tbuckley/cabot-search huggingface dataset:
CD12 A case of occupational acrylate allergy: a success story!
Authors: Yasmin Khan, Faheem Latheef
Journal: British Journal of Dermatology (2024)

Abstract A 35-year-old nail and beauty technician presented with severe hand and finger dermatitis. She had a 5-year history of eczema on her neck and trunk, which had improved with avoidance of balsam of Peru, to which she had previously tested positive on patch testing. Unfortunately, the patient began experiencing debilitating hand symptoms 2 years ago, escalating into painful, cracked, excoriated and fissured hands. Further patch testing revealed positive reactions to acrylates, specifically 2-hydroxyethyl methacrylate, ethylene glycol dimethacrylate, 2-hydroxyethyl acrylate, and triethylene glycol diacrylate – common components in acrylic, gel and shellac nail products used daily in her profession. Advised on strict allergen avoidance, the patient hesitated, citing practicality concerns given her lack of alternative income sources and qualifications. Reluctant to undergo a period of avoidance, she grappled with accepting her occupation as a likely source of her hand dermatitis and was keen to explore alternative options. Occupational acrylate allergy poses challenges for nail technicians, with symptoms often proving difficult to control once sensitized. Rapid acrylate penetration through most glove types complicates protective measures. Nitrile gloves offer marginally longer protection compared with latex, while laminate 4H gloves provide superior defence but limit manual dexterity. A study exploring an in vivo model for glove efficacy used open chambers filled with the acrylate gels, which were applied to the back with tape, and gloves attached as a membrane between the gel and the skin [Ursberg AM, Bergendorff O, Thorsson AC, Isaksson M. Is there a good in vivo method to show whether gloves are sufficiently protective when a nail technician is exposed to (meth)acrylates? An in vivo pilot study. Contact Dermatitis 2016; 75: 62–5]. The glove materials were then tested at four exposure times. This study showed promise in ascertaining which gloves offered appropriate protection for an individual, but is limited in practicality due to its prolonged duration. Applying the results from the study to clinical practice, the patient was first treated with oral steroids to clear her hands, and was then recommended to double glove during procedures. She was advised to ensure that she spent no more than 20 min with each client, in order to reduce penetration time of the acrylate through the gloves. This, along with frequent handwashing in between clients and regular workspace cleaning, has allowed her to successfully continue her career for the last 3 years. This case underscores the importance of finding collaborative solutions with patients, even if not medically ideal, and offering practical approaches for individuals facing challenging allergens to avoid. This case also highlights the usefulness of applying basic science research to clinical practice for the benefit of patients.
P059 Cutaneous sarcomas: a 5-year review of treatment outcomes and literature
Authors: Jenny Chung, Chrystalla Macedo, Rishika Sinha
Journal: British Journal of Dermatology (2024)

Abstract Cutaneous sarcomas comprise 5% of skin cancers yet carry great morbidity and mortality. They include atypical fibroxanthoma (AFX), pleomorphic dermal sarcoma (PDS), leiomyosarcoma (LMS), dermatofibrosarcoma protuberans (DFSP) and angiosarcoma (AS) (Stoneham S, Hunter A, Raahimi M et al. Cutaneous sarcoma: a review and practical approach to management. Clin Exp Dermatol 2023; 48: 866–72). Standardized agreed national guidelines for the management of these rare tumours are lacking, and we rely on guidance from sarcoma specialists (Dangoor A, Seddon B, Gerrand C et al. UK guidelines for the management of soft tissue sarcomas. Clin Sarcoma Res 2016; 6: 20). However, these tumours are lower grade, and do not carry the same local and metastatic recurrence risk as noncutaneous sarcomas. The aim of this study at a tertiary UK centre was to review the treatment and follow-up outcomes of patients with sarcoma managed locally. All patients with biopsy-proven cutaneous sarcomas discussed at our skin cancer multidisciplinary team (MDT) from March 2020 to January 2024 were retrospectively reviewed. Patient demographics, and histology were gathered along with the treatments offered, recurrence and follow-up outcome. All patients were restaged using the American Joint Committee on Cancer soft tissue sarcoma criteria. In total 40 patients met the criteria; their mean age at diagnosis was 70 years (range 24–91) and 25% were immunosuppressed. The cohort was followed up for an average of 11.3 weeks (range 1–36). The diagnoses included PDS (35%), AFX (20%), LMS (20%), DFSP (15%) and AS (5%); all but one had T1 or T2 disease. Overall, 97% of patients received surgery first line, with a clearance rate of 85% (29 of 34). Two patients had recurrence: one with PDS, requiring further surgery, and one with AS, who was managed at a sarcoma unit. There were no metastases reported or deaths due to disease. Most patients (80%) remain in clinical remission. Appropriate imaging and follow-up recommendations were made in most cases, according to their diagnosis. In summary, many of the patients with cutaneous sarcoma in the study had superficial disease. Despite our conservative surgical margins offered and a short duration of follow-up, we observed a 5% recurrence rate with no metastases. This study highlights the importance of an MDT approach to cutaneous sarcomas, which helps draw expertise from different specialties. Our lower recurrence rate and metastases compared with literature suggests that patients with cutaneous sarcoma could be safely managed in local skin cancer MDTs. We propose national guidance to help similar skin cancer MDTs and clinicians to standardize and reduce variation in care, as well as to provide an evidence base on which to recommend monitoring of this rare group of tumours.
CD14 Efficacy of narrowband ultraviolet B phototherapy vs. low-dose oral ciclosporin as second-line management in antihistamine-refractory chronic spontaneous urticaria: a noninferiority, randomized study
Authors: N Roshini, Hitaishi Mehta, Anuradha Bishnoi, Davinder Parsad, Sendhil Kumaran
Journal: British Journal of Dermatology (2024)

Abstract Literature regarding the role of narrowband ultraviolet B (NB-UVB) phototherapy in the treatment of antihistamine-resistant chronic spontaneous urticaria (CSU) is scarce, and ciclosporin has established its role in management. We aimed to study the efficacy of NB-UVB phototherapy vs. low-dose oral ciclosporin in the management of chronic refractory urticaria (CRU), terms of change in Urticaria Activity Score (UAS), Urticaria Control Test (UCT), Chronic Urticaria Quality of Life (CU-QoL) and Angioedema Activity Score (AAS). In this randomized prospective noninferiority study, 50 patients were recruited who fulfilled the criteria of oral antihistamine-refractory CSU, namely 6 months of spontaneous urticaria with no response from three consecutive months of antihistamines, and steroid dependence. The patients were randomized to receive NB-UVB (group A) or ciclosporin 3 mg kg−1 (group B) for 90 days, with post-treatment follow-up of 90 more days. Patients were assessed fortnightly. The mean (SD) UAS7 decreased from baseline scores of 24.8 (8.2) and 27.1 (8.2) to 0.82 (1.47) and 0.28 (1.4) in group A and group B, respectively at the end of the 90-day treatment (P &amp;lt; 0.001). These increased to 1.55 (1.74) and 4.13 (4.85) at day 180 in groups A and B, respectively (P = 0.01 and P = 0.002). The mean (SD) UCT scores increased from baseline 8.52 (2.8) and 8.24 (2.67) to 15.0 (1.7) and 15.9 (0.4) at day 90 (P &amp;lt; 0.001), which decreased to 14.9 (1.0) and 14.1 (2.0) at day 180 in groups A and B, respectively (P = 0.03 and P = 0.001). The mean (SD) CU-QoL decreased from baseline scores of 26.8 (14.9) and 30.0 (14.9) to 3.4 (6.3) and 0.48 (2.0) at day 90 (P &amp;lt; 0.001 and P = 0.002), which increased to 2.1 (2.3) and 4.9 (5.2) at day 180 in groups A and B, respectively (P = 0.09 and P = 0.001). The mean (SD) AAS7 scores decreased from baseline 2.0 (4.7) and 4.9 (8.2) to 0 (0) and 0 (0) at day 90 in both groups (P = 0.04 and P = 0.007). AAS7 scores remained at 0 through follow-up. Ciclosporin performed as a crisis buster, giving early and better control of CRU during the treatment period; however, disease relapsed promptly on stopping ciclosporin. On the other hand NB-UVB had more sustained suppression of CRU even during follow-up. Thus NB-UVB is an effective, safe, affordable therapeutic modality for steroid-dependent CRU. Our study had a small sample size and the results may not be representative of a bigger population.
P030 Implementing the Edmonton Obesity Staging System: a cross-sectional study of the prevalence and management of obesity in a systemic therapies clinic
Authors: Olga Tummon, Rebecca Gill, Michelle Murphy
Journal: British Journal of Dermatology (2024)

Abstract Registry studies from the UK and Ireland report the incidence of obesity among patients on systemic treatment for psoriasis as 40%. This is almost double the background population prevalence of obesity in the UK (26%) and Ireland (23%). Patients with higher body mass index (BMI) have poorer responses to systemic therapies. This study aimed to investigate the prevalence and management of obesity among consecutive patients attending dermatology systemic clinics. Weight and height were recorded, and a patient questionnaire was distributed. Patients identified as living with obesity were classified using the Edmonton Obesity Staging System (EOSS). The EOSS categorizes patients living with obesity into five stages based not solely on BMI but on the presence of obesity-related comorbidities; studies have shown the staging system correlates with clinical outcomes. The study included 113 participants. The median age was 49 years (range 19–79), and 57% (64) of participants were female. The most common diagnosis was psoriasis (77%, 88), followed by atopic dermatitis (16%, 19) and hidradenitis suppurativa (HS) (0.4%, five). Defining a BMI of ≥ 25 kg m−2 as overweight and ≥ 30 kg m−2 as obese, 38% (43) of patients were overweight and 45% (51) were living with obesity. The mean BMI was 31.4 kg m−2, with an SD of 7.3 (range 19.4–53.5). The mean BMI in patients with psoriasis was 31 kg m−2, with eczema 28 kg m−2 and HS 41 kg m−2. Of those living with obesity, 31% (16) fulfilled the requirements for EOSS stage 3, and 32% (37) met the criteria for EOSS stage 2. Hypertension at 31% (36) and mental health issues related to weight at 33% (38) were the two most common self-reported comorbidities. In total, 23% (26) of patients were being prescribed a biologic agent at an increased dose or frequency, and 92% (24) of these patients were either overweight or obese, reflecting the challenges of treating this patient cohort. Overall, 80% (41) of patients in the study classified as living with obesity expressed an interest in accessing medical management for their obesity, while 10% (n = 9) reported that a doctor had discussed obesity management options with them. This is the first study to implement an obesity staging system to examine patients with dermatological diagnoses. The results show that our patients on systemic therapies do not simply have high BMIs but also have physical and psychological consequences. New medical options for the management of obesity have the potential to help many of our patients and, in turn, improve their coexisting dermatological diseases. The EOSS is a valuable tool in time-poor environments to assess obesity and facilitate discussion of management options.
CPC03 Notch your average dermatitis
Authors: Amy Long, Lisa Murphy, Claire Quigley, Niamh Leonard, Julieanne Clowry
Journal: British Journal of Dermatology (2024)

Abstract We present the case of triangular nasal notch sign in a White woman with previous exposure to tumour necrosis factor (TNF) inhibition for Crohn disease, which persisted throughout a biologic-free period. The 33-year-old woman presented with symptoms of nasal rash, itch and cosmetic concern for bilateral indentations in the nasal soft triangle, ongoing for 6 years. Medical history was notable for childhood atopic dermatitis, herpes labialis and Crohn disease. Her Crohn disease was well controlled on ustekinumab, commenced in the last year. She commenced adalimumab 6 years before the rash first appeared, but had discontinued this agent 4 years prior to her presentation to dermatology. On examination she had patchy erythema with scale and crust affecting her nasal tip, septum, alar sidewalls and columella, with loss of the normal nostril contour and cicatricial indentation at the apex of the nasal soft triangle bilaterally. She had evidence of acute herpes simplex virus (HSV)-1 infection of the upper lip. A punch biopsy from the left nasal tip showed acanthosis and spongiosis with a dermal mixed inflammatory infiltrate including lymphocytes, histiocytes and neutrophils. There was focal ulceration and intraepithelial small abscesses, without features of granulomatous inflammation. Triangular nasal notch sign is a clinical sign that was first described in 2019 (Mesnard C, Aubert H, Bourreille A et al. The triangular nasal notch sign in patients with Crohn disease treated with tumour necrosis factor inhibitors. Br J Dermatol 2019; 181: 1103–4). This group reported eight patients with Crohn disease exposed to TNF inhibitors, presenting with a cicatricial triangular nasal notch, and hypothesized that TNF inhibition specifically was implicated in the development of the phenomenon. Similarly to these patients, our case had exposure to anti-TNF; however, the persistence of nasal dermatitis throughout a ‘biologic-free’ period is novel. The pathophysiology of TNF inhibitor-induced nasal dermatitis and triangular nasal notch sign is not fully understood. It has been hypothesized that it is within the scope of paradoxical reactions seen with TNF inhibitors and persistent Staphylococcal aureus infection. An association with HSV-1 has not been previously reported in the context of this condition. Nasal swabs in this case showed commensals only; however, clinical improvement of nasal inflammation was achieved with topical mupirocin, prophylactic valaciclovir and a short course of oral azithromycin. The singular association with Crohn disease and limited involvement of the nose is also as yet unexplained and requires further research. We encourage greater reporting of this phenomenon, to increase awareness among clinicians and to help identify the exact pathomechanism and optimal treatment.
P065 Attitudes and practices of patients with inflammatory bowel disease towards skin cancer risk and sun protection
Authors: Maeve Herlihy, Eve Blake, Garry Courtney
Journal: British Journal of Dermatology (2024)

Abstract Skin cancer is the most common form of cancer in Ireland, with over 13 000 new cases diagnosed annually. People with inflammatory bowel disease (IBD) may be at higher risk of skin cancer. A meta-analysis performed on more than 170 000 patients diagnosed with IBD found that patients with IBD had a 37% higher risk of developing melanoma than expected in the general population (relative risk 1.37, 95% confidence interval 1.10–1.70). This increased risk was independent of IBD treatment. Additionally, many of the treatments used for IBD involve supressing or altering the immune system. Immunosuppression is a risk factor for all types of skin cancer, and cutaneous malignancies in immunocompromised patients tend to behave more aggressively compared with those in the general population. The British Association of Dermatologists has published preventive guidelines for patients on immunosuppression, but specific gastroenterology recommendations are lacking. Prevention and early detection are therefore of paramount importance. Our aim was to assess knowledge of skin cancer risk factors and photoprotective behaviours in an Irish cohort of at-risk patients with IBD. A questionnaire was given to patients attending our IBD clinic. Clinical data were recorded including diagnosis, immunosuppressants, skin cancer risk factors and photoprotective behaviours. In total, 87 patients (52% women) with IBD (63% Crohn disease, 35% ulcerative colitis) were included. All participants were White, with 77% recorded as having fair or very fair skin. Most patients (97%) were on treatment for their IBD (66% on biologics, 25% on immunomodulators). Over one-third of participants (35%) were unaware of an increased skin cancer risk associated with IBD. Four patients had a history of skin cancer, two of which were melanoma. Half of patients (48%) had been sunburnt in the last year, and 36% had more than 10 burns in their lifetime. In total, 57% of patients reported a history of blistering sunburn and 22% of patients had used sunbeds. Knowledge of skin cancer risk factors and worrisome features was generally good, and the majority of our cohort (74%) always wore suncream abroad. However, less than half wore suncream frequently in Ireland (37%) or when it is cloudy (22%), and also did not take other important measures, such as reapplying suncream every 2 h (43%), or wearing a hat (26%) or protective clothing (32%). Our study highlights gaps in the education of our IBD cohort regarding skin cancer risk and prevention, and suggests that primary prevention of skin cancer in this IBD cohort is suboptimal. Ideally, educational interventions to enhance patient awareness and encourage adequate photoprotection and skin self-surveillance should be undertaken and assessed.
P035 Quantifying the mutation burden of a therapeutic course of narrowband ultraviolet B (UVB) to help inform on the carcinogenicity of narrowband UVB
Authors: George Coltart, Joanna Fowler, Roshan Sood, Chester Lai, Noeline Nadarajah, Philip Jones, Eugene Healy
Journal: British Journal of Dermatology (2024)

Abstract Narrowband ultraviolet B (NB-UVB) is recommended by NICE as a treatment for chronic plaque and guttate psoriasis that cannot be controlled with topical therapies. However, ultraviolet radiation is a carcinogen that causes DNA mutations in the skin, and in some cases results in skin cancer development. To date, there have been no studies determining how many mutations develop in human skin as a result of a therapeutic course of NB-UVB, and therefore we investigated the mutation burden of NB-UVB in the current study. Although whole-exome or whole-genome sequencing and target-enriched sequencing can detect mutations in large clones of mutated skin cells, these approaches do not detect mutations occurring only in single skin cells, hence we used a novel type of sequencing called Nanorate sequencing (which can identify mutations occurring in just a single molecule of DNA) in this study. We obtained 6-mm punch biopsies of normal skin (buttock and/or forearm) before and after a course of UV from patients (n = 16) undergoing NB-UVB treatment for psoriasis. Epidermis was microdissected from the dermis and the epidermal DNA was sequenced using nanorate sequencing. DNA from venous blood underwent whole-genome sequencing as germline control for accurate identification of mutations in the epidermal samples. The numbers of DNA mutations were compared between the skin samples taken before and after NB-UVB in order to quantify the mutation burden attributable to the course of NB-UVB. Minimal erythema doses ranged from 0.3 to 0.9 J cm−2 and the total dose received during the course of NB-UVB ranged from 14.8 to 133 J cm−2. There was a significant rise in the number of mutations in buttock and forearm skin due to the NB-UVB treatment, with median increases in single-base substitutions per megabase of 1.09 SBS/Mb (P = 0.001) and 3.77 SBS/Mb (P = 0.0098) in buttock and forearm epidermis, respectively. The change in number of mutations secondary to NB-UVB treatment was predominately due to UV signatures SBS7a and SBS7b, with the DBS1 (CC&amp;gt;TT mutations) double-base substitution signature also identified in buttock and forearm skin samples. Comparison of the increase in mutation burden from NB-UVB with the mutation burden in keratinocyte cancers indicated that, for more susceptible patients, a course of NB-UVB therapy contributed as much as one-sixteenth of the total mutational burden of a cutaneous squamous cell cancer.
P108 Acne as an adverse effect of upadacitinib treatment for atopic dermatitis in adults and adolescents: a systematic review of short-term analysis
Authors: Rubiana Sarto, Luana Baptistele Dornelas, Sara Baldé Monteiro, Naína Oliveira Ricardo
Journal: British Journal of Dermatology (2024)

Abstract Atopic dermatitis (AD) is a chronic, recurrent, immune-mediated inflammatory skin disease characterized by eczema and intense itching. There are many drugs used in patients with AD, but none of them is preferential. In this context, upadacitinib, an oral Janus kinase inhibitor, has been suggested for AD treatment. However, acne has been described as a potential adverse effect of this drug. We aim to compare the incidence of acne among patients treated with upadacitinib and placebo through randomized clinical trials (RCTs) in adolescents and adults with moderate-to-severe AD. The PubMed, Scopus and Cochrane databases were used to search for RCTs comparing upadacitinib and placebo in adolescents and adults with moderate-to-severe AD. The outcome assessed was acne. We included four RCTs: Measure Up 1 and Measure Up 2 (together abbreviated here as MUp), AD Up (ADUp) and Rising Up (RUp). These involved 2855 patients allocated to receive placebo, upadacitinib 15 mg or upadacitinib 30 mg. Of these patients, 269 had acne as an adverse event. The follow-up period was 16 weeks. Acne was predominant in the upadacitinib 30-mg group (19.8% in RUp, and 15.2% in MUp + ADUp). Patients aged 18–40 years were the most affected by acne, especially those in the upadacitinib 30-mg group. The body area most affected by acne was the face in all groups and studies (placebo: 80% in RUp and 89.5% in MUp + ADUp; upadacitinib 15 mg: 83.3% in RUp and 96.4% in MUp + ADUp; upadacitinib 30 mg: 94.4% in RUp and 96.2% in MUp + ADUp). The most common presentation of acne was as inflammatory papules (placebo: 100% in RUp and 84.2% in MUp + ADUp; upadacitinib 15 mg: 83.3% in RUp and 91.7% in MUp + ADUp; upadacitinib 30 mg: 88.9% in RUp and 8.4% in MUp + ADUp). There were two episodes of medication discontinuation due to acne, each in the RUp study in the upadacitinib 15-mg and 30-mg groups. Our ana­lysis suggest that acne as an adverse effect was more intense in the upadacitinib 30-mg group in all studies. Also, the face was the most common site of manifestation, and the most common presentation was as papules.