tbuckley/cabot-search huggingface dataset:
A longitudinal study on SARS-CoV-2 seroconversion, reinfection and neutralisation spanning several variant waves and vaccination campaigns, Heinsberg, Germany, April 2020 to November 2022
Authors: Bianca Schulte, Enrico Richter, Antonia Büning, Maximilian Baum, Annika Breuer, Jasmin Zorn, Julia König, Melanie Geiger, Monika Eschbach-Bludau, Johanna Heuser, Dominik Zölzer, Marek Korencak, Ronja Hollstein, Eva Beins, Dorian Emmert, Souhaib Aldabbagh, Anna Maria Eis-Hübinger, Hendrik Streeck
Journal: Eurosurveillance (2024)

BackgroundSince its emergence in December 2019, over 700 million people worldwide have been infected with SARS-CoV-2 up to May 2024. While early rollout of mRNA vaccines against COVID-19 has saved many lives, there was increasing immune escape of new virus variants. Longitudinal monitoring of population-wide SARS-CoV-2 antibody responses from regular sample collection irrespective of symptoms provides representative data on infection and seroconversion/seroreversion rates.AimTo examine adaptive and cellular immune responses of a German SARS-CoV-2 outbreak cohort through several waves of infection with different virus variants.MethodsUtilising a 31-month longitudinal seroepidemiological study (n = 1,446; mean age: 50 years, range: 2-103) initiated during the first SARS-CoV-2 superspreading event (February 2020) in Heinsberg, Germany, we analysed acute infection, seroconversion and virus neutralisation at five follow-up visits between October 2020 and November 2022; cellular and cross-protective immunity against SARS-CoV-2 Omicron variants were also examined.ResultsSARS-CoV-2 spike (S)-specific IgAs decreased shortly after infection, while IgGs remained stable. Both increased significantly after vaccination. We predict an 18-month half-life of S IgGs upon infection. Nucleocapsid (N)-specific responses declined over 12 months post-infection but increased (p < 0.0001) during Omicron. Frequencies of SARS-CoV-2-specific TNF-alpha+/IFN-gamma+ CD4+ T-cells declined over 12 months after infection (p < 0.01). SARS-CoV-2 S antibodies and neutralisation titres were highest in triple-vaccinated participants infected between April 2021 and November 2022 compared with infections between April 2020 and January 2021. Cross neutralisation against Omicron BQ.1.18 and XBB.1.5 was very low in all groups.ConclusionInfection and/or vaccination did not provide the population with cross-protection against Omicron variants.
BC01 Evaluation of effectiveness of fractional ablative CO2 laser and triple combination cream in the treatment of melasma: a randomized controlled study
Authors: Kaushal Verma, Utpal Patel, Neetu Bhari, G Sethuraman
Journal: British Journal of Dermatology (2024)

Abstract Melasma is a common pigmentary disorder causing considerable cosmetic disfigurement and psychological distress. Treatment of melasma remains a challenge despite the availability of several therapeutic agents, due to its refractory and recurrent nature. Triple combination cream (TCC) consisting of hydroquinone (4%), tretinoin (0.05%) and fluocinolone acetonide (0.01%) is considered to be the first-line therapy for melasma. Ablative fractional lasers have been reported to be effective. We evaluated the effectiveness and safety of fractional ablative CO2 and TCC in melasma in a split-face randomized control study. Clinically diagnosed adult patients with symmetrical melasma were included in the study and were randomized to receive either fractional CO2 laser, once every 4 weeks plus TCC (group A), or TCC alone (group B) to either side of the face once daily for 12 weeks. The patients were evaluated every 4 weeks to determine treatment response and adverse effects, and were followed for another 12 weeks to determine relapse. There were 54 patients (19 male and 35 female; mean age 33.0 years, SD 7.7; age range 21–57 years). They had melasma for 0.5–15 years (mean duration 5.7 years, SD 3.5). Following treatment, the mean melanin index and modified Melasma Area and Severity Index (mMASI) scores decreased in both groups. The mean (SD) melanin index decreased from 46.5 (5.2) to 43.7 (5.6), P &amp;lt; 0.001, in group A, and from 47.0 (5.5) to 44.3 (5.5), P &amp;lt; 0.001, in group B. The mean (SD) mMASI decreased from 4.4 (1.8) to 2.8 (1.6), P &amp;lt; 0.001, in group A, and from 4.4 (1.9) to 3.2 (1.7), P &amp;lt; 0.001, in group B. The changes were statistically significant, but were comparable between the two groups (P = 0.47 and P = 0.20, respectively). However, improvement in Physician’s Global Assessment (PGA) was superior in group A vs. group B (60.8% vs. 39.1%, P &amp;lt; 0.001. Also, the mean (SD) patient self-assessment scores were 5.9 (2.0) and 4.6 (2.0) in group A and group B, respectively (P &amp;lt; 0.001) showing a better response in group A. There were no significant adverse effects. However, 67% of patients (34 of 51) had a relapse, with gradual increases in MI, mMASI, PGA and patient self-assessment scores in both groups during post-treatment follow-up. Therefore, the study has shown that fractional CO2 laser offers modest additional benefit and is safe in the treatment of melasma. Hence, further studies are required.
O10 A national retrospective cohort study of the incidence and trends of 3061 cases of cutaneous T-cell lymphoma in England between 2013 and 2020
Authors: Charlotte Sheern, Nick J Levell, Polly Jeffrey, Khaylen Mistry, Matthew J Scorer, Zoe C Venables
Journal: British Journal of Dermatology (2024)

Abstract There are limited epidemiological data available for cutaneous T-cell lymphoma (CTCL). This retrospective, national cohort study reported CTCL incidence from 2013 to 2020, including the early impact of the COVID-19 pandemic. National data were extracted from the ‘Get Data Out’ National Disease Registration Service, haematological malignancies dataset. Crude incidence rates (CIRs) were reported per 100 000 person-years (PY) from 2013 to 2020. Joinpoint regression was used to assess trends and annual percentage change from 2013 to 2019. Incidence rate ratios with Poisson regression were used to assess the early impact of COVID-19 on CIR in 2020 vs. 2019. In total, 3061 new cases of CTCL were diagnosed in England between 2013 and 2020 (mean 383 new diagnoses per year). The CIR was 0.69 PY over the whole period, 0.75 PY [95% confidence interval (CI) 0.68–0.83] in 2013, and 0.60 PY (95% CI 0.54–0.67) in 2020. Over the 8 years analysed, 38% of patients (1153 of 3061) were female and 62% (1908 of 3061) were male (ratio 1 : 1.7). Overall, 61% of patients (1858 of 3061) were aged &amp;lt; 70 years and 39% (1203 of 3061) were aged ≥ 70 years. The annual percentage change from 2013 to 2019 was −1.21% (95% CI −3.52 to 1.15) overall, −2.36% (95% CI −9.65 to 5.30) in those aged &amp;lt; 70 years, and −0.96% (95% CI −4.03 to 2.40) in those aged ≥ 70 years. During the early COVID-19 pandemic, the CIR fell significantly, by 15%, from 0.71 PY (95% CI 0.64–0.78) in 2019 to 0.60 PY (95% CI 0.54–0.67) in 2020 (P = 0.02, incidence rate ratio = 0.85). This is the first and largest national dataset to report the incidence of CTCL in England. The number of diagnoses per year reduced over the period, with a greater reduction seen in patients aged &amp;lt; 70 years; however, these trends were not significant. A fall in incidence was observed during the early COVID-19 pandemic. The time from first presentation to diagnosis of CTCL is approximately 6 years. The data were limited by the complex variety of clinical, histological and molecular features of CTCL, which make diagnosis challenging. Higher incidences have been described internationally, with a CIR of 0.86 PY reported in the USA, and 0.96 PY in France. Cases that did not have a histological diagnosis or dataset completed by a multidisciplinary team meeting may have been missed. Limitations of the study include a lack of data on ethnic groups and CTCL subtypes. These data are essential in expanding our knowledge of the changes in national CTCL epidemiology, and supporting ongoing research.
PD12 Roadmap on how to set up home handheld phototherapy in the National Health Service: implementation of evidence-based treatment in the ‘real world’
Authors: Viktoria Eleftheriadou, Carla Francis, Joanne Hale, James Halpern
Journal: British Journal of Dermatology (2024)

Abstract Vitiligo is the most common pigmentary disorder, and affects around 0.4% of the population in the UK. Recently conducted, two large retrospective observational studies using the UK Clinical Practice Research Datalink and Hospital Episode Statistics databases demonstrated that adults with vitiligo have an increased risk of subsequently being diagnosed with new-onset depression (25%) and anxiety (23%). The studies also found that people with both vitiligo and a mental health comorbidity have increased use of primary care services and are twice as likely to have recorded time off work and unemployment. Interestingly, the majority of patients (85%) were not prescribed any vitiligo-related treatments within a year of diagnosis for vitiligo. Second-line treatment for vitiligo includes either whole-body or localized phototherapy. Traditionally, narrowband ultraviolet B (NB-UVB) is reserved for people with extensive vitiligo and is delivered in secondary care using full-body units, requiring regular hospital attendance. In the current National Health Service (NHS) crisis, many NHS dermatology departments offer phototherapy either to a very limited number of patients with vitiligo or not at all, due to constraints on phototherapy services. The British Association of Dermatologists guidelines recommend that limited vitiligo can be treated with handheld NB-UVB devices. This recommendation was based on the results of a large, pragmatic, randomized controlled trial of home handheld phototherapy combined with topical corticosteroid for people with active, limited vitiligo (HI-Light trial). The trial was completed almost 5 years ago; however, only one centre in Wales chose to continue with the home handheld phototherapy service on the NHS after the completion of the trial. A new, unique, national, tertiary, research and treatment centre for children and adults with vitiligo has recently been established in England. In our centre, we offer home handheld phototherapy to eligible patients, who are often referred from out of area, therefore making a combination of topicals and NB-UVB more accessible. We designed patient-facing literature, a special pro forma for vitiligo clinic, and several other documents to assist in safety assurance and quality improvement processes. We describe the pathway that we followed when establishing this new service in the NHS. We have trained 20 patients so far. We describe the safety and efficacy results of home handheld phototherapy combined with topical treatments such as calcineurin inhibitors and corticosteroids, as well as oral antioxidants. We hope that our roadmap will pave the way for a home handheld phototherapy service in other centres, which would make phototherapy more accessible for patients with a variety of skin diseases such as vitiligo, hand eczema and scalp psoriasis, among others.
Poster presentationsPD10 Photosensitivity diseases in children: 10 years’ experience from a tertiary photodiagnostic service
Authors: Jessica McKeever, Andrea Lesar, Sally H Ibbotson
Journal: British Journal of Dermatology (2024)

Abstract Photosensitivity diseases are a wide-ranging group of disorders, with heterogeneity in diagnostic categories, characteristics and management. Photosensitivity at any age poses specific challenges, with adverse impact on quality of life being highly significant, and children are of particular concern (Rizwan M, Heylett AK, Richards HL et al. Impact of photosensitivity disorders on the life quality of children. Photoderm Photoimmunol Photomed 2012; 28: 290–2). Our aim was to review the clinical and photodiagnostic characteristics of 209 children (aged ≤ 16 years), assessed through a tertiary photodiagnostic service between 2013 and 2023. We conducted this retrospective study with Caldicott Guardian approval (CALDICOTT-2023-011) and the presenter, a final-year medical student, analysed clinical photodermatology notes and our in-house photodiagnostic database with support from senior clinical supervisors. The median age of presentation was 8 years (range 4 months to 16 years), with a male-to-female ratio of 1 : 1.2. Most patients were of skin phototype II (40.6%), with only five being phototype IV and two phototype V. The median time from onset of symptoms to assessment was 3 years (range 1 month to 14 years). Polymorphic light eruption (PLE) was the most prevalent condition, diagnosed in 50.4%. A range of other diagnoses were seen, with photosensitivity excluded in 7.3%. Of those who underwent monochromator phototesting (n = 180), abnormal results were detected in 29 patients (16.1%), and 27 of 128 patients (21.1%) tested had an abnormal ultraviolet B TL-01 minimal erythema dose. Of 128 patients who were photopatch tested, 27 (21.1%) showed positive reactions. Vitamin D levels were insufficient in eight (24%) of the 33 patients tested. Paediatric antinuclear antibodies were tested in 29% of patients, with 11 (18%) being positive (≥ 1 : 80), although lupus was diagnosed in only two cases. Of 109 patients tested for porphyria, 11 (10.1%) were positive, seven being diagnosed with erythropoietic protoporphyria. One patient was diagnosed with xeroderma pigmentosum (XP). Children’s Dermatology Life Quality Index (CLDQI) assessment was available in 69%, with a median score of 10 (range 1–29). This study provides detailed characterization of photosensitivity diseases in children seen through a national photodiagnostic service. While PLE was the most common diagnosis, a range of other diagnoses were seen, including lupus, porphyrias and XP, highlighting the need for such specialist services. The delays in diagnosis and severity of impact on quality of life are of concern and emphasize the importance of raising awareness of photosensitivity in children in primary care. Prompt diagnosis, psychological support and holistic care are identified aspects of service provision.
British Society for Cutaneous AllergyOral presentationsCD01 Isobornyl acrylate in nail cosmetics
Authors: Fangyi Xie, Jane Sansom, Aparna Sinha
Journal: British Journal of Dermatology (2024)

Abstract We present two cases of patients with allergic contact dermatitis to acrylates from gel nail kits, containing isobornyl (meth)acrylate (IBA). IBA has been associated with contact allergic dermatitis from medical devices, namely insulin pumps and continuous glucose-monitoring devices. However, it has not previously been reported with nail cosmetics. We examined commercially available nail cosmetics to look for the presence of IBA. We compiled the ingredients of the top 10 search results from four online sources (Amazon, Boots, Look Fantastic, Nail Polish Direct) for ‘gel nails’. We looked for ingredients in the initial website, the official product website and the safety data sheet, or emailed the company where the information was not available. One patient was a 23-year-old woman who was a keen recreational acrylic, gel and press-on nail user, with a 6-year history of a blistering rash in the periungual region and fissuring of the finger pulps. She had positive patch test reactions to multiple acrylates: 2-hydroxyethyl methacrylate (HEMA), 1,4-butanediol dimethacrylate, 1,6-hexanediol diacrylate, triethylene glycol diacrylate, diethylene glycol diacrylate, ethyl methacrylate, ethyl acrylate, methyl methacrylate, 2-hydroxyethyl acrylate and IBA. The second patient was a 45-year-old woman with chronic atopic dermatitis who had recently developed a facial flare after using gel nails. She had positive patch test reactions to diethylene glycol diacrylate, methylisothiazolinone and methylchloroisothiazolinone. Both patients used commercial gel nails containing IBA. Thirty-two of 40 (80%) products were gel nail polishes, and the rest were two each (5%) of gel-like polish, gel nail tips, stick-on gel nails and topcoat. Twenty of 40 (50%) products had no ingredients listed on the commercial website, of which six (30%) had no further information on the official product website or on the initial websites. All products contained at least one acrylate. IBA was in eight of 34 (24%) products, of which four were in the isobornyl methacrylate form. The most common acrylates were acrylate copolymers (17 of 34, 50%), HEMA (13 of 34, 38%), 2-hydroxypropyl acrylate (10 of 34, 29%), di-HEMA trimethylhexyl dicarbamate (6 of 34, 18%), hydroxyethyl acrylate (6 of 34, 18%) and trimethylolpropane triacrylate (5 of 34, 15%). The incidence of acrylate allergic contact dermatitis has risen due to the increasing popularity of salon and nonoccupational use with home ultraviolet light devices to cure monomers. Limitations of the study include only online searches, which may miss common products in salons or stores. We wanted to highlight the presence of IBA in commercially available nail cosmetics, given the recognized cross reactions and cosensitizing potential of acrylates.
P071 Are Welsh primary schools sunproofed? Results of a national survey: sun protection practices in primary schools in Wales
Authors: Rachel Abbott, Daniel Tod, Kirsty Lanyon, Timothy Driscoll, Swetha Prathap, Alan Watkins, Julie Peconi
Journal: British Journal of Dermatology (2024)

Abstract Skin cancer rates are on the rise globally. School sun safety programmes are recommended by the World Health Organization to reduce the risk of future skin cancer at the population level; however, these are encouraged but not mandated in Wales. Our study aimed to explore current sun protection practices and sun safety education in primary schools in Wales, and whether these are linked to the existence of a formal sun safety policy. To do this, we distributed an online survey to all 1241 Welsh primary schools asking about sun safety practices, education and formal policies. In total, 471 (38.0%) schools responded to our survey, with the characteristics of responding schools generally matching the profile of schools in Wales. A minority (22, 4.7%) of responding schools reported they had sufficient shade for most activities. In the spring and summer terms almost two-thirds of schools encourage hat wearing (304, 64.8% of available data) and suncream (296, 63.2%). While nearly all schools reported that parents were encouraged to apply suncream to students before school (449, 95.7%), there was wide variation in other suncream application practices. Less than one-third of schools (129, 29.0%) reported that they include sun protection education in the curriculum in every year group, with 11.7% (52) including this in certain years only. Schools with a formal sun safety policy were more likely to report more comprehensive sun protection practices, including having sufficient shade [odds ratio (OR) 1.51, 95% confidence interval (CI) 1.04–2.19; P = 0.03], having spare hats for pupils to wear (OR 1.59, 95% CI 1.07–2.37; P = 0.02), providing guidance for staff (OR 5.87, 95% CI 3.05–11.3; P &amp;lt; 0.001), encouraging them to model sun safe behaviours (OR 1.82, 95% CI 1.18–2.80; P = 0.007) and teaching sun protection education as part of the curriculum in every year group (OR 2.56, 95% CI 1.76–3.71; P &amp;lt; 0.001). The existence of a formal policy did not seem to affect a school’s practice with respect to suncream. While in most cases, the existence of a formal policy suggests more comprehensive sun protection practices and education in schools in Wales, sun protection measures and education need improvement across the primary school sector to reverse rising skin cancer rates.
P084 The prevalence of inflammatory back pain in a secondary care psoriasis cohort
Authors: Alexandra Phillips, Joe Eddison, Aparna Sinha, Elizabeth Reilly
Journal: British Journal of Dermatology (2024)

Abstract The articular manifestations of psoriasis are well recognized. While peripheral psoriatic arthritis is the most common form, patients with psoriasis are also more likely to have axial disease either through axial psoriatic arthritis or axial spondyloarthritis. Isolated axial disease may be missed by screening tools such as the Psoriasis Epidemiology Screening Tool (PEST) but can cause significant morbidity. In addition, the average diagnostic delay for axial spondyloarthritis is 8.5 years (Zhao SS, Pittam B, Harrison NL et al. Diagnostic delay in axial spondyloarthritis: a systematic review and meta-analysis. Rheumatology 2021; 60: 1620–8), and its association with psoriasis therefore presents an important screening opportunity within the dermatology clinic. This exploratory survey aimed to establish the prevalence of symptoms of inflammatory back pain (IBP) among a cohort of patients with psoriasis in secondary care to determine the unmet service need. Patients with a diagnosis of psoriasis seen in the dermatology department of a UK secondary care hospital between 1 March 2021 and 12 October 2023 (n = 1529) were identified through electronic clinical noting. Patients who had a mobile phone number recorded (n = 1516) received a text message inviting them to complete the National Axial Spondyloarthritis Society screening survey for IBP. The link remained open for 3 weeks and written consent was embedded within the questionnaire. Patients were then identified through their email address or by email contact to facilitate referral to rheumatology and the collection of additional clinical information. In total 355 responses were received, of which six patients did not provide consent, two patients entered duplicate responses and two patients did not have psoriasis. Overall, 30% (n = 103) reported having chronic back pain; 22% (n = 77) screened positively for possible IBP, of whom 47 were not known to rheumatology. Twenty-five patients provided identifying details allowing further analysis. The average Psoriasis Area and Severity Index score of those with possible IBP was 13.3 and the average Dermatology Life Quality Index was 16.4. The PEST score was recorded for seven patients and was positive for two of these. There is a high prevalence of possible IBP among our cohort of patients with psoriasis in secondary care. The majority of cases are not known to rheumatology, indicating a high potential unmet need. The PEST score was infrequently recorded and correlated poorly with the score for possible IBP, supporting the understanding that it is not an effective screening tool for axial disease. Use of a more sensitive screening tool for IBP may aid in identifying patients with psoriasis who also have axial PsA or spondyloarthritis and help facilitate earlier diagnosis and treatment.