tbuckley/cabot-search huggingface dataset:
P033 Do suspected cancer pathway referrals to dermatology meet the NICE criteria for referral?
Authors: Harriet O’Neill, Maulina Sharma, Hossain Shahidullah
Journal: British Journal of Dermatology (2024)

Abstract Suspected cancer pathway referrals to dermatology are increasing to an extent that is overwhelming services, yet only 6% of these receive a diagnosis of melanoma or squamous cell carcinoma [Cancer Waiting Times (CWT) urgent suspected cancer referrals: referral, conversion and detection rates. Available at: https://www.cancerdata.nhs.uk/cwt_conversion_and_detection (last accessed 5 February 2024)]. There is an urgent need to identify factors that might reduce inappropriate referrals and improve this conversion rate. We analysed 100 urgent suspected skin cancer referrals from primary care, received consecutively from 1 October. Data were extracted for referring healthcare practitioner, suspected diagnosis and whether the referral was judged to meet the NICE criteria for referral of suspected skin cancers. Only 68% (n = 68) of referrals met the NICE referral criteria for urgent suspected skin cancer. In total, 97% (n = 31) of the referrals that did not meet these criteria had an eventual diagnosis of a benign lesion or nonsignificant basal cell carcinoma (BCC); one referral judged inappropriate had the clinical outcome of a BCC on the nasal tip, which would have met the NICE criteria. Overall, 17% (n = 17) of referrals came from non-general practitioners (GPs) such as physician associates or advanced nurse practitioners. These referrals were less likely to be judged to meet the NICE referral criteria than those from GPs: 41% (n = 7) of non-GP referrals were deemed appropriate vs. 73% (n = 61) of referrals from GPs. Adherence to the NICE criteria for referring suspected skin cancers to dermatology is disappointing. Crucially, less than half of referrals from non-GPs met these criteria, compared with nearly three-quarters of those from qualified GPs. This raises the case for only accepting referrals for suspected skin cancer from qualified GPs. Our evidence suggests that such a stance could potentially lead to a 5% reduction in referrals overall. It is also significant that not one of the referrals deemed to be inappropriate on paper led to an eventual diagnosis of melanoma or squamous cell carcinoma. This suggests that triaging referrals at the pre-appointment stage with the option of querying or even rejecting referrals that do not meet NICE criteria would be low risk. This could potentially reduce urgent suspected skin cancer referrals by 32%.
BH16 Central centrifugal cicatricial alopecia and fibroproliferative disorders: exploring the association with uterine leiomyomas
Authors: Laksha Bala, Christie Tsang, Vani Agarwal, Noha Elshimy
Journal: British Journal of Dermatology (2024)

Abstract Central centrifugal cicatricial alopecia (CCCA) is a type of scarring alopecia, which typically starts on the crown and progresses in a centrifugal manner. It predominantly affects women of African descent and often has devastating psychosocial implications. The pathogenesis of CCCA is not fully understood and therapeutic options are limited. It has been proposed that CCCA is a fibroproliferative disorder (FPD) with persistent, low-grade inflammation resulting in end-stage fibrosis. People of African descent are at increased risk of FPDs including uterine leiomyomas (ULs), possibly due to the protective effect of profibrotic alleles against helminthic infections (Dina Y, Okoye GA, Aguh C. Association of uterine leiomyomas with central centrifugal cicatricial alopecia. JAMA Dermatol 2018; 154: 213–14). There are only eight publications to date that explore the potential link between CCCA and ULs. A retrospective cohort study found that Black women with CCCA have nearly five times increased odds of ULs, compared with Black women without CCCA (Dina et al.). Fibroproliferative genes (e.g. platelet-derived growth factor and collagen genes I and III) are upregulated in areas of scalp affected by CCCA, compared with unaffected scalp in the same patients, with an overlap in pathogenic mediators with other FPDs including atherosclerosis and hepatic fibrosis (Aguh C, Dina Y, Talbot CC Jr, Garza L. Fibroproliferative genes are preferentially expressed in central centrifugal cicatricial alopecia. J Am Acad Dermatol 2018; 79: 904–12). These findings may help identify future therapeutic targets to treat CCCA. Current approaches use anti-inflammatory medications to halt disease progression. However, unlike other scarring alopecias, patients with CCCA often have minimal visible scalp inflammation, despite worsening fibrosis and hair loss. Hence, particularly for patients who do not improve with anti-inflammatory treatments, antifibrotic agents may play a therapeutic role in the future, with medications such as losartan and statins demonstrating potential for halting CCCA progression. We conducted a retrospective cohort study among patients with CCCA presenting to our tertiary-centre hair clinic, using Black women with lichen planopilaris (LPP) as a comparator group (n = 20). We found that 80% of Black women with CCCA had reported ULs, compared with 50% of Black women with LPP. In light of this potential association, dermatologists should be encouraged to screen for symptoms of ULs, alongside other FPDs, and counsel patients regarding potential comorbidities associated with CCCA. This may allow for prompt diagnosis of life-altering comorbidities and significantly ameliorate patients’ quality of life.
P032 Prevalence and severity of dermatological symptoms experienced after critical care admission: an observational study
Authors: Zara Ali, Navneet Kalsi
Journal: British Journal of Dermatology (2024)

Abstract Recent medical advances mean that more people survive critical illnesses and intensive care unit (ICU) admissions. This has led to an uptick in reported physical, cognitive and mental health issues post-ICU (Hiser SL, Fatima A, Ali M et al. Post-intensive care syndrome (PICS): recent updates. J Intensive Care 2023; 11: 23). Despite existing research, dermatological symptoms post-ICU care have been overlooked. This study aims to assess the prevalence and extent of such symptoms in patients 1 month after ICU admission. Local approval was obtained for the study. We enrolled ICU patients admitted for 5 days or longer, or with advanced respiratory issues, from 1 August to 30 November 2023. Telephone interviews were conducted with patients 1 month after ICU admission to assess previous and new dermatological diagnoses or symptoms. If new disease was present, patients were asked about the impact on their quality of life, and if they had sought treatment. Of 148 ICU admissions in a 4-month period, 70 met the study’s criteria. Exclusions were made for patients with primary skin issues (n = 1), deceased or on an end-of-life pathway (n = 25), or still under specialist care (n = 10). Three patients could not be reached. In total, data from 31 patients were included; their ages ranged from 18 to 89 years (mean 61.8, SD 16.9) and 48% were female. Twenty-three patients (74%) experienced dermatological issues post-ICU, including xerosis (n = 8), nonspecific pruritic erythematous rash (n = 5), mouth ulcers (n = 3), hair loss (n = 3), brittle nails (n = 3), cellulitis (n = 2), seborrhoeic dermatitis (n = 2) and pruritus (n = 2). Six patients reported that these caused a significant impact on their daily life (causing low mood, or interrupting sleep or daily activities), while nine reported a moderate impact (causing irritation but not halting usual activities). Nine sought healthcare advice to treat their symptoms, while 10 self-managed with over-the-counter products. Among those with post-ICU dermatological issues, six had a formal chronic dermatology diagnosis, and a further nine reported previous skin problems. The eight patients without post-ICU dermatological symptoms had no formal skin disease diagnoses. Our findings indicate that a notable portion of ICU patients experience skin impairments, and a potential predictor is identified, as 65% of affected patients have a history of chronic skin disorders or symptoms. Dermatological symptoms post-ICU significantly or moderately affected daily life for most individuals, leading them to seek treatment following hospital discharge. Further research is warranted to explore the risk of cutaneous impairment post-ICU, and we propose preventive measures such as prescribing prophylactic emollients to mitigate this risk.
P036 Dupilumab treatment normalizes skin barrier function in children aged 6–11 years with moderate-to-severe atopic dermatitis
Authors: Michael J Cork, Donald Leung, Peck Ong, Simon Danby, Marco Ramirez-Gama, Shannon Garcia, Taylor Patricia, Rob Byers, Stephen Matcher, Joseph Zahn, Gabriel Bologna, Annie Zhang
Journal: British Journal of Dermatology (2024)

Abstract Atopic dermatitis (AD) is associated with significant disruption in skin barrier function, mediated by the type 2 inflammatory cytokines interleukin (IL)-4 and IL-13. This study reports the effect of dupilumab treatment in paediatric patients (aged 6–11 years) with moderate-to-severe AD on skin barrier function and clinician- and patient-reported outcomes. PELISTAD (NCT04718870) was an open-label, exploratory study on skin barrier function in children aged 6–11 years with moderate-to-severe AD treated with dupilumab for 16 weeks based on baseline patient weight (300 mg every 4 weeks: ≥ 15 kg to &amp;lt; 30 kg; 200 mg every 2 weeks: ≥ 30 kg to &amp;lt; 60 kg) and matched healthy volunteers. Transepidermal water loss (TEWL) was assessed longitudinally after skin tape stripping from lesional and nonlesional skin of patients with AD treated with dupilumab, and from healthy skin. Eczema Area and Severity Index (EASI) and skin pain numerical rating scale (NRS) were assessed during the same periods. Twenty-three dupilumab-treated patients and 18 healthy volunteers were included in the study. After 16 weeks of dupilumab treatment, median (95% confidence interval) TEWL after five skin tape strips significantly decreased in the lesional skin of patients with AD (33.8, 25.2–42.3) compared with baseline (63.7, 44.1–83.3; P &amp;lt; 0.001). Least squares mean (standard error) TEWL after five skin tape strips in lesional skin (30.7, 3.5) was comparable with that observed in healthy skin (27.8, 4.4) at week 16 (P = 0.62). Similar improvement was observed in nonlesional skin (25.5, 2.1), which did not significantly differ from healthy skin (24.6, 2.6; P = 0.79). Mean (SD) EASI decreased from 34.8 (11.9) at baseline to 11.3 (11.0) at week 16. Improvement was also observed in skin pain NRS, which decreased from mean (SD) 6.8 (2.5) at baseline to 2.3 (1.4) at week 16. Overall safety was consistent with the known dupilumab safety profile. Dupilumab treatment normalizes skin barrier function and improves clinician- and patient-reported outcomes in paediatric patients aged 6–11 years with moderate-to-severe AD. This research was sponsored by Sanofi and Regeneron Pharmaceuticals Inc. ClinicalTrials.gov identifier: NCT04718870.
BT25 Successfully utilizing a novel teledermatology pathway in a suspected skin cancer clinic: improving patient experience and reducing time from referral to assessment
Authors: Sophie Holloran, Catarina Quaresma, James Roberts, Dheeksha Ponpandian, Yousef Kordi, Emily Ko, Helen Whitley, Jolita Zakaraite
Journal: British Journal of Dermatology (2024)

Abstract In the UK the incidence of skin cancer has increased by 26.1% since 2013, with 225 000 cases diagnosed in 2019. In response to the rising demand we must adapt our service pathways to ensure patients have a reliable, responsive service that meets the National Health Service Faster Diagnosis Standard. Prior to adapting our service, we had 600–900 referrals per month, with an increasing backlog of patients who were waiting to be seen, missing the 14-day target. For several years, an effective collaborative partnership with our plastic surgery colleagues has greatly improved our skin cancer service; patients were seen face to face, with dermatology and plastic surgery consultants working side by side in a polyclinic format. Despite this, the pressure on services still resulted in a backlog, with only 0.7% of referrals seen within 14 days in July 2023. In July, we introduced a teledermatology service to run in tandem to our face-to-face service; this allowed for increased capacity and also improved our referral response times. There are several exclusion criteria for our new pathway. If a general practitioner refers a lesion with a high level of concern for malignancy, if the patient is over 85 years old, or if there are multiple lesions, patients are assessed face to face; the remainder are reviewed via teledermatology. Within 7 days of referral, the patient is assessed face to face by an experienced dermatology healthcare assistant. They complete a skin cancer assessment and take macro and dermoscopic images of the lesion. This information is uploaded onto our electronic medical record and reviewed by a consultant within 5 days. If the lesion is concerning for malignancy or the diagnosis is unclear, patients are booked for face-to-face review within 14 days. The patient can also be directly listed for surgery; for those directly listed, they are sent a letter with our minor surgery patient leaflet and offered a face-to-face appointment prior to their procedure only if they desire. For benign lesions, the patient is discharged directly following teledermatology review. Our system has been designed to be flexible; if it is felt there are other lesions of concern by the healthcare authority, or if there is insufficient information or subquality images, the patient can be easily and quickly transferred to a face-to-face review. Within 6 months, we are now seeing over 95% of our referrals within 14 days. Our data demonstrate that by adapting our service and introducing a teledermatology pathway, we have significantly improved time from referral to assessment and improved the experience for patients. We aim to continually improve and adapt the service, adjusting it as needed with service demand.
O04 How useful is chest X-ray in addition to routine QuantiFERON® in the detection of latent tuberculosis prior to biologics?
Authors: Niamh Kearney, Fawad Aslam, Grace Boyd, Natasha Boylan, Emma Laverty, Rosie O’Hare, Victoria Campbell, Susannah Hoey, Donal O’Kane
Journal: British Journal of Dermatology (2024)

Abstract The British Association of Dermatologists (BAD) 2020 psoriasis biologics guidelines recommend routine screening for latent tuberculosis infection (LTBI) prior to treatment, using a QuantiFERON®/interferon-gamma-releasing assay (IGRA), with consideration of local policy on additional screening using chest X-ray (CXR). QuantiFERON® is highly sensitive (approximately 96%) in detecting LTBI, while CXR is both poorly sensitive and poorly specific. CXR is included as a baseline test on the BAD biologics 2014 checklist followed in our trusts. Northern Ireland has the lowest annual incidence of tuberculosis in the UK. The aim of this study was to assess the utility of routine CXR in addition to IGRA before commencing biologics. Patients in two of the five trusts in Northern Ireland receiving biologics that require LTBI screening were identified using trust dermatology biologics databases. Electronic records were reviewed, collecting information on demographics, CXR and IGRA results, and respiratory clinic outcomes. We identified 995 patients, 528 male (53.1%) and 467 female (46.9%), with a mean age of 49.2 years. In total, 685 patients had an IGRA, with 16 of 685 positive (2.3%) and 4 of 685 indeterminate (0.6%). In the four patients with an indeterminate result, just one had a subsequent positive IGRA (0.1%). Overall, 949 patients had a CXR, with 83 of 949 (8.7%) noted to have any abnormality. Twenty-six patients (2.7%) required follow-up imaging, including CXRs (n = 13), computed tomography (n = 10) and echocardiograms (n = 3). Just eight patients had features suggestive of TB on CXR (0.8%). When the χ2-test was used, patients were just as likely to have an abnormal CXR if they had a positive (1 of 16, 6%) or negative IGRA (59 of 666, 8.9%; P = 0.93). Twenty-three patients were referred to the respiratory clinic with a positive IGRA or CXR (2.3%), with 20 patients treated for LTBI (2.0%). Three patients were treated on the basis of a CXR result (0.3%), including two patients without an IGRA and one patient with a negative IGRA. Tuberculosis is uncommon in our dermatology population in Northern Ireland, with just 2% of patients in two trusts treated for LTBI prior to commencing a biologic. QuantiFERON® is a highly sensitive test, detecting LTBI in 1.7% of 665 patients tested in this study. CXR, in contrast, identified changes suggestive of LTBI in 0.8%, with 8.3% noted to have another incidental finding, resulting in a burden of additional imaging requirements. Routine CXR in this cohort did not provide additional diagnostic value in the detection of LTBI. QuantiFERON® alone could be considered sufficient for screening.
BC02 Role of platelet-rich plasma in atrophic acne scars along with microneedling and subcision
Authors: Shashank Bhargava
Journal: British Journal of Dermatology (2024)

Abstract Atrophic acne scarring is one of the most common sequel of acne vulgaris. The objective of this study was to evaluate the role of platelet-rich plasma (PRP) as adjunctive therapy to a combined subcision and needling treatment in severe (grade 4) atrophic acne scarring. In total 78 patients with grade 4 atrophic acne scars were randomly divided into two groups with 39 patients each: group A underwent three sessions of subcision and microneedling, while group B had three treatments of subcision, needling, and topical application of PRP. The sessions were repeated every 4 weeks. Scar grading was assessed 6 months following the final session. The participant’s assessment of treatment response was also considered. Scar improvement by ≥ 50% was reported significantly more often by patients in group B than in group A (P = 0.025). There were 11 patients from group B who improved by two grades, in comparison with only three from group A. The physician’s evaluation of improvement correlated with the patients’ own assessments: 50% of patients in group A and 67% in group B showed improvement of 25–49% and 50–74%, respectively. The mean duration of downtime was shorter among patients in group B than in group (21.1 vs. 32.9 h, respectively). Icepick scars showed the least improvement when compared with other variants of atrophic scars. In conclusion, PRP definitely works as an adjuvant modality to treat atrophic acne scars.
PD02 Sunscreen database app
Authors: Donna Parkin, Surayyakhanam Kayamkhani, Jean Ayer
Journal: British Journal of Dermatology (2024)

Abstract Sunscreens play a pivotal role in the effective management of photodermatoses by safeguarding the skin against harmful ultraviolet radiation, thereby mitigating the onset or exacerbation of symptoms. However, complications arise when individuals develop allergies to sunscreen filters and other formula constituents. Navigating the process of finding a suitable sunscreen that offers adequate protection without triggering adverse reactions can often be challenging. Careful scrutiny of product labels is vital for individuals with known allergies. However, deciphering ingredient information can be difficult due to the small print size and complex chemical names. To address this, we present the development of an innovative sunscreen database designed to help healthcare professionals to identify appropriate sunscreens for patients with sunscreen allergies in a clinical setting. The Sunscreen database has been developed using Power Apps. The application has two interfaces, one for administrators and one for guest users. Administrators are granted access to add, edit and delete sunscreens and ingredients in the existing dataset. Various data fields are provided, including the sunscreen name, sun protection factor, star rating, ingredients, ultraviolet filters, formulation date, and company details. The home page displays a table of all sunscreens we have populated the database with. Filter and search options using simple drop-down menus provide a customized list of sunscreens, facilitating easy access to sunscreen information and quick and accurate decision making. The app allows groups to be assigned to ingredients with several names, which keeps the ingredient list simple. Moreover, if an ingredient from a group is selected for filtering out of the sunscreen dataset, all the remaining ingredients in that group will be automatically selected as well. This saves time and effort that would otherwise be spent manually selecting each individual ingredient in a group. Currently, the app can only be used by clinicians within the Northern Care Alliance, as the current system is set up for data integrity and security. External use may be permitted, but at this early stage, access must be granted from the IT department and their email added as a guest into the trust network. The aim of this project is to provide clinicians with a tool that generates printable, personalized recommendations for this patient group, especially for those who have confirmed allergies following formal patch testing. By providing patients with an allergen-free list of sunscreens, the app empowers them to make informed choices about the sunscreen products they use.