tbuckley/cabot-search huggingface dataset:
GD08 A retrospective study of skin diversity and disease, in the depiction of protagonists vs. antagonists, in popular global animations
Authors: Edwina Tang, Faisal Dubash
Journal: British Journal of Dermatology (2024)

Abstract Our retrospective study explores skin conditions and diverse skin phenotypes in the depiction of protagonists vs. antagonists, within popular global animations. Animations throughout media, across continents, can influence younger audiences and societal perspectives. These inevitably impact self-perception and a patient’s personal experience of skin disease, for example acne portrayed in a cartoon villain. Shan Yu, Disney’s villain in Mulan, is portrayed with darker skin, a distinct beard and scars. The choice to associate skin colour and disorders with negatively portrayed characters drives cognitive assignment of a character’s morality, which thus may drive societal prejudice. We collected data assessing skin colour and dermatological characteristics of heroes or villains, in animations worldwide. The top 10 most popular animations for each major continent were identified and analysed from rankings obtained from the Internet Movie Database (IMDB) website. Animations were collected from Asia, Australasia, Africa, Europe, North America and South America. Major blocs of Asia included the top 10 most popular animations from India, China, Japan, the Middle East and South East Asia. Skin tones were captured and put into four categories: grey-hued, pallor, darker than ‘normal’ phenotype and fairer than ‘normal’ phenotype. For example, a character is classified as darker than ‘normal’ if their skin tone is darker than the majority skin colour for that region. While grey-hued and pale complexions are consistently utilized to portray popular villains, there was a global pattern of using contrasting skin colour, depending on the continent. In Europe and Australia, villains with darker skin colours were more common. Acne, warts and scarring were commonly portrayed in villains. In contrast, African villains with distinct skin tone were fairer, whereas their animated African heroes had a skin tone representative of the majority population. Interestingly, in India, more than half of villains were portrayed with darker skin. Sociocultural and colonial-rooted influence of skin tone in Indian society could explain why over half of its popular villains are darker in skin tone. The availability of skin whitening products aligns with postcolonial bias, suggesting that lighter skin symbolizes power, status and beauty. Skin colour and skin disorders in character portrayal may push the notion of ‘good guys’ vs. ‘bad guys’, thus driving prejudice against particular ethnic groups. Colonial media narratives ‘othering’ ethnic groups exemplify how discrimination and hatred may develop. We propose that animators carefully consider the negative impact of their work, including perpetuation of stigma in society, prior to release into the public domain.
BI41 Azacitidine-induced neutrophilic dermatosis
Authors: Jaimie Oldham, Portia Goldsmith
Journal: British Journal of Dermatology (2024)

Abstract We present the case of a 66-year-old lady with a background of myelofibrosis that had progressed from Janus kinase 2-positive essential thrombocythaemia. She had recently been started on azacitidine and ruxolitinib and had received two cycles of this medication. She was admitted under the care of haematology with progressive pus-filled blisters and had been treated with broad-spectrum intravenous antibiotics for presumed cellulitis with significant deterioration. She was delirious and significantly unwell with a raised respiratory rate, reduced oxygen saturations, hypotension, tachycardia and a temperature. On examination she had tender erythematous, necrotic and exudative areas over both lateral upper arms and her abdomen (which was an injection site for treatment with azacitidine). A skin biopsy was performed and advice was given to start 60 mg of prednisolone (a dose of just under 1 mg per kg) as well as adding in cover for fungal infection. Almost immediately she reported feeling better and by the next day her observations had normalized and she was afebrile so the antifungals and antibiotics were stopped. She was discharged on a weaning course of prednisolone (40 mg for 3 days, 30 mg for 3 days and then weaning by 5 mg every 5 days) and was advised to stop azacitidine. Her skin improved and healed quickly and her symptoms did not return on cessation of steroids. Her biopsy showed a pandermal neutrophilic infiltrate and was negative for all bacterial and fungal stains. Neutrophilic dermatoses have been reported both in patients with underlying myelodysplastic syndrome and with use of azacitidine. The correlation with the drug timeline and the fact that the skin has not worsened since, despite the underlying myelodysplastic syndrome worsening, would lend support to this being a reaction to the medication.
GD07 Skin neglected tropical diseases and global health: migration and integration beyond borders
Authors: Niraj Parajuli
Journal: British Journal of Dermatology (2024)

Abstract Skin neglected tropical diseases (NTDs) are a group of diseases that present with cutaneous manifestation. There are at least 12 listed diseases included in the list of skin NTDs by the World Health Organization. Among these, some diseases are typically present more commonly in certain geographical locations compared with others. For example, leprosy is more common in the Asian subcontinent and Buruli ulcer in the African region. In this new world with easy global reach due to the ease of travel, skin NTDs are not restricted only to the tropics. Despite the propensity of these diseases to occur in the tropics and among poorer populations, they can be diagnosed in clinics globally. Therefore, all global dermatologists should have a good knowledge of these conditions wherever they are located. So, should we start on a global health topic for all skin NTDs? Travel data from Nepal showed that 3.48 million passengers travelled internationally from Nepalese airports, which included 1.93 million departures and 1.55 million arrivals. Similarly, a total of 105 million passengers arrive in the UK each year. This unrestricted massive travel between countries poses a huge risk of infectious diseases transferring from their countries of origin in the tropics to European countries. Moreover, mutation of the vectors and climate change have made it possible for certain diseases to adapt to colder climates. Leprosy, scabies, cutaneous leishmaniasis and resistant dermatophyte infection are commonly seen in Nepal. All of these diseases can present with varied clinical presentations. So, due to global travellers, diseases of the tropics may not remain only diseases of the tropics, which has been shown in recent years. Can this be an opportunity for a mutual learning experience between countries of the tropics and Europe? The tropics could learn from research conducted in the Western world, and both can work together in controlling NTDs.
P009 Cylindrocarcinoma: a rare entity
Authors: Rory Barry, Jennifer Boggs, Máirín McMenamin, Rupert Barry
Journal: British Journal of Dermatology (2024)

Abstract A 73-year-old man was referred from a secondary hospital to the dermatology department with a 2-year history of a biopsy-reported recurrent basal cell carcinoma on the left nasal ala. Full-skin examination revealed a solitary 20 × 11-mm, slightly tender, pink-coloured nodule. His past medical history was significant for multiple nonmelanoma skin cancers and colon cancer. No regular medications were prescribed. Mohs micrographic surgery was performed, with two layers required for margin clearance. The Mohs debulk described a carcinoma with features suggestive of a cylindrocarcinoma with necrosis and a high mitotic rate. On immunohistochemical profiling, tumour cells were strongly positive for S0X10, p63 and p53; had multifocal moderate positive staining for S100; had membranous staining for BerEP4; and were focally positive for CD117. Tumour cells were negative for epithelial membrane antigen, calponin, smooth muscle actin, keratin 20, chromogranin, GATA3 and p16. A PET-CT scan was performed, which ruled out any metastatic disease. No clinical recurrence has been observed 8 months after excision. Cylindromas are benign adnexal neoplasms, usually arising on the head and neck. Malignant transformation of these tumours has been reported only rarely, with fewer than 50 cases in the literature. A female predominance has been noted in both benign and malignant cylindromas. Nineteen cases of metastatic disease have been described, typically in the high-grade form of this malignant tumour, with spread to local lymph nodes or distant viscera. Histopathologically, cylindrocarcinomas may show a salivary gland-type basal cell adenocarcinoma-like pattern. Depending on the grade of the tumour, basaloid cells vary in size and degree of nuclear pleomorphism, and are surrounded by a hyaline eosinophilic sheath. Loss of the hyaline sheath network in a jigsaw pattern can be recognized by partial or complete loss of periodic acid–Schiff positivity in malignant cases. Focal to extensive tumour necrosis is frequently seen. Lymphovascular or perineural invasion is not typically identified. The similar clinical characteristics of cylindrocarcinomas to basal cell carcinomas prompt an important differential diagnosis for dermatology clinicians to be aware of, given the metastatic potential. The rapid growth over 2 years in our case is atypical for basal cell carcinomas and more in keeping with cylindrocarcinomas, as documented in previous case reports of this rare tumour. This case also highlights the merits of reviewing histology slides from the original referring centre when performing Mohs micrographic surgery.
H21 These Barbies were dermatologists
Authors: Claire Quigley
Journal: British Journal of Dermatology (2024)

Abstract Greta Gerwig’s 2023 Barbie blockbuster provided an infectious reminder that women are capable of the success of their male counterparts, as well as emphasizing the impressiveness of female empowerment and leadership. Luckily, in dermatology, we have had this leadership from the beginning. According to the 2022 UK consensus of consultant physicians, women make up 51% of higher specialty trainees, and there have been more women than men in training since 2013. However, despite this, only 41% of the consultant physician workforce are women while 59% are men (Royal College of Physicians of Edinburgh. Focus on Physicians. Census of Consultant Physicians and Higher Specialty Trainees in the UK 2016–17. Edinburgh: Royal College of Physicians, 2017). However, dermatology stands out as a female-predominant area of specialization. In the UK in 2016, 57% of consultants and 75% of higher specialty trainees in dermatology were women [Royal College of Physicians. The UK 2022 census of consultant physicians. Available at: https://www.rcplondon.ac.uk/projects/outputs/uk-2022-census-consultant-physicians (last accessed 29 February 2024)]. There is likely a multitude of reasons contributing to this, but the historical influence of prominent female leaders in the specialty cannot be ignored. Presented here are a select group of pioneering female dermatologists whose careers and contributions to the field of dermatology paved the way for the development of one of the few female-dominated medical specialties. Helen Ollendorff-Curth was a female pioneer of genodermatology and is commemorated with four eponyms: the Ollendorff probe sign, the Curth criteria, Buschke–Ollendorff syndrome, and ichthyosis hystrix, Curth–Macklin type (IHCM). Loretta Joy Cummins was the first woman to pass the Dermatology Board examination in the USA and the first to be president of the New England Dermatological Society. Cummins founded a fund for Massachusetts General Hospital and a scholarship fund for women at Tufts Medical School. Agnes Blackadder was the first female consultant dermatologist in the UK, when she was appointed consultant dermatologist at St John’s Hospital, London in 1907. Daisy Maude Orleman Robinson’s achievements include becoming the first female dermatologist in the USA in 1905, as well as being the first female dermatologist to present a case at a dermatological meeting, to publish a scholarly paper in dermatology, and to present a case at an international dermatology meeting. These influential women were catalysts for creating and cultivating a specialty that promotes female leadership in the world of dermatology, medicine and science.
BI25 Crusted scabies in a patient with Down syndrome on risankizumab: a complex interaction of biologics, neurological background and immunodeficiency in psoriasis management
Authors: Dalvir Singh Bajwa, Pooja Jassal-Prior, Nick J Reynolds
Journal: British Journal of Dermatology (2024)

Abstract Scabies, caused by Sarcoptes scabiei, presents a significant global health challenge and is primarily transmitted through skin-to-skin contact. Despite the remarkable advances in the use of biologics to treat psoriasis, a concerning trend of increased susceptibility to infections and infestations has emerged. In this comprehensive case study, we report the complex clinical scenario of a patient with a neurological disorder and psoriasis undergoing biologic treatment who was subsequently diagnosed with crusted scabies predominantly localized to her psoriatic plaques. A 37-year-old female patient with Down syndrome undergoing risankizumab biologic therapy for psoriasis was reviewed in the biologics clinic on a routine appointment. The patient exhibited a notable escalation in her Psoriasis Area and Severity Index (PASI) score, increasing from 11.4 to 30.6, accompanied by crusted plaques resembling the distribution of her psoriasis. Dermoscopic examination revealed distinctive burrows and mites, with microscopic confirmation of three scabies mites. A scabies outbreak in the patient’s care facility prompted a comprehensive treatment regimen involving topical permethrin and oral ivermectin, resulting in nearly complete clearance. However, residual crust necessitated additional topical treatments for resolution. Crusted scabies, prevalent in individuals with immunodeficiencies and neurological disorders such as Down syndrome, is intricately linked to cognitive impairment, altering itch perception and fostering parasite proliferation despite elevated IgE and eosinophils. Notably, crusted scabies demonstrates elevated interleukin (IL)-17 levels, potentially indicating T helper (Th)17 dysregulation. Risankizumab, an IL-23 inhibitor, influences the inflammatory function of CD4+ helper T cells, particularly Th17 cells, which produce cytokines such as IL-17A and IL-17F. The pathogenesis of psoriasis involves a positive feedback loop wherein IL-17 stimulates keratinocytes to produce inflammatory mediators, exacerbating inflammation and keratinocyte proliferation. Our hypothesis suggests that risankizumab-induced downregulation of Th17, combined with the patient’s Down syndrome background, heightened the risk of scabies infestation, leading to crusted scabies development in specific areas. This comprehensive case study highlights the importance of considering crusted scabies in immunosuppressed or neurologically affected patients with refractory psoriasis, providing valuable insights into the intricate interplay between biologics, patient characteristics and cutaneous manifestations.
Poster presentationsBT15 Ethical implications of artificial intelligence in dermatology: use-case analysis of skin cancer diagnostic smartphone apps
Authors: Fazal Shah, Daniel Arecco, Heather Draper, Rubeta Matin
Journal: British Journal of Dermatology (2024)

Abstract Skin cancer is the most common cancer worldwide. Early diagnosis is crucial for improving patient survival and morbidity. Artificial intelligence (AI)-assisted smartphone applications (apps) for skin cancer potentially offer accessible, early risk assessment of suspicious skin lesions. If harnessed to effective and responsive dermatology services, they may improve patient outcomes. The integration of novel technologies into dermatology raises ethical concerns. Ethical principles for acceptable AI governance are well known. Less well elucidated are how these should be applied to actual AI apps. Ethical use-case analysis can improve this understanding. Accordingly, we undertook an ethical use-case analysis of commercially available skin cancer apps. We applied previously described methods for ethical analysis of clinical AI applications to two popular skin cancer apps: SkinVision and Scanoma (Rogers WA, Draper H, Carter SM. Evaluation of artificial intelligence clinical applications: detailed case analyses show value of healthcare ethics approach in identifying patient care issues. Bioethics 2021; 35: 623–33). Systematic searches incorporating published literature, regulatory documents, and websites were undertaken to provide a detailed description of each app, and review the available evidence about their development, effectiveness and use. Screening for inclusion was undertaken by two researchers independently. Ethical concerns were identified with reference to previously described ethical concerns and principles for AI-assisted healthcare. These data were also independently checked and agreed on. By conceptualizing ethical principles within the use context of skin cancer apps, we identified specific ethical issues arising throughout the AI lifecycle of both apps. One company provided extensive detail regarding algorithm development and decision making; this information was insufficiently reported for the other app. Other concerns identified related to the number, quality, consistency and independence of studies assessing algorithm efficacy. Limited efforts to address potential skin tone biases and exclusion of patients with darker skin as target users by one app risk perpetuating existing inequalities. Inadequate regulatory requirements were highlighted. To the best of our knowledge, this study represents the first ethical use-case analysis of patient-facing AI-assisted skin cancer apps. Our findings suggest inadequate incorporation of bioethical norms such as justice, responsibility and transparency into the development and deployment of both apps. Improved regulation will increase accountability. Ensuring ethics by design through integration between technology developers, dermatologists, ethicists and patients is urgently needed to prevent the potential benefits of AI-assisted skin cancer apps being overshadowed by potential ethical harms.
Poster presentationsH05 Tutankhamun’s patchouli slumber: are we sleeping on it in dermatology?
Authors: Nabiah Malik, Yasmin Nikookam, Johnathan Hirniak, Ahmad Sayedyusef
Journal: British Journal of Dermatology (2024)

Abstract Patchouli oil is derived from the patchouli plant, a member of the family Lamiaceae. Similar plants from this family include mint, sage and lavender. The Pogostemon cablin species of the plant is the most popular for cultivating essential oil due to the species’ outstanding therapeutic properties. The oil is obtained through an intricate steam distillation process. Initially used in South East Asia to mask the smell of body decomposition during funerals in the 17th century, and later as an insect repellent in the 1800s, patchouli leaves entered the European market in the 19th century. Nowadays, it is used across perfumery, aromatherapy, skincare and spiritual practices. Once a symbol of wealth, patchouli was so beloved by Tutankhamun that he was buried with 10 gallons of the oil in his tomb in ancient Egypt. Concerning dermatological conditions, patchouli was an early treatment for acne due to its anti-inflammatory and antibacterial properties. It has also shown benefits for dermatitis, eczema, dandruff and oily scalp conditions. As a cell rejuvenator, it can help reduce scar appearance and aid in wound healing. These effects are attributed to the flavonoids, mono- and sesquiterpenoids present in patchouli. In 2013, Yang et al. used molecular docking technology to investigate the antibacterial activity of patchouli oil in vitro (Yang X, Zhang X, Yang SP, Liu WQ. Evaluation of the antibacterial activity of patchouli oil. Iran J Pharm Res 2013; 12: 307–16). Twenty-six compounds in the oil displayed antibacterial activity. In further studies, molecular docking tools and viewer software were used for virtual screening of these compounds. The most significant finding was alpha-patchouli alcohol being a potential inhibitor of the cyclo-oxygenase 1 enzyme. Inhibiting this enzyme would reduce the prostaglandin production involved in the inflammatory process. Different studies have also shown a correlation with patchouli oil and the downregulation of matrix metalloproteinases (MMP-1 and MMP-3) involved in collagen degradation. Further experimental evidence has demonstrated positive results for ultraviolet-induced skin photoageing and the protective effects of P. cablin in mice. Researchers applied patchouli oil for 2 h before ultraviolet exposure to the dorsal skin of mice. Patchouli oil doses of 6 mg per mouse and 9 mg per mouse significantly suppressed skin wrinkle formation, improved skin elasticity, and increased collagen content by 21.9% and 26.3%, respectively. Patchouli oil maintains a prominent role in traditional Asian medicine, while in the West, there is minimal literature, indicating substantial potential for patchouli in dermatological practice. The promising evidence for photoageing necessitates continued investigation. In the cosmetic industry, patchouli remains a popular ingredient in beard oils and more, appreciated by many.