bluuebunny/crossref_metadata_2025_split huggingface dataset:
CD02 A retrospective comparison of Chemotechnique Cosmetic series–positive contact allergens with the British Society for Cutaneous Allergy facial series
Authors: McFeely Orla , Byrne Emma , Storan Eoin 
Published: June 2023

Abstract
Patch testing is an important tool in the assessment of facial dermatitis. The cosmetic or facial series of haptens are highly relevant in facial dermatitis. The British Society for Cutaneous Allergy has recently updated the facial series to include the reduced number of 24 haptens. We compared positive allergens found in the Chemotechnique Cosmetic series (60 haptens) with that of the British Society for Cutaneous Allergy (BSCA) facial series. We conducted a retrospective review of patients who were patch tested to the Chemotechnique Cosmetic series over a 30-month period. We recorded and compared positive contact allergens in this series with that of the BSCA facial series. Sixty-three patients were patch tested to the Chemotechnique Cosmetic series over a 30-month period. Twenty-one patients were diagnosed with at least one positive contact allergen. In total, 35 contact allergies were diagnosed. Contact allergen positivity was seen to sorbitan oleate (Span 80; positive rate 4.7%), thimerosal (Merthiolate; positive rate 4.7%), chloroacetamide (positive rate 4.7%), hexahyrdo-1,3,5-tris(2-hydroxyethyl) triazine (Groton BK; positive rate 4.7%), abitol (hydroabietyl alcohol; positive rate 9.5%), benzophenon-3 (Eusolex® 4360, EscalolTM 567, oxybenzone; positive rate 4.7%), sorbitan sesquioleate (positive rate 14.2%), benzyl salicylate (positive rate 9.5%), tert-butyl hydroquinone (positive rate 14.2%), tea tree oil oxidized (positive rate 4.7%), 3-(dimethylamino)-1-propylamine (positive rate 4.7%), Amerchol (positive rate 4.7%), quaternium (positive rate 4.7%), methyldibromo glutaronitrile (MDBGN; positive rate 9.5%), methylisothiazolinone (MI; positive rate 4.7%), sodium metabisulfite (positive rate 28.5%) and gallate mix (positive rate 28.5%). Nine patients (43%) were found to have more than one contact allergy. Five of the positive haptens (Amerchol, quaternium, MDBGN, MI and sodium metabisulfite) are captured within the BSCA standard series but are not found within the BSCA facial series. Benzophenone 3 is captured within the BSCA extra facial series. Five further haptens [sorbitan oleate (Span 80), thimerosal (Merthiolate), chloroacetamide, hexahyrdo-1,3,5-tris(2-hydroxyethyl) triazine (Groton BK) and benzyl salicylate] were captured with the Chemotechnique series. However, these five are not included in the BSCA facial series and would not otherwise have been identified. Seventeen per cent of contact allergies would not have been diagnosed in this study if the BSCA facial series had been applied. This study highlights the variation in positivity seen between the Chemotechnique and BSCA facial series and the potential for missed diagnoses.
CD03 Contact sensitization to shellac: a possible marker of fragrance allergy
Authors: Ghadiri Sina , Sambi Pavan , Wilkinson Mark , Whitehouse Heather 
Published: June 2023

Abstract
Shellac, the purified resin produced from the female lac bug (Kerria lacca), has its application within a wide range of industries, including healthcare, food, wood treatments and cosmetics. Shellac 20% alcohol is included in the British Society for Cutaneous Allergy/European Society of Contact Dermatitis extended facial series based on frequency of reactions exceeding the 0.3% threshold. However, the source of primary sensitization remains difficult to characterize through patch testing as relevance is not always clear and the test preparation has an irritant potential. We present a series of 28 patients from 2013 to 2022 with positive or irritant reactions to shellac, to elucidate its reaction pattern and relevance within our outpatient population. Cases with confirmed shellac positivity (‘+’ reactions and higher) or irritant reactions using a test preparation with alcohol 20% (Chemotechnique MB Diagnostics, Vellinge, Sweden) on days 2 and 4 of patch testing in a cosmetic series were retrieved between 2013 and 2022 from a total of 5458 people tested. Data collected from records included degree of positivity, irritancy, relevance, coexisting allergens, primary anatomical site and previous history of atopy. Data were processed using Microsoft Excel. We report 21 positive reactions, 14 (67%) of which were weak. Eleven (52%) positive reactions were deemed of current relevance, seven (33%) of doubtful relevance, one (5%) of past relevance and one (5%) a crossreaction to fragrance. Seven (25%) patients had documented irritant reaction to shellac. Nickel and colophony were the most common coexisting allergens in shellac-positive patients (positive in five and four cases, respectively). Nine (43%) cases with positive reaction had coexisting positivity of fragrance markers (which included one or more of geraniol, citral, Evernia furfuracea, turpentine, propolis, colophony, abitol, isoeugenol, cinnamyl alcohol, Jasminum officinale, jasmine absolute, majantole or benzaldehyde), indicating a higher prevalence than existing rates from studies in the general population. Fourteen (67%) positive cases documented the face as the primary site of disease, and 16 (76%) had a personal history of atopy. Our results indicate a significant association between shellac positivity and coexisting fragrance allergy, suggesting a role as a marker of fragrance allergy due to cross-reaction. When comparing irritant reactions to the proportion of positive reactions, this was higher than in previous US population-based reports (five irritant cases vs. 64 positive cases of a total cohort of 612 cases) but significantly lower than in a recent German population-based study (90 irritant cases vs. 76 positive cases of a total cohort of 2167), in all instances using the alcohol 20% preparation.
CD04 An unusual case of menorrhagia and an episodic rash
Authors: Latheef Faheem 
Published: June 2023

Abstract
A 24-year-old female university student from Hong Kong was referred with a 4-month history of a vesicular rash on her lips, eyes and oral mucosa that always appeared around the same time of her menstrual cycle. She would also get similar lesions on her neck, arms and legs. She was seen in dermatology and given a provisional diagnosis of erythema multiforme/recurrent herpes simplex and started on treatment, as well as prophylactic dose aciclovir for a few months. Despite this, there was no improvement in symptoms and her viral swabs also came back negative. She was referred for a second opinion, and, on reviewing her history, she volunteered that she suffers from menorrhagia. On questioning regarding any use of painkillers, she took out a packet of 60-mg etoricoxib that she had been getting from Hong Kong over the counter (OTC) and which was not on her records in the UK. She was taking this on day 1 of her period, and the vesicular eruption appeared the following day; it also became apparent that it would occur at the same sites on her body each time. A fixed drug eruption (FDE) to etoricoxib was suspected, and patch testing was undertaken to our baseline, facial and photopatch series (which includes a number of nonsteroidal anti-inflammatory drugs), to the medication crushed in paraffin applied to the back as standard and also to the specific sites at which the eruptions occur on the neck, arms and legs (lesional skin) under occlusion. No reactions were seen at 48 h, but at 72 h, we noted vesicular eruptions morphologically identical to the very dramatic photos she had on her phone but only in the areas where she had previously reacted (lesional skin); no reaction was seen on the nonlesional skin on the back where the standard patch testing was performed. Her rash fully resolved after stopping the etoricoxib. This case highlights the importance of enquiring about OTC medications when seeing patients with unusual or recalcitrant presentations as the flare with the menstrual cycle was a red herring and also highlights the importance of patch testing lesional skin with the culprit medication to avoid false negatives when considering FDE. This is a rare presentation of a FDE to etoricoxib, with only eight other cases reported in the literature, but this should be considered as a differential diagnosis in someone presenting with an erythema multiforme-like eruption.
CD06 Delving in to Disperse Orange 1
Authors: Butt Sanaa , Thompson Donna 
Published: June 2023

Abstract
Disperse Orange 1, colour index 11080, is an azo dye. Collectively, azo dyes are a common cause of textile-related allergic contact dermatitis (ACD). A 2006 European Union (EU) directive restricts the sale of any articles or dyed items that have direct and prolonged contact with the skin or the oral cavity and contain more than 30-ppm azo dyes. These include a wide range of items such clothing, bedding, furniture, toys and yarn. Despite clear regulation set out by the directive, these dyes have been detected within garments produced and sold within the EU (https://echa.europa.eu/regulations/reach/legislation). In our cutaneous allergy clinic, we have patch tested a total of 547 patients to the clothing and dye series. Only seven (1.3%) have tested positive to Disperse Orange 1. We present a series of cases and highlight the suspected sources of exposure. We identified a total of seven patients, four of whom were male. Their ages ranged between 20 and 78 years. Aside from Disperse Orange 1, all patients developed positive patch test results to other disperse dyes. Three patients also reacted to paraphenylenediamine. Sites affected included the head and neck (n = 4), hands (n = 2), chest (n = 1) and leg (n = 1). Other series patients tested positive to included fragrances, metals, rubber, acrylates and local anaesthetics. Suspected sources of Disperse Orange 1 included hair dyes, clothing, wound dressings and a thyroid shield. Few cases of ACD have been published on Disperse Orange 1. One report noted a textile necklace as a source of a severe localized ACD (Nygaard U, Kralund HH, Sommerlund M. Allergic contact dermatitis induced by textile necklace. Case Rep Dermatol 2013; 5:336–9). We wish to raise awareness of the presence of problems with Disperse Orange 1, despite the EU directive. Members should consider a variety of sources, including traditional items such as clothing and hair dyes and also newer items such as dressings and thyroid shields, as suspected in our cases.
DP03 (P23) Primary penile melanoma and penile lichen sclerosus
Authors: Dear Kate , Kravvas George , Sim Sharmaine , James Mariel , Watchorn Richard , Haider Aiman , Ellery Peter , Freeman Alex , Alnajjar Hussain , Muneer Asif , Bunker Chris 
Published: June 2023

Abstract
The association between squamous cell malignancies and genital lichen sclerosus (GLSc) is well established. There is an increasing literature regarding the relationship of GLSc with genital malignant melanoma (MM). While there have been several reported cases of vulvar melanoma associated with lichen sclerosus (LSc), there have been fewer cases published with regard to male genital (M)GLSc and penile (Pe)MM. The aims of this study were to explore the relationship between PeMM and MGLSc by reviewing all cases managed by our multidisciplinary service over a period of 11 years. All patients known to our tertiary urology and male genital dermatology service with a diagnosis of penile MM and where histology was available for review were identified over an 11-year period (2011–2022). Two independent dermatologists reviewed the clinical records and photographs where available. Two independent mutually blinded histopathologists reviewed the histology and recorded features of GLSc where present. In cases of discordance between histopathologists, a third independent histopathologist reviewed the cases. Eleven patients were identified for inclusion in the study. Overall, GLSc was present on histopathology in nine of 11 cases (82%). Findings were concordantly positive in five cases and concordantly negative in one case. In cases of discordant findings (n = 5), the third histopathologist determined GLSc to be present in four cases and absent in one case. Clinical photographs were available for three cases, and clinical features of GLSc were seen in all of them; they also all had positive histopathological findings. Clinical notes, including electronic notes and letters, were available for review in eight cases. Symptoms in keeping with GLSc were mentioned in only one case, and signs suggestive of GLSc were documented in three cases. Penile MM is a rare entity accounting for 0.7% of penile cancer and 0.1% of MM cases. Like other malignancies, MM is a multifactorial disease caused by a combination of environmental factors and altered host responses contributing to an alteration of regulatory processes. Although ultraviolet exposure is important in the pathogenesis of extragenital MM, this cannot be a factor for genital disease. However, specific risk factors for genital MM have not yet been elucidated. To our knowledge, there have only been three previously documented cases (all from our group) of PeMM coexisting with GLSc. In this present study, finding of GLSc in nine of 11 men with PeMM is suggestive of a causative relationship. We postulate that this is related to chronic melanocytic distress created by chronic inflammation secondary to LSc.
DP11 Dermal plexiform spindle cell lipoma: a perplexing entity
Authors: Byrne Tiarna , McDonald Louise , Holte Kristofer 
Published: June 2023

Abstract
We present a 66-year-old man who presented to dermatology with an unusual lesion. An outdoor worker with prior history of melanoma, the patient was referred with a new pigmented lesion adjacent to his melanoma scar. This was identified as a seborrhoeic keratosis and the patient was reassured. Following a full body examination, an incidental lesion was identified on the left anterior shoulder. The lesion measured 9 × 7 mm, was dermal-based, dome-shaped, soft to palpation and skin coloured with light peripheral pigmentation. The lesion was featureless upon dermoscopic examination. The clinical differential diagnosis included neurofibroma and an intradermal naevus. The lesion was narrowly excised. Histological examination revealed an ill-defined, wedge-shaped dermal lesion with tumour fascicles with a vaguely plexiform arrangement. The widely separated fascicles comprised loosely arranged spindle cells, mature adipocytes and scant collagen fibres with a myxoid stroma. The spindle cells were stained diffusely with CD34 immunohistochemistry. The adipocytes and a proportion of spindle cells (around 20–30%) were stained with S100. The features were in keeping with a dermal plexiform spindle cell lipoma. Spindle cell lipoma is an uncommon benign, histologically distinct tumour, accounting for 1.5% of all adipocytic neoplasms. More common within the subcutis, it is rare for these lesions to present with a purely intradermal location. Dermal spindle cell lipomas tend to be less cellular than their subcutaneous counterpart. This coupled with the variable representation of the three constituent lesion components (spindle cells, mature adipocytes and fibromucinous stroma) results in a wide range of possible differential diagnoses. The plexiform variant of spindle cell lipoma (PSCL) is a poorly recognized form with even greater potential for misdiagnosis, particularly with plexiform neurofibroma—­leading to an erroneous diagnosis of neurofibromatosis. Dermal PSCL is an exceptionally rare diagnosis with only eight cases reported in the literature thus far. Here, we report a further case of dermal plexiform spindle cell lipoma, with, for the first-time, corresponding clinical images. In our summary, we discuss in detail the potential diagnostic pitfalls of this rare tumour and how to best employ immunohistochemical staining to avoid them.
DP13 A case of poikilodermatous plaque-like haemangioma: a newly described entity
Authors: Elamin Shahd , Hennell Claire , Dolan Olivia 
Published: June 2023

Abstract
A 56-year-old man was referred with a 1.5 cm × 1.5 cm asymptomatic erythematous and scaly plaque on his right upper calf of 6 months’ duration. He had no similar lesions or prior skin issues. He had no significant comorbidities and was on no regular medications. There was no known family history of relevance. The initial clinical findings were felt to be in keeping with Bowen disease. He was treated once with cryotherapy, followed by two cycles of 5-fluorouracil cream, applied once daily over 4 weeks. Despite this, the plaque persisted and increased in size, measuring 3 cm × 2.5 cm. A 4-mm incisional biopsy was performed. Histopathology findings showed an acanthotic epidermis with compact hyperkeratosis, overlying a superficial dermal vascular lesion that consisted of a distinctive band-like proliferation of small endothelial cell-lined vessels. Background fibrosis and oedema were noted, as well as loss of elastic fibres within the lesional area, demonstrated by elastic van Gieson stain. Positive immunohistochemistry staining included CD31 and erythroblast transformation-specific-related gene stains, helping to confirm this lesion’s vascular origin, with a negative result for D2-40 (podoplanin), suggesting no lymphatic involvement. The histological appearances were thought to fit with a diagnosis of poikilodermatous plaque-like haemangioma (PPLH), a newly described entity of acquired vascular proliferation. Poikilodermatous plaque-like haemangioma, first described in 2019, usually presents as a solitary atrophic erythematous-to-violaceous plaque typically found in the lower limbs (Semkova K, Carr R, Grainger M et al. Poikilodermatous plaque-like hemangioma: case series of a newly defined entity. J Am Acad Dermatol 2019; 81:1257–70). Reassuringly, it has a benign course, but it can be persistent (Semkova et al.). Our patient was keen for treatment as the lesion was continuing to grow, causing him concern. However, there is sparse information available in the literature regarding effective treatments for PPLH. The case was discussed at the departmental clinicopathological meeting. The plaque was felt to be too superficial to merit any radiological investigation of the soft tissues. Surgical excision was discussed but given the size and location would most likely require a large skin graft. Sclerotherapy was considered but not felt to be appropriate in this setting. A trial of laser therapy was regarded as the best option given the superficial nature of this vascular lesion. He has since started a course of pulsed dye laser (PDL) at a wavelength of 585 nm, and we wait with interest to determine if it is effective. We therefore present this case to raise awareness of PPLH as a newly described entity and to consider it in the differential of a solitary atrophic erythematous plaque on a sun-protected site.
DP15 ‘Unwell water’: the potential importance of environmental factors in skin cancer in people of colour
Authors: Junejo Muhammad Hyder , Cernova Jeva , Ligaj Marcin , Stodell Matthew , Harwood Catherine 
Published: June 2023

Abstract
Ultraviolet radiation (UVR) is the most common environmental carcinogen to cause cutaneous squamous cell carcinoma (cSCC). However, other carcinogens may also play a role and should be suspected when cSCC occurs in people with skin of colour (SOC) in whom ultraviolet (UV)-induced cSCC is less common. We present the case of a South Asian female who presented with an aggressive cSCC, which we hypothesize was related to previous arsenic exposure. A 70-year-old Bangladeshi woman (skin phototype V) presented with a 4-cm diameter, tender, keratotic plaque at the base of her left thumb, which had been present for 12 years and was slowly enlarging. There was no associated lymphadenopathy. She also had multiple palmoplantar keratotic papules and two hyperkeratotic plaques in UV-protected areas on her trunk. Histology of the lesion on her thumb confirmed a cSCC with high-risk features: poorly differentiated, invasion 9.5 mm into fibromuscular tissue, perineural invasion (nerve diameter &gt; 0.1 mm) and vascular invasion. The truncal plaques were confirmed to be SCC in situ. The cSCC was incompletely excised and subsequently showed extensive involvement of periosteal soft tissues with invasion into bone marrow. Staging computed tomography showed no evidence of nodal or distant metastatic disease. She subsequently underwent ray amputation and remains under close clinical surveillance. Given the cSCC location and her skin phototype, potential non-UV radiation (UVR) causes were explored. In view of the palmoplantar keratotic papules and SCC in situ, chronic arsenic exposure was suspected. Further questioning revealed a history of drinking well water in a rural village in Bangladesh throughout childhood and early adulthood, although exposure had stopped &gt; 40 years ago. Arsenic exposure from contaminated groundwater was therefore considered to be the most likely diagnosis. She was started on long-term chemoprevention with acitretin. Arsenic is a potent human carcinogen and a well-recognized cause of cSCC; the latency period may be 30–40 years. Most cases are likely to be in people exposed through environmental arsenic exposure, such as contaminated groundwater, with some cases of exposure to arsenic-containing traditional medicines also reported. Carcinogenic mechanisms are uncertain but may involve dysregulation of the Hippo signalling pathway. In summary, although the incidence of UVR-related cSCC is lower, this case highlights the importance of considering risk factors, other than UVR, in cSCC arising in people with SOC. Identifying relevant carcinogens may require a detailed travel, social and cultural history and, more importantly, an awareness of the non-UVR causes of cSCC.
DP16 Trichilemmocysticus naevus: a rare birthmark treated successfully with erbium ablative laser
Authors: Bennett Hannah , Urwin Rachel , Merchant Will 
Published: June 2023

Abstract
We report a rare case of a 58-year-old woman with a naevus trichilemmocysticus. The patient presented to a tertiary dermatology centre with longstanding skin changes to her trunk. The changes had been apparent since childhood and became more prominent in her teens. Examination showed a linear Blaschkoid distribution of subtle hyperpigmentation and warty follicular prominence to the left submammary region, extending to the left upper back, where comedones and cystic papules were also noted. Histopathology confirmed the presence of cysts containing keratin, lined by trichilemmal-type squamous epithelium, representing trichilemmal cysts. The overlying epidermis appeared normal. Given the Blaschkoid distribution and the presence since childhood, it was thought that this most likely represented a naevus trichilemmocysticus. Tantcheva-Poor et al. described and named this as a rare type of organoid naevus-type lesion in 2007 (Tantcheva-Poor I, Reinhold K, Krieg T, Happle R. Trichilemmal cyst nevus: a new complex organoid epidermal nevus. J Am Acad Dermatol 2007; 57:S72–7). Only seven cases have been identified and reported in the literature. These have been characterized by multiple follicular filiform hyperkeratoses and trichilemmal cysts in a Blaschkoid distribution. Most cases described involve extensive areas of the skin and present with disfiguring lesions. Histology reports confirm epidermal acanthosis with deep invaginations filled with massive orthokeratosis, parakeratotic columns and an absent granular layer (isthmic or trichilemmal differentiation) with keratosis in sebaceous ducts and acrosyringia. Our patient is currently undergoing successful treatment with erbium laser under local anaesthesia, in order to improve the texture and appearance of the birthmark. This has been achieved by ablation to the warty areas to the level of upper papillary dermis, with focal deeper ablation to the skin overlying each cyst, followed by the use of a meibomian cyst curette for enucleation.