tbuckley/cabot-search huggingface dataset:
P107 Updating the Assessment of the Psychological and Social Effects of Acne (APSEA) through factor analysis: developing the novel APSEA-3
Authors: Georgina Jones, Jim Morgan, Eva Lau, Moe Latt, Natasha Lee, Ibtessam El-Mansori, Alison Layton
Journal: British Journal of Dermatology (2024)

Abstract Health-related quality of life is now recognized as an essential outcome to assess in acne trials and practice. Many patient-reported outcomes exist, including the Assessment of the Psychological and Social Effects of Acne (APSEA), which is an acne-specific measure (Layton AM, Seukeran D, Cunliffe WJ. Scarred for life? Dermatology 1997; 195: 15–21). APSEA was developed in 1990s and subsequently psychometric standards and methods have progressed. The purpose of this study is to conduct an updated psychometric analysis of the APSEA among a cohort of patients being treated for acne in routine clinical practice. Exploratory factor analysis (EFA), a method of classical test construction, was carried out (n = 993). To test the adequacy of the sample size for undertaking factor analysis, values for the Kaiser–Meyer–Olkin test and Bartlett’s test of sphericity were calculated, as well as Cronbach’s alpha. Following the EFA and generation of the proposed scales, the individual domains were calculated and transformed onto a scale of 0–100 by summing the items within the scale, dividing by the total possible score within that domain. A confirmatory factor analysis (CFA) was then undertaken using a new second dataset (n = 501) to test the factor conceptual framework, using MPlus 8.6 software (http://www.statmodel.com). Descriptive statistics and tests of internal consistency reliability and construct validity (concurrent) were also undertaken using a priori hypotheses and comparisons with the Dermatology Life Quality Index (DLQI) and Patient Health Questionniare-9 (PHQ-9). The EFA suggested a three-domain model (anxiety and depression, body image and self-esteem, and social functioning), which was confirmed in the CFA analysis whereby the goodness of fit indices all indicated good model fit (RMSEA = 0.038, CFI = 0.96, TLI = 0.96, SMR = 0.048). Cronbach’s alpha values exceeded 0.70, and item-total correlations exceeded 0.40 for all three domains, indicating good internal consistency reliability. All three APSEA domains were also positively correlated with the DLQI and the PHQ-9, indicating good construct validity of the tool. This EFA study has demonstrated the validity and reliability of a novel version of APSEA, which we have termed APSEA-3 to reflect the three unique domains it captures. Preliminary results show that the tool is responsive to change and useful for measuring the psychosocial impact of acne.
P102 Cutaneous noninfectious manifestations of chronic granulomatous disease: a prospective study
Authors: Vinay Keshavamurthy, Anubha Dev, Ridhima Aggarwal, Pandiarajan Vignesh, Amit Rawat, Debajyoti Chatterjee, Sunil Dogra
Journal: British Journal of Dermatology (2024)

Abstract Dermatological manifestations in chronic granulomatous disease (CGD) include skin infections and sterile cutaneous inflammatory lesions. The objective of this study was to assess the clinical and histopathological features of noninfectious skin lesions in patients with CGD. This was a cross-sectional observational study from January 2022 to June 2023, carried out at a tertiary care centre. Forty-eight patients with CGD who were registered in the paediatric immunology clinic were screened for cutaneous noninfectious lesions during their routine follow-up. We describe the frequency of cutaneous noninfectious lesions among patients with CGD, along with their clinicodemographic and histopathological features. Noninfectious inflammatory skin lesions were present in 11 of 48 (23%) patients with vCGD. The mean age of this cohort (n = 11) was 19.8 years (SD 5.2). Centrofacial papulopustular lesions and erythematous infiltration involving the nose and the perinasal area (nose sign) were observed in 5 of 11 patients. Five patients presented with yellowish-orange, discrete, papular lesions involving the face and trunk, mimicking acne-like eruptions. Two patients had lesions of hidradenitis suppurativa. Histopathological examination revealed ill-formed granulomas with a mixed inflammatory infiltrate in the patients with facial lesions, while three patients with acneiform eruptions showed well-formed granulomas. The median age at onset of symptoms of CGD (48 vs. 7 months, P = 0.005; difference between groups 35 months, 95% confidence interval 12–78) and the median age at diagnosis of CGD (150 vs. 48 months, P = 0.008, difference between groups 72 months, 95% confidence interval 22–132) were significantly higher in patients with CGD who developed noninfective, inflammatory skin lesions compared with those without such skin lesions. The proportion of patients with NCF1 mutation was significantly higher in patients with noninfective inflammatory skin lesions (73% vs. 27%, P = 0.011). No correlation was seen between the type of skin manifestation and pathogenic mutation. In conclusion, inflammatory noninfectious cutaneous lesions can occur in CGD in the form of perinasal infiltrated papules and pustules (nose sign), as well as acne­iform lesions, and can be clues towards clinical diagnosis.
P056 Reflectance confocal microscopy and basal cell carcinoma: is it time to embrace the new technology?
Authors: Isabelle Nicholls, Hina Baloch, Jennifer Garioch, May Fadhil
Journal: British Journal of Dermatology (2024)

Abstract Reflectance confocal microscopy (RCM) is a noninvasive technique for in vivo examination of the skin. In vivo RCM can be used to diagnose basal cell carcinoma (BCC) noninvasively. Previous studies have demonstrated that RCM is an accurate technique for the diagnosis of BCC. RCM has the advantage that it is noninvasive and provides the diagnosis within a few minutes. By contrast, the current standard of care requires an invasive biopsy, taking several days before the result is available, and is costly and can result in sampling errors. We provide a snapshot of how we have integrated RCM into our service, and how it has reduced the number of biopsies, resulting in significant cost savings and shortening patients’ pathways. Sixty-three patients with suspected BCC of the head and neck were referred to our RCM clinic in January, February and March 2023. A diagnosis of BCC was made by RCM in real time in 89% of cases (56 of 63). Confirmation of the diagnosis of BCC in clinic facilitated discussion with the patient at the same outpatient attendance with regards to treatment, without the need for an additional outpatient visit. Overall, 11% of patients (seven of 63) suspected of having a BCC, whose diagnosis could not be confirmed by RCM, required a biopsy that confirmed the diagnosis of BCC. The median turnaround time for the biopsy result was 12 days. The cost of a punch biopsy in our hospital is £330 per patient, of which £176 is attributable to histopathology costs. Following the diagnosis of BCC, 73% (46 of 63) were referred directly for Mohs surgery, 12% (eight of 63) had conventional excision, 5% (three of 63) were referred for radiotherapy, and 10% (six of 63) were managed conservatively. We have shown that integrating RCM into our dermatology service has negated the need for biopsy in 89% of head and neck BCCs referred to the RCM clinic. RCM has resulted in shortening of patients’ pathways, it has reduced the pressure on our histopathology service, it has lessened the risk of false negative biopsies due to sampling errors, and it has produced significant cost savings. The diagnosis of BCC by RCM is a simple skill to acquire and allows the clinician to make the diagnosis with a few minutes. For patients, it is a more acceptable method of diagnosing BCC without recourse to biopsy. For the wider NHS, it has the potential for significant cost savings.
BH08 Evaluating quality-of-life measures for alopecia: a comparative analysis of Dermatology Life Quality Index and Hospital Anxiety and Depression Scale correlations with disease severity
Authors: Chris Puo Nen Lim, Susan Holmes
Journal: British Journal of Dermatology (2024)

Abstract Assessing quality of life (QoL) is crucial in managing patients with alopecia areata (AA), but the optimal health-related quality-of-life (HRQoL) measures remain debated. This uncertainty has been highlighted by recent clinical trials of Janus kinase inhibitors for severe AA, which employed various tools to evaluate the impact of AA and treatment effects on patient QoL. Measures used included generic scores [e.g. Hospital Anxiety and Depression Scale (HADS) and EuroQol (EQ)-5D-5L] and AA-specific scores (e.g. Alopecia Areata Symptom Impact Scale and Skindex-16-AA). Despite the well-recognized psychological impact of severe AA, EQ-5D-5L-based cost-effectiveness models failed to demonstrate significant improvement post-treatment. The current study aimed to evaluate the usefulness of QoL scores [Dermatology Life Quality Index (DLQI) and HADS] routinely collected from patients attending a specialist alopecia clinic. As there is no gold-standard QoL measure for alopecia, we analysed whether there was a correlation between DLQI and HADS, and with clinician-rated disease severity. The influence of psychiatric history and patient age was also assessed. Quantitative data were evaluated using SPSS (version 29.0.1.0; IBM, Armonk, NY, USA) for descriptive and parametric analyses. In total, 179 patients were assessed (17 male, 162 female; age 15–78 years). The results showed moderate positive correlations between DLQI and HADS-D (depression; P &amp;lt; 0.001), DLQI and HADS-A (anxiety; P &amp;lt; 0.001), and DLQI and total HADS (P &amp;lt; 0.001). DLQI correlated positively with clinician-rated disease severity (P = 0.003); however, no association was observed between HADS and clinician-rated disease severity scores. Patients with a pre-existing psychiatric history had higher DLQI (P = 0.03), HADS-D (P &amp;lt; 0.001) and HADS-A scores (P &amp;lt; 0.001). Patients with scarring alopecia tended to have lower DLQI scores, while patients with nonscarring alopecia had higher scores (P &amp;lt; 0.006). There was a statistically significant relationship between DLQI and patients’ ages, with younger patients more likely to have ‘moderate’ or ‘very large’ DLQI (P &amp;lt; 0.004). On the basis of these results, DLQI and HADS correlate moderately; however, only DLQI correlates with clinician-assessed disease severity. Patients with a psychiatric history and nonscarring alopecia tended to have higher scores, and younger patients tended to score more highly using DLQI. The impact of alopecia on patients is often severe; however, the best measure(s) of assessment is unclear. Although it has limitations, DLQI seems to be a reasonable QoL measure for patients with alopecia and correlates with clinician assessment of disease extent. However, further research is required to identify the most useful QoL tools for patients with alopecia, and disease registries will facilitate this work.
P070 The epidemiology of skin cancer in Greater Manchester 2017–22: a retrospective cohort study using primary care records
Authors: Lana Y H Lai, Ben W M Sim, Tracey Farragher, Brian McMillan, Emma McMullen, Zoe C Venables, Zenas Z N Yiu
Journal: British Journal of Dermatology (2024)

Abstract Skin cancer is the commonest cancer in the UK, with increasing incidence, creating a significant workload for dermatology departments. Greater Manchester is one of the most populous areas in the UK, and understanding the regional skin cancer trends is vital for healthcare service planning and public health interventions. The Greater Manchester Care Record (GMCR) holds data from 99.5% of general practices on &amp;gt; 3 million registered patients (Watkinson RE, Williams R, Gillibrand S et al. Ethnic inequalities in COVID-19 vaccine uptake and comparison to seasonal influenza vaccine uptake in Greater Manchester, UK: a cohort study. PLOS Med 2022; 19: e1003932). It was approved for research access for COVID-19 response analysis, which allowed this opportunity to understand the epidemiology of skin cancer in Greater Manchester. This retrospective observational cohort study of the GMCR included cases of basal cell carcinoma (BCC), cutaneous squamous cell carcinoma (cSCC) and malignant melanoma (MM) registered between January 2017 and December 2022. We calculated the crude incidence rate (IR) per 100 000 person-years by skin cancer type, age group and sex. To avoid duplication, we restricted cases to a timeframe of at least 2 weeks before a subsequent case was counted, based on expert advice and review of the data. The denominator was the summation of 1 year of follow-up for each registered patient as of December each year. We compared the IR from GMCR to the national cancer registry IR from the ‘Get Data Out’ skin initiative. We identified 42 370 cases of BCC, 7503 cSCC and 7924 MM between 2017 and 2022, with respective median (interquartile range) ages at diagnosis of 73.3 years (62.3–80.9), 73.6 years (62.2–81.9) and 62.0 years (49.1–73.8); the majority (&amp;gt; 87%) of the population was White. The IR ranged from the lowest at 185, 44 and 36 per 100 000 person-years in 2020 (coinciding with the early stages of the pandemic) to the highest at 265 (2022), 35 (2019) and 54 (2022) per 100 000 person-years for BCC, cSCC and MM, respectively. The incidence rate ratios (95% confidence interval) for 2020 vs. 2019 were 0.79 (0.76–0.81), 0.98 (0.91–1.06) and 0.87 (0.80–0.94) for BCC, cSCC and MM, respectively. The male-to-female ratio was around 1 for BCC and cSCC until age 70 years, after which there was an increasing male preponderance, while for MM the same divergence started at age 50 years. We report lower IRs for both BCC and cSCC compared with England, and a higher IR for MM. We present the epidemiology of skin cancer in Greater Manchester from a novel primary care dataset, showing reductions in IR during 2020 of 21%, 2% and 13% for BCC, cSCC and MM, respectively. We report a lower than expected IR of cSCC, which is a likely underestimate and requires further investigation.
BH17 A case of talquetamab-induced onychomadesis with associated palmoplantar keratoderma and desquamation
Authors: Claire Quigley, Al Mutasim Al Qassabi, Lisa Murphy, Amy Long, Irene Timoney, Rory Barry, Sophie Diong, Susan O’Gorman
Journal: British Journal of Dermatology (2024)

Abstract Herein we present the case of a 59-year-old woman who presented to our department with shedding of nails on all 10 fingers and toes, as well as desquamation of the skin on the palms of her hands and soles of her feet. She had a background history of relapsing refractory multiple myeloma and had not responded to multiple other lines of therapy. However, she had biochemical and clinical remission of her multiple myeloma with a new monoclonal antibody agent, talquetamab. She presented to our clinic with significant nail and skin changes that occurred 2 weeks into treatment with talquetamab. She reported shedding of the nails on all 10 fingers and toes, with recurrent cycles of regrowth and shedding. She also reported increased thickened scale and peeling of the skin on the palms of her hands and soles of her feet. Examination revealed onychomadesis of all nails and toenails as well as palmoplantar keratoderma and desquamation. Talquetamab is a bispecific monoclonal antibody targeting human CD3 surface antigen, and GPRC5D tumour-associated antigen. It was approved as a conditional monotherapy for relapsing refractory multiple myeloma in August 2022. In trials, nail-related adverse events occurred in 57% of patients receiving talquetamab and skin-related adverse events occurred in 67% of recipients. To our knowledge, there has been only one other case report of onychomadesis described in relation to talquetamab therapy. It is postulated that the target protein GPRC5D is also present in nails, with talquetamab treatment leading to nail matrix arrest and subsequent nail shedding. These changes have impacted on our patient’s quality of life, including affecting her manual dexterity. Treatment with ultrapotent topical steroids has provided only modest benefit.
BH15 The burden of alopecia areata: examining baseline health-related quality of life and clinical assessment tools
Authors: Aoife Boyle, Dmitri Wall, Ian McDonald
Journal: British Journal of Dermatology (2024)

Abstract Alopecia areata (AA) is an autoimmune-mediated, nonscarring hair loss that affects 2% of the population. Patients with AA experience significant impairment in health-related quality of life (HRQoL), particularly mental health (Senna M, Ko J, Glashofer M et al. Predictors of QOL in patients with alopecia areata. J Invest Dermatol 2022; 142: 2646–50). The Severity of Alopecia Tool (SALT) is a physician-derived, semiobjective measure, frequently used in clinical practice, that calculates the extent of scalp hair loss. Nonscalp hair or quality of life is not incorporated and may explain why SALT can underestimate the overall impact of AA (Senna et al.; Wall D, Rees H, Bokhari L et al. Signposts to the promised land in alopecia areata. J Invest Dermatol 2023; 143: 9–10). The Dermatology Life Quality Index (DLQI) and Hospital Anxiety and Depression Scale (HADS) are common HRQoL assessments. Emerging disease-specific tools, which examine both hair loss extent and quality-of-life impact, include the Alopecia Areata Patient Priority Outcomes (AAPPO) and the Alopecia Areata Symptom Impact Scale (AASIS). This study aimed to determine the baseline HRQoL burden among adult patients with AA in a newly developed hair research clinic. A secondary aim was to examine how HRQoL assessments compared with SALT vs. newer compound measures, AAPPO and AASIS. A retrospective chart review identified 20 patients with complete data. The mean SALT score was 61.2. The mean DLQI score was 11.05, indicating a very large impact on QoL as measured by DLQI bands. Overall, 15% of patients experienced no effect, 25% a small effect, 10% a moderate effect, 30% a very large effect and 20% an extremely large effect. The mean HADS-D (depression) score was 8, indicating a borderline score. In total, 47% had normal scores, 21% had borderline scores and 32% had abnormal scores. Similarly, the mean HADS-A (anxiety) score was borderline at 9.9; 26% had normal scores, 21% borderline scores and 53% abnormal scores. The mean total AAPPO score was 16.8 out of 44. The highest mean subscore was the emotional symptoms subscore of 9.9 out of 16, followed by a hair loss subscore of 9 out of 16 and an activity limitations subscore of 3.9 out of 12. The mean total AASIS score was 118 out of 170. The highest mean subscore was the symptoms subscore of 36.9 out of 70, followed by the feelings subscore of 17.5 out of 40 and daily functioning subscore of 24.1 out of 60. SALT had a nonsignificant positive association with HRQoL. AAPPO and AASIS had significant positive associations with HRQoL. In conclusion, our study has demonstrated a significant impact on HRQoL among patients with AA, irrespectively of the degree of hair loss. Our study has also shown that the emerging disease-specific tools, AAPPO and AASIS, are superior in determining the overall impact of AA compared with SALT.
CD09 Prevalence of contact allergy in patients with vulval dermatoses: a 10-year retrospective review
Authors: Wajeeha Khan, Shaheen Akhter, Natalie Stone, Mahbub M U Chowdhury, Ruwani Katugampola
Journal: British Journal of Dermatology (2024)

Abstract Allergic contact dermatitis (ACD) is an important diagnostic consideration in the evaluation of patients presenting with vulval dermatoses. Although ACD coexisting with vulval dermatoses is uncommon, identifying and avoiding the allergens can have a positive impact on the management and quality of life of patients. The aim of this retrospective review of patch test data was to identify relevant allergens in patients presenting with vulval dermatoses in two specialist centres. Relevant data were extracted from electronic database and patch test departmental records between 2013 to 2023 from two specialist cutaneous allergy centres. Patch tests were performed in accordance with the International Contact Dermatitis Research Group and European Society of Contact Dermatitis guidelines. Patch test readings were performed on day 2 and day 4, and positive reactions were recorded. In total, 155 female patients with a mean age of 53.4 years were referred for patch testing. Vulval pruritus (37.5%) and vulval eczema (29%) were the two most common presenting complaints for patch test referral. All patients were tested to the standard and anogenital series, and some to extra series including medicaments, cosmetic, plants, acrylates, hairdressing and own products, depending on clinical history. Multiple allergens were identified including metals, topical drugs, fragrances, preservatives, cosmetic constituents and rubber additives. The most common clinically relevant allergens were fragrances (27.4%), preservatives (18.5%), textile dyes (4.5%) and medicaments (2.5%). Interestingly, 9.6% of patients were tested to the acrylate series, but none had a positive reaction. Fragrance allergy was prevalent in patients with a history of vulval lichen planus and lichen sclerosus. Numerous products were implicated in causing the dermatosis, including sanitary pads, wipes, shower gels and topical medications. Overall, 76% of patients noticed improvement after avoidance of relevant allergens. Patients with chronic vulval dermatoses are at increased risk of ACD and should be assessed for possible contact dermatitis. Patch testing is required to identify relevant contact allergens, the most common of which from our cohort include fragrances, preservatives, textile dyes and medicaments. These results are comparable with previous results reported by Woodruff and Vandeweege (Woodruff CM, Trivedi MK, Botto N, Kornik R. Allergic contact dermatitis of the vulva. Dermatitis 2018; 29: 233–43; Vandeweege S, Debaena B, Lapeere H, Verstraelen H. A systematic review of allergic and irritant contact dermatitis of the vulva: the most important allergens/irritants and the role of patch testing. Contact Dermatitis 2023; 88: 249–62). Patient education and follow-up are essential in optimizing treatment and preventing recurrence of vulval ACD.