tbuckley/cabot-search huggingface dataset:
P098 Association between air pollution and incidence of psoriasis: a nationwide population-based case–control study
Authors: Chia-Lun Li, Sheng-Hsiang Ma, Chun-Ying Wu, Ying-Syuan Lyu, Yun-Ting Chang, Chon-Kit Ao, Chen-Yi Wu
Journal: British Journal of Dermatology (2024)

Abstract Air pollution (AP) is an alarming public health crisis worldwide. Common ambient pollutants include sulfur dioxide (SO2), carbon monoxide (CO), ozone (O3), coarse particulate matter (PM10), fine particulate matter (PM2.5), and nitrogen dioxide (NO2). Although previous studies have shown that AP has been associated with various cardiovascular, respiratory and inflammatory diseases, the relationship between AP and psoriasis remains unknown. This nationwide, population-based case–control study aims to explore the relationship between AP and incident psoriasis, using data from the National Health Insurance Research Database of Taiwan between 2012 and 2018. Patients with newly diagnosed psoriasis were included, which was confirmed by board-certified dermatologists or rheumatologists on at least three occasions. Exclusion criteria included patients with a diagnosis of psoriasis before 2012, patients under 20 years of age in 2012, or incomplete AP data. For each patient with psoriasis, four controls were matched considering age, sex, urbanization level, index date and comorbidities. AP data were retrieved from 73 general air quality monitoring stations operated by the Taiwan Environmental Protection Administration. Exposure to air pollutants (SO2, CO, O3, PM10, PM2.5 and NO2) was analysed in the 5 years preceding psoriasis diagnosis and in controls. The mean pollution levels were further divided into four quartiles (1 = lowest and 4 = highest) to assess the dose–response effect. A conditional logistic regression model was used to assess the association. Our study included 45 093 patients with psoriasis and 180 372 matched controls. No significant intergroup difference was found in age, sex, urbanization level or comorbidities. After adjusting for age, sex, urbanization, index date and comorbidities, the second and third concentration quartiles of CO exposure were associated with a decreased psoriasis incidence [adjusted odds ratio (aOR) 0.94, 95% confidence interval (CI) 0.91–0.97; and aOR 0.91, 95% CI 0.89–0.94, respectively), while the third concentration quartile of PM10 (aOR 1.05, 95% CI 1.02–1.08) and the second concentration quartile of PM2.5 (aOR 1.08, 95% CI 1.04–1.11) were associated with a slightly increased incidence of psoriasis. Using a model incorporating all air pollutants, we found that the levels of PM10 (quartile 4: aOR 1.09, 95% CI 1.03–1.16), PM2.5 (quartile 2: aOR 1.08, 95% CI 1.04–1.13) and NO2 (quartile 4: aOR 1.14, 95% CI 1.05–1.23) were associated with a slight increase in the incidence of psoriasis. Our study shows that although exposure to certain PM10, PM2.5 and NO2 levels was significantly associated with incident psoriasis, the increased risks were trivial, with no dose–response relationship.
P067 A novel validated patient decision aid to enhance shared decision making for the management of actinic keratosis
Authors: Geoffrey Brent, Caroline Beardmore, Kate Mayers, Alberto Barea, Venura Samarasinghe, Vanessa Pinder, Julia Soo, Victoria Akhras, Zainab Jiyad
Journal: British Journal of Dermatology (2024)

Abstract Actinic keratoses (AKs) are common premalignant lesions relating to chronic ultraviolet exposure. Several management options exist, including active surveillance, multiple topical therapies, cryotherapy, curettage and cautery, and photodynamic therapy, each with their own risks, benefits and efficacy. Best practice currently involves shared decision making between patient and clinician, particularly when there are numerous management options. Patient decision aids (PDAs) can be beneficial in the shared decision-making process. Between December 2022 and August 2023 we developed and validated a PDA for the management of AKs, in concordance with the International Patient Decision Aids Standards. A two-page leaflet was created with key information on the standard management options, such as what the treatment involves, side-effects and efficacy. Alpha testing of the draft PDA was conducted initially, with positive feedback from clinicians and patients. Beta testing was then undertaken, in which the PDA was used in consultations with 21 consecutive patients across three separate hospital trusts in dermatology clinics. Included patients were over 18 years of age and diagnosed clinically or histologically with one or more AKs. Patients were excluded if there was any suspicion of squamous cell carcinoma, or if they had tender or hypertrophic AKs. Two validated outcome measures, the Decisional Conflict Scale (DCS) and the nine-item Shared Decision Making Questionnaire (SDM-Q-9), were used for all patients. The majority of patients (75%) indicated a high level of decisional conflict prior to using the PDA, with a total mean DCS score of 53.0 (95% confidence interval 43.2–62.8), where a higher value corresponds with increasing decisional conflict. Following use of the PDA, the total mean DCS score improved to 13.0 (95% confidence interval 8.0–17.9). This represents a significant reduction in DCS score (P &amp;lt; 0.001), with the majority of responses as ‘strongly agree’ and ‘agree’ that the PDA facilitated their management decision. The total SDM-Q-9 score was 791/900 (87.9%), which indicates a high level of shared decision making following use of the PDA. As AKs can be managed in numerous ways, information given to patients can be overwhelming, making the decision more challenging for patients. A PDA given to the patient can reduce decisional conflict and improve the shared decision-making process. We suggest that this validated PDA can be used in various settings to facilitate informed care: during primary care consultations, in secondary care in both specialist nurse and doctor-led clinics, and also at the interface between primary and secondary care when responding to Advice and Guidance queries.
CD07 Let the games begin! Paediatric facial allergic contact dermatitis secondary to a gaming virtual reality headset
Authors: Shaheen Akhtar, Natalie Stone
Journal: British Journal of Dermatology (2024)

Abstract A 13-year-old boy presented with an 8-year history of recurrent facial dermatitis. He had a history of atopic eczema and had developed intermittent swelling, redness and scaling of the face for several years, initially thought to be related to sunscreen exposure but more recently associated with prolonged time wearing his virtual reality (VR) headset. The distribution of the rash over the cheeks coincided with areas in contact with the headset rubber foam padding. Patch testing to the British Society for Cutaneous Allergy standard series, facial series, photoallergen series and a sample from the headset foam showed positive reactions to carba mix 3% (day 2+, day 4++), methylchloroisothiazolinone with methylisothiazolinone (MCI/MI) 0.02% (day 2+, day 4+), methylisothiazolinone (MI) 0.2% (day 2+, day 4+), 2-bromo-2-nitropropane 0.5% (day 2+, day 4+), methyldibromoglutaronitrile 0.3% (day 2−, day 4+), benzisothiazolinone 0.1% (day 2+, day 4+), propolis (day 2−, day 4+) and the patient’s own VR headset sample as is (day 2+, day 4+). Carba mix was felt to be relevant to the sponge rubber headset padding, which was also positive on testing. 2-Bromo-2-nitropropane was of current relevance to use of a facial ‘cooling spray’ containing this preservative. The other reactions were of unknown relevance. Avoidance of the headset led to complete resolution of symptoms. The VR company has since provided a cover for the padding, which has allowed our patient to wear the device without flaring his skin. The UK has one of Europe’s largest gaming markets, with projections indicating a surge in video game users from 51.2 million in 2023 to an estimated 57.6 million by 2027. Approximately 56% of the UK population engages in gaming, with most notably the demographic aged 16–24 years reporting 88% engagement in video games, and 68% of individuals aged 7–18 years owning gaming consoles. VR headsets are currently utilized by only 1% of children aged 3–15 years, hindered by the substantial price tag of £1420 for some VR headsets. However, the availability of more affordable alternatives will drive increased usage. Virtual meetings and working from home are becoming commonplace, widening potential exposure to VR headsets in the workplace. Gaming controllers are reported to cause ACD, as well as ‘PlayStation thumb’, with desquamation, lichenified hyperkeratotic papules and fissures on the lateral aspect of the thumbs. PlayStation palmar hidradenitis manifests with discrete, erythematous, tender nodules over the finger pulps and the palmar aspects of both hands, caused by repeated trauma while gaming. To our knowledge, ACD caused by a VR headset has not been previously reported. We would like to highlight this potential new source of ACD to the gaming and wider working population.
BH14 Bald-faced lies: a qualitative review of misinformation on alopecia
Authors: Paula Finnegan, Cathal O’Connor, Michelle Murphy
Journal: British Journal of Dermatology (2024)

Abstract Hair loss, or alopecia, is a major issue worldwide, and can be associated with negative psychological effects. Patients often use the internet and social media to research health-related issues. Health misinformation can confuse patients and have a negative impact on decision making, leading patients to search for illogical ‘causes’ and seek groundless ‘cures’. A PubMed literature search was performed, using the terms ‘alopecia’ AND ‘misinformation’ OR ‘disinformation’ OR ‘conspiracy theory’, alongside a Google search using combinations of these terms. Further searches were also performed on social media platforms including Instagram, TikTok, X (formerly Twitter) and Facebook. Four papers were deemed to be appropriate for inclusion. Common myths highlighted on social media included false causes of hair loss, criticism of conventional hair loss treatments, recommendation of alternative hair loss treatments (including for chemotherapy-induced hair loss) and unhelpful haircare practices. False causes of hair loss included hat wearing, sun exposure, excess washing or brushing, use of gelatin-containing hair products, excess testosterone, and sexual intercourse. Many posts criticized conventional alopecia treatments, including minoxidil, topical steroids, finasteride and Janus kinase inhibitors. Several alternative treatments were promoted online, often as ‘natural’ supplements, such as zinc, iron, biotin, and various oils and extracts. Certain common haircare practices were discouraged or recommended online, such as hair brushing and hair straightening. All healthcare professionals, including dermatologists, are responsible for actively combatting health misinformation.
P075 A retrospective review of isotretinoin treatment-related psychosexual health side-effects in a tertiary dermatology clinic
Authors: Kyriaki Stefania Mitsaki, Sumir Chawla, Eirini Merika
Journal: British Journal of Dermatology (2024)

Abstract Isotretinoin is the gold-standard treatment for severe acne. Growing concerns about its association with psychiatric and sexual side-effects have led to the introduction of new monitoring requirements by the Medicines and Healthcare products Regulatory Agency. Herein we present pivotal real-world data on treatment-related psychosexual side-effects. The primary aim of this review was to evaluate mental health outcomes in terms of depressive symptoms and quality of life in patients treated with isotretinoin. Our secondary endpoint was to evaluate the effect of isotretinoin on sexual function. We conducted a retrospective cohort study of 167 consecutive patients who completed treatment with isotretinoin for acne vulgaris between 1 November 2019 and 31 October 2023. Patient Health Questionnaire-9 (PHQ-9) scores, Cardiff Acne Disability Index (CADI) scores and subjective symptom reports were collected at baseline and each follow-up until completion of treatment. We compared data on baseline characteristics, clinical and biochemical side-­effects and dosing regimens for patients who met the criteria for moderate or severe depression vs. those with mild or no depressive symptoms. Mean PHQ-9 and CADI scores improved significantly following isotretinoin completion compared with baseline (P &amp;lt; 0.05). Twenty patients (12.0%) met the criteria for moderate or severe depression at baseline. Of these, five patients were on antidepressive therapy and two patients experienced worsening of symptoms on isotretinoin. In total 11 patients (6.5%) met the criteria for moderate or severe depression at the final follow-up; nine of these had reported no or mild depressive symptoms at baseline. Logistic regression analysis did not identify potential risk factors for psychiatric adverse effects with isotretinoin, including no correlation with the average daily or total cumulative dose. We report no cases of suicidal ideation, suicide or erectile dysfunction. A single case of low libido was noted; however, symptoms were mild and did not warrant discontinuation of treatment. The mean follow-up duration after discontinuation of treatment was 209 days. Our analysis did not identify an association of isotretinoin with new-onset depressive symptoms or sexual dysfunction above the background prevalence. The findings support an overall favourable risk profile of isotretinoin at the population level, but the possibility of rare, idiosyncratic adverse events cannot be excluded.
CD06 Beryllium is back: a case of culinary contact dermatitis
Authors: Pui Chi Lee, Donna Thompson
Journal: British Journal of Dermatology (2024)

Abstract Beryllium is a metal with physical properties including a great strength-to-weight ratio, making it stronger than steel. It is a useful material in many industries and is used in metal alloys. It is found in tools, dental and medical prostheses, and the aerospace industry. We report an unusual case of occupational hand dermatitis in a chef secondary to beryllium-containing tools. A 23-year-old woman with hand dermatitis was seen in our cutaneous allergy clinic for patch testing. She is right-handed and reported a 3-year history of blistering, erythema and cracking of the palms of both hands. A suspected source was the professional chef’s knives that she had purchased over 7 years ago and had been using daily. There was no past medical or surgical history of note, and no history of dental work. Patch testing was performed to the standard, cosmetics, rubber, metals, plants and woods series, with a positive reaction to only diallyl disulfide (1% in petrolatum) on day 2 (48 h). However, she later developed a new positive reaction on day 9 (216 h), confirmed to be beryllium sulfate tetrahydrate (1% in petrolatum). Her hand dermatitis improved with garlic avoidance, and the discontinued use of the utensils, often made with beryllium-containing alloys. At our centre, we have patch tested a total of 731 patients to beryllium in our extended metal series in the past 20 years. There were four other patients who patch tested positive to beryllium with association to occupation and medical prostheses. In one case it was felt that the copper beryllium alloy wires used in the flexible leads of their pacemaker were relevant. Beryllium is an uncommon cause of allergic contact dermatitis, with published case reports notably highlighting the tendency to late reactions, particularly occurring between day 7 and day 10 (Toledo F, Silvestre JF, Cuesta L et al. Contact allergy to beryllium chloride: report of 12 cases. Contact Dermatitis 2011; 64: 104–9). Such delayed reactions are often under-reported, as routine patch test readings are not performed after day 4 or day 7. Toledo et al. published a case series of 12 patients with positive reactions to beryllium chloride and suggested that readings between day 7 and day 10 can be useful whenever beryllium is patch tested. Our case reinforces the value of taking patch test readings beyond day 4 when specific metal allergies are suspected. It also demonstrates beryllium-containing utensils as a cause of culinary contact dermatitis and highlights these as an additional source of occupational exposure.
CD05 Consort allergic contact dermatitis to occupational acrylates
Authors: Yasmin Khan, Faheem Latheef
Journal: British Journal of Dermatology (2024)

Abstract A 52-year-old woman presented to dermatology with severe widespread dermatitis, characterized by spongiosis on a recent skin biopsy. Despite thorough investigation, a definitive cause remained elusive. The patient underwent patch testing with the baseline, photopatch, anti-infective, excipient, cosmetic, textile, fragrance and acrylate series. Patch testing revealed multiple positive 3+ blistering reactions to various acrylates: 2-hydroxyethyl methacrylate, 2-hydroxypropyl methacrylate, ethylene glycol dimethacrylate, 1,4-butanediol dimethacrylate, 1,6-hexanediol diacrylate, tetrahydrofurfuryl methacrylate, tetraethylene glycol dimethacrylate, butyl acrylate, ethyl acrylate, 2-hydroxyethyl acrylate and triethylene glycol diacrylate. The patient lacked any direct exposure to acrylates through common sources such as gel, shellac or acrylic nails; dental materials; dressings or bone cement. Further inquiry revealed that the husband’s profession was in windscreen repairs, where he routinely handled resins containing acrylates, which he would wipe on to his work overall. It emerged that the transfer of resin onto his clothing, subsequently laundered alongside the patient’s own clothes, likely facilitated sensitization. Analysis of the husband’s work-related resin products confirmed the presence of several acrylates implicated in the patient’s patch test reactions. Given the severity of her symptoms, including blistering reactions, a consort allergic contact dermatitis (CACD) to occupational acrylates was strongly suspected. Following counselling on allergen avoidance strategies, the patient consciously avoided close contact with her partner’s work clothing and began laundering her garments separately. Remarkably, this intervention led to complete resolution of her symptoms. CACD, also referred to as connubial contact dermatitis, is a recognized phenomenon wherein one develops allergic reactions to allergens originating from another individual. A recent systematic review reported a female predominance (62.8%) in cases of CACD, with partners or spouses being the most common consorts (50.0%) (Lee J, Guo S, Dinalo J et al. Consort allergic contact dermatitis: a systematic review. Dermatitis 2022; 33: 181–6). Exposure from a partner’s occupation was noted in a subset of cases (14.6%), underscoring the relevance of occupational history in such presentations. A caregiving relationship was also frequently involved. This case represents the one of the first documented instances of CACD attributed to occupational acrylates. It highlights the need for comprehensive social and occupational history taking in dermatology settings. It underscores the importance of considering potential sources of allergen exposure from partners or dependants, particularly in cases with unusual clinical presentations.
DS08 (P054) National incidence and survival of extramammary Paget disease 2013–2020 in England: reporting a total of 740 cases
Authors: Shweta Karkara, Farishta Khan, Birgitta van Bodegraven, Zoe C Venables
Journal: British Journal of Dermatology (2024)

Abstract Extramammary Paget disease (EMPD) is a rare disease affecting the rich apocrine gland-bearing areas commonly involving the genital and perianal skin. It was first described in 1889 by Radcliffe Crocker. Clinical features of EMPD are insidious and nonspecific, frequently resulting in delayed diagnosis. Diagnosis of EMPD is important due to its association with an underlying malignancy, most commonly urothelial or anorectal, but it may also be cervical, prostatic, ovarian or endometrial in 10–30% cases. Until recently, there were limited national epidemiological data on incidence and survival. National data on EMPD incidence and 5-year survival in England from 2013 to 2020 were extracted from report-level data published openly by the ‘Get Data Out’ National Disease Registration Service programme. Crude incidence rates are reported per 100 000 person-years (PY). Survival is reported as overall Kaplan–Meier survival and net survival with associated 95% confidence intervals (CIs). Data for 2020 vs. 2019 incidence rate ratios with 95% CIs were calculated using the exact Poisson method. In total, 740 new cases of EMPD were diagnosed between 2013 and 2020, with a mean of 93 cases per year. The average crude incidence rate of EMPD per year was 0.17 per 100 000 PY (95% CI 0.14–0.21). The crude incidence rate in 2013 was 0.16 per 100 000 PY (95% CI 0.13–0.20), which increased nonsignificantly in 2019 to 0.20 per 100 000 (95% CI 0.16–0.24). During 2020, the first year of the COVID-19 pandemic, incidence decreased to 0.14 per 100 000 (95% CI 0.11–0.18). The incidence rate ratio between 2020 and 2019 was 0.73 (95% CI 0.54–0.98), with a P-value of 0.03. The 5-year overall Kaplan–Meier survival was 74.1% (95% CI 63.4–82.1) for EMPD diagnosed in 2013. Important limitations include lack of published data on site, age group, depth of invasion and associated comorbidities including malignancies due to small numbers. The reported net survival for EMPD is comparable with that for melanoma and prostate and breast cancer, presumably a result of its association with other underlying malignancies. The increase in crude incidence rates likely represents the ageing population, and one might expect age-standardized rates to be relatively static. The apparent decrease in the crude incidence rate of EMPD during 2020 demonstrates the impact of the pandemic on skin cancer services, as also shown for melanoma and other cancers. A study in The Netherlands assessed 178 cases of invasive and 48 cases of in situ EMPD and found an overall relative 5-year survival of 72% for invasive tumours and an incidence rate of 0.11 per 100 000 PY for EMPD. These data are important in better understanding the trends and outcomes of this rare and poorly understood tumour.