tbuckley/cabot-search huggingface dataset:
P099 Use of roflumilast in erosive oral inflammatory conditions
Authors: Rachel Botrugno, Bijaya Rajlawat, Daniel Finn, Paul Devakar Yesudian
Journal: British Journal of Dermatology (2024)

Abstract Roflumilast is a phosphodiesterase type 4 (PDE4) inhibitor commonly used in respiratory medicine to manage chronic obstructive lung disease. Recently, there have been case reports of its effectiveness in oral mucosal conditions. We review five patients with different erosive mucosal lesions who responded to this medication. All patients were commenced on 250 μg daily, increasing to 500 μg if indicated. Case 1 is a 57-year-old woman who presented to the dermatology/oral medicine (DOM) clinic with long-standing recurrent aphthous stomatitis from her late teens. Treatment with colchicine and dapsone in combination was ineffective. Roflumilast was added and colchicine was stopped following a positive response. Case 2 is a 78-year-old woman seen in DOM in 2021 with erosive oral lichen planus. She did not respond to oral hydroxychloroquine, mycophenolate mofetil, azathioprine and multiple tapering courses of systemic steroids. Roflumilast was commenced recently, and the patient has not reported any flares since. Case 3 is a 26-year-old man with recurrent erythema multiforme predominantly involving the oral mucosa with erosive changes. He was treated with dapsone, prophylactic valaciclovir, and multiple courses of tapering prednisolone. Response was noted but breakthrough flares continued to occur. Roflumilast was commenced 6 months ago with no flares noted since. Case 4 is a 67-year-old woman who presented to dermatology in 2022 with severe oral erosive lichen planus of 4 years’ duration. Treatment with courses of oral prednisolone, hydroxychloroquine and acitretin were ineffective. Roflumilast was introduced, with excellent remission of all the erosions for the last 7 months. Case 5 is a 34-year-old woman who presented to DOM in August 2021 with recurrent deep, severe aphthous stomatitis. She was previously prescribed mycophenolate mofetil and reducing oral systemic steroids by dermatology for severe pyoderma gangrenosum; however, it did not help the oral ulcers. Hydroxychloroquine, colchicine and azathioprine were ineffective for the aphthous stomatitis. Roflumilast was commenced, resulting in clearance of the oral ulcers. Roflumilast acts by inhibiting PDE4, which in turn increases cyclic adenosine monophosphate, and this causes inflammatory modulators such as interleukins and tumour necrosis factor-α to be downregulated. These inflammatory mediators play a role in oral erosive conditions such as oral lichen planus and recurrent aphthous stomatitis. PDE4 inhibitors, including roflumilast and apremilast, have shown promising results in managing oral ulceration in patients with Behçet disease and aphthous ulcers. We advocate the use of roflumilast for oral erosive conditions when standard systemic agents are ineffective or cause side-effects.
P094 Oral tofacitinib monotherapy for the management of moderate-to-severe alopecia areata in children and adolescents: a retrospective analysis of 36 cases
Authors: Hitaishi Mehta, Rahul Mahajan, Dipankar De, Sanjeev Handa
Journal: British Journal of Dermatology (2024)

Abstract Alopecia areata (AA) poses a significant challenge in the paediatric population, with limited treatment options. Oral tofacitinib has emerged as a promising modality, with case reports and small series suggesting safe and effective use in children with AA. This retrospective analysis sought to expand the knowledge base around tofacitinib’s role in managing AA in the younger population and to provide valuable insights into challenges encountered when faced with no responsive to treatment. This retrospective chart review spanned from January 2021 to December 2023 and included 36 patients aged ≤ 16 years with moderate-to-severe AA [Severity of Alopecia Tool (SALT) score &amp;gt; 25], who received ≥ 6 months of oral tofacitinib therapy. The treatment response was defined as ≥ 75% reduction in SALT score (SALT 75) at 6 months. Other outcome measures of interest included times to attain SALT 50, SALT 75, SALT 90 and SALT 100, and incidence of adverse events. In total 36 patients were included, with a mean age of 10.1 years (SD 3.8, range 3–16), with 17 male and 19 female patients. AA subtypes included patchy (19%), ophiasis (17%), subtotalis (28%), totalis (8%) and universalis (28%). The mean SALT score at baseline was 73.1 (SD 26.7). The mean duration of oral tofacitinib treatment was 8.69 months (SD 3.17, range 6–16). SALT 50 was achieved by 26 patients, with an equivalent number attaining SALT 75. Additionally, 24 patients reached SALT 90, while 19 patients reached SALT 100. The mean (SD, range) durations in months to achieve SALT 50, SALT 75, SALT 90 and SALT 100 were 2.81 (1.16, 1–6), 4.08 (1.69, 1–8), 5.71 (2.14, 3–10) and 6.74 (2.35, 3–12), respectively. Ten of the 36 patients (28%) were classified as nonresponders. Nonresponders exhibited a higher median total duration of illness, higher baseline SALT score, and higher incidence of atopy and nail involvement compared with responders. Adverse events were noted in nine patients, with two cases necessitating treatment discontinuation due to adverse events. Among those not showing a response, three patients each underwent a transition to combination therapy of oral steroids with methotrexate and topical immunotherapy with diphenylcyclopropenone. Notably, regrowth was observed in two patients from the former group, while none from the latter group experienced similar positive outcomes after the therapeutic strategy shift. Limitations of the study include the retrospective nature and small sample size. This comprehensive analysis enriches the existing literature on the role of tofacitinib in paediatric AA, addressing gaps in approved treatments and providing valuable guidance for clinicians navigating the challenges of nonresponsiveness in this vulnerable population.
DS04 A transcontinental qualitative comparison study of two Mohs external quality assurance programmes
Authors: Arif Aslam
Journal: British Journal of Dermatology (2024)

Abstract Mohs micrographic surgery (MMS) has been shown to be an effective treatment for nonmelanoma skin cancer. It provides distinct advantages over traditional excisional surgery and its success rate is dependent on the accurate microscopic evaluation of carefully mapped specimens. The Mohs surgeon must be able to translate abnormal findings on the tissue map into appropriate sequential tumour removal. A critical component of this technique is the surgeon’s skill in interpreting histological specimens. Some studies have investigated the concordance of Mohs surgeons’ interpretation of frozen sections with that of dermatopathologists. The American College of Mohs Surgeons has successfully run an annual diagnostic quality control virtual exam. The Australasian College of Dermatologists (ACD) has a well-established external and independent quality assurance programme in conjunction with the Royal College of Pathologists Australia Quality Assurance Program. The British Society for Dermatological Surgery launched its own external quality assessment programme in 2022. This study compares the quality control programmes of both Australia and the UK and highlights key differences and lessons from both.
BC07 Hair oiling: a paradigm shift in the deep-rooted ritual from East to West
Authors: Fabliha Hussain, Faisal Dubash
Journal: British Journal of Dermatology (2024)

Abstract For centuries, generations of African and South Asian women have continued the cultural practice of hair oiling. Pure coconut, castor, amla and argan oils have been used, typically as a prewash ritual. While there is limited clinical evidence on the role of hair oils in trichology, they remain both accessible and inexpensive with a relatively minimal risk profile. The continual rise of globalization and social media, and increased self-care awareness, are factors that have driven their popularity in recent years. The demonstrable shift in mainstream appeal for hair oiling in the West is evidenced by a surge in Google searches for hair oil routines, the emergence of trending social media hashtags such as #HairSlugging, and frequent features by popular media outlets such as Vogue and Grazia magazines. Deeply negative perceptions of the practice, previously held in the West, have undergone an unanticipated U-turn. As the cosmeceutical industry exploits this opportunity, the long-standing ritual has been repackaged to target the Western consumer. Advancements in manufacturing technology have resulted in the modernization of these ancient remedies, from pure oils and homemade blends of the past to more complex formulations that are lightweight, fragranced and more user-friendly. The now expansive hair oil market and widespread global uptake of the practice warrant clinician awareness and the ability to relay accurate evidence on the hair care practice. Benefits of regular hair oiling that are commonly claimed include treating hair loss, thinning and breakage. Studies have considered factors such as emollient effect, saponification, antimicrobial activity, ultraviolet protection and tensile strength. We reviewed the literature to examine the leading hair oils in current use, their biochemical profiles and potential therapeutic benefits. The results demonstrated that despite a plethora of carrier and essential oils in mainstream use, there is only evidence from a limited number of oils, for specific aspects of hair health. Greater evidence was observed for coconut-based hair oils, which demonstrate a protective role in prewash use, preventing increased hair porosity, providing colour protection and improving tensile strength, but not for hair growth. Randomized controlled trial evidence exists for rosemary oil, showing hair growth in androgenetic alopecia. We propose further comparative research of hair oils to delineate the evidence base for their use. This would help consumers differentiate between commercially labelled pseudoscientific benefits and any actual robust evidence base.
Poster presentationsBH07 Intralesional vitamin D as immunotherapy for palmoplantar and periungual warts: how effective is it?
Authors: Shashank Bhargava
Journal: British Journal of Dermatology (2024)

Abstract Warts are a viral infection of the skin caused by human papillomavirus, occurring in the form of verrucous growths over the surface of the skin. Incomplete removal or local recurrence of the infection is the disadvantage with the currently available local tissue destructive therapies. Newer therapy, such as intralesional immunotherapy with purified protein derivatives, offers the advantage of taking care of the viral infection not only at treatment site but also at remote sites, and also offers lifelong immunity. The current study was conducted on 40 patients of all ages with palmar, plantar and periungual warts. After clinical examination, patients were given 0.1–0.2 mL of vitamin D intralesionally in the largest wart at intervals of 3 weeks for three sessions. Patient assessment in follow-up visits was done with clinical photographs and by filling in pro formas for effects and side-effects. Complete clearance was seen in 31 patients (78%), partial clearance in 5 (13%) and no clearance in 4 (10%). There was variation in response in different morphological types of warts, with 100% clearance in plantar and palmar warts, and 70% clearance in periungual warts. In conclusion, intralesional vitamin D is useful in all types of warts; it can be used as a valuable first-line treatment in difficult-to-treat sites like palmoplantar warts and periungual warts.
P092 Bidirectional association between alopecia areata and herpes zoster: a nationwide population-based study
Authors: Chia-Lun Li, Sheng-Hsiang Ma, Ying-Hsuan Tai, Ying-Xiu Dai, Yun-Ting Chang, Tzeng-Ji Chen, Mu-Hong Chen
Journal: British Journal of Dermatology (2024)

Abstract Alopecia areata (AA) is the most common cause of immune-mediated alopecia. Due to the autoimmune nature of AA, researchers have investigated its potential links with infectious diseases. Herpes zoster (HZ) is one of the most common infectious diseases encountered in clinical practice, with a lifetime risk of 30%. However, only a few studies have reported a potential association between AA and HZ. This nationwide, population-based cohort study aims to explore the bidirectional relationship between AA and HZ, using data from the National Health Insurance Research Database (NHIRD) of Taiwan between 1997 and 2013. Individuals aged ≥ 10 years with a diagnosis of AA or HZ were included. Both AA and HZ diagnoses were confirmed by board-certified dermatologists on at least three occasions. For every patient with AA or HZ, 10 matched controls were randomly selected. These individuals were matched for age, sex, monthly income and residence. The primary outcomes assessed were new-onset HZ for patients with AA and new-onset AA for patients with HZ. Using a Cox regression model with adjustment for potential confounders, we assessed the risk of HZ in patients with AA, and vice versa. The cumulative incidence of disease was analysed using Kaplan–Meier survival curves with log-rank tests. In study 1, we included 9072 patients with AA and 90 720 matched controls. In study 2, we included 31 570 patients with HZ and 315 700 matched controls. Compared with controls, patients with AA had a 3.93-fold [95% confidence interval (CI) 3.42–4.52] increased risk for HZ, while patients with HZ had a 5.20-fold (95% CI 4.21–6.42) increased risk for AA. Both associations remained significant after stratification by sex and age. The 15-year cumulative incidence of HZ in the AA group was significantly higher than in the controls, and vice versa (P &amp;lt; 0.001). Furthermore, patients with AA had 4.97-fold (95% CI 2.55–9.68) and a 3.42-fold (95% CI 2.55–4.59) elevated risk for HZ ophthalmicus (HZO) and HZ with nervous system complications, respectively, in comparison with controls. Patients with HZO and HZ with nervous system complications exhibited 3.85-fold (95% CI 1.43–10.4) and a 5.00-fold (95% CI 3.42–7.32) increased risk for AA, respectively, compared with controls. We also found that patients with AA had a significantly younger age at HZ diagnosis compared with controls (40.6 vs. 50.6 years, P &amp;lt; 0.001). Our study revealed a bidirectional association between AA and HZ. Clinicians should remain vigilant regarding this link in both patient cohorts.
CD03 Watch out! Allergic contact dermatitis to acrylates in a smart watch
Authors: Anna Davies, Natalie Stone
Journal: British Journal of Dermatology (2024)

Abstract A 15-year-old girl with long-standing atopic dermatitis and hay fever presented to the patch test clinic with an atypical distribution of eczema over the trunk, elbows and perioral skin. Close examination additionally revealed a well-defined patch on the dorsal left wrist, at the exact site of her Apple smart Watch. She was a competitive swimmer and gym user. Her medications were tranexamic acid, topical steroids and emollients. Testing to the British Society for Cutaneous Allergy standard, medicaments, facial, oral, metals and acrylate series (applied on day 2) showed positive reactions to methylisothiazolinone (day 2+, day 4++), methylchloroisothiazolinone/methylisothiazolinone (MCI/MI) (day 2+, day 4++), benzophenone-3 (day 2−, day 4+), benzophenone-4 (day 2−, day 4+), sodium benzoate (day 2−, day 4+), benzoyl peroxide (day 2−, day 4+), isobornyl acrylate (day 2+), ethylene glycol dimethacrylate (day 2+) and hexanediol diacrylate (day 2+). The benzophenones were of current relevance to her sun protection factor-containing emollient. Sodium benzoate was present in her shower gel and shampoo, as well as her favourite Vimto squash. Benzoyl peroxide was of unknown relevance and MI/MCI was thought to be of past relevance. The acrylates, in particular isobornyl acrylate, were postulated to be of current relevance to her Apple Watch. Since avoiding the allergens, including the Apple Watch, her eczema has significantly improved, specifically clearing at the wrist and perioral skin. Our patient had no known previous acrylate exposure, in particular no history of using gel or acrylic nails. The Apple product website declares that many of their products contain trace amounts of acrylates and methacrylates. Knowledge that acrylates are a common cause of allergic contact dermatitis (ACD) in diabetic devices, and strong clinical suspicion about the watch, prompted us to test with the acrylate series. There are two previous reported cases of Apple Watch ACD, both attributed to nickel (Levian B, Chan GC, Adler BL. Out of REACH: allergic contact dermatitis to nickel in an Apple Watch. Contact Dermatitis 2024; 90: 99–101; Ko WC, Yu J. Nickel allergy elicited by an Apple Watch. Dermatitis 2022; 33: e11–12). Nickel is mentioned on the Apple product website, but that states that release levels are low. Interestingly in one case the dimethylglyoxime spot test was negative (Levian et al.) and the acrylate series was not tested. Our patient tested negative to nickel. There are many reported cases of ‘irritancy’ caused by smart watches; however, most have not been patch tested to the acrylate series. To our knowledge this is the first case suggesting acrylate ACD caused by a smart watch. We encourage others to test with the acrylate series in similar future cases.
P085 Efficacy and safety of 611 for the treatment of moderate-to-severe atopic dermatitis in adults
Authors: Jianzhong Zhang, Yan Zhao, Qinghong Zhou, Yuyu Xu
Journal: British Journal of Dermatology (2024)

Abstract Atopic dermatitis (AD) is a chronic, recurring, inflammatory skin disease characterized by extensive rashes on the body, leading to symptoms such as persistent itching and exudation. There is still a need for safe and effective therapies to improve disease management for uncontrolled moderate-to-severe AD, as current treatments may not adequately control the disease. 611 is a novel monoclonal antibody that targets interleukin (IL)-4Rα. It can selectively bind to IL-4Rα, thereby obstructing the signalling pathways of both IL-4 and IL-13. This action aids in modulating immune function, offering potential relief for conditions such as AD and other related diseases. In this phase II study, the safety and efficacy of 611 was investigated in moderate-to-severe AD in adult patients. In total 93 patients were randomly assigned to three groups: group A received a loading dose of 600 mg of 611 followed by 300 mg every 2 weeks (Q2W), group B received a loading dose of 600 mg of 611 followed by 300 mg every 4 weeks (Q4W), and there was also a placebo group. The primary efficacy endpoint was the proportion of patients with Eczema Area and Severity Index (EASI) 75 response (≥ 75% reduction in score from baseline) at week 16. The results showed positive responses in primary and all secondary endpoints in adult patients with moderate-to-severe AD after treatment with 611. There was a significant difference between 611 and placebo in EASI 75 improvement, with a 60.0% response rate for 611 compared with 15.6% for placebo (P &amp;lt; 0.001). The percentage of patients achieving IGA 0/1 (Investigator’s Global Assessment score of 0 or 1, and ≥ 2-point reduction from baseline) also exhibited a significant difference in the groups receiving 611 or placebo, with rates of 35.5% and 9.4%, respectively (P &amp;lt; 0.05). The other endpoints, including EASI 90, EASI 50, and numerical rating scale reduction by ≥ 4 points, improved more in the groups receiving 611 than for placebo. Regarding safety data in the trial, treatment with 611 showed results comparable with placebo. 611 showed a positive effect in treatment of patients with moderate-to-severe AD in terms of efficacy and safety. 611 has potentially become a promising treatment product targeting IL-4Rα, following on from dupilumab.
P022 A case of cutaneous plasmacytosis occurring in a patient with pulmonary adenocarcinoma
Authors: Joelle Teoh, Alex Gan, Somaia Elsheikh, Ting Seng Tang
Journal: British Journal of Dermatology (2024)

Abstract A 43-year-old woman of Japanese origin presented with a 4-year history of a slow-spreading rash over her face, torso and legs. This consisted of symmetrical hyperpigmented nodular lesions, which were asymptomatic and persistent with no identifiable triggers. Apart from iron-deficiency anaemia, she was otherwise fit and well, with an unremarkable family history. Examination revealed a widespread hyperpigmented erythematous rash distributed symmetrically across the back, with multiple smaller lesions over the face, axilla, torso and legs. Routine biochemistry was unremarkable apart from low ferritin level. Electrophoresis and IgG subclass analysis showed a mildly raised IgM, but was otherwise unremarkable. Investigations for HIV, hepatitis, syphilis and chlamydia were unremarkable. Histopathology showed a mild to focally moderate perivascular and minimally interstitial mononuclear cell infiltrate in the superficial and deep dermis. The infiltrate consisted of lymphocytes, histiocytes and particularly large numbers of CD20+ plasma cells. There was no cytological atypia, with most of the plasma cells expressing IgG. Kappa and lambda in situ hybridization showed a polytypic population of plasma cells. Subsequent imaging studies detected a lung nodule, which was later surgically excised and confirmed to be a pulmonary adenocarcinoma. There was no evidence of significant lymphadenopathy to suggest Castleman disease or lymphoma. Cutaneous plasmacytosis (CP) is a rare skin disorder characterized by multiple reddish-brown nodules with polyclonal plasma-cell proliferation, usually accompanied by a polyclonal hypergammaglobulinaemia. CP is seen predominantly in Asian populations and commonly affects the trunk, particularly the axillae, but can also involve the face and extremities. The pathogenesis of CP remains poorly elucidated; however, existing evidence indicates that an aberrant production of interleukin-6 might be a cause. Histopathology typically shows perivascular and periadnexal mature, polytypic, plasma-cell-rich infiltrate in the superficial and deep dermis. Treatment modalities such as topical and systemic corticosteroids, topical tacrolimus, systemic chemotherapy, cyclophosphamide, psoralen plus ultraviolet A (PUVA) phototherapy and radiotherapy have been used, with varied response. In our patient, topical and systemic corticosteroids did not result in significant improvement, and further PUVA phototherapy has been planned.