bluuebunny/crossref_metadata_2025_split huggingface dataset:
P95 A single-centre retrospective study of the association between subacute cutaneous lupus erythematosus and malignancy
Authors: Duff Eimear , Gilhooley Eimear , O’Shea Finbar , Wynne Bairbre 
Published: June 2023

Abstract
Subacute cutaneous lupus erythematosus (SCLE) is a rare photosensitive dermatosis that has been classically categorized as idiopathic or drug-induced. A proliferation of case reports and small case series support the hypothesis that the presentation of new-onset idiopathic SCLE can be a facultative paraneoplastic phenomenon. There remains a lack of consensus regarding the investigations that this dermatosis should initiate, and in which patients. The aims were to investigate the proportion of patients with biopsy-consistent SCLE who had an underlying malignancy, and to analyse the demographic, clinical and laboratory characteristics associated with this. We conducted a histopathology database word search of skin biopsy reports from 1995 to 2021. We performed a retrospective chart review of electronic and paper records and analysed demographic, clinical and laboratory data of patients with possible SCLE. This study received full ethical approval from the relevant local research ethics committee. Of 64 patients initially identified, 35 had SCLE following clinicopathological correlation and had sufficient data available for inclusion. In this cohort, a total of 16 (46%) patients had a malignancy, either preceding or following SCLE diagnosis. In eight (23%) patients, malignancy was diagnosed within 1 year of SCLE onset. SCLE was considered drug induced in 14 (40%) of cases. Eleven (31%) cases were considered to be idiopathic; of these, five (45%) were subsequently diagnosed with malignancy. Malignancies subsequent to the diagnosis of idiopathic SCLE all occurred in women (aged 66–74 years). There were no significant differences in the autoantibody profiles between patients with malignancy and the overall SCLE cohort. Malignancies were detected, on average, 41 days (range 11–74) after the diagnosis of SCLE. Subtypes of cancer diagnosed post-SCLE were lung (n = 4, all current or ex-smokers) and colorectal (n = 1, a never smoker). In four of these cases, investigation for malignancy was specifically advised by dermatology. This is the first reported retrospective study to explore the under-recognized association between SCLE and malignancy. Clinicians should be aware of the potential paraneoplastic nature of SCLE, especially in the context of risk factors such as smoking history and an older age profile.
P99 Skin disease in people living with HIV in the UK: a retrospective analysis
Authors: McCluskey Jamie , Hickling Louis , Iwuji, Collins , Chandler David 
Published: June 2023

Abstract
The spectrum of skin disease associated with advanced HIV infection is well described and can vary between countries, potentially as a result of genetic differences and access to antiretroviral treatment (ART). Effective ART has modified the skin manifestations of HIV in the modern era. The aim of this study was to characterize the profile of skin disease in a UK-based population of people living with HIV (PLHIV). A retrospective review of inpatient admission records was conducted of all patients admitted to a tertiary hospital between June 2020 and October 2022. Data were collected using a standardized data extraction form in Microsoft Excel. Descriptive analysis was undertaken within Excel. Ninety-seven patients were identified (median age 55 years), of whom 82 (85%) were male. Median duration of HIV infection was 15 years [interquartile range (IQR) 8.66–19.58], with a median duration on ART of 9 years (IQR 3–16). Fourteen patients were ART naïve and were diagnosed as being HIV positive on admission. Median CD4 count at presentation was 351 × 106 cells L−1 (IQR 136–579). Fifty-five patients presented with a single dermatological condition, 30 presented with 2 and 10 presented with 3. Of the conditions identified, 48% were skin infections, 18% were skin tumours, 10% were inflammatory dermatoses and 2.8% were drug reactions. In the remaining 21%, the diagnosis was unknown; this included rashes (44%), skin lesions (33%) and ulcers (22%). The most common dermatological condition identified was cellulitis (n = 18; 19%). Of the infections seen, 46% were primary bacterial infections, 27% were primary viral infections, 22% were primary fungal, 3% were primary parasitic and 1% were systemic bacterial infection with skin involvement. Ten per cent of patients presented with Kaposi sarcoma, an AIDS-defining illness. Of the 97 patients, 27% presented with advanced HIV (CD4 &lt; 200 × 106 cells L−1). The most common conditions in this group were oral candidiasis (30%), cellulitis (15%), seborrhoeic dermatitis (15%) and Kaposi sarcoma (15%). Bacterial skin infections were the most common dermatological conditions overall, while oral candidiasis was the most common condition in those with advanced HIV. The causes of almost one-quarter of dermatological presentations were unknown during inpatient admission, highlighting the importance of expert dermatological input. Further work is needed to validate these findings in a larger population of PLHIV, including those managed in an outpatient setting.
P103 A retrospective observational study of toxic epidermal necrolysis at a tertiary referral centre from 2015 to 2022
Authors: Watson Nicola , Best Katie , Meggitt Simon , Hampton Phil 
Published: June 2023

Abstract
Toxic epidermal necrolysis (TEN) is associated with high mortality and morbidity. Owing to a lack of robust evidence, treatment guidelines are ambiguous and clinicians must use discretion in management decisions, specifically with regard to the use and choice of systemic agents, including immunosuppressants. We present a retrospective study of cases referred to a tertiary referral centre between 2015 and 2022. Cases were identified using histopathology coding and a database compiled by clinicians. Forty cases were categorized as follows: TEN (n = 12); Stevens–Johnson syndrome (SJS)/TEN overlap (n = 5); SJS (n = 5); unclear (n = 9); insufficient information (n = 5) and others [n = 9 (lupus, n = 4; erythema multiforme major, n = 3; burn, n = 1; recurrent erythema multiforme, n = 1)]. The median age of patients with TEN was 66 [interquartile range (IQR) 53.3–74; 33% men, 67% women]. The median percentage body surface area of epidermal loss was 40% (n = 8; IQR 30–70). Forty-two per cent of patients had an underlying malignancy. Implicated medications included nivolumab/ipilimumab (n = 2), co-trimoxazole (n = 2), carbamazepine (n = 1) and proton pump inhibitors (n = 3). Sixty-seven per cent of patients with TEN were managed by the burns centre, with a further 17% admitted to the intensive care unit. One patient presented directly to the dermatology team and 58% were transferred from other hospitals. The median time from the documented onset of rash to transfer to specialist care was 5 days (IQR 2.8–11.5). Thirty-three per cent of patients were given immunosuppression (intravenous methylprednisolone). The median duration of admission was 14 days (IQR 7.5–21.5). Fifty-eight per cent of patients (n = 7) survived. None of the five patients who died had received immunosuppression. The median time from onset of rash to receiving specialist care was 3.5 days for those who survived (n = 4) vs. 10 days for those who did not (n = 3; P = 0.03). Thirty-three per cent of patients had documented chronic complications (severe ophthalmic sequelae, n = 2; circumcision for phimosis, n = 1). This study was limited by the retrospective collection of data and the method used to identify cases. The current evidence for the treatment of TEN is primarily derived from small case series that often combine heterogeneous cases of TEN, SJS/TEN overlap and SJS. This is highly problematic as the risk–benefit dynamic varies greatly between patients with SJS, who have an excellent prognosis without treatment, and patients with TEN with a high associated mortality, who potentially have more to gain from immunosuppression. Our data support the need for patients to access specialist care promptly, to allow for early consideration of immunosuppression. Future research should focus on effective treatments for reducing mortality in cases of TEN specifically.
BH01 Experiences of nail pathology seen within a specialist clinic over 1 year
Authors: Wolfe Charlotte , Ye Christina , Li Ling , Yiu Daniel , Laheru Dhruvkumar 
Published: June 2023

Abstract
Nail disorders comprise an important subset of dermatological conditions that can pose diagnostic and therapeutic challenges for clinicians. The pathology can be limited to the nail or reflect wider systemic processes. We present a single-centre cross-sectional study on nail conditions seen within a specialist nail clinic over a 12-month period. Demographic and clinical data were collected retrospectively using electronic patient records and analysed using a coding framework. In total, 62 new patients, including 12 paediatric patients, were seen between August 2021 and July 2022. The average patient age was 41 years. Only four patients were seen twice. In terms of ethnicity, 28 patients were White, six were Asian, two were Black and one patient was of mixed race. Ethnicity data were unavailable for 25 patients. Although most patients presented with a single pathology (76%), 24% presented with two or more pathologies. In total, 79 nail diagnoses were given for 62 patients; aetiological categories included infection (onychomycosis, infection other), inflammatory, tumour, trauma, melanonychia, congenital, structural, systemic and idiopathic. Patients had fingernail involvement alone, toenail involvement alone or involvement of both sites. The most common pathologies seen were infection (other) and infection (onychomycosis), accounting for 33% of the conditions seen; melanonychia was next most frequently observed at 18%. Onychomycosis accounts for up to 40% of all nail diseases in the UK. In our nail clinic, onychomycosis consisted of 17.7% of diagnoses. Across Europe, the overall prevalence has been reported to be 23%. In France, the prevalence of onychomycosis is reported to be 20–30% within general practice and dermatology. The true incidence is difficult to assess due to the lack of large-scale studies. We may see fewer cases in secondary care due to the podiatry service available in the UK. The availability of podiatry professionals varies across the world and we believe this plays a role in the presentation of nail diseases to physician-led clinics. Our review here did not encompass UK 2-week-wait cancer referrals, which were accommodated with our consultant as soon as possible. Patients often present to our clinic due to diagnostic uncertainty, especially regarding linear melanonychia, which generates anxiety in primary care. Secondary complications such as nail dystrophy and toenail displacement are also frequent causes for referral. This review, although single centre and retrospective, is a comprehensive snapshot of nail pathology at a UK specialist centre and demonstrates the pathologies encountered in secondary care, helping to plan future services and direct both primary care and trainee teaching.
BH02 Online psychological support for patients with alopecia areata: an evaluation of available online psychological support material based on the National Centre for Complementary and Integrated Health guidelines
Authors: Lumley Rebecca , Asfour Leila , Montgomery Kerry 
Published: June 2023

Abstract
Alopecia areata is an autoimmune disorder causing nonscarring hair loss that is associated with significant psychological comorbidity (Macbeth AE, Holmes S, Harries M et al. The associated burden of mental health conditions in alopecia areata: a population-based study in UK primary care. Br J Dermatol 2022; 187:73–81). In addition to seeking psychological support from medical professionals, patients will often turn to online resources. In this study, we evaluated the range and quality of the online psychological support material available for patients with alopecia areata. A Google search was undertaken using private browsing on 5 June 2022, with several search terms: ‘alopecia areata online support group UK’, ‘alopecia support’ and ‘alopecia areata psychology’. The National Centre for Complementary and Integrated Health (NCCIH) guidelines for the evaluation of online resources were used. These guidelines assess information source and accuracy, funding, peer review status, linking policies and contemporaneity. Our search generated a total of 154 000 results. Advertisements, scientific articles, educational resources and duplicates were excluded, with nine resources included in the final analysis. Of the nine resources reviewed, three were specific for patients with alopecia areata, with the remaining resources focused on other types of hair loss. Six were authored or reviewed by dermatologists and seven had a documented peer review process of their content. One resource had no clear authorship and three had no clear peer review process. Nine of the resources were charity funded and one was a National Health Service resource. Four had been updated in the last 3 years and a further two within 5 years. All resources had clearly documented security and linking policies. All resources acknowledged the psychological impact of hair loss and eight had links to support groups or discussion forums. Only five had psychological support and advice on their website, with others only referring to the psychological burden and then signposting patients on to other sources for support. Only three of the resources referred to therapies such as cognitive behavioural therapy. The prevalence of mental health comorbidity in alopecia areata is high compared to the general population (Macbeth et al.). Our preliminary study has shown that the online psychological support available is lacking. With patients increasingly turning to the Internet for support and health information, there is an opportunity and need for development in this area.
BH05 Successful treatment of acrodermatitis continua of Hallopeau with methotrexate
Authors: Bala Laksha , Hussain Khawar , Phillips Derrick 
Published: June 2023

Abstract
A 39-year-old woman was referred with a 3-month history of brittle nails, painful fingertips and psoriasiform plaques affecting her torso and limbs. She had a past medical history of macrocytic anaemia secondary to dietary B12 and folate deficiencies, which required inpatient transfusions. She had no previous dermatological concerns, and there was no history of infection or trauma to the affected sites. On examination of her hands and feet, there was evidence of nailbed pustulation, subungual hyperkeratosis, onychodystrophy, anonychia of multiple nails and dactylitis, consistent with acrodermatitis continua of Hallopeau (ACH) with associated psoriasis. At diagnosis, the patient’s Dermatology Life Quality Index (DLQI) was 16, she had a Psoriasis Area and Severity Index (PASI) score of 18 and a Psoriasis Epidemiology Screening Tool (PEST) score of 4. Nail fungal culture was negative. Plain radiographs of the hands and feet demonstrated a flexion deformity of the left fifth finger distal interphalangeal joint, with otherwise normal bone texture, alignment and joint spaces. The patient was initially treated with potent topical corticosteroids and vitamin D analogues, with little improvement. The patient was commenced on 15 mg subcutaneous methotrexate (MTX), with close monitoring of serum and red cell folate given her background of folate deficiency, which was being actively replaced. Within 3 months of starting MTX monotherapy, the patient’s hands had dramatically improved with skin and fingernail changes largely resolved, and an improvement in manual dexterity (DLQI 11, PASI 3, PEST 5). MTX was increased to 20 mg once weekly and the patient was also started on sulfasalazine 500 mg twice daily by her rheumatologist for psoriatic arthritis. ACH is a chronic pustular eruption initially affecting distal phalanges with gradual proximal progression and the potential development of generalized pustular psoriasis. ACH is considered a variant of palmoplantar pustulosis, commonly affecting adult females with localized trauma and infection as possible triggers. Given the rarity of ACH, the evidence base for therapy is limited to case reports and series, with no standardized treatment guidelines. Topical therapies include corticosteroids, calcineurin inhibitors and vitamin D analogues. Local phototherapy and systemic therapy with acitretin, MTX and ciclosporin have been described, with wide-ranging results. In severe cases such as this, patients typically receive biologic therapy, with variable responses reported with tumour necrosis factor-α inhibitors, anti-interleukin (IL)-6 therapy, and anti-IL-12/IL-23 and anti-IL-17 therapy. We present a rare case of severe ACH and psoriasis, treated with MTX monotherapy, which was not only clinically effective but also cost-effective.
BI13 (P99) Skin disease in people living with HIV in the UK: a retrospective analysis
Authors: McCluskey Jamie , Hickling Louis , Iwuji Collins , Chandler David 
Published: June 2023

Abstract
The spectrum of skin disease associated with advanced HIV infection is well described and can vary between countries, potentially as a result of genetic differences and access to antiretroviral treatment (ART). Effective ART has modified the skin manifestations of HIV in the modern era. The aim of this study was to characterize the profile of skin disease in a UK-based population of people living with HIV (PLHIV). A retrospective review of inpatient admission records was conducted for all patients admitted to a tertiary hospital between June 2020 and October 2022. Data were collected using a standardized data extraction form in Microsoft Excel. Descriptive analysis was undertaken within Excel. Ninety-seven patients were identified (median age 55 years), of whom 82 (85%) were male. Median duration of HIV infection was 15 years [interquartile range (IQR) 8.66–19.58], with a median duration on ART of 9 years (IQR 3–16). Fourteen patients were ART naïve and were diagnosed as being HIV positive on admission. Median CD4 count at presentation was 351 × 106 cells L–1 (IQR 136–579). Fifty-five patients presented with a single dermatological condition, 30 presented with two and 10 presented with three. Of the conditions identified, 48% were skin infections, 18% were skin tumours, 10% were inflammatory dermatoses and 2.8% were drug reactions. In the remaining 21%, the diagnosis was unknown; this included rashes (44%), skin lesions (33%) and ulcers (22%). The most common dermatological condition identified was cellulitis (n = 18; 19%). Of the infections seen, 46% were primary bacterial infections, 27% were primary viral infections, 22% were primary fungal, 3% were primary parasitic and 1% were systemic bacterial infection with skin involvement. Ten per cent of patients presented with Kaposi sarcoma, an AIDS-defining illness. Of the 97 patients, 27% presented with advanced HIV (CD4 &lt; 200 × 106 cells L–1). The most common conditions in this group were oral candidiasis (30%), cellulitis (15%), seborrhoeic dermatitis (15%) and Kaposi sarcoma (15%). Bacterial skin infections were the most common dermatological conditions overall, while oral candidiasis was the most common condition in those with advanced HIV. The causes of almost one-quarter of dermatological presentations were unknown during inpatient admission, highlighting the importance of expert dermatological input. Further work is needed to validate these findings in a larger population of PLHIV, including those managed in an outpatient setting.
BI28 Phaeohyphomycosis in the immunosuppressed patients: the challenges of treatment
Authors: Khan Farishta , Jayaprakash Sindoora , Verpetinske Indre 
Published: June 2023

Abstract
Phaeohyphomycosis is a group of multisystem mycoses owed to heterogeneous organisms called ‘dematiaceous’ or ‘melanized’ fungi. The presence of melanin in their cell walls is a distinguishing feature, likely to be acting as a virulence factor. Widely abundant in the environment, these organisms commonly infect humans through traumatic inoculation and have many clinical forms of presentation, including cutaneous, subcutaneous, systemic, and rarely disseminated. Both immunocompetent and immunocompromised hosts are affected. Diagnosis of the cutaneous infection is primarily reliant on histology and culture; treatment is not standardized and is based on clinical experience. We report a case of a 39-year-old man who presented to the dermatology clinic with ‘lumps’ on his lower limbs. His background included poorly controlled hypertension and diabetes mellitus type 2 leading to nephropathy and necessitating a renal transplant, which failed. A 5-year period of dialysis involving a sedentary lifestyle was followed by a repeat renal transplant during which time he developed multiple warty-looking nodules of varying size, with pseudomilia cysts on his lower limbs in addition to stasis changes. Histology reported a pigmented mould infection (probably phaeohyphomycosis), and there was no growth on culture. The patient was trialled on two azole antifungals at different times, but on both occasions, he dived into congestive cardiac failure needing intensive care unit admissions. Reducing immunosuppression therapy was difficult considering his previous failed renal transplant. Owing to the extent and multiplicity of the lesions on the background of immunosuppression, the surgical treatment option poses significant risks. Currently, he is managed on topical treatment with some stabilization of the lesions; however, it is unclear how these will progress in the future. Although uncommon, the number of patients with phaeohyphomycosis has increased due to awareness of melanized fungi on a background of the global COVID-19 pandemic, with SARS-CoV-2, and the use of immunosuppressive agents such as glucocorticoid therapy increasing the risk of infections of deep mycosis. Treatment for phaeohyphomycosis has largely been surgical excision for localized lesions in addition to oral antifungals. Our case highlights that, in transplant patients, therapeutics are difficult, with life-threatening complications from oral antifungals and the risks of surgical intervention including ulceration, bleeding and infections. In addition, the cosmetic appearance of the prevalent noticeable lesions for a relatively young patient is also significant and patient counselling is vital, especially when treatment options are minimal.