tbuckley/cabot-search huggingface dataset:
P005 Painful palmar papules: a rare variant of a familiar dermatosis
Authors: Parvathy Santhosh, Mamatha George, Shwetha V Rajiv, Gopalapillai Nandakumar
Journal: British Journal of Dermatology (2024)

Abstract A 52-year-old man presented with painful lesions over the palms for 10 days, associated with low-grade fever. The lesions were exquisitely painful and affected his activities of daily living. He had type 2 diabetes mellitus, managed with metformin and glimepiride. On examination, multiple, discrete, erythematous, tender papules of size 0.3 × 0.3 cm to 1 × 1 cm over both palms were noted. The fingertips were erythematous and tender. Blood investigations were unremarkable, except for a blood glucose level of 19.5 mmol L−1. Skin biopsy showed hyperkeratosis, spongiosis and dermal elastosis with necrobiotic collagen surrounded by histiocytes and lymphocytes, with occasional foreign-body giant cells. Alcian blue stain revealed abundant mucin deposition. A diagnosis of acute-onset painful acral granuloma annulare was made. He was treated with potent topical corticosteroids along with anti-inflammatory medications. The lesions subsided fully within 8 weeks, with residual peeling of skin. Granuloma annulare (GA) classically presents as asymptomatic to mildly pruritic, localized clusters of small papules that coalesce into annular and arciform lesions. The common variants are localized GA, generalized GA and subcutaneous GA. Perforating GA and patch-type GA are unusual. Palmoplantar, Blaschko linear, pustular and visceral variants are considered extremely rare. Although hands and feet are common sites of granuloma annulare, lesions of the classical type occur on the dorsal surfaces. Acute-onset acral painful GA is considered a rare and distinct variant, characterized by the sudden eruption of tender papules on the hands and/or feet, with or without scattered lesions on other sites. There may be associated systemic features like fever, malaise, arthralgia and diarrhoea, with elevated inflammatory markers. The condition was first described as a separate entity in 2006 (Brey NV, Malone J, Callen JP. Acute-onset, painful acral granuloma annulare: a report of 4 cases and a discussion of the clinical and histologic spectrum of the disease. Arch Dermatol 2006; 142: 49–54). Subsequently, there have been a few other reports. Histology of GA shows an interstitial or palisading pattern of granulomatous inflammation with collagen degeneration and mucin deposits. The more common interstitial pattern shows upper and mid-dermal histiocyte collections, scattered between and around collagen bundles and vessels. In the palisading pattern, a central zone of necrobiotic collagen is surrounded by palisading histiocytes. Treatments reported to be effective in acute-onset painful acral GA include topical, intralesional and systemic steroids and hydroxychloroquine. Painful lesions, palmar lesions and systemic features are unusual in GA. Associated systemic features and deranged blood parameters might prompt unnecessary investigations. Hence, the significance of clinicopathological correlation in the diagnosis of this entity needs to be emphasized.
BI21 Lues maligna mimicking pyoderma gangrenosum and cutaneous lymphoma
Authors: Ning McKenzie, Matthew Hickey, Carlo de la Sancha, Sarah Coates, Kieron Leslie
Journal: British Journal of Dermatology (2024)

Abstract A 44-year-old man was referred for 2 months of erythematous ulcerative papules and plaques on the scalp, face and lower legs. The lesions started as painful ‘pimples’. He also reported fever and chills. He had a 5-year history of well-controlled HIV on antiretroviral therapy since diagnosis and a prior history of recurrent syphilis. Exam showed a large violaceous plaque on the right cheek with surrounding erythematous papules and an additional erythematous papule on the left ear. On the bilateral ankles and calves were four ulcers with necrotic centres and purple borders. The differential diagnoses included pyoderma gangrenosum and cutaneous lymphoma. A punch biopsy of the right zygomatic area showed dermatitis with a dense, diffuse plasma cell infiltrate suggestive of syphilis. The acid-fast bacteria (AFB), periodic acid–Schiff with diastase (PAS-D), and spirochete stains were all negative. Rapid plasma regain (RPR) was reactive at 1 : 4096. HIV was detected at &amp;lt; 30 copies per mL. Absolute CD4 T-cell count was 529 cells per μL. AFB and fungal cultures were negative, and bacterial culture showed rare Staphylococcus aureus. Although the spirochete stain was negative, it is only 70% sensitive and the positive RPR with histopathology supportive of syphilis in a patient who was positive for HIV confirmed the diagnosis of lues maligna. The patient received one dose of 2.4 million units of intramuscular penicillin G benzathine. He continued empiric doxycycline 200 mg daily, which had previously been initiated, and continued doxycycline postexposure prophylaxis after diagnosis. The patient reported healing with no new lesions 3 weeks after treatment. A new question brought on by this case is whether prior history of recurrent syphilis infection has a role in developing lues maligna. This patient in particular required syphilis treatment four times in the 3 years leading up to his presentation. Current literature describes a patient who was treated for secondary syphilis, then reinfected with malignant syphilis. However, further research is needed to elicit whether recurrent syphilis infections increase the chances of severe infection or malignant syphilis.
P002 Inflammatory vitiligo with raised borders: a rare case of pseudolymphoma mimicking hypopigmented mycosis fungoides
Authors: Maged Daruish, Cecilia Grossmith, Saleem Taibjee
Journal: British Journal of Dermatology (2024)

Abstract A 51-year-old woman was referred to our department with a mildly itchy persistent rash that had started 3 years earlier on the back of her thighs, leaving pale skin as it progressed. She noted worsening of the rash during winter months. There was a history of psychological stress preceding the onset of the rash. Clinical examination revealed bilateral symmetrical annular hypopigmented patches with erythematous and slightly scaly raised edges. Symmetrical patches of depigmentation were also seen on her forearms. An incisional biopsy from the left posterior thigh, including the hypopigmented centre and adjacent erythematous rim, revealed unremarkable epidermis corresponding to the hypopigmentation, while the advancing edge showed interface changes with a bandlike lymphohistiocytic infiltrate and prominent lymphocytic exocytosis. The lymphocytes were positive for pan T-cell markers (CD2, CD3, CD5, CD7), with relatively equal CD4 and CD8 populations. Melan-A indicated reduced density of melanocytes. There was no evidence of clonality on T-cell receptor (TCR) gene rearrangement studies. Punch biopsy from a depigmented patch on the right forearm was unremarkable on haematoxylin and eosin sections. However, melan-A indicated that the epidermis was completely devoid of melanocytes. The diagnosis of inflammatory vitiligo with raised borders (IVRB) was made. IVRB is a rare subtype of vitiligo that typically presents with a raised erythematous, scaly and pruritic edge surrounding depigmented patches. Differentiating IVRB from hypopigmented mycosis fungoides can be challenging, both clinically and histologically, due to the prominent lichenoid infiltrate with epidermotropism and the predominance of CD8+ lymphocytes that can be found in both. Helpful clues include the characteristic erythematous border, as well as lack of clonality on TCR gene rearrangement studies in IVRB (Gomez-Moyano E, Vera-Casaño A, Gamero AH et al. Inflammatory vitiligo or hypopigmented mycosis fungoides? J Pediatr Hematol Oncol 2010; 32: 338–9). Melanocytes and epidermal melanin are more likely to be preserved in hypopigmented mycosis fungoides [El-Darouti MA, Marzouk S, Azzam O et al. Vitiligo vs. hypopigmented mycosis fungoides (histopathological and immunohistochemical study, univariate analysis). Eur J Dermatol 2006; 16: 17–22]. Clinicopathological correlation is crucial to make the distinction.
BI29 Mycosis fungoides presenting in a patient with <i>NFKB1</i> haploinsufficiency-associated common variable immunodeficiency
Authors: Kieran Carty, Gerard Crotty, Kevin Molloy
Journal: British Journal of Dermatology (2024)

Abstract A 52-year-old man with a history of common variable immunodeficiency (CVID) secondary to NFKB1 haploinsufficiency was referred to the dermatology clinic. He had a worsening rash on his arms and legs with a background of a longstanding rash on his trunk for the last 2 years and his groin area for the preceding 12 years. He was diagnosed with CVID in 2009 and was receiving three-weekly intravenous immunoglobulin infusions. He had a history of childhood eczema and his son also had a history of eczema. On examination, the patient had erythematous infiltrated impetiginized plaques on his upper abdomen, buttocks and thighs and more subtle patches on his right chest consistent with a diagnosis of mycosis fungoides. His modified Severity-Weighted Assessment Score was 27.6 (patch 3.4%, plaque 12.1%). His staging investigations identified a weak clonal T-cell population in his bone marrow biopsy [B0b (L) lymphopenia]; a fludeoxyglucose F18 (FDG) avid lymph node in the region of his rash (likely dermatographic) and a discordant B-cell lymphoproliferation in biopsies of his FDG avid lung lesions. Lymphoma occurs in an estimated 2–8% of patients with CVID, the majority of which are non-Hodgkin lymphoma. To our knowledge, this is the first reported case of mycosis fungoides, the most common form of cutaneous T-cell lymphoma (CTCL) arising in a patient with NFKB1 haploinsufficiency. A recent report by Spangenberg et al. (Spangenberg MN, Grille S, Simoes C et al. Case report: mycosis fungoides as an exclusive manifestation of common variable immunodeficiency in a family with a NFKB2 gene mutation. Front Oncol 2023; 13: 1248964) described a family with two brothers who presented with mycosis fungoides as an exclusive symptom of a CVID, where whole-exome sequencing of the index patient revealed a pathogenic variant of the NFKB2 gene. High constitutive nuclear factor (NF)-κB activity in CTCL is responsible for increased malignant cell survival and proliferation and induction of NF-κB-dependent proinflammatory and anti-inflammatory cytokines. The role of NF-κB in CTCL lymphomagenesis warrants further investigation. Our case highlights that not only does a gain in NF-κB activity appear to confer an increased risk of developing mycosis fungoides, but a loss of such activity can also appear to confer an increased risk.
BT20 Comparison of colour accuracy of a DSLR camera and mobile phone cameras used for dermoscopy images: a pilot study
Authors: Daryl Teo, Aparna Potluru, Kazeem Salako
Journal: British Journal of Dermatology (2024)

Abstract Dermatology, being a visual specialty, lends itself well to the advent of telemedicine. Utilization of teledermatology has been greatly expanded since the COVID-19 pandemic. Patients are increasingly making use of their own personal devices to capture images of their skin conditions to show the clinician. Advances in cameras of mobile phone devices have also encouraged good-quality image capturing. However, mobile phone cameras have inbuilt software that is often calibrated to deliver appealing consumer photography. Each company has their own software and marketing regarding this. The present pilot study aims to compare the colour accuracy of DSLR and mobile phone cameras used in dermoscopy images. Dermoscopic images allow for consistent lighting to standardize comparison. We used a DSLR camera (Nikon D7200 body with the DermLite Foto II Pro dermoscopy lens) as the standard for comparison, which is likely to produce a better image. Four mobile phones were used (Apple iPhone 12 Pro, Samsung Galaxy Note 8, Samsung Galaxy S21 Ultra, and Google Pixel 7A) and dermoscopy images were captured through a Heine DELTAone. Three photos of a melanocytic naevus each from five participants were taken. All raw images were transferred to a computer and analysed with FIJI, ImageJ freeware. RGB images were converted to the CIELAB colour space. The CIELAB colour space was used as a device-independent model to compare colour difference, which was determined by the computation of total colour difference (ΔE). ΔE values in all participants were calculated, with the lowest mean difference for Pixel 7A (12.9), followed by iPhone 12 Pro (18.6), Note 8 (20.0) and S21 Ultra (26.1). Of note, there was a greater mean difference across all devices in our participants of Afro-Caribbean ethnicity (25.7) compared with other participants. There is variation in colour accuracy between mobile phone devices in comparison with DSLR photography for our dermoscopic images of melanocytic naevi. This difference appears more pronounced in Black individuals. It is important for dermatologists to be aware of the devices used in capturing these images when they are used as part of any telemedicine service. Careful consideration is required for assessing rashes in patients with darker skin tones, especially as those clinical photographs would not have consistent lighting and exposure factors, which can influence the final image. The study can be expanded to include more participants and images to further investigate these differences.
BG06 Patient perspectives on living with multiple actinic keratoses: a qualitative study
Authors: Ciara Drumm, Aoife Moloney, Blaithin Moriarty, Aoife Lally
Journal: British Journal of Dermatology (2024)

Abstract Actinic keratoses (AKs) are chronic recurrent erythematous scaly lesions that appear most commonly on sun-damaged skin. Although many AKs will regress, up to 16% will progress to cutaneous squamous cell carcinoma. Therefore, field treatment is advised. Due to the long-term recurrence rates with the current available treatments and the need for repeated courses of treatment, there may be a substantial burden on patients. In this qualitative study, we aimed to understand the challenges experienced by patients with multiple AKs. Purposive sampling was used to recruit patients with a history of multiple AKs to two patient focus groups. To facilitate discussion, only 10 patients were invited to attend each focus group. Six patients were able to attend the first focus group and seven the second patient focus group, with circumstances such as personal or family illness resulting in four patients missing the first focus group and three the second. The first focus group was unscripted, unstructured, and conducted by the lead investigator and a cancer specialist nurse. The discussions that arose during the first focus group were then used to guide and structure the second focus group. An interview guide was developed by the lead investigator and reviewed by a consultant dermatologist. The second focus group was semistructured to allow flow of discussion and was conducted by the lead investigator and two specialist nurses. This focus group was audio-recorded with written and informed consent from all participants and then transcribed and analysed using Gioia methodology on NVivo software (version 12; QSR International, Doncaster, Australia). This research adopts constructivist ontological and subjectivist epistemological assumptions, which recognize that patients have unique experiences, values and preferences that should be considered in their treatment choices. Four themes and 16 subthemes were identified through analysis of the transcript. The first theme, physical and emotional impacts, was subdivided into impact on mood, living with uncertainty and recurrence, insecurity and coping mechanisms. The second theme focused on the impact of the COVID-19 pandemic and covered access to care, reduction in functioning and loss of support. The third theme refers to patient support and experience and explored individualized treatment, neglected examination areas, lack of reassurance, awareness campaigns and the benefits of sharing personal experiences. The final theme looked at communication and information through patient empowerment and understanding, individual variations in treatment, accessibility of information, evidence-based information, and the communication gap. The burden and impact of AKs is poorly understood. This qualitative study explores the experiences, concerns and priorities of patients with multiple AKs, and may assist development of shared decision-making pathways for this group.
BT12 Great expectations: implementing artificial intelligence software into a regional skin cancer teledermatology service
Authors: Philippa Walker-Smith, Anne-Marie Christie, Annabel Scott, Arani Chandrakumar
Journal: British Journal of Dermatology (2024)

Abstract Every year 2-week rule (TWR) referrals for skin cancer are increasing, reflected at both national and local level, and they are projected to rise further. The number of substantive staff in dermatology is not increasing and innovative solutions are necessary. We present an evaluation of a south-east UK dual-site teledermatology TWR service 1 year after implementation of the artificial intelligence software DERM, provided by third-party Skin Analytics (SA). Our TWR service successfully initiated a photodermatology service by use of a ‘PhotoHub’ for skin lesions. SA DERM was subsequently implemented to analyse these images and autonomously triage the patients into (i) TWR referral to secondary care dermatology, (ii) benign and for automated discharge, or (iii) ‘other’ diagnosis for general practitioner or community review. Lesions deemed benign by DERM underwent a safety-net review by an SA consultant dermatologist prior to discharge. Patients referred to secondary care dermatology were reviewed on a virtual platform by a trust consultant dermatologist to determine an appropriate pathway. SA DERM aimed to (i) speed up local cancer diagnosis, (ii) reassure patients with benign lesions faster, (iii) support workforce capacity and (iv) be cost-effective. Over a 12-month period (July 2022 to July 2023), 1599 patients seen in the PhotoHub underwent analysis by SA DERM. By the end of the pilot around 30% of the monthly TWR referrals were being analysed. SA DERM had a correct automated discharge rate of 20%. In total, 50% of cases were referred directly to trust dermatologists for further triage via the SA online platform. Overall, 41% of patients analysed by SA DERM avoided urgent face-to-face appointments. SA Derm demonstrated &amp;gt; 95% target sensitivity for melanoma and squamous cell carcinoma and &amp;gt; 90% for basal cell carcinoma and premalignant lesions. Patient and end users reported a 75% positive experience. The hospital skin cancer performance target increased from 36% to 95%. Clinicians have been surveyed on their experience. In conclusion, SA DERM helps manage the continued increase in TWR referrals. It demonstrated an improvement each quarter as the software was established. However, a large proportion of teledermatology images requiring triage remained, with the subsequent administrative burden. Future local challenges include encouraging community referrals via the PhotoHub and addressing the waiting list backlog for ‘routine’ appointments so this pathway can be utilized for lower-grade skin lesions. Clinician concerns remain. Ongoing engagement with AI solutions is likely to be required to develop skin cancer services fit for future demand.
Adherence to the planetary health diet and cognitive decline: findings from the ELSA-Brasil study
Authors: Natalia Gomes Gonçalves, Leandro Teixeira Cacau, Naomi Vidal Ferreira, Paulo Andrade Lotufo, Alessandra Carvalho Goulart, Maria Carmen Viana, Sandhi Maria Barreto, Isabela Martins Bensenor, Dirce Maria Marchioni, Claudia Kimie Suemoto
Journal: Nature Aging (2024)
PS08 Exploring the health inequality gap in atopic dermatitis among LGBTQ+ and minority ethnicity communities
Authors: Bernard Ho, Yousaf Aftab, Owen Wright, Susan Moloney, Lynne Corner
Journal: British Journal of Dermatology (2024)

Abstract Research evidence suggests inequities in access to specialist atopic dermatitis (AD) care for LGBTQ+ and minority ethnicity groups, who can experience poorer outcomes and higher consultation rates with a general practitioner before being referred to a specialist. Understanding of why such inequities exist is limited. The research that exists is largely quantitative and lacks both patient and professional perspectives. This study aimed to address this gap through in-depth exploration of the patient journey and generation of novel insight. We used qualitative methods involving one-to-one interviews and focus groups with members of LGBTQ+ and minority ethnicity groups aged ≥ 18 years and living in the UK with a medical diagnosis of AD. People registered their interest in the study via Voice, a public engagement platform, followed by purposive sampling and selection of 20 patient participants (10 LGBTQ+ and 10 minority ethnic) to maximize diversity and generation of a broad perspective. Five healthcare professionals representing a range of clinical practice were identified from known academic sources, and/or snowball sampling to take part in an interview. Ethical approval and full participant consent were obtained. Interviews and focus groups were conducted remotely via Zoom; they were recorded then transcribed anonymously. Interviews followed a semistructured topic guide covering screening, diagnosis, general views of healthcare professionals, treatment, management and symptoms. Data were analysed thematically and compared for commonalities and differences both across and within groups. To date, 10 interviews have been completed, with six LGBTQ+ participants and four minority ethnic participants (seven female, two male, one nonbinary, one trans-female), age range 24–47 years. Preliminary results suggest that while discrimination-based barriers are not prevalent, the care system can be perceived as lacking empathy and understanding of the patient experience for people living with AD. Participants expressed personal expertise in their condition, with a desire for access to a more holistic approach to AD care that includes preventative measures. However, short consultation times with primary care givers deterred discussion beyond episodic treatment. Participants were unaware of such care options being available through alternative sites of care (pharmacies). This study is ongoing but has already generated deeper insight into the patient journey for people living with AD. Further analysis will illuminate perceived barriers to specialist care for members of LGBTQ+ and minority ethnicity groups and how these might be addressed. The findings will inform general patient-centric recommendations for practice and guide further qualitative work specific to subcommunity needs. Pfizer sponsored and funded this study.