tbuckley/cabot-search huggingface dataset:
BT06 (P034) Using artificial intelligence to bridge the technical gap in dermatology: the role of large language models in creating an interactive Fitzpatrick skin phototype assessment
Authors: Mohamad Zeina, Bassam Zeina, Parashkev Nachev
Journal: British Journal of Dermatology (2024)

Abstract Patient engagement is evolving with the advent of digital tools such as interactive websites and artificial intelligence (AI), yet significant barriers remain in the technical expertise required to create tools that benefit patients. We explore how large language models (LLMs), a type of AI that can facilitate and accelerate programming tasks, can enable clinicians and researchers to create interactive web-based patient engagement tools without the need for a dedicated web developer. We explore this possibility by developing, with the help of an LLM, an interactive skin self-assessment web tool. We used GPT4, a state-of-the-art LLM, as a web development assistant, and created an interactive JavaScript web page that guides patients through the Fitzpatrick skin phototype questionnaire. This involved building a minimal version first, and iteratively improving it. This web page initially asked the user the first two questions of the assessment, calculated a score, and returned this to the user. Once the code written by GPT4 was tested and shown to work, the tool was gradually improved to include all questions in the Fitzpatrick scale, and the result was modified to provide not only the total score, but also the result category. GPT4 allowed us, with no experience writing interactive JavaScript web pages, to develop and launch a web page that guides patients through a Fitzpatrick scale assessment. When GPT4 was asked to expand the questionnaire from two questions to the whole test, it gladly did so; however, the questions were not accurate. It then had to be given the specific wording of the questions and answers for the test, which it incorporated into functioning JavaScript code. This had to be performed in stages, adding two questions at a time, due to context limitations at the time. When this introduced issues, such as the code breaking or the website style looking inconsistent, GPT4 was able to fix these issues when they were described to it. Since the web page’s launch in March 2023, the web page has been viewed 1875 times by 1419 unique users. This study demonstrates one way in which LLMs can be used to enhance patient engagement in dermatology, by facilitating the creation of interactive skin assessments with utility in many dermatology settings. Hallucination remains a problem, and any created tools must be thoroughly verified for factuality. Although no authors had any experience writing interactive JavaScript, they have coding experience elsewhere, and future work should assess whether similar results can be achieved by a broader user base. Two authors received funding from a commercial organization for this work (A &amp; Z Dermatology Clinic Ltd).
BT10 (P025) Community lesion imaging clinics for tele-triage of suspected skin cancer: implementation of a low-cost model in an NHS trust
Authors: Hannah Morgan, Huw Greenish, Hafsa Faarax Shirwac, Colin Fleming, Alexander D G Anderson
Journal: British Journal of Dermatology (2024)

Abstract Across the NHS there has been a significant and sustained rise in referrals for suspected skin cancer, resulting in a capacity crisis in many NHS trusts. Teledermatology has been successfully used to triage suspected skin cancer referrals nationally, but often involves dedicated medical photographers and expensive equipment. The aim of this study was to report the initial results of tele-triage based on a low-cost community imaging lesion clinic (CLIC) service using dermatology staff and readily available equipment. CLICs were provided in a community hospital setting and staffed by band 3 healthcare assistants. A structured questionnaire was completed and data entered directly into a cloud-based software platform (Islacare, London, UK) using an iPad. The same iPad was used to capture a localizing shot, a close-up macro shot using a readily available clip-on macro lens and a dermoscopic image using a Dermlite DL4. Patients under 18 years of age, those referred with more than three lesions, and patients with genital lesions were excluded. Referral letters, questionnaire data and images were reviewed by a senior dermatologist within 48 h on the Isla platform. In total, 438 patients were reviewed (489 lesions) between August and November 2023. The male-to-female ratio was 1.08, with a median age of 72 years (interquartile range 62–80). Overall, 122 of 438 patients (27.9%) were discharged directly from triage, with advice returned to the referrer. An additional 91 of 438 (20.8%) were identified as suitable for direct listing for biopsy or simple excision. Four of 438 (0.9%) were referred to another specialty following triage, one of 438 (0.2%) had a delayed face-to-face assessment organized, one of 438 (0.2%) declined to participate in tele-triage and requested a face-to-face appointment, one of 438 (0.2%) experienced technical problems, and in one of 438 (0.2%) the site for review was not clear. A potential total of 218 of 438 (49.8%) face-to-face assessments were avoided. The average time for clinician review was 2 min 55 s per patient. Tele-triage using a low-cost CLIC was well tolerated, feasible and effective and resulted in a capacity increase of almost 50%. A significant proportion of patients were managed in a community setting without the need for travel to hospital. One further advantage was the creation of a consecutive series of images and metadata suitable for future study of diagnostic artificial intelligence algorithms or submission to a national dataset.
SG13 Managing cutaneous manifestations of FH-associated tumour predisposition syndrome: a systematic review of case reports
Authors: Amber O’Brien, Schaida Schirwani
Journal: British Journal of Dermatology (2024)

Abstract The cutaneous manifestations of fumarate hydratase (FH)-associated tumour predisposition syndrome, otherwise called hereditary leiomyomatosis and renal cell carcinoma (HLRCC), can be managed in a variety of ways including surgical excision, oral and topical analgesia, laser therapy and cryotherapy. While some of these methods are considered well established, others are less widely used and there is little evidence reported comparing the outcomes after treatment. This systematic review of case reports aims to determine how symptom burden after surgical excision of the cutaneous lesions differs from symptom burden after analgesic treatment or other methods. The databases OVID MEDLINE, Embase and Scopus were searched with terms such as ‘HLRCC’, ‘cutaneous’, ‘leiomyoma’ and ‘management’. In total, 19 case reports with a total of 23 patients diagnosed with HLRCC and cutaneous manifestations, for example leiomyomas, were included in this systematic review. These case reports were dated between 2009 and 2022. Eleven of these patients had their cutaneous lesions treated with surgical excision, eight were treated with analgesia and nine were treated with ‘other methods’. ‘Other methods’ was defined as any treatment that was not surgical or simple analgesia, and included carbon dioxide laser therapy, erbium laser therapy, liquid nitrogen cryotherapy, phototherapy, botulinum toxin, electrocoagulation, and immunosuppression with azathioprine. Some patients were treated with a combination of methods. Surgical excision showed the poorest symptom outcomes after treatment, with 9% of patients showing improvement of symptom control after treatment compared with 75% of patients having symptom improvement with analgesic treatment and 89% after ‘other methods’. When surgical excision was combined with analgesia or ‘other methods’, symptom control was improved compared with surgical excision when used alone. This review shows that surgical excision may not provide optimal symptom control for patients with cutaneous manifestations of HLRCC, and other treatments should be considered. Surgical excision of cutaneous lesions allows histopathological confirmation of leiomyomata and therefore has an important role in the diagnosis of HLRCC, so it should not be excluded from treatment recommendations. However, clinicians should consider combining excision with another treatment, for example analgesia with agents such as gabapentin. Further research in the form of a large cohort study or randomized control trial is necessary to confirm the observations made by this systematic review by providing more quantitative data.
BT13 (P028) The importance of clinical metadata when triaging patients for face-to-face assessment and possible biopsy in a teledermatology pathway
Authors: Shafiqul Islam, Joseph Walls, Per Hall, Haider Raza, John Gan, Alba Garcia, Gordon Wishart
Journal: British Journal of Dermatology (2024)

Abstract The 7-point checklist (7PCL) is recommended by NICE to select patients with pigmented lesions and possible melanoma for urgent referral. This research investigates the potential of using machine learning (ML) models that utilize patient metadata from a teledermatology pathway including 7PCL for suspicious skin lesion detection, and compares the performance gain for each meta-feature added with the 7PCL. We analysed clinical metadata from 53 601 skin lesions in 25 105 patients who attended private skin cancer diagnosis clinics in the UK between 2015 and 2022. For each lesion, we included the following meta-features: 7PCL (change of lesion size, shape, colour, lesion &amp;gt; 7 mm, inflamed, oozing, itching), weighted 7PCL, Williams score characteristics (patient age, patient sex, natural hair colour, arm mole count, sunburn history, prior nonmelanoma skin cancer), the overall Williams score, prior melanoma, lesion location, lesion age, and whether this was a predominantly nonpigmented pink lesion. All lesions were categorized as suspicious (10%) or nonsuspicious (90%) by skin cancer specialists during telemedicine triage (cancer detection rate = 5%). All meta-features were used as ML model inputs to classify whether each input was associated with suspicious or nonsuspicious classes. This study integrates five ML models (naive Bayes, logistics regression, support vector machine, random forest, and multilayer perceptron) to detect suspicious skin lesions based on patient metadata. Firstly, we compared the ML model performance between the original 7PCL and weighted 7PCL in correctly identifying suspicious skin lesions. We then added each meta-feature with 7PCL and tabulated the performance gain. We utilized balanced accuracy, sensitivity, specificity and area under the curve as evaluation metrics. There were no significant differences observed in model performance between the 7PCL and weighted 7PCL (sensitivity 68.1%). However, the performance of the ML model was improved significantly for each added meta-feature, with the best performance gain (sensitivity 85.2%) observed when 11 meta-features (lesion pink, Williams score, lesion age, sunburn, patient age, Williams group, patient sex, hair colour, site of the lesion on the body, freckling tendency, and mole count) were added to the 7PCL. This research has identified the optimal subset of meta-features that improve ML model performance for categorizing suspicious skin lesions during telemedicine triage, compared with 7PCL alone. Fusing these high-performing meta-features with image modalities is likely to further boost the ML model performance for skin cancer detection, and they could also be used to modify current skin cancer referral guidelines. The study is funded and supported by Innovate UK and the private teledermatology pathway provider.
P010 Eosinophilic dermatosis of haematological malignancy mimicking insect bite-like reaction in a patient with chronic lymphocytic leukaemia: a case report
Authors: Kasthuri Nallathamby, Kat Moss, Richard Azurdia, Nitin Khirwadkar
Journal: British Journal of Dermatology (2024)

Abstract We present a case of a patient presenting with severe insect bite-like reactions in her skin with underlying chronic lymphocytic leukaemia (CLL). A 71-year-old woman was diagnosed with CLL in 2017 after presenting with a low-level lymphocytosis. She has never required treatment for CLL and remains under active observation in the haematology clinic. She was initially referred to dermatology 5 years ago with a nonresolving insect bite-like rash on her chest. The biopsy of the lesion was thought to be reactive with CLL infiltration. Over the years she has had a number of flare-ups of differing severity; the rash has always been itchy, and she has often presented with tense vesiculobullous lesions, occasionally haemorrhagic in appearance. Multiple biopsies were taken over a period of 5 years due to the diagnostic challenge, with the main differentials being urticarial vasculitis, insect bite-like reactions, Wells syndrome/dermal hypersensitivity reaction and Churg–Strauss syndrome. One of the common trends with the patient’s rash and blistering lesions is that they have often flared up during the summer, during gardening or travelling, and she has also reported them after receiving the COVID-19 vaccine. There was no reaction following the flu vaccine. Biopsies were always negative for direct immunofluorescence, ruling out immunobullous reactions. There was often the presence of a heavy neutrophilic infiltrate, vascular inflammation, and vague granulomata with absence of frank vasculitis. Following multidisciplinary team discussion and close clinicopathological correlation, we have concluded that this could be eosinophilic dermatosis of haematological malignancy mimicking insect bites, of which only a few reported cases have been documented. This case report reviews the association between CLL and insect bite-like reaction and highlights the challenges associated with diagnosing and managing such dermatological manifestations. Previous literature showed no clear association with regards to treatment of CLL causing regression of the dermatological manifestation. The treatment is difficult and recurrences are common (Rodríguez-Lojo R, Almagro M, Piñeyro F et al. Eosinophilic panniculitis and insect bite-like eruption in a patient with chronic lymphocytic leukaemia: a spectrum of the same entity. Dermatol Res Pract 2010; 2010: 263827). In our case, the plan is to actively treat the underlying haematological malignancy and to assess the possibility of bringing the cutaneous manifestation under control. This case also highlights the lack of tailored therapeutic strategies for patients with CLL, in the context of its diverse and complex dermatological presentation.
BI19 SCAR: more than just a mark on the skin
Authors: Emma Carroll, Marion Leahy, Eilis Nic Dhonncha
Journal: British Journal of Dermatology (2024)

Abstract Drug-induced hypersensitivity syndrome (DIHS) is a severe and potentially life-threatening condition characterized by a delayed onset of hypersensitivity reactions, occurring days to weeks after exposure to a causative drug in predisposed individuals. Here, we present the case of a 34-year-old female patient with DIHS that demonstrated an uncommon response to initial high-dose immunosuppression. The patient was admitted to hospital with an erythematous, maculopapular rash affecting the abdomen and chest, having undergone three cycles of ipilimumab/nivolumab immunotherapy for pT4a N1 malignant melanoma of the anal canal. The rash rapidly progressed to involve 90% of the body surface area within a matter of days. Concurrently, blood investigations revealed an acute liver injury and thyrotoxicosis. Notably, eosinophil levels were within normal limits. A skin biopsy displayed features consistent with DIHS, including interface dermatitis and basal vacuolar degeneration. Initial management involved intravenous high-dose methylprednisolone and mycophenolate mofetil following guidelines for acute liver injury. However, the patient’s skin deteriorated further and became dusky, despite high-dose immunosuppression. Her liver function also continued to decline. Following discussion with the hepatology unit, it was determined that the patient exhibited an atypical resistance to significant doses of immunosuppression, posing a unique challenge in the management of DIHS. After literature review and discussion with a DIHS specialist, treatment was transitioned to ciclosporin. Remarkably, within days of ciclosporin initiation, the patient demonstrated notable improvement in both cutaneous manifestations and liver function. This case underscores the complexity in managing DIHS, particularly when confronted with an unexpected lack of response to conventional high-dose immunosuppressive regimens. Currently there is a lack of formal clinical guidance regarding the management of complex cases of DIHS. This case highlights the challenges posed to clinicians when faced with such scenarios.
PS01 (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.
H23 A sailor went to C
Authors: Lisa Murphy
Journal: British Journal of Dermatology (2024)

Abstract As modern fad diets and chronic illnesses have led to a re-emergence in the presentation of scurvy to dermatology services, we aimed to review the original cohort of patients that gave this condition notoriety – sailors. Scurvy is a disease process secondary to vitamin C deficiency. It has a number of dermatological manifestations, including petechiae, perifollicular haemorrhage, bruising and gingivitis. These presentations occur as vitamin C (ascorbic acid) plays a fundamental role in collagen synthesis. When this process is defective, impaired wound healing is seen. This condition became synonymous with the British and European sailing community during the age of exploration, and it is estimated that 2 million sailors died as a result between the 16th and 18th centuries alone. As ascorbic acid is not naturally produced by humans, we are reliant on external sources of vitamin C to replenish stores. Key sources of vitamin C include fresh fruit and vegetables, such as citrus fruits, spinach, potatoes, berries and tomatoes. Given that there were generally only nonperishable foods available on board these sailing ships, thousands of sailors fell victim to scurvy. James Lind played a notable role in the discovery of vitamin C as a therapeutic agent in the treatment of scurvy and is credited with being the father of the modern-day clinical trial as we know it. The first authenticated example of a therapeutic experiment with controls appears to have been James Lind’s trial in 1747 of the value of citrus fruits in treating scurvy in sailors. (Thomas DP. Sailors, scurvy and science. J R Soc Med 1997; 90: 50–4). Captain James Cook, the eminent sailor, was also one of the first to establish that the provision of fresh vegetables on board could prevent scurvy from developing while on long voyages of exploration. Even in the most severe and end-stage cases of scurvy, it was discovered that the disease process could be reversed with sufficient vitamin C supplementation. While this condition is often considered to be a historical disease, having once been referred to as the ‘plague of the seas’, it is one that dermatologists should continue to be cognizant of when treating patients in modern society.