bluuebunny/crossref_metadata_2025_split huggingface dataset:
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% female, 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 were 0.88 [95% confidence interval (CI) 0.83–0.93] for SCC and 0.87 (95% CI 0.84–0.91) for BCC. For Samsung 10, the AUROCs were 0.85 (95% CI 0.79–0.90) and 0.87 (95% CI 0.83–0.90), and for 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 iPhone 6S of biopsied-only lesions, the sensitivity rates in detecting SCC and BCC were 98% (95% CI 88–100) and 94% (95% CI 90–97), respectively; the specificity rates were 38% (95% CI 33–44) and 28% (95% CI 21–35), respectively; the positive predictive values were 17% (95% CI 16–19) and 59% (95% CI 56–61), respectively; and the NPVs were 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.
P67 Overall lifetime risk for alopecia areata is 2.1% and is higher in women, non-White ethnic groups and the most deprived: a UK population-based cohort study
Authors: Thompson Andrew R , Tziotzios Christos , Nesnas John , Randall Rowena , Czachorowski Maciej , Messenger Andrew 
Published: June 2023

Abstract
Alopecia areata (AA) is an immune-mediated nonscarring alopecia often associated with substantial morbidity. However, there are limited population-based data on potential disparities in the burden of AA, including across different ethnicities and sociodemographic classifications. We aimed to provide the first large-scale, population-based evaluation of lifetime risk of AA across sociodemographic subgroups. This study used routinely collected data from a large UK population-based database: the Oxford-Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC). All children and adults registered with general practices contributing to the RCGP RSC network in the period 2009–2018 without a prior diagnosis of AA were included. People were considered to develop AA if they had an AA diagnosis and, in the subsequent 365 days, no code for an alternative diagnosis (e.g. traction alopecia and scarring alopecia). The cumulative lifetime risk of AA was estimated at age 80 years using survival models, with age as the timescale and accounting for the competing risk of death. Lifetime risk was calculated for the whole population and by sociodemographic subgroups comprising sex, major UK ethnicity groups and socioeconomic deprivation. In a total population of 4 052 231, 6961 developed new-onset AA. The lifetime risk in the overall population was 2.11% [95% confidence interval (CI) 2.06–2.16]. There was substantial difference in lifetime risk of AA by ethnicity; lifetime risk was 1.74% (95% CI 1.68–1.80) in the White subgroup, 5.87% (95% CI 5.51–6.24) in Asian, 3.03% (95% CI 2.63–3.42) in Black, 4.44% (95% CI 3.50–5.37) in mixed and 4.47% (95% CI 3.63–5.31) in other ethnic groups. Females had a higher lifetime risk of AA than males: 2.35% (95% CI 2.28–2.43) vs. 1.88% (95% CI 1.81–1.94). Lifetime risk was greater with increasing socioeconomic deprivation: least-deprived 1.68% (95% CI 1.59–1.78) vs. most-deprived quintile 2.92% (95% CI 2.77–3.07). Our findings demonstrate that AA affects nearly 1 in 50 people over a lifetime. Lifetime risk is substantially greater in people of non-White ethnicity and is highest in those of Asian ethnicity (one in 17 people). The lifetime risk is also higher in females and those with the greatest socioeconomic deprivation. Clinicians should be aware of the disproportionate distribution of AA across the population and support the provision of healthcare resource to groups with the highest burden.
Funding sources: this research was sponsored by Pfizer. Project management, medical writing and statistical support were provided by Momentum Data, UK, and were funded by Pfizer.
P79 A multidisciplinary expert consensus on the assessment of and support for mental health in children and young people living with skin conditions
Authors: Moledina Zahra , McPherson Tess , Ravenscroft Jane , Ali Rukhsana , Baron Susannah 
Published: June 2023

Abstract
Psychological and mental health concerns are common in children and young people (CYP) living with skin conditions and can have a profound impact on wellbeing. However, there is limited guidance on how best to assess and support the mental health of this population, who are at risk of poor health outcomes. The British Society for Paediatric and Adolescent Dermatology (BSPAD) formed a working group to address the mental health needs of CYP with skin conditions, including hair and nails. A systematic review, appraisal of literature and a national survey were carried out, and a multidisciplinary consensus guideline group was convened, comprising dermatologists with expertise in paediatric dermatology and psychodermatology, psychologists, psychiatrists, general practitioners, paediatricians and specialist nurses. Two multidisciplinary virtual panel meetings took place: (i) an initial meeting to discuss the scope, review the current evidence and identify areas for development and (ii) a second meeting to agree the content and wording of the recommendations. The primary objective was to provide consensus-based guidance on the assessment and monitoring of, and support for, mental health in CYP with skin conditions. Secondary objectives were to address important practical clinical questions relating to primary guidance objectives and provide audit and research recommendations. The expert panel achieved consensus on 11 recommendations for health workers managing CYP with skin conditions. A new patient-completed history-taking aid called ‘You and Your Skin’ was developed and is being piloted. The recommendations focus on improved mental health assessments for CYP presenting with a skin condition, with clinical guidance and suggested screening measures included. Information is given regarding accessing psychological support for CYP when required, and recommendations were provided for training in mental health and neurodiversity for staff. The methodology and recommendations will be presented in full. Embedding a psychosocial approach within services treating CYP with skin disease should ensure that CYP with psychological needs are able to be identified, listened to, supported and treated. This is likely to improve health outcomes.
P87 Therapeutic outcomes in xanthoma disseminatum with cladribine: a long-term experience of six patients from a tertiary care institute
Authors: Taneja Neha , Sharma Ananya , Sharma Ritu 
Published: June 2023

Abstract
Xanthoma disseminatum is a rare, non-Langerhans-cell histiocytosis with systemic involvement that has limited treatment options and response. Cladribine has been previously reported in few case reports and a single case series to induce long-term remission of cutaneous lesions. The aim was to study the treatment outcomes in a long-term follow-up of patients with xanthoma disseminatum, treated with cladribine. This was an ambispective case series of six patients diagnosed with xanthoma disseminatum on the basis of clinical and histopathological features. All patients were treated with monthly cycles of cladribine (2-chlorodeoxyadenosine) 0.14 mg kg−1 daily for 5 days a month, ranging from two to eight cycles. The follow-up period ranged from 2 months to 4.75 years. There were four males and two females in our series, with mean (SD) age of 25.3 (13.1) years (range 9–48). Disease duration at presentation ranged from 1.5 to 8 years. All patients presented with skin-coloured to yellowish-brown papules in a periorbital, perioral and flexural distribution. Four of six (67%) patients had mucosal involvement. All but one patient had associated diabetes insipidus. Half the patients had bone involvement, and two showed extensive infiltrates in the brain causing neurological symptoms. Patients receiving at least three cycles (n = 5) reported a mean improvement of 72% in cutaneous lesions at the end of the follow-up period, allowing for the avoidance of tracheostomy in a patient with laryngeal involvement. Imaging (magnetic resonance imaging of the brain, positron emission computed tomography) repeated in four patients after 3–6 cycles showed evidence of significant improvement in extracutaneous disease. Adverse effects were noted in four (67%) patients, including transient leukopenia in three, post-infusion fever in one and proximal renal tubular acidosis in one. All side-effects were resolved after the cessation of therapy and/or with supportive treatment; no serious infections were reported. Cladribine is a purine analogue that has an antiproliferative effect on histiocytes and lymphocytes, as well as an immunomodulatory action. It has emerged as an effective therapeutic modality for patients with xanthoma disseminatum that necessitates further evaluation for dosage and safety.
P96 Nutrition in dermatology practice: an unmet need for both patients and healthcare professionals
Authors: Lockwood Katie , Dhariwal Sukhjit , Hall Wendy , Gibson Rachel , Griffiths Christopher , Ahmed Alia , Maruthappu Thiviyani 
Published: June 2023

Abstract
The role of diet and nutrition in the management of chronic inflammatory skin conditions such as eczema, psoriasis and acne is one of the commonest questions asked by patients. Despite this, there is little guidance or training to help healthcare professionals provide disease-specific evidence-based recommendations to patients. Furthermore, growing evidence supports the role of diet and nutrition in the management of skin conditions such as psoriasis and atopic eczema. We sought to explore dermatology professionals’ experiences of patients’ dietary habits in an outpatient setting. We circulated a questionnaire to members of the British Dermatological Nursing Group and the British Association of Dermatologists. We collected demographic data, along with information on how frequently professionals were asked about diet by patients, how confident they felt responding to questions and concerns expressed regarding dietary restrictions, and whether dietitian input or nutrition training would be of benefit to their practice. Three of the authors received funding from the Psoriasis Association. We received 95 responses from dermatology nurses and 64 from doctors. Over 60% of respondents held senior positions with over 10 years of experience. Almost 100% of respondents reported being asked about diet by patients and 73.1% did not feel confident when answering these questions. Patients were most commonly asked about nutrition in relation to inflammatory conditions such as eczema (95.3%), acne (95.3%) and psoriasis (76.6%). All doctors and 97.8% of nurses reported having experienced patients restricting their diet without supervision, and the majority expressed concerns about such dietary modifications. Dairy, gluten and refined sugar were the most commonly excluded foods. Professionals also reported that patients admitted to following restrictive diets and undertaking ‘food intolerance testing’ that they had encountered online. Over 90% of respondents felt that additional nutrition training and access to specialist dietician support would be of benefit to dermatology practice. Dermatology professionals are frequently asked about nutrition and the role of diet yet often lack confidence in responding to these enquiries. Dermatology patients appear vulnerable to dietary misinformation presented online regarding ‘intolerance tests’, and this has the potential to worsen with ongoing delayed access to secondary care. There are also concerns regarding unsupervised restrictive diets, which can negatively impact patients’ mental health and predispose to eating disorders and nutritional deficiencies. Specialist nutrition training for dermatology professionals and the support of dietitians in the clinical setting would help address this unmet need and provide holistic patient care.
P104 Use of intravenous antibiotics in severe hidradenitis suppurativa: a multicentre retrospective study
Authors: Tan Xiang Li , Aziz Sally , Rashidghamat Ellie , Hemsley Carolyn , Goldenberg Simon , Lamb Ruth 
Published: June 2023

Abstract
Hidradenitis suppurativa (HS) is a chronic inflammatory condition, characterized by recurrent abscesses and sinus tracts in intertriginous areas. Intravenous (IV) antibiotics are used in cases of severe HS after the failure of conventional therapies, or to optimize patients prior to initiation of biologics or surgery. However, there is limited evidence on the efficacy of IV antibiotics [Join-Lambert O, Coignard-Biehler H, Jais J-P et al. Efficacy of ertapenem in severe hidradenitis suppurativa: a pilot study in a cohort of 30 consecutive patients. J Antimicrob Chemother 2016; 71:513–20; Ingram JR, Collier F, Brown D et al. British Association of Dermatologists guidelines for the management of hidradenitis suppurativa (acne inversa) 2018. Br J Dermatol 2019; 180:1009–17]. Our aim was to determine the immediate and long-term impact of IV antibiotics in severe HS and to develop a pre- and post-IV antibiotics assessment and care pathway. We conducted a multicentre retrospective review of patients with HS treated with IV antibiotics at two tertiary HS centres between 2013 and 2022. In total, we included 30 patients (14 females and 16 males), with a mean (SD) age of 42.6 (12.8) years (range 15–66) and a mean (SD) body mass index of 29.96 (7.31) kg m−2. All patients were classified as Hurley stage 3. The majority of patients received ertapenem (n = 24); other antibiotics included ceftriaxone (n = 5) and meropenem (n = 1). Patients had an average of 38.7 days on treatment (range 14–56). There were statistically significant improvements at the completion of antibiotics in biochemical and haematological parameters, including C-reactive protein −27.5 mg L−1 [95% confidence interval (CI) −11 to −57; P &lt; 0.003], white cell counts −1.75 × 109 cells L−1 (95% CI −0.95 to −2.80; P &lt; 0.001) and haemoglobin +7 g L−1 (95% CI 2.5–13; P &lt; 0.005). Dermatology Life Quality Index (out of 30) also improved significantly at completion (−5, 95% CI −1 to −10; P &lt; 0.008). These were all maintained 12 months postcompletion. Clinical severity of HS assessed through pain visual analogue score (VAS), discharge VAS, DERMVAS, overall VAS, and HS Physician Global Assessment showed improvement but did not reach statistical significance. Improvement in discharge VAS [out of 10; −2, 95% CI −1.5 to −4.5 (P &lt; 0.066)] achieved borderline significance. To our knowledge, this is the largest analysis of the efficacy of IV antibiotics in patients with the most severe form of HS (i.e. Hurley stage 3), where we show improvement in clinical parameters and quality of life. The findings of this study should encourage a randomized controlled study to determine conclusive evidence to guide the evidence-based management of severe HS and have informed the development of a more formal assessment pathway.
BG09 RASA1 exon deletion in a neonate with vascular malformations
Authors: Mann Nina , Solman Lea , Searle Claire , Srinivasan Jothsana , Ravenscroft Jane C 
Published: June 2023

Abstract
A full-term infant was noted to have a large, macular, pale-pink vascular birthmark across the left side of the chest, extending to the upper arm. Three smaller pale-pink irregular birthmarks on the elbow, thigh and flank were noted, as was an enlarged left upper arm. He had an oxygen dependency shortly after birth for which he required admission to the neonatal unit. A detailed history revealed that his father, paternal grandmother and aunt had similar birthmarks. His paternal aunt had an episode of bleeding from a spinal arteriovenous malformation (AVM) in her teens, which had been investigated with genetic testing by Sanger sequencing, but this did not identify a variant in RASA1. Following involvement from the dermatology, neonatology, genetics and radiology teams, investigations were organized. Findings included a high-flow vascular malformation with arteriovenous shunting on magnetic resonance imaging (MRI) of the left arm, normal MRI head and spine, and normal cardiac anatomy. Genetic testing by next-generation sequencing detected a heterozygous exon 21–23 deletion in RASA1. A diagnosis of capillary malformation–AVM syndrome (CM–AVM) was confirmed. Results of genetic testing of the father are awaited. Referral to a tertiary centre for consideration of management of AVM is underway. CM–AVM is a rare autosomal dominant condition. Pathogenic variants in RASA1 result in a lack of functional p120-RasGAP protein, which leads to abnormalities in angiogenesis, although this pathway is not well understood (Wooderchak-Donahue W, Johnson P, McDonald J et al. Expanding the clinical and molecular findings in RASA1 capillary malformation-arteriovenous malformation. Eur J Hum Genet 2018; 26:1521–36). Cutaneous vascular malformations, classically pink–red with a pale halo, are the most consistent cutaneous manifestation, but they may be subtle and can mimic other vascular birthmarks such as segmental infantile haemangioma, salmon patches or port wine stain. In our patient, pale halos were not apparent until 4 months of age. Identification is important as life-threatening complications from cutaneous vascular arteriovenous fistulas can occur (Wooderchak-Donahue et al.). This case highlights the importance of clarifying a family history, classifying vascular birthmarks and working with the multidisciplinary team. Genetic testing should be considered, even with previous negative analysis, as test sensitivity has improved and will now include analysis of EPHB4, which has also been associated with CM–AVM.
BG10 A case of pachydermoperiostosis (primary hypertrophic osteoarthropathy)
Authors: Brindley Luke , Hunjan Manrup , Lewis Helen , Lovgren Marie-Louise , Titheradge Hannah 
Published: June 2023

Abstract
We report a case of a 21-year-old man who was referred from the community with concern about persistent swollen and inflamed eyelids together with possible facial acne. He was known to have hypertrophic osteoarthropathy under the care of rheumatology for which he was on regular infliximab infusions. He had previously been treated with methotrexate (intolerant) azathioprine and adalimumab (lack of efficacy). He also had a long-standing history of inflammatory bowel disease and associated complications: iron-deficiency anaemia, previous choledochal cyst and biliary stricture, as well as previous deficiencies in vitamins B12, A and E. The patient was known to the genetics team, with prior genetic testing demonstrating that he is homozygous for a pathogenic SLC02A1 variant (c.1264_1265delAC). This gene encodes a prostaglandin transporter involved in mediating the uptake and clearance of prostaglandins in numerous tissues. On examination, he was found to have pronounced thickening of the facial skin, especially the forehead, alongside deep furrowing of the scalp. The eyelids were severely swollen and inflamed, with prominent straight eyelashes. There were milia present on the face predominantly on the brow and cheeks. There was clubbing of all digits on his hands and feet. The cutaneous findings were deemed all in keeping with pachydermoperiostosis. Pachydermoperiostosis, also known as primary/idiopathic hypertrophic osteoarthropathy, Touraine–Solente–Gole syndrome and Rosenfeld–Kloepfer syndrome, was first described by Friedrich in 1868. This is a rare condition, and both autosomal dominant and autosomal recessive modes of inheritance have been noted. The condition usually presents during puberty and the hallmark features are thickening and coarsening of the facial skin, periostosis and digital clubbing. Other cutaneous features can include seborrhoea with sebaceous hyperplasia, acne, hyperhidrosis and cutis verticis gyrata. Ocular manifestations include blepharoptosis, floppy eyelid syndrome, and hypertrophy of both the eyelids and palpebral conjunctiva. Crohn disease and multiple bone and joint issues are known features of the condition (Doshi D. Touraine–Solente–Gole syndrome. Orbit 2018; 37:97–101; Tabatabaei SA, Masoomi A, Soleimani M et al. Pachydermoperiostosis: a clinicopathological description. J Curr Ophthalmol 2019; 31:450–3). This reported case demonstrates both classic cutaneous and other organ system features of this rare genetic condition. It highlights the importance of being able to recognize all the associated findings when a patient presents with thickening of their facial skin and eyelids.