenty-first century, all healthcare professionals must attempt to promote sustainable practice where possible. The British Society of Dermatological Surgery sustainability guidelines published in 2022 advocate multiple strategies for improving sustainability in skin cancer surgery, including a reduction of activity via prevention measures, low-carbon alternatives, operational resource use and research and innovation. It is recommended that ‘see-and-treat clinics’ should be offered where staff and facilities are available, as one of several methods to lower the carbon footprint of dermatological surgery. We performed a cross-sectional study in a single tertiary dermatology department, focusing on carbon dioxide (CO2) emissions associated with travel to and from skin surgery appointments from 1 January 2022 to 31 December 2022. Our dermatology department is located in an urban area and also receives referrals from rural locations. The distance from the patient’s home to the hospital was calculated in kilometres using Google Maps. Total CO2 emissions were calculated using an online calculator recommended by the Environmental Protection Agency of Ireland and were reported in metric tonnes of CO2. Fuel consumption was based on the average car with unknown fuel. In total, 2358 procedures were performed on 2184 patients, 54% of whom were male (n = 1180). The total distance travelled by patients was 109 787.94 km, averaging 50.27 km per patient (range 1.3–168). This generated 18.74 metric tonnes of CO2 emissions. Eighteen per cent (n = 389) of patients underwent surgical procedures on the same day as their outpatient clinic. Same-day surgery led to a reduction of 35 275 km, averaging 90.68 km per patient (range 1.3–120). This represented a reduction of 6.02 metric tonnes of CO2 emissions. This is equivalent to the CO2 emitted from six transatlantic flights. In our department, absorbable sutures are used, where possible, to reduce unnecessary travel to our department or to a general practice for suture removal. Results for benign lesions are communicated via letter, to minimize return to the clinic. This study highlights the reduction in CO2 emissions associated with same-day dermatological surgery. The limitations of this study include an assumption of travel to and from hospital appointments by car and of travel from the address stated in patient records. Dermatologists should consider the environmental impact of skin surgery and implement sustainable options when service planning.