tbuckley/cabot-search huggingface dataset:
BI40 A common conclusion to an uncommon case
Authors: Bo Liu, Farishta Khan, Ava Lee
Journal: British Journal of Dermatology (2024)

Abstract Dermatophytes are a prevalent cause of superficial skin infections, affecting approximately 20–25% of the global population. Mortality as a result of dermatophytes is low; however, rising cases of recurrent and recalcitrant dermatophytoses owing to emerging antifungal resistance pose a significant health challenge. Early diagnosis and adequate treatment can significantly reduce morbidity and improve patients’ quality of life. We present the case of a 57-year-old woman with a background of precursor B-cell acute lympho­blastic leukaemia diagnosed in 2019. Her disease was stabilized on ponatinib over the last 1.5 years following failed treatment with conventional chemotherapy, allogeneic bone marrow and T-cell transplants and multiple tyrosine kinase inhibitors. She was referred by the haematology team, with a 3-week history of a symmetrically distributed erythematous annular rash that was well demarcated and scaly on her face, trunk and limbs, with large islands of sparing on her trunk. The rash had a burning and itchy quality. Prior to referral, she had 8 days of oral prednisolone 20 mg once daily for what was initially suspected to be graft-versus-host disease and her skin improved slightly with less inflammation. The differential diagnosis list remained broad. She was initiated on Dermovate ointment. Biochemistry and immunology lab investigations were unremarkable. Mycology cultures of skin scrapings were negative; however, a skin punch biopsy taken from a fresh erythematous edge showed histological features in keeping with a dermatophyte infection. She achieved full clearance of her rash following a 6-week course of oral terbinafine and fluconazole at intervals. This case demonstrates the atypical presentation of a common skin infection in an immunocompromised host that can mimic many dermatological conditions. This is particularly important when the addition of steroid treatment could alter a common presentation even further. This case reminds us that common causes can still be common, including in atypical presentations, where treatment outcomes can be satisfying and rewarding when combined with good clinical history taking. Importantly, to combat rising resistant dermatophyte infections, it is now even more prudent to not miss this common diagnosis.
BI37 Efficacy of psoralen plus ultraviolet A therapy for the treatment of chronic cutaneous graft-versus-host disease: a retrospective study analysis from a tertiary care centre
Authors: Monal Sadhwani, Vinay Kulkarni
Journal: British Journal of Dermatology (2024)

Abstract Cutaneous graft-versus-host disease (GVHD) is a well-recognized complication, occurring in 60–80% of patients after allogeneic bone marrow stem cell transplantation (BMSCT) (Garbutcheon-Singh KB, Fernández-Peñas P. Phototherapy for the treatment of cutaneous graft-versus-host disease. Australas J Dermatol 2015; 56: 93–9). The chronic type manifests as either a lichenoid or sclerodermatous form. Phototherapy is an effective treatment option as it works by immunomodulatory effects. We retrospectively reviewed eight cases of chronic cutaneous GVHD. All the patients had undergone allogeneic BMSCT for an underlying haematological disorder at a tertiary care centre in western India. Each patient was administered phototherapy with ultraviolet (UV)A radiation twice a week. All of them received 8-methoxy­psoralen at a dose of 0.6 mg kg−1 as a photosensitizer, 2 h prior to UVA therapy. The percentage improvement in body surface area involved was calculated at the end of therapy and results were analysed using SPSS. Also, the doses of steroids and immunosuppressants were tapered while the patient was on phototherapy. A total of eight patients were enrolled in the study; five (63%) were male (63%) and three (38%) were female. The mean age at the time of presentation was 37.75 years. Five patients (63%) had lichenoid GVHD, while the other three cases (38%) had sclerodermatous type GVHD. Six patients had undergone allogeneic BMSCT for leukaemia, while one patient had myelofibrosis and one case was diagnosed with Diamond–Blackfan syndrome. The mean time to develop GVHD after bone marrow transplant was 9.5 months and the mean body surface area involved at the time of diagnosis was 50.6%. There was more than 50% improvement in five cases (63%) after an average of 36.3 sessions of psoralen plus UVA (PUVA), while one case (13%) relapsed after achieving complete remission. One patient (13%) was lost to follow-up as he was not able to visit the hospital frequently for twice-weekly sessions. One patient (13%) died while on PUVA therapy owing to relapse of leukaemia. Generally, all the patients tolerated PUVA well, except two patients who experienced nausea after taking psoralen, one patient with dizziness after PUVA therapy and one patient who complained of pigmentation of skin over the extremities. The percentage reduction in the dose of steroids before and after phototherapy was also found to be statistically significant. We conclude that PUVA therapy is an effective nonaggressive modality for treating chronic cutaneous GVHD, especially the lichenoid form. It offers a major advantage of an immunosuppressive sparing effect as well as a good safety profile.
BI34 Lung toxicity with methotrexate: fact or fiction?
Authors: Adam Gold, Paul D Yesudian
Journal: British Journal of Dermatology (2024)

Abstract Methotrexate (MTX) is widely used as a first-line immunomodulator for inflammatory skin diseases. MTX-induced lung toxicity is a rarely reported complication, and its prevalence is unclear. We conducted a survey of UK clinicians on their experiences with MTX lung toxicity. In total, 109 clinicians, including 54 dermatologists (49.5%), 19 radiologists (17.4%), 26 respiratory physicians (23.9%) and 10 respondents not stating their specialty (9.2%), completed an online questionnaire that assessed their experiences with MTX-induced lung toxicity. A total of 12 questions were sent to clinicians across the UK from October 2023 to December 2023. Overall, 93 clinicians (85.3%) reported seeing either no cases (n = 58, 53.2%) or between 1 and 5 cases (n = 35, 32.1%) of MTX-induced lung toxicity. Of these, only four (3.7%) respondents identified MTX-induced lung changes in patients with dermatological indications, in the absence of other causes. One respondent did not answer the question of how many cases they had seen. In the subgroup of clinicians who observed more than 5 cases (n = 15, 13.8%), there were no dermatologists, and none reported MTX use for dermatological indications. All patients had rheumatological/connective tissue diseases (CTDs). Of those who reported seeing more than 5 cases, 10 (67%) were respiratory physicians and 5 (33%) were radiologists. Of those who reported seeing no cases of MTX-related lung changes, 41 (71%) were dermatologists. The main lung complications reported were pulmonary fibrosis and pneumonitis, with variable outcomes regarding improvement. In a 2009 literature review of 3463 patients with rheumatoid arthritis treated with MTX, 84 patients (2%) experienced some form of lung toxicity, with only 15 cases (0.4%) being attributed to MTX. In contrast, in 2015 a review of clinical trials involving patients with psoriasis, psoriatic arthritis or inflammatory bowel disease found no significant increase in respiratory adverse events for MTX users over treatment periods of 16–52 weeks. Of 1630 participants in 7 trials, only 1 MTX-treated patient developed pneumonitis (0.06%). These findings are reassuring and seem to suggest that lung toxicity is more commonly linked to CTD or other conditions rather than to MTX treatment for skin disease.
PA28 Reactive infectious mucocutaneous eruption: a case series of four children
Authors: Elisabetta Muttoni, Gordon Hale, Catherine Jury, Paula Beattie
Journal: British Journal of Dermatology (2024)

Abstract Reactive infectious mucocutaneous eruption (RIME) is a reactive inflammatory mucositis most commonly but not exclusively associated with Mycoplasma pneumoniae. It presents with a mucosal- predominant eruption with sparse to no skin involvement. We describe four recent cases in children between 6 and 13 years of age. All four children presented with increasing lip discomfort with subsequent lip swelling, sloughing and crusting. The intraoral mucosa was affected to varying degrees. All described a prodromal illness with cough and general malaise, and three patients also reported fevers. Skin manifestation varied, with two patients having no cutaneous involvement while two patients had sparse pink macules and negative Nikolsky sign. Investigations included an extended respiratory screen and chest X-ray to check for underlying infection, and M. pneumoniae was detected in two patients. Skin swabs for virology and bacteriology were also taken. Management focused on pain control, nutritional support and good mouth care. The patients required admission to hospital for fluid resuscitation and analgesia. Mouth care was implemented with regular benzydamine hydrochloride spray and Gelclair gel, and white soft paraffin alongside Trimovate cream (oxytetracycline and nystatin) for the lips. Due to ongoing diffuse erosions of the buccal mucosae with haemorrhagic crusting of the lips, one patient required a short course of oral steroids. Reactive infectious mucocutaneous eruption was previously termed Mycoplasma pneumoniae-induced rash and mucositis; however, reports of this entity being caused by other infections including enterovirus, influenza B virus and SARS-Cov-2 has led to a change in terminology (Mahama A, Kojder P, Thibodeaux Q, Ruth J. Reactive infectious mucocutaneous eruption following COVID-19 in an adolescent boy: case report and review of the literature. Pediatr Dermatol 2023; 40: 162–5). Mucosal membranes are significantly more affected than skin in RIME. Skin involvement can be sparse or absent, differentiating it from Stevens–Johnson syndrome/toxic epidermal necrolysis, which presents with rapidly progressive skin necrosis and is often drug induced, and from erythema multiforme, which is characterized by typical target lesions (Tonkin R, Ladha M, Johnson N et al. Reactive infectious mucocutaneous eruption – repeat etanercept after intravenous immunoglobulin: a case report. SAGE Open Med Case Rep 2022; doi: 10.1177/2050313X221117887). Investigations for underlying respiratory infection and treatment with appropriate antibiotic therapy should be implemented. Supportive care in the form of pain relief, and nutritional and fluid support is important. Systemic steroids may be required to truncate the inflammatory response, although there is a lack of prospective data. In conclusion, our aim is to bring awareness to this condition to facilitate its recognition, diagnosis and treatment.
H09 Sir Jonathan Hutchinson’s melanotic whitlow: evolution of Hutchinson’s sign
Authors: Abbey Smith, Hayley Smith, Angana Mitra
Journal: British Journal of Dermatology (2024)

Abstract ‘It needs sometimes, the eye of faith to recognize the narrow band of black which borders the inflamed part’. – Hutchinson J. Notes towards the formation of clinical group of tumors. Am J Med Sci 1886; 91: 470. This groundbreaking observation by Sir Jonathan Hutchinson in 1886, initially termed the ‘melanotic whitlow’, refers to pigmentation change in the nailfold, often accompanied by painful inflammation. Historically such lesions were considered traumatic; however, through careful clinical observation and meticulous documentation, Hutchinson recognized that this manifestation could be associated with malignancy. The melanotic whitlow later evolved into the eponymous Hutchinson sign, which we continue to use in today’s assessment of melanonychia. Sir Jonathan Hutchinson was born in 1882 in Selby, emerging from a modest background to become a pioneering figure in 19th-century medicine. He was a distinguished British surgeon and pathologist with an interest in dermatology, ophthalmology, neurology and the study of syphilis. More than a clinician, Hutchinson was a dedicated teacher, writer and philanthropist, actively sharpening medical education and research, with his medical bibliography consisting of over 1000 published reports. His work traversed a diverse range of medical domains, with numerous eponyms across various fields attributed to him. In dermatology, we commonly know him for Hutchinson freckle (lentigo maligna) and use Hutchinson sign to describe the periungual extension of a longitudinal pigmented band onto the nailfold, typically representing progression of subungual melanoma. Although it remains a crucial diagnostic marker of subungual melanoma, our understanding of this phenomenon and our ability to detect it have evolved over the last century. Over time the term ‘pseudo-Hutchinson sign’ has been coined as a mimic of Hutchinson sign due to the reflection of pigmentation of the nailbed and nail matrix through a transparent nailfold. This is seen in nonmelanoma conditions such as Bowen disease, ethnic melanonychia, nail naevi, subungual haematoma, Peutz–Jeghers or Laugier–Hunziker syndrome, and other inflammatory pathologies. Further evolution of this eponym can also be attributed to the advent of dermoscopy. The aptly named micro-Hutchinson sign, describes the dermoscopic detection of subtle cuticular pigmentation, often elusive to conventional naked-eye examination, and is thought to be indicative of malignancy. Hutchinson’s detailed description of the melanotic whitlow has contributed significantly to our assessment of nail pigmentation and melanoma. From his first description of the ‘narrow band of black’ to Hutchinson sign, we now have three variations of this eponymous term, used widely by modern-day dermatologists and aiding in the analysis of melanonychia.
PS07 (P107) Updating the Assessment of the Psychological and Social Effects of Acne (APSEA) through factor analysis: developing the novel APSEA-3
Authors: Georgina Jones, Jim Morgan, Eva Lau, Moe Latt, Natasha Lee, Ibtessam El-Mansori, Alison Layton
Journal: British Journal of Dermatology (2024)

Abstract Health-related quality of life is now recognized as an essential outcome to assess in acne trials and practice. Many patient-reported outcomes exist, including the Assessment of the Psychological and Social Effects of Acne (APSEA), which is an acne-specific measure (Layton AM, Seukeran D, Cunliffe WJ. Scarred for life? Dermatology 1997; 195: 15–21). APSEA was developed in 1990s and subsequently psychometric standards and methods have progressed. The purpose of this study is to conduct an updated psychometric analysis of the APSEA among a cohort of patients being treated for acne in routine clinical practice. Exploratory factor analysis (EFA), a method of classical test construction, was carried out (n = 993). To test the adequacy of the sample size for undertaking factor analysis, values for the Kaiser–Meyer–Olkin test and Bartlett’s test of sphericity were calculated, as well as Cronbach’s alpha. Following the EFA and generation of the proposed scales, the individual domains were calculated and transformed onto a scale of 0–100 by summing the items within the scale, dividing by the total possible score within that domain. A confirmatory factor analysis (CFA) was then undertaken using a new second dataset (n = 501) to test the factor conceptual framework, using MPlus 8.6 software (http://www.statmodel.com). Descriptive statistics and tests of internal consistency reliability and construct validity (concurrent) were also undertaken using a priori hypotheses and comparisons with the Dermatology Life Quality Index (DLQI) and Patient Health Questionniare-9 (PHQ-9). The EFA suggested a three-domain model (anxiety and depression, body image and self-esteem, and social functioning), which was confirmed in the CFA analysis whereby the goodness of fit indices all indicated good model fit (root mean square error of approximation = 0.038, comparative fit index = 0.96, Tucker–Lewis index = 0.96, standardized root mean squared residual = 0.048). Cronbach’s alpha values exceeded 0.70, and item-total correlations exceeded 0.40 for all three domains, indicating good internal consistency reliability. All three APSEA domains were also positively correlated with the DLQI and the PHQ-9, indicating good construct validity of the tool. This EFA study has demonstrated the validity and reliability of a novel version of APSEA, which we have termed APSEA-3 to reflect the three unique domains it captures. Preliminary results show that the tool is responsive to change and useful for measuring the psychosocial impact of acne.
H11 The pioneer of dermatology in Northern Ireland: what a legacy!
Authors: Ji Fung Yong, Laoise Griffin
Journal: British Journal of Dermatology (2024)

Abstract Henry Samuel Purdon (1843–1906) was the pioneer of dermatology in Northern Ireland. Born into a family of doctors, Purdon qualified as a physician in Scotland, earning an M.D. (Glasglow) and an L.R.C.P. (Edinburgh). His interest in dermatology started under the influence of McCall Anderson’s dermatological teaching in Glasglow. After his return to Belfast, he quickly gained the public approval in an open meeting at 12 Wellington Place, resulting in the establishment of ‘The Belfast Dispensary for Diseases of the Skin’ in 1865. With creativity, he made wax models of skin diseases to gain financial support to fund the institute. The models included lupus vulgaris, which was very prevalent during that time. With the steady increase in attendance, the dispensary was renamed ‘The Belfast Hospital for Diseases of the Skin’ in 1866. In 1868, the Belfast Charitable Society funded the construction of a new hospital in Regent Street, which was opened in 1869. This new building provided mainly outpatient facilities with consultation rooms and an operating theatre, which were deemed sufficient, in addition with eight inpatient beds. Despite hectic clinical commitments, in 1870 Purdon became the editor of the Journal of Cutaneous Medicine, which invited articles from the USA, and from Europe and the UK. Further, Purdon published three dermatology textbooks, titled On Neurotic Cutaneous Disease, Including Erythema (1869), Classification, Correct Dietary, and Treatment of Diseases of the Skin: as Practised at the Belfast Hospital of the Skin (1889) and A Treatise on Cutaneous Medicine and Disease of the Skin (1875), which recorded his clinical experience. With Purdon’s famous reputation in dermatology, the need of the service had drastically increased. His fame attracted funding of £4000 from philanthropist Edward Benn, to build a new skin hospital on Glenravel Street in 1873. The Benn Skin Hospital was opened in 1875. This hospital was fully furnished with the finest amenities, with 30 hospital beds and a suite of baths to meet service demand. Purdon was elected president of Benn’s hospital and held this position until his death, at the age of 62. Purdon’s legacy in dermatology was carried down by his son, Elias Bell Purdon, until the hospital was destroyed by a Luftwaffe bomb during the Belfast Blitz in 1941. In 1957, ‘The Purdon Skin Ward’ in the Royal Victoria Hospital Belfast was established to recognize Purdon’s service to dermatology.
H10 Extramammary Paget disease: from the 19th century to now – where ‘Paget’ meets the scrotum and beyond
Authors: Honey Brandy Frimpong-Manso, Zoe C Venables, Nick J Levell
Journal: British Journal of Dermatology (2024)

Abstract Sir James Paget (1814–1899), born in Great Yarmouth, Norfolk, and a surgeon at St Bartholomew’s Hospital in London, first described Paget disease of the breast in 1874. He identified 15 women with chronic nipple lesions described as ‘eczematous ulcerative or vesicular lesions with clear yellowish exudate’. All these cases later developed into malignant lesions and this condition was subsequently termed mammary Paget disease. In 1887, Henry Radcliffe Crocker (1846–1909) documented the first case of what is today known as extramammary Paget disease (EMPD). Crocker was a dermatologist at University College Hospital. He was a founding member of the Dermatological Society of London in 1899 and president of the Dermatological Society of Great Britain and Northern Ireland. In ‘Paget’s disease, affecting the scrotum and penis’, published 1889, Crocker detailed a 60-year-old man presenting with an ‘oozing, well-defined area of superficial ulceration’ on the front, left side of the scrotum and under the surface of the penis. He described similarities to eczema but that the lesion was much deeper and well defined. Many treatments and remedies had no effect. Two nodules later appeared in the affected area, suggesting malignancy. This case was presented by Crocker at the Dermatological Society of London, where members identified similarities to mammary Paget disease. Sir James Paget reviewed the patient and agreed with the similarities, suggesting excision of the affected area. Cancerous cells were seen on microscopic investigation of the nodules. Crocker described the sweat coils and ducts forming a cancerous structure, in keeping with the known pathophysiology of EMPD primarily affecting apocrine-rich areas. Darier and Coulillaud reported a patient with perianal manifestation of Paget disease in 1893. These cases identified this rare but significant skin condition associated with underlying malignancy. Today, EMPD represents approximately 6.5% of all cutaneous Paget disease. The management of EMPD has changed little since it was first described in the 19th century, with identification and treatment of an associated malignancy and surgery remaining the mainstay of treatment.