tbuckley/cabot-search huggingface dataset:
P109 Association between air quality index and the risk of rosacea: a nationwide population-based cohort study
Authors: Sheng-Hsiang Ma, Chun-Ying Wu, Meng-Chieh Li, Hsiu J Ho, Chon-Kit Ao, Chen-Yi Wu
Journal: British Journal of Dermatology (2024)

Abstract Air pollution is associated with several inflammatory skin disorders. However, the association between air quality and rosacea remains unclear. Our objective was to investigate the association between air quality index (AQI) and the incidence of rosacea. Overall, 21 709 479 participants without rosacea before 2008 were recruited from the Taiwan National Health Insurance Research Database. The long-term average AQI value for each participant was acquired from the Taiwan Air Quality Monitoring System Network and was calculated from 1 January 2008 until the diagnosis of rosacea, withdrawal from National Health Insurance, or 31 December 2018. We observed a significant association between AQI and the incidence of rosacea, with each unit elevation in AQI increasing the risk of rosacea by 5%. Compared with the quartile 1 group, the quartile 2, 3 and 4 cohorts exhibited 1.82-fold, 4.48-fold and 7.22-fold increased risks of rosacea, respectively. Additionally, exposure to PM2.5, SO2 and CO increased the risk of rosacea, whereas exposure to PM10 was associated with a lower risk. Limitations of this study include its retrospective design and involvement of participants mainly from Taiwan. Additionally, some potential confounding factors may not have been accessible in the database. This study supported a significant dose–response relationship between AQI and the incidence of rosacea.
BH03 Do patients with afro-textured hair who are experiencing hair loss feel understood by their dermatologists? A cross-sectional study
Authors: Emma Amoafo, Holly Baker, Victoria Akhras
Journal: British Journal of Dermatology (2024)

Abstract Providing good-quality care for skin and hair conditions in patients with skin of colour is an important area of dermatology. This study aims to analyse patient perceptions of their dermatology experience with hair loss and caring for afro-textured hair. We also examined whether they were signposted to the British Association of Dermatologists patient information leaflet (BAD PIL) ‘Caring for Afro-textured hair’ [British Association of Dermatologists. Caring for Afro-textured hair. Available at: https://www.bad.org.uk/pils/caring-for-afro-textured-hair (last accessed 19 April 2024)]. Patients with afro-textured hair attending a consultation for hair loss between 2020 and 2023 were included. Patients consented to participating in an anonymous online survey. A Google form was emailed to participants between December 2023 and January 2024, with responses recorded. A link to the BAD PIL was attached to the survey. Seventeen patients responded. Of these, 59% did not receive a diagnosis prior to seeing a dermatologist. In total, 71% of patients did not fully understand the cause of their hair loss and commonly used social media (53%), online websites (41%, including 18% using the BAD website) and family and friends (35%) to seek information about hair loss. Social media (35%) and family and friends (29%) were the most common forms of seeking information regarding caring for their hair. After seeing a dermatologist, 13 patients (76%) received a diagnosis. Fourteen patients (82%) were offered a biopsy, which 12 underwent. Overall, 29% of patients believed their dermatologist understood their hair loss very well, 24% somewhat well, 35% not very well and 6% not at all. Most patients (63%) had the same understanding about their hair loss after their consultation, and half of patients (47%) did not gain any confidence about managing their hair loss. Patients are more likely to refer to the BAD website after seeing a dermatologist (35%). However, only five patients (29%) were signposted to the BAD PIL during their consultation. Overall, 41% of patients found the leaflet somewhat or very helpful. Patients expressed that their consultation was more beneficial when they were seen by a doctor with afro-textured hair, and were disappointed when signposted to leaflets that featured hair loss in non-afro-textured hair. Others feel saddened because there is ‘no cure’ and current management has not helped. This study highlights the challenges that patients with afro-textured hair face in the management of their alopecia. There appears to be a perception that dermatologists do not fully understand hair loss in afro-textured hair, unless they have such hair themselves. Further education to dermatology colleagues is imperative to improve patient care and satisfaction. The BAD PIL is a useful signpost, which can be more reliable than patients relying on social media for advice.
P113 Ocular involvement and care provision in children with epidermolysis bullosa
Authors: Marina Shatskikh, Fiona Browne
Journal: British Journal of Dermatology (2024)

Abstract Epidermolysis bullosa (EB) is a group of skin fragility conditions that result from defects in connective tissue proteins. Classification is based on the level of skin cleavage, with four major subtypes (Has C, Bauer JW, Bodemer C et al. Consensus reclassification of inherited epidermolysis bullosa and other disorders with skin fragility. Br J Dermatol 2020; 183: 614–27). Skin fragility is a cardinal feature of EB but mucosal involvement is highly variable depending on subtype. There are limited data evaluating ocular mani­festations of EB, associated management and related outcomes. The aim of this study was to assess ocular manifestations among children with EB attending the National EB Clinic and to compare management against current best practices [Chen VM. Eye care for EB patients: strategies to prevent blistering, scarring and vision loss. Lecture at the DEBRA Care Conference, 2018. Available at: https://www.debra.org/eb-care-tips/eye-care (last accessed 19 February 2024)]. This would provide a better understanding of patients’ needs, helping to identify gaps in care and develop strategies to support patients in obtaining care. We carried out a retrospective chart review, correlating patients’ genotype, phenotype, ocular symptoms and management of the same (access to ophthalmology and treatment adherence). Additionally we circulated a postal questionnaire to patients and carers. Records of 69 patients (52% female) aged 10 months to 22 years were reviewed. The average age at diagnosis was 1.7 years. Overall, 51% had EB simplex (EBS), 19% dominant dystrophic EB (DDEB), 17% recessive dystrophic EB (RDEB), 10% junctional EB (JEB) and 3% Kindler syndrome. In total, 38% of all patients had ocular involvement. Those most commonly affected had RDEB (35%) or JEB (23%). Patients with EBS (31%), DDEB (8%) and Kindler syndrome (4%) presented with mild ocular concerns including itch (27%), dryness (42%) or sticky eyes (27%). More severe ocular involvement presented as redness (12%), pain (19%), inability to open the eye (15%), excessive tearing (15%), blepharitis (8%), conjunctival or corneal erosions, ulcerations or scarring (27%), trichiasis (4%), astigmatism (4%), amblyopia (8%) and/or vision loss (35%), necessitating regular ophthalmology review. Only 36% of patients were referred to ophthalmology, either at diagnosis or at onset of symptoms. Of those, 16% attended annually, with follow-up for others generally limited to ‘as required’. Our results highlight gaps in care. Only a small proportion of patients are engaged with ophthalmology services; over 60% have never been formally assessed. Given the variability in the presentation and severity of eye disease, prompt ophthalmology review at the time of diagnosis is vital to manage symptoms and minimize long-term damage. A personalized approach to management is key to ensure that patients’ unique needs are met and outcomes improved.
P081 A highly selective Janus kinase 1 inhibitor, ivarmacitinib ointment, for the treatment of atopic dermatitis: results from a phase II study
Authors: Baoping Li, Joshua S H Goh, Duoqin Wang, Jinhua Xu, Aik Han Goh
Journal: British Journal of Dermatology (2024)

Abstract Atopic dermatitis (AD) is a pruritic chronic inflammatory skin disorder. Ivarmacitinib, a highly selective inhibitor of Janus kinase 1, potently suppresses cytokine signalling involved in AD pathogenesis. A randomized, double-blind, vehicle-controlled, seamless and adaptive-designed phase II/III study was conducted to evaluate the efficacy and safety of ivarmacitinib ointment in patients with AD. The results of phase II are reported here. The study was registered with ClinicalTrials.gov (NCT04717310). In total, 128 patients aged 18–65 years with mild-to-moderate AD were randomly assigned (1 : 1 : 1 : 1) to receive twice-daily topical ivarmacitinib ointment 2%, 1% or 0.5%, or vehicle for 8 weeks. Efficacy evaluation included Eczema Area and Severity Index (EASI), Investigator’s Global Assessment (IGA), Scoring of Atopic Dermatitis (SCORAD), Pruritus numerical rating scale (NRS) and Dermatology Life Quality Index (DLQI). At week 8, all three doses met the primary endpoint, mean percentage change of EASI from baseline. The results in the arms with ivarmacitinib 2%, 1% and 0.5% were −56.1%, −54.6% and −66.9% (P = 0.06, 0.08, 0.002, respectively), compared with vehicle (−40.2%). The ivarmacitinib 0.5% ointment group also achieved IGA response (IGA score of 0/1 with ≥ 2 points improvement from baseline) compared with vehicle. Other endpoints including SCORAD, NRS and DLQI all showed therapeutic benefit at week 8 in the ivarmacitinib ointment regimens. The ivarmacitinib ointment demonstrated good safety results and was well tolerated. In conclusion, ivarmacitinib ointment at 2%, 1% or 0.5% strength significantly improved signs and symptoms compared with vehicle and was well tolerated in adult patients with mild-to-moderate AD. This study was funded by Reistone Biopharma Co., Ltd.
P068 A history of mycosis fungoides: from Alibert to mogamulizumab
Authors: Nicholas A Johnson, Zoe C Venables, Khaylen Mistry, Nick J Levell
Journal: British Journal of Dermatology (2024)

Abstract In 1806, French physician Baron Jean-Louis Alibert treated a 56-year-old man with a desquamating rash and skin tumours. Alibert considered this to be a variant of yaws. In 1829 Alibert named the condition mycosis fungoides (MF), meaning ‘mushroom-like fungal disease’. Over 100 years later, French dermatologist Albert Sézary published papers from 1938 to 1949 detailing a mysterious disease that caused erythroderma and ‘cellules monstrueuses’, describing cutaneous ‘monster cells’. In 1961, these clinical findings were collated together into ‘Sézary syndrome’. There was widespread confusion between these conditions, i.e. fungal infections and yaws. In the 1870s English dermatologist William Tilbury Fox published a dermatology atlas detailing cases similar to what we know now as MF, with the name ‘fibroma fungoides’. The atlas described MF as a type of fungus, before giving a description of yaws and painting a clinical picture that differed from that of a lymphoma. In 1975, Pierre-Antoine-Ernest Bazin and associates suggested the classification system and term we now recognize as cutaneous T-cell lymphoma (CTCL). Neoplastic cells have been thought to arise from chronic activation of T cells via antigen-presenting cells, yet the antigen to trigger this response remains unknown. Several potential bacterial, viral, fungal and iatrogenic causes have been studied, but no reliable triggers have been discovered. In 2018, the World Health Organization and European Organisation for Research and Treatment of Cancer officially recognized four types of MF. These are the classic Alibert–Bazin type (representing 88.6% of cases) and its three subtypes; folliculotropic MF (11.4%), Pagetoid reticulosis, and granulomatous slack skin (both with a combined 1% prevalence). CTCL has an incidence of approximately 0.2–0.6 per 100 000 person-years, with MF being the most common subtype. MF is twice as common in male as in female patients. It is twice as common in those of Black ethnic background than in White and Asian ethnicities. Development of immunohistochemistry and polymerase chain reaction for the T-cell receptor gene in the 1980s improved the diagnosis of CTCL. However, diagnosis of MF remains challenging due to its heterogeneous presentation, often mimicking inflammatory dermatoses. Advanced diseases therapies have evolved from cytotoxic chemotherapy in the 1970s to novel monoclonal antibodies such as mogamulizumab, targeting proteins on T-cell lymphoma cells (CCR4). Reflection on the past two centuries from Alibert to mogamulizumab offers insight into the challenges that accompany the aetiology, diagnosis, classification and management of MF.
Clinicopathological CasesCPC01 An unexpected infection in dermatology outpatients: cutaneous diphtheria
Authors: Helena Wells, Joanne Hague, Claudia Roberts
Journal: British Journal of Dermatology (2024)

Abstract A 29-year-old asylum seeker presented to the emergency department with abdominal pain and a 1-month history of bilateral crusted plaques on his shins, associated with night sweats and lethargy. On examination he had multiple crusty erythematous plaques on the lower limbs, with some scattered pustules. Full-body examination was otherwise normal, except for multiple palpable inguinal lymph nodes bilaterally. Investigations revealed normal bloods and also included chest X-ray, urinalysis and computed tomography of the urinary tract. A dermatology referral was made, and differentials included ecthyma, atypical mycobacterial infection, fungal infection, or an iatrogenic cause with secondary infection. The patient was planned for multiple punch biopsies to be sent for haematoxylin and eosin staining, and tissue and mycobacterial culture. Unfortunately, a skin swab was rejected. A punch biopsy sent for culture surprisingly demonstrated the growth of a Gram-positive rod, identified as Corynebacterium ­diphtheriae, which was toxin gene positive. Histology showed a vesicopustule within the stratum corneum and upper epidermis containing neutrophils. The patient was diagnosed with cutaneous diphtheria. Cutaneous diphtheria is the most common nonrespiratory manifestation of the disease and can occur as a primary infection or in a pre-existing wound (Rahim NRA, Koehler AP, Shaw DD, Graham CR. Toxigenic cutaneous diphtheria in a returned traveller. Commun Dis Intell Q Rep 2014; 38: E298–300). It presents with shallow rolled-edged ulcers with a grey membrane at any skin site, including the genitals. It is reported that diphtheria is most contagious in its cutaneous form, where ulcers act as a reservoir for infection, which can be spread via wound manipulation (de Benoist A, White JM, Efstratiou A et al. Imported cutaneous diphtheria, United Kingdom. Emerg Infect Dis 2004; 10: 511–13). Prior vaccination does not prevent infection but stops systemic symptoms. Although rare, cases of cutaneous diphtheria are increasing in the UK, especially in asylum seekers. This case was identified by the dermatology department, which can be the location of first presentation. Lesions are clinically indistinguishable from other cutaneous infections, and so diphtheria must be considered as a differential in high-risk individuals. Vaccination does not prevent infection, but merely reduces the severity of the disease course. This can have important implications for staff safety if not recognized early, as in our case multiple exposed members of staff were required to isolate, take prophylactic antibiotics and receive a booster vaccination following exposure.
P110 Comparative efficacy of low-dose oral minoxidil, topical minoxidil, and platelet-rich plasma with topical minoxidil in androgenetic alopecia: a randomized controlled trial
Authors: P Janaani, Sendhil Kumaran, K Vinay, Hitaishi Mehta, Vinod Kumar Sharma
Journal: British Journal of Dermatology (2024)

Abstract Androgenetic alopecia (AGA) is conventionally managed with topical minoxidil, while platelet-rich plasma (PRP) and oral minoxidil present alternative options. Head-to-head trials are scarce, necessitating a comparative study. This randomized controlled trial aimed to compare the efficacy of low-dose oral minoxidil (2.5 mg once daily), topical minoxidil (5% twice daily), and PRP (four sessions, conducted every 4 weeks) combined with topical minoxidil 5% twice daily in individuals with AGA. Natural regulatory T cells (Tregs; CD4+ CD25high FOXP3+) reside within hair follicles, fostering the proliferation of hair follicular stem cells through the NOTCH signalling pathway by elevating Jagged1 ligand expression. Additionally, the study explored the impact of these treatments on Treg cell populations – inducible Treg cells (CD4+ CD25low FOXP3+) and natural Treg cells (CD4+ CD25high FOXP3+) – and signalling molecules including cytotoxic T-lymphocyte-associated protein (CTLA)4, NOTCH and Jagged1. In total 66 male participants were randomly assigned to three groups of 22 patients each: oral minoxidil (Group 1), topical minoxidil (Group 2) and PRP with topical minoxidil (Group 3). Clinical and videodermoscopic assessments were conducted every 8 weeks, over 32 weeks. Treg cell populations and signalling molecules were analysed in skin biopsies (n = 5 from each group) obtained at baseline and 32 weeks. At 32 weeks, six (27%) patients each in Group 1 and Group 3, and three (14%) patients in Group 2 showed improvement in the grade of AGA. At 32 weeks, Group 3 significantly surpassed Groups 1 and 2 in increasing terminal hair density (P = 0.03 and P = 0.02, respectively). Group 1 had notably decreased vellus hairs compared with Group 3 (P = 0.02), and no significant difference was seen between Groups 2 and 3 (P = 0.2). Reduction in hair diameter diversity was observed with all three modalities, with earlier responses in Groups 1 and 3 (P &amp;lt; 0.01). A proportionate significant increase in natural Treg cells and a decrease in inducible Treg cells was observed at week 32 compared with baseline, without significant modality-specific differences: Group 1, mean 36.2 (SD 15); Group 2, mean 22 (SD 3.4); Group 3, mean 33.7 (SD 10); P = 0.31. A mean decrease in CTLA4 level and an increase in NOTCH and Jagged1 levels with a weakly negative nonsignificant correlation was observed in all three groups at week 32, with no modality-specific differences. Combining PRP with topical minoxidil achieved superior terminal hair density, while oral minoxidil exhibited an advantage in reducing vellus hair density. The study endorses low-dose oral minoxidil as an alternative to topical use and indicates the benefits of combining oral or topical minoxidil with PRP.
PD14 Trends, knowledge and practice on sunscreen use in patients referred via the suspected cancer pathway: a multisite survey
Authors: Lucy McAllister, Erin Ifan, Siwaporn Hiranput, Paul Devakar Yesudian
Journal: British Journal of Dermatology (2024)

Abstract Sunscreens are widely accepted as a safe and effective method for reducing skin cancer incidence and addressing photoageing and sun-induced pigmentary changes. Market research indicates a worldwide increase in sunscreen sales; however, real-world data on consumer understanding, selection and use of these products remain scarce. A questionnaire was distributed to patients attending clinics in five hospital sites after referral for suspected skin cancers. Data collected included demographics, occupation and previous dermatological diagnosis. Sunscreen use, sun protection factor (SPF), ultraviolet star rating, presence of a visible light filter, and frequency and anatomical areas of application were also recorded. Understanding of SPF definition was assessed using a multiple-choice question. Data were analysed using SPSS software (IBM, Armonk, NY, USA), and a χ2-test was applied to identify associations between patient characteristics and sunscreen use. In total, responses were received from 126 patients; 54 (43%) were male and 72 (57%) female. The most frequent age category was 61–70 years (n = 31, 25%) and, where data on skin type were captured, Fitzpatrick types I and II were most prevalent (n = 62, 84%). Of the responses regarding employment, 16 (29%) worked in outdoor occupations. Overall, 63 patients had no prior dermatoses (49%). Of the 126 respondents, 97 stated regular use of a sunscreen product, which was significantly associated with female sex: χ2 (1, n = 126) = 14.4, P &amp;lt; 0.001. No relationship was identified between age or occupation and sunscreen use. Products were applied in sunny weather (n = 76, 66%), rather than daily. SPF 50 was the most frequent factor used (n = 39, 41%). In total, 84 (87%) did not know whether their product contained a visible light filter. The scalp was a frequently missed site of application (n = 17, 16% applied to the scalp). Approximately half of responses (n = 47, 53%) reported the correct definition of SPF. Evidence suggests that those with previous cutaneous malignancy tend to be better educated on SPF properties of sunscreen than the general population. However, there are very limited data available on understanding of visible light blockage. In this survey only 13% knew whether their sunscreen contained a visible light filter, which confers major advantages in reducing hyperpigmentation and photoageing. As ultraviolet vs. visible light protection varies between products, targeted education may enable better choices. Men are statistically more likely to develop skin cancers, yet they underutilize sunscreens, frequently omitting high-risk sites for carcinogenesis, which our findings corroborate.
CD16 Medical-grade manuka honey and a sugar-free manuka honey extract inhibit allergic IgE-induced mast-cell degranulation: potential role as an topical anti-inflammatory agent in atopic dermatitis
Authors: Omar Abdelwahab, Bashir Lwaleed
Journal: British Journal of Dermatology (2024)

Abstract Mast-cell numbers and activity are both increased in atopic dermatitis (AD) lesions. AD is characterized by allergen–IgE–FcεRI-induced mast-cell activation, associated with allergic responses to specific types of foods or allergens. Medihoney® (MH) is a medical-grade manuka honey with strong antimicrobial properties. Recent reports also suggest it has anti-inflammatory properties via inhibition of histamine release by mast cells. In the present study, we investigated the anti-inflammatory effect of MH and a sugar-free manuka honey extract (EX) against allergic inflammation by studying its effect on mast-cell degranulation induced by IgE. LAD-2 human mast cells were preincubated overnight with 100 ng mL−1 of human myeloma IgE, then activated by 1% antihuman IgE for 40 min with or without 20-min preincubation with 4%, 2% and 1% of MH or EX. Degranulation was assessed by measuring release of the lysosomal enzyme β-hexosaminidase. Both MH and EX induced significant dose-dependent inhibition of IgE-induced mast-cell degranulation, culminating at 85% and 100% inhibition, respectively, at 4% concentration. In conclusion, MH and EX potentially inhibit allergic IgE-induced mast-cell degranulation. Aqueous preparations of MH and EX (applied topically) could potentially be useful as anti-inflammatory agents directed against the allergic inflammation involved in the pathophysiology of AD.