bluuebunny/crossref_metadata_2025_split huggingface dataset:
H09 Is cannabis use in dermatology topical? Reviving the historical highs
Authors: Moon Emily , Unter Simon , Gee Bruce 
Published: June 2023

Abstract
Cannabis refers to product derived from a plant species known as Cannabis sativa. The plant contains cannabinoids, two of the most prominent being tetrahydrocannabinol (THC) and cannabidiol (CBD). THC is the primary psychoactive component in cannabis, while CBD, discovered by chemist Roger Adams in 1942, is nonpsychoactive. Cannabis with high THC levels is referred to as marijuana. With global policy changes and government approvals, CBD has recently garnered significant interest due to increased awareness of its therapeutic potential. This surge in demand has fuelled the multi-billion-dollar global CBD market with projections of sustained growth in the future. The use of cannabis for medicinal purposes has a rich history, dating back to ancient civilizations. From traditional Chinese medicine using cannabis preparations for rashes to ancient Egyptians using it for wounds to Arab traditional medicine using it to treat lichen planus, the therapeutic benefits of cannabis have been widely recognized throughout history. Sir William O’Shaughnessy, an Irish physician, discovered the therapeutic properties of cannabis in India in the 19th century and led to its widespread use in Europe and North America. However, in the early 20th century, cannabis was banned in many countries as part of a movement to control the use of addictive substances. The discovery of the endocannabinoid system in the late 20th century marked a turning point in the understanding of how cannabinoids interact with our bodies. This intricate network, made up of endocannabinoids, cannabinoid receptors and enzymes, regulates pain perception, metabolism, circadian rhythm, immune system, and more. Preclinical evidence supports the therapeutic potential of topical CBD for dermatological inflammatory diseases such as acne and eczema, as well as skin cancer (Lowe H, Toyang N, Steele B et al. The endocannabinoid system: a potential target for the treatment of various diseases. Int J Mol Sci 2021; 22:9472). The accumulation of evidence supporting its therapeutic potential has led to a change in societal and cultural perspectives toward cannabis, resulting in the UK government’s approval of limited medicinal use in 2018, as well as the opening of the nation’s first legal cannabis farm in 2021. In 2018, Epidyolex® (cannabidiol) became the first US Food and Drug Administration-approved medical-grade CBD for treating rare forms of epilepsy. Cannabis’ potential therapeutic properties offer a promising outlook for cannabis-based medicine in dermatology. While CBD’s lipophilic nature and its instability in solution pose challenges for its transdermal delivery, ongoing research and study may offer solutions. It is imperative that dermatologists stay informed about CBD advancements as its growing availability and potential indications are likely to drive its popularity.
H10 An Oscar for Lassar
Authors: Al-Kutubi Huda , Salimi Maryam , Patel Pooja , Andrew Kashini , King-Stokes Natalie , Orpin Stephe 
Published: June 2023

Abstract
Oscar Lassar (1849–1907) was born in Hamburg to a wealthy merchant family and received a top-class education. After enrolling in the school of medicine at Heidelberg, he volunteered for military service at the outbreak of the Franco–Prussian war in 1870. He served on the front line, was promoted to officer in reserves and decorated with the Iron Cross for his bravery. He returned to complete his medical training and would eventually open a dermatology hospital in Berlin, which unified patient care, research and teaching. In only a few years this hospital would become world renowned. Catering for both inpatient and outpatient care, he was able to offer a wide range of treatments, including complex topical therapy, electrotherapy and surgical procedures. His pasta salicylica (Lassar’s paste) remains to this day a great topical treatment for atopic dermatitis. Lassar recognized the importance of an experienced nursing team to support these activities. Furthermore, he understood the importance of a well-equipped dermatology department and was quick to acquire innovative technology to expand therapeutic options, including X-ray equipment for the treatment of tumours and a Finsen carbon arc lamp for treating lupus vulgaris, thus augmenting his reputation as a Wunderarzt. Lassar made great contributions towards solidifying dermatology as a highly regarded speciality through the establishment of journals and speciality societies. He involved himself in public health measures by campaigning for the establishment of public baths, which would allow even the poorest in society to enjoy clean water facilities at a low cost, thereby reducing the spread of infectious diseases. As a man, he was described as a larger-than-life character with a personal style that meant newspapers gladly reported on his activities, making him an excellent public relations master. Lassar’s recreation was chiefly riding and driving. He was an excellent linguist, an admirable host and fond of children, for whom he wrote Geschichten und Gedichten fiir kleine Kinder (Stories and Poems for Little Children). He died in an automobile accident and his burial on Christmas Eve was marked nationally by the German newspapers, and internationally by his patients and colleagues. In Lassar, we have a great historical example of effective visionary leadership that enabled the expansion of dermatological practice and the promotion of patient care at the time.
H12 Royal rashes: a potted dermatology history in the British monarchy
Authors: Wolfe Charlotte , Fisher Rachel 
Published: June 2023

Abstract
Skin diseases have affected a significant proportion of the population throughout history, royalty being no exception. On reviewing monarchs over the centuries, underlying health conditions can be gleaned from their reported skin conditions and physical appearance. In the 14th century, King Henry IV seized the throne from his cousin Richard II. Henry IV was debilitated by a skin disease thought to be leprosy or severe psoriasis, believed to be a punishment from God for being the first king to execute an archbishop. He is reported to have developed great pustules and eventually necrotic ulcers. King Henry VIII, famous for his six wives, also suffered with poor health during his reign from 1509 to 1547. By the age of 44 years, he was reportedly significantly obese, suffering from bilateral leg ulcers that became recurrently infected, leaving him unable to walk. The aetiology of the king’s ulceration may encompass a range of potential diagnoses. It is likely to have been as a result of venous disease with stasis dermatitis alongside trauma and obesity. Henry’s daughter Queen Elizabeth I, who reigned from 1558 to 1603, suffered from smallpox in 1562, which left her face scarred. Her physical scars were concealed with early forms of lead-laced makeup. She also reportedly suffered from hair loss. This may have been telogen effluvium secondary to stress, or it is possible that she suffered from female pattern hair loss. Alternatively, the application of lead to her face may have contributed to her alopecia. The following century, Queen Anne, the monarch that unified England and Scotland and took ownership of Gibraltar, is thought to have suffered from systemic lupus erythematosus. Portraits have demonstrated the classic malar rash, facial oedema and joint swellings. She also suffered many miscarriages and eventually a lethal stroke, raising suspicion for associated antiphospholipid syndrome. Moving to the 20th century, Prince William of Gloucester, a grandson of King George V, suffered from a photoexacerbated blistering skin rash. Three years later, he was diagnosed with porphyria, giving credence to the theory that the madness of King George III, one of William’s ancestors, was due to porphyria. However, this has been disputed, and manic–depressive psychosis is felt to be the more likely explanation. With up to 33% of the UK population suffering with skin conditions at any one time, a significant number of the current royal family will have a variety of skin diseases. How will their dermatological history be told in the future?
H14 ‘Reflection for the day’
Authors: Long Amy , Long Alison 
Published: June 2023

Abstract
Thomas B. Fitzpatrick had a tremendous influence on the specialty of dermatology, including seminal scientific contributions, a legendary ability to teach and train, and remarkable innovations in clinical dermatology. Born in Wisconsin in 1919, he received his medical degree from Harvard, followed by a PhD in pathology. He served 2 years at an Army Chemical Centre, where his interest in skin pigmentation led to the discovery of human tyrosinase. Further innovation in basic sciences followed, with the discovery of the melanosome and epidermal melanin unit. He added to his academic accolades by completing a fellowship in chemistry at Oxford, then returned to the USA to pursue clinical dermatology training at Mayo Clinic. At the age of 32 years, following substantial success in his early career, he was appointed Professor and Chair of Dermatology at the University of Oregon. By 39 years of age, he was Chair of the Harvard Medical School Dermatology Department, Harvard’s youngest Professor and Chair, while serving as Chief of Dermatology at Massachusetts General Hospital. He was a master at motivating students and sharing his passion for dermatology. He often said ‘Practicing dermatologists are like the woodwind section of the orchestra—small in number, when they play they must play well’. In 1971, he wrote the first multiauthor medical textbook in the field entitled Fitzpatrick’s Dermatology in General Medicine, now in its eighth edition. Dr Fitzpatrick contributed heavily to the clinical advances in dermatology in the latter half of the 20th century. Alongside dermatopathologist Wallace Clark, he established the very first pigmented lesion clinic in 1966. From that clinic, studies enabled Dr Clark to devise the Clark level staging system for melanoma. Fitzpatrick described early diagnostic signs in melanoma, and the concept of sunlight as a factor in its aetiology. In 1975, he devised the Fitzpatrick scale of skin phototypes, which described a person’s skin type in terms of response to ultraviolet (UV) radiation exposure. To huge success, he experimented with psoralen and UVA to treat psoriasis, coining the term photochemotherapy, or PUVA. Fitzpatrick was a highly productive medical scholar, while having many other notable qualities and interests. He was an avid lover of music, a skilled pianist and a Johannes Brahms enthusiast. The Boston Globe called him a ‘dermatologist with an infectious enthusiasm for his specialty and philosopher’s love of a good quote’. For 20 years, he co-edited the Globe’s popular ‘Reflection for the Day’, alongside his loving wife Beatrice. Thomas Fitzpatrick was admired by many until his passing in 2003, leaving us with so much to remember him by.
H16 Arsenic to biologics: psoriasis treatment through the ages
Authors: Sarfraz Rabia 
Published: June 2023

Abstract
In the 19th century when arsenic was the recommended treatment for psoriasis, little consideration was given to the toxic side-effects of the potent carcinogen. Thomas Girdlestone, an English physician, is said to have been the first to advocate for the use of arsenic to treat psoriasis. Girdlestone prescribed Fowler’s solution, a solution of potassium arsenite 1%. In 1876, Alexander John Balmanno Squire inadvertently discovered dithranol, a known treatment for ringworm, to be efficacious in treating psoriasis. However, it was Eugen Galewsky, in 1916, who then went on to synthesize anthralin, a synthetic form of dithranol, to target psoriasis. A key historical figure was William H. Geockerman, an American dermatologist, who developed Goekerman therapy—a regimen that combined the use of coal tar and ultraviolet (UV) light to treat moderate-to-severe plaque psoriasis. In 1953, John Ingram, an English dermatologist, discovered that the beneficial effects of dithranol paste could be enhanced by adding it to coal tar and UV light—later coined the ‘Ingram regimen’. Philip Showalter Hench, Edward Calvin Kendall and Tadeus Reichstein received the Nobel Prize in Medicine and Physiology for the development of cortisone; it proved to be useful in topically treating many skin diseases, but it had a limited effect on psoriasis. The production of synthetic corticosteroids soon followed, which, conversely, proved to be successful in treating psoriasis. However, the daunting side-effects of corticosteroids limited their long-term use. In 1951, a patient with rheumatoid arthritis showed dramatic improvement in their psoriasis when treated with aminopterin, as recorded by Richard Gubner, a New York cardiologist. PUVA was developed in the 1970s—a photochemotherapy for psoriasis that combined psoralen with UVA radiation to clear skin lesions. Interestingly, in 1500 Bc, the ancient Egyptians were known to use a combination of psoralen and sunlight to treat vitiligo. Furthermore, in the 1980s, researchers noted complete clearance of psoriasis in a patient with osteoporosis who was prescribed an oral form of vitamin D. This chance observation then led to the development of topical vitamin D analogues for the treatment of psoriasis that work by encouraging normal skin growth and slowing down overproduction of skin cells. Finally, in 2003, the first biologic treatments were approved for psoriasis by the US Food and Drug Administration—a significantly safer and more efficacious alternative to the controversial arsenic treatments that were used over 200 years ago.
H20 Gin or tonic: the dermatological hazards of cocktail-based quinine
Authors: Passby Lauren 
Published: June 2023

Abstract
Derived from Cinchona tree bark, quinine was first found to be beneficial to health by indigenous Amazonian peoples. Seventeenth-century Jesuit missionaries sent the bark and seeds back to Europe, where word of its therapeutic properties spread. Quinine was promoted as an antiseptic treatment for a range of ailments from the 1600s onward, including septicaemia, erysipelas and scarlet fever. The dermatological risks of quinine quickly became recognized, with Bartholow stating in his 1876 work that ‘The action of quinia has occasionally been attended by the appearance of an eruption on the skin. Sometimes the exanthem has been in the form of an erythema, sometimes it has assumed the appearance of urticaria.’ The pharmacological properties of quinine were exploited by colonial institutions such as the East India Company, who combined a pragmatic approach to antimalarial prophylaxis with a British penchant for aperitivos. The bitter taste of quinine in tonic water led to the addition of water, sugar, lime and gin, giving rise to the gin and tonic (G&T). Its enduring popularity is, in part, due to the astringent nature of quinine and its acidic content that acts as a ‘stomachic tonic; that is, promote appetite, the flow of gastric juice, and the digestive power’. However, since its advent, the G&T has been attributed to many cases of dermatological malaise, as discovered by this systemic review of the published PubMed and SCOPUS literature. To the adage ‘new drugs, new eruptions’, the G&T was no exception. The first published skin reaction to quinine in tonic water dates from 1955, occurring shortly after the patient attended a cocktail party after which they developed ‘a burning sensation in the groins and in his hands and feet’ with progressive oedema and erythema to these areas, spreading to involve nearly all of the body. Other published cases describe (in decreasing frequency) fixed drug eruptions, photosensitive reactions, allergic urticaria and lichenoid drug reactions triggered by quinine in G&Ts. The spectrum of eruptions triggered by tonic water extends to Stevens–Johnson syndrome/toxic epidermal necrolysis triggered by scotch and tonic water consumed at the patient’s peril during a convention in 1972. With an enduring popularity spanning two centuries, and a declaration from Churchill that ‘the gin and tonic has saved more Englishmen's lives, and minds, than all the doctors in the Empire,’ it is vital that dermatologists are aware of the potential dermatological hazards of the G&T.
H23 Traditional healing by skin cauterization (kaiy)
Authors: Al Haddabi Atheer , Williamson Emilia Duarte 
Published: June 2023

Abstract
The practice of kaiy is an ancient medical traditional therapy that is still used in Africa and the Middle East. Kaiy is the Arabic word for cautery; a red-hot iron or coal is placed to the skin. This causes sharp circular, oval or linear burns that are placed in a symmetrical configuration, usually resulting in permanent scars. This practice is undertaken by traditional healers. A Somali woman was referred by her general practitioner to dermatology for an itchy scar on her mid-upper abdomen. She reported that 40 years ago, she had traditional skin cautery therapy to the area for bone pain, which was later diagnosed as rheumatoid arthritis. On examination, she had a 4 × 0.7 cm keloid scar that was treated with a course of KenalogTM injections. This sparked an interest in understanding the practice of kaiy, and a literature review was performed. Cauterization results in the burning of tissue in order to close wounds or stop bleeding. The patient’s symptoms help to decide the location of cauterization. For example, if the presenting complaint is jaundice, the cautery is placed on the left hand. Other medical presentations that kaiy is used for include back pain, headache, depression, chest pain and exorcism. Is this practice useful or are patients being burned for no reason? Historically, it was felt that it was valuable in preventing infection; however, there is no scientific basis for this. The practice was believed to result in the destruction of pathogenic substances within the body due to the extreme heat. Patients who have undergone this therapy report that it gives them short-term relief of their symptoms; this is likely to be due to the release of endogenous opioids, allowing the body to stop the sensation of unremitting pain. Complications are commonly witnessed and consist of deep skin burns, deferred wound healing and secondary wound infections. More serious complications include septic shock, ulceration and viral transmission such as hepatitis B (Farid MK, El-Mansoury A. Kaiy (traditional cautery) in Benghazi, Libya: complications versus effectiveness. Panafr Med J 2015; 22:98; Budair F. Dermatoses due to Arabic cultural and traditional practices. Indian J Dermatol Venereol Leprosy 2019; 85:448–54). Kaiy should be included in the differential diagnosis of a patient presenting with multiple symmetrical scars. Some patients may not be forthcoming in admitting to the treatment if not specifically asked. This presentation aims to increase awareness in dermatologists of this practice.
PA04 (P05) A rare presentation of blistering in an adolescent
Authors: Watson Nicola , Charlton Fraser , Hampton Philip , Dubois Anna , Leech Suzy 
Published: June 2023

Abstract
A previously well 16-year-old male presented with florid and widespread tense bullae and erosions. He gave a 2-week history of an erythematous rash consisting of crusted erosions that started on his chest and face. He denied any new medications or over-the-counter preparations. There was no preceding systemic illness, and no history of cold sores or sexual contacts. In the 24 h prior to his admission, his rash had become widespread, involving his trunk, limbs, hands, ears, face, lips, oral and genital mucosa. He had started to feel systemically unwell and was in significant pain. On examination, he had a combination of heavily crusted erosions and extensive tense bullae containing straw-coloured fluid on a background of inflamed skin. The morphology was herpetiform in some areas. There was notable extension of bullae onto the palms and penis, as well as intraoral and labial erosions. Viral skin swabs were negative, and his biopsy subsequently demonstrated subepidermal blistering with neutrophil-rich inflammation and positive direct immunofluorescence (IMF) for C3 and IgG only. Serum autoantibodies were negative. Childhood bullous pemphigoid (BP) was initially the working diagnosis, but indirect IMF showed localization to the base of the blister and anticollagen VII antibodies later proved positive, consistent with a diagnosis of epidermolysis bullosa acquisita (EBA). Given the clinical features, it was classified as BP-like EBA. He was initially treated with high-dose oral prednisolone, superpotent topical steroids and analgesia as an inpatient. Mycophenolate mofetil (MMF) was initiated, and his corticosteroid dose was slowly tapered. His condition was completely controlled with MMF 500 mg twice daily at 4 months. The patient then elected to stop taking MMF and remains in complete remission at 7 months. The EBA is rare in adults and even more so in children. The mean age of onset is 44–54 years, but up to 5% of reported cases are in children/adolescents. Four subtypes are described: classic mechanobullous, BP-like, mucous membrane pemphigoid-like and linear IgA bullous dermatosis-like. The BP-like EBA is characterized by widespread vesicles and tense bullae, commonly on an inflammatory background and lacking skin fragility, scarring or milia. Oral and genital mucosae are frequently affected in paediatric cases of EBA. Various steroid-sparing treatment modalities are described, including dapsone, colchicine and MMF. The prognosis in the paediatric population is favourable compared with that of adults: the majority achieve complete remission or complete control on treatment.
PA05 A rare case of cardiocutaneous syndrome in a young child
Authors: Marini Susanna , Katugampola Ru 
Published: June 2023

Abstract
A 19-month-old infant came to our attention showing clinical signs consistent with focal keratoderma limited to the palms and soles, dystrophic pachyonychia of all his nails and scalp alopecia characterized by sparse curly hair. His oral cavity examination revealed periodontitis, early tooth decay and notching of the incisor teeth. The patient is the second child of a nonconsanguineous, otherwise healthy couple. No other family members were reported to have similar skin and oral alterations. Based on the characteristic appearance of his cutaneous lesions, he was investigated for a palmoplantar keratoderma disorder and was subjected to genetic testing. Results confirmed a mutation within DSP, a gene responsible for encoding the most abundant component of desmosomes, a major cell adhesion junction, particularly prominent in epidermal and cardiac tissue. Mutations in genes encoding desmosomal components are known to be associated with a broad spectrum of phenotypical alterations of skin and hair structures. The same genetic anomaly accounts for 40–50% of cases of arrhythmogenic cardiomyopathy (Pigors M, Schwieger-Briel A, Cosgarea R et al. Desmoplakin mutations with palmoplantar keratoderma, woolly hair and cardiomyopathy. Acta Derm Venereol 2015; 95:337–40). Despite being asymptomatic, our young patient was referred to cardiology for further investigations and surveillance. At the age of 7 years, routine electrocardiography revealed new conduction abnormalities. An echocardiogram confirmed a dilated cardiomyopathy that, combined with the previously described cutaneous and oral alterations, led to a diagnosis of cardiocutaneous syndrome. An overview of the clinical features associated with desmoplakin mutations reported in medical literature illustrates the complexity of this group of disorders and their genotype–phenotype correlations, which cannot be easily predicted. Our reported case is a paradigmatic example of diagnostic difficulties often encountered when facing concomitant dermatological and oral conditions in the same patient, emphasizing the importance of recognizing oral, dental and skin signs to be a potential risk factor for hidden cardiac diseases.