bluuebunny/crossref_metadata_2025_split huggingface dataset:
H19 The bronze diabetic
Authors: Mulholland Orlagh , McKenna Kevin 
Published: June 2023

Abstract
Many works of art throughout the centuries have not only garnered intrigue, but also debate among physicians relating to a possible medical diagnosis depicted by the artist. Representation of both anatomy and disease with the use of votive offerings and forms of grotesque art is well recognized. Such work was particularly prevalent in pieces produced during the Hellenistic Age and includes statuettes, anatomical replicas, coins and other art work. Diseases such as acromegaly, Gorlin syndrome, lymphoedema, neurofibromatosis and ophthalmic disorders, among others, have been represented in such pieces. It had been thought by the suppliants that in presenting these offerings to the Gods, particularly Asclepius, the Greek god of medicine and son of Apollo, they could be cured from their ailments. An example of an artistic piece representing an individual with disease is that of a small bronze statuette described as a ‘Statue of an Emaciated Man’ and housed at the Dumbarton Oaks Research Library and Collection, Washington DC. It is a small bronze statue measuring at just 11.5 × 5 × 8.3 cm, and is thought to date from around the first century Bc to the first century Ad. It depicts a gaunt young man sitting atop a bench with his left hand held limply and an apparently swollen right foot. It has been suggested that this individual could have suffered from lead poisoning. However, lead neuropathy is typically symmetrical and emaciation is uncommon. A more common source of lead poisoning in ancient times was wine drinking, as lead was used both as a sweetener and preservative. In addition, occupational exposure was common as lead was used widely in pottery, painting, lead smelting and glass ceramics. A disease that could explain the three features of emaciation, wrist drop and a swollen foot is diabetes mellitus. Diabetes had been recognized in Egyptian manuscripts dating back to 1500 Bc commenting on ‘honey urine’. Diabetes has been well documented during the Hellenistic Age with Apollonius of Memphis in 250 Bc being credited for coining the term ‘diabetes’. Insulin insufficiency can cause emaciation mainly through ketosis. The neuropathy of diabetes mellitus can affect single nerves, and a radial nerve palsy resulting in a wrist drop has been recognized. The appearance of an apparent swollen foot could be due to a Charcot joint, which is a result of repetitive microtrauma-induced complications of polyneuropathy. In conclusion, we believe this statuette represents features consistent with diabetes mellitus and is a ‘bronze diabetic’.
PA08 Do parents and carers of children with eczema understand topical steroid potency? Results of a patient survey
Authors: Moss Celia , Lambert Alice , Haider Zahra , Proctor Andrew 
Published: June 2023

Abstract
Dermatologists consider topical corticosteroids (TCS) to be the first-line active treatment for most inflammatory skin disorders, including eczema. Well-known adverse effects can usually be avoided by careful prescribing. However, widespread public antipathy to TCS, sometimes amounting to steroid avoidance and phobia, can impair patient care. This fear is largely independent of steroid potency, even though there can be up to a 100-fold difference between the mildest and the most potent products. National Institute for Health and Care Excellence guidelines refer to the World Health Organization’s four-level grading system (mild, moderate, potent and very potent), but information about potency is never found on TCS packaging and rarely in patient information leaflets (Haider Z, Proctor A, Moss C. Potency of topical steroids should be clearly labelled on all packaging. Br J Dermatol 2023; 188:427–8). We surveyed parents and carers to investigate their knowledge and understanding of steroid potency. A SurveyMonkey® questionnaire was promoted by the National Eczema Society on social media, and by Eczema Outreach Support in a newsletter to supporters in January 2023. Of 984 responses received, 25% were from parents or carers of children with eczema. Of these, 97% knew that TCS could have different strengths (potencies), but 44% did not know how many different grades there were, with only 20% correctly answering four. Despite this, 77% of respondents felt ‘somewhat confident’ or ‘very confident’ that they knew how strong their cream was, but of those who were ‘very confident’, 29% did not know how many potency grades there were. Follow-up questions revealed that of those who had used these specific TCS, 93% knew that hydrocortisone is mild, but only 48% correctly identified Fucidin H as mild. Only 54% correctly identified DermovateTM as very potent. When asked ‘Where would you look to find out how strong your steroid creams and ointments are?’ most (69%) answered ‘on the packaging’. Ninety-seven per cent were in favour of clear potency labelling on all steroid creams and ointments. Sixty-two respondents provided free-text comments that were analysed thematically: 51% expressed confusion about TCS or a need for more information; 18% complained that general practitioners were not sufficiently knowledgeable; 20% voiced concerns about TCS, some vehemently, and most citing ‘topical steroid withdrawal’; 11% were positive about TCS and the information provided, two of whom used the ‘Aron regimen’. Several responses indicated confusion between percentage concentration (stated on the tube) and potency. These findings confirm the clinical impressions that parents of children with eczema have limited understanding of potency and need clearer information on the tube and packaging.
PA22 Topical tacrolimus management of chronic recurrent skin reaction to mauve stinger jellyfish envenomation
Authors: West Cavan , Alessandrini Virginia , Gass Julia K 
Published: June 2023

Abstract
Chronic skin eruptions may follow the acute reaction to envenomation by some jellyfish, the incidence and management of which are not well described. We describe management with topical tacrolimus of a chronic eruption following envenomation by Pelagia noctiluca (‘mauve stinger’), one of the most common stinging jellyfish in the Mediterranean Sea. An 8-year-old girl was stung on the arm by a P. noctiluca in Menorca, Spain. First-aid measures with vinegar and topical antihistamine were administered, and the discomfort settled within 24 h. Five days later, the sting site became increasingly painful and itchy, with superficial ulceration and arm swelling. A second sting site on the lower leg reacted in a similar manner. She was systemically well. She was treated with oral co-amoxiclav, fusidic acid and betamethasone valerate 0.1% cream, and nonadhesive dressings. She initially responded well, but was required to continue the use of potent topical steroid after 3 weeks, as the symptoms recurred within 48 h of halted application. The use of topical tacrolimus cream 0.03% achieved symptom control when used in a slowly weaning regime over 3 months, with a brief flare of skin symptoms around the time of contracting COVID-19. She has now been asymptomatic for 12 months, and the sting site is a maturing scar. Envenomation reactions to jellyfish of the phylum Cnidaria (including P. noctiluca) are the result of varying pathophysiological mechanisms. The tentacles and bell of P. noctiluca carry toxin-releasing epithelial organelles called nematocysts. When triggered, the stinging apparatus fires, injecting thousands of mineralized spine-covered tubules and toxins such as porins [Yanagihara AA, Wilcox C, Smith J, Surrett GW. Cubozoan envenomations: clinical features, pathophysiology and management. In: The Cnidaria, Past, Present and Future (Goffredo S, Dubinsky Z, eds). Cham: Springer, 2016; 637–52]. Acute tissue damage and inflammation are caused by physical trauma and venom effects. Vinegar used at the time of a sting may permanently prevent discharge from unfired and noninjected nematocysts. Hot-water immersion for 30 min inactivates venom, and topical steroids reduce inflammation. The delayed and prolonged skin response (presenting after the primary reaction to envenomation), as in our case, is likely to be an immunological response to the retained, embedded nematocyst structures and may include granulomatous reactions, and eventually scarring. Optimal acute first-aid measures (as above) are thought to reduce incidence of late skin sequelae. This report highlights the successful use of topical tacrolimus immunomodulation for an established delayed reaction.
PA24 Abnormal interferon signature in a patient with chilblain lupus
Authors: Oldham Jaimie , O’Toole Edel 
Published: June 2023

Abstract
A 5-year-old girl of Sri Lankan ancestry with no history of parental relatedness presented with the clinical features of chilblain lupus. This was particularly florid over her dorsal fingers, toes and the soles of her feet with areas in keeping with panniculitis on her calves and an epidermal naevus on the right side of her trunk. There was no ulceration or necrosis. Her parent reported occasional fevers and palpable lymph nodes in her neck. She also has bilateral astigmatism and mild valvular and supravalvular pulmonary stenosis. Blood tests showed a persisting mild transaminitis, an antinuclear antibody of 1 in 160 and a negative double-stranded DNA. She had a skin biopsy that showed supporting features for chilblain lupus. A lymph node biopsy showed nonspecific changes. The clinical suspicion was of a mild form of Aicardi–Goutières syndrome (AGS), and a genetic panel was performed that included TREX1, RNASEH2B, TMEM173 and SAMHD1 (all negative). The common mechanism behind these conditions is a type I interferonopathy. We sent blood on a research basis for RNA extraction and testing of her interferon (IFN) gene signature (IGS), which came back as abnormal (11.895; cutoff score of 2.758); she had normal expression of neutrophil-associated genes. This IFN score is on par with patients who have confirmed AGS or STING-associated vasculopathy with onset in infancy. An IGS is derived from the expression of IFN-regulated genes. A raised IGS has not only been reported to be useful as a biomarker in many rheumatic diseases, but is also used to help identify type I interferonopathies where genetic testing has not identified any clear pathogenic mutations (Crow YJ, Stetson DB. The type I interferonopathies: 10 years on. Nat Rev Immunol 2022; 22:471–83). National Institute for Health and Care Excellence guidelines allow for treatment of interferonopathies with baricitinib in patients with two documented high IFN gene signatures, which is our current plan for this patient.
PD07 Sun exposure and associated risks in 17 countries: UK results
Authors: Passeron Thierry , Dreno Brigitte , Puig Susana , Goh Chee L , Lim Henri W , Ly Fatimata , Kang Hee Y , Morita Akimichi , Ocampo Candiani Jorge , Schalka Sergio , Wei Liu , Le Floc’h Caroline , Kerob Delphine , Krutmann Jean 
Published: June 2023

Abstract
Primary and secondary prevention of skin cancer varies considerably from one country to another. This survey investigates knowledge and behaviours regarding sun exposure in the UK. This UK survey (n = 1000) was conducted online from 28 September to 18 October 2021 and was part of a worldwide survey (n = 17 001) conducted in 17 countries (five continents). Automated selection from the Ipsos online panel ensured samples of 1000 individuals in each country fit the quotas method based on sex, age, employment status and country regions. Data covered demographics, phototype, exposure habits and practices, and knowledge and understanding of risks. The population comprised 49% men [mean (SD) age 46.6 (15.7) years]; 61% were of skin phototypes I–II. Seventy-six per cent of Britons stated that a tanned skin looks attractive vs. 72% worldwide. Seventy per cent of Britons indicated that a tan gives a healthy look, a different perception compared with worldwide (64%). Most Britons were aware of sun-related skin health issues, a better awareness compared with worldwide (94% vs. 88%). Sixty-one per cent did know that sun protection is useful when the weather is overcast, a similar knowledge as worldwide (61%). Furthermore, 15% indicated it was safe to expose themselves without protection when already tanned, a better knowledge than worldwide (23%). In terms of photoprotection, 15% said they protected themselves from the sun all year round, a lower score compared with worldwide (23%). In detail, Britons were more likely to put sunscreen on their face (71% vs. 60%), on their hands, neck and ears (64% vs. 52%), and on the arms, legs and chest (69% vs. 55%) compared with the global population. However, Britons were less likely to try to stay in the shade (73% vs. 77% worldwide) or avoid midday sun exposure (53% vs. 66%). Of those who applied sunscreen, 69% applied it only once or twice a day – a slightly better practice compared with the worldwide average (74%). In terms of knowledge, 71% did not understand the difference between ultraviolet (UV)A and UVB vs. 70% worldwide. Although the risks of sun exposure are widely recognized, sun protection practice is inadequate. This survey provides insight into the need for additional photoprotection education in the UK.
PD08 Sun protection practices of men in the west of Ireland
Authors: Hynes Jason , Griffin Laoise , Laing Mary 
Published: June 2023

Abstract
Irish men get more skin cancer than women, especially of the head and neck area. They typically get more sun exposure and are less likely to wear sun protection factor (SPF). Little is known about the types of hats men wear, or photoprotective practices regarding the lips. We carried out an observational study, using a questionnaire, on men aged &gt; 18 years attending dermatology for any reason. Fitzpatrick skin type and Norwood classification for male pattern baldness was documented. Sixty-one men [mean (SD) age 56 (16.9) years] were involved. Forty-nine per cent were attending for the assessment of skin lesions. Thirty-eight per cent were on immunosuppression. Sixty-four per cent worked outdoors currently or in the past, 79% have or had spent &gt; 3 h outdoors daily. Twenty-six per cent had a Norwood classification of ≥ 3v (vertex of scalp showing). The majority (71%) was of Fitzpatrick skin types I and II. Seventy-nine per cent wore SPF, 19% daily and 17% during the summer. Only 15% of men reported wearing lip SPF. Sixty-eight per cent reported wearing a hat on a ‘sunny day’. Of these, 54% wear baseball (BB) caps, 20% wear a wide-brimmed hat (WBH), 20% a narrow-brimmed hat, 4% a wool or traditional cap and 2% a total face covering. Age did not influence whether a hat was worn, but it did influence the type, with younger men more likely to wear BB caps and older men more likely to wear WBH. Those with hair thinning were more likely to wear a hat (87% vs. 67%). Non-hat-wearers were also less likely to wear SPF. Despite the incidence of skin cancer in sun-exposed sites in men, few studies have focused on photoprotective practices of the head and neck. Our study demonstrates that while Irish men wear SPF, few wear SPF on their lips. Additionally, Irish men often wear a hat type that would not be considered to provide adequate photoprotection to the head and neck. Hat type varied with age, with younger patients wearing less photoprotective hats. When considering photoprotection campaigns, factors such as age, fashion trends and education regarding lip SPF should be considered.
PD11 Photodynamic therapy for treating acne vulgaris
Authors: Ralph James , Alani Angela , Markham Trevor , Murphy Annette 
Published: June 2023

Abstract
In recent years, photodynamic therapy (PDT) has been advised as a possible adjunct to conventional therapy for acne vulgaris (acne). Both the 2021 National Institute for Health and Care Excellence acne guidelines and the 2018 British Association of Dermatologists’ PDT guidelines include PDT as an option to consider for acne in those aged 18 and older and if other treatments are ineffective, not tolerated or contraindicated. There is, at present, insufficient evidence to suggest an exact dosage or treatment protocol. Herein, we present a case of successful use of PDT in a patient with difficult-to-manage acne and the protocol employed. A 21-year-old woman has been attending dermatology for 10 years for acne, with keloid scarring, which is most extensive on her back. She was previously treated with spironolactone and a combined oral contraceptive pill. Topical retinoids and antibiotics, including trimethoprim (to which she developed erythema multiforme), clindamycin, azithromycin and tetracyclines, had all been used for various periods without sustained successful clearance. The patient has a general anxiety disorder with low mood and is taking quetiapine. She is a social media advocate for people with mental health issues and has good insight into her mood. She is educated regarding isotretinoin and contraindications to its use. The patient was treated with a trial of two sessions of PDT 1 week apart. The target area was prepared 3 h in advance of light with methyl aminolaevulinate 16% (as hydrochloride) spread to a thickness of 1–5 mm beyond the area border. Red light (635 nm) with a total dose of 37 J cm−2 was provided for 7 min and 50 s each time. The patient has Fitzpatrick skin type I and experienced moderate postprocedural erythema, which later resolved. At both the 3- and 6-month clinical follow-up, the patient is effectively clear of active acne in the treated area. There is previous residual scarring. The patient is not using any topical or systemic acne treatments. Options for acne treatment are diverse. However, some patients experience ineffective clearance or tolerance, and are not good candidates for isotretinoin. Dermatology centres with PDT may help provide an alternative solution. This case illustrates the successful application of PDT for acne and adds to the body of literature to support its inclusion in the aforementioned guidelines.
PS09 The raising of Lazarus: re-engagement of adults with atopic dermatitis following the advent of novel effective therapies
Authors: O’Connor Cathal , Murphy Michelle 
Published: June 2023

Abstract
Atopic dermatitis (AD) has a devastating impact on quality of life, and persistent AD affects at least 7% of adults. Until recently, options for severe AD beyond topical therapies were limited to phototherapy and conventional immunosuppressive systemic drugs. With the advent of highly effective targeted treatments such as dupilumab and Janus kinase inhibitors (JAKi), patients with AD who had been lost to follow-up in dermatology are now returning en masse for consideration of biologic treatment or JAKi. The aim of this study was to analyse qualitatively the recapture of adults with severe AD who had previously been lost to follow-up because of disillusionment with suboptimal therapies and care. Semi-structured interviews were performed with 12 adults with severe AD to discuss their pathway to return to dermatology. Thematic analysis divided concepts into two categories: experiences of losing contact with dermatology and experiences of re-engagement with dermatology. Themes related to leaving dermatology care included the ineffectiveness of older treatments, toxicity of older treatments, attendance futility, dermatologist fatigue and ‘fizzling out’. ‘The ciclosporin would work for a few weeks but then I would have a flare, and my kidneys nearly gave out’; ‘I could tell the dermatologist was sick of looking at me. Back then I thought I was the problem, but now I think he was embarrassed because he couldn’t help me’; ‘I never decided I was going to stop going, it just ended up fizzling out and never going back.’ Themes related to re-engaging with dermatology care included social media influence, novelty, exasperation with quality of life and the life-changing improvements seen with novel treatments. ‘I saw someone on Facebook showing pictures after a few weeks on the injection and I went straight to my GP for a referral back to the dermatologist’; ‘After 60 years with eczema I just wanted to try something new, even if it killed me!’; ‘A few days after starting the tablets I left like Lazarus, it was like standing up out of a wheelchair for the first time in my life.’ This study highlights the reasons why adults with AD left dermatology services, explains why they re-engaged and deeply explores the transformative effect that novel treatments have had on the AD landscape. As adults with AD continue to return to dermatology care, the implications of increasing patient numbers needing biologic and JAKi therapy should be factored into healthcare and finance planning.
PS14 Bimekizumab response up to 3 years in patients with moderate-to-severe plaque psoriasis who responded at week 16: post hoc results from the BE BRIGHT open-label extension trial
Authors: Warren Richard B , Strober Bruce , Lebwohl Mark , Foley Peter , Langley Richard G , Davis Leah , Hoepken Bengt , Szilagyi Balint , Ciaravino Valerie , Bewley Anthony 
Published: June 2023

Abstract
Treatment with the interleukin-17A/F inhibitor bimekizumab (BKZ) has demonstrated maintenance of efficacy and health-related quality of life (HRQoL) outcomes over 2 years. The objective of this analysis was to assess the long-term response in patients with moderate-to-severe plaque psoriasis who achieved Psoriasis Area and Severity Index (PASI) ≤ 2, a key treat-to-target outcome, after 16 weeks of BKZ treatment over 3 years. Patients who completed a 52- (BE VIVID) or 56-week (BE SURE and BE READY) phase III feeder study were eligible to enrol in the BE BRIGHT open-label extension (OLE) (NCT03370133, NCT03412747, NCT03410992 and NCT03598790). Upon OLE entry, patients received BKZ 320 mg Q4W or Q8W based on feeder study treatment and week 52/56 PASI 90 (≥ 90% improvement in PASI) response. Patients switched from BKZ Q4W to Q8W at OLE week 24 (based on investigator discretion and PASI 90 response), or OLE week 48/next scheduled visit (all patients). Achievement of body surface area (BSA) ≤ 1% and PASI 0 (all studies), and Dermatology Life Quality Index (DLQI)0/1 (BE SURE and BE READY only due to schedule differences) is reported among week 16 PASI ≤ 2 responders through year 1 (feeder study week 52/56) and year 3 (OLE week 96). Analysed patients were randomized to BKZ, received BKZ maintenance dosing from feeder study week 16 and entered the OLE, including a subset who received BKZ Q4W through to week 16 then continuous BKZ Q8W (Q4W/Q8W/Q8W). Missing data were imputed using modified nonresponder imputation (mNRI): patients who discontinued treatment due to lack of efficacy or treatment-related adverse events were considered nonresponders; multiple imputation was used for all other missing data. The week 16 responder rate is also reported (NRI). At baseline, 989 patients were randomized to BKZ; 87.8% (n = 868) achieved PASI ≤ 2 at week 16. Of these, 694 entered the OLE. Among week 16 PASI ≤ 2 responders (n = 694), 91.9% and 82.3% achieved BSA ≤ 1% and PASI 0 after year 1 (52 weeks), and 88.6% and 74.1% after year 3, respectively. Among week 16 PASI ≤ 2 responders (n = 445), 87.8% and 86.8% achieved DLQI 0/1 after year 1 (56 weeks) and year 3, respectively. Of the week 16 PASI ≤ 2 responders who received BKZ Q4W/Q8W/Q8W (n = 189), 95.2% and 87.6% achieved BSA ≤ 1% and PASI 0 after 1 year (52 weeks), and 93.4% and 79.7% after 3 years, respectively. Among the Q4W/Q8W/Q8W patients, 94.1% and 91.2% achieved DLQI 0/1 after year 1 (56 weeks) and year 3, respectively. The BKZ provided long-term efficacy and HRQoL benefits. Among week 16 PASI ≤ 2 responders, the vast majority sustained high levels of clinical and HRQoL responses through 3 years of BKZ treatment, including those who received BKZ Q4W/Q8W/Q8W.
Funding: UCB Pharma. Medical writing: Costello Medical.