tbuckley/cabot-search huggingface dataset:
P027 Are skin cancer teaching ‘super clinics’ safe and effective? Results of a UK pilot study
Authors: Huw Greenish, Hafsa Faarax Shirwac, Hannah Morgan, Harry Heath, Sarah Carswell, Alexander D G Anderson
Journal: British Journal of Dermatology (2024)

Abstract The ‘super clinic’ model is a response to skin cancer capacity pressures facing the NHS and the need to deliver educational opportunities and supervision to trainees, specialty and specialist (SAS) doctors and specialist nurses. This model involves a single specialist supervising multiple trainees and personally reviewing a high number of patients. It is unknown whether the rapid decision making inherent in this way of working affects clinical performance. This pilot study aimed to assess the implementation of an educational super clinic in an NHS hospital dermatology department and to compare performance against standard practice. Super clinics were run over a 6-month period in 2022. A single permanent associate specialist oversaw up to three trainees, each of whom had their own list of cases. Patients were referred via the suspected skin cancer pathway. After reviewing each patient, trainees presented relevant findings and a working diagnosis to the specialist, who examined the patient, then confirmed the diagnosis and agreed a management plan. All patients were offered a full skin check. Both standard and super clinics lasted 3–4 h. Electronic patient records and histology results were reviewed to establish ultimate diagnoses. The proportions of patients in whom histology was obtained and any form of skin cancer was ultimately diagnosed were compared with data from the same specialist’s standard 2-week-wait clinics during the study period. In total, 345 patients were seen in 12 super clinics (average 29 patients per clinic, maximum 41), while 589 patients were seen in standard clinics (14 patients per clinic) over the same period (no trainees present). Clinicians under supervision included two dermatology ST3 doctors, one dermatology trust grade doctor, one genitourinary medicine consultant, three ST1–2 doctors and two clinical nurse specialists. Histology was obtained in 174 of 345 (50%) patients in the super clinic group vs. 262 of 589 (44%) in the regular clinic group (P = 0.08). There was no significant difference in the number of patients ultimately diagnosed with a malignancy in the super clinics (100 of 345, 29%) vs. the regular clinics (159 of 589, 27%) (P = 0.51). The super clinic model facilitated face-to-face supervision and education for multiple trainees, while simultaneously more than doubling new patient capacity. Compared with standard clinics, there was no negative impact on the specialist’s diagnostic confidence (histology rate) or cancer pick up rate. These findings suggest that the super clinic model is both safe and effective.
P021 The diagnosis and management of pemphigus vegetans in pregnancy
Authors: Cornelius Clancy, Fawad Hussain, Elena Pappa
Journal: British Journal of Dermatology (2024)

Abstract A 31-year-old woman, 16 weeks pregnant at presentation and with no prior medical history, presented to hospital with 2 months of progressive vegetative plaques of the perioral and nasal mucosa, and genital pruritus. After review by medical teams and initiation of treatment for pelvic inflammatory disease, her genital pruritus resolved. However, the patient re-presented to the emergency department 1 week later due to persistence of her facial lesions. Initial diagnoses considered included exuberant granulation tissue in response to infection, nasal papilloma prolapse, pyodermatitis–­pyostomatitis vegetans, and pemphigus vegetans. Due to concerns of facial disfigurement, a biopsy from the lower lip was completed. This revealed mild acantholysis, further confirmed by direct immunofluorescence, with intercellular deposition of IgG and C3 within the intraepidermal space, consistent with a diagnosis of pemphigus vegetans [Messersmith L, Krauland K. Pemphigus vegetans. In: StatPearls. Available at: https://www.ncbi.nlm.nih.gov/books/NBK545229 (last accessed 1 February 2024)]. Published case reports of pemphigus vegetans treatments were reviewed and the options discussed with the patient. Systemic treatment was declined due to associated risks with pregnancy, and instead topical management was initiated with a trial of triamcinolone injections over the course of several months, which significantly improved the patient’s physical appearance. Systemic treatment was initiated postpartum with oral corticosteroids, allowing disease remission with ongoing patient follow-up. This case highlights the diagnostic challenge in diagnosing rare conditions such as pemphigus vegetans in pregnancy, treating severe immunobullous disease during pregnancy, and the psychological impact of immunobullous disease.
P019 Cutaneous amyloidoma: a rare variant of primary cutaneous marginal zone lymphoproliferative disorder
Authors: Sarah Fleming, Shane Brennan, Kevin Molloy
Journal: British Journal of Dermatology (2024)

Abstract A 71-year-old male patient presented to the dermatology department with a nontender erythematous nodule on the left arm. Incisional biopsy illustrated a dermal-based perivascular plasma-cell infiltrate with kappa-light chain restriction. There was also marked deposition of dermal amorphous eosinophilic material, with similar amorphous material deposition within vessel walls. Apple green birefringence under polarized light with Congo red staining was observed. Review at the UK National Amyloidosis Centre concluded that this was consistent with cutaneous amyloid-L (AL) amyloidosis. A bone marrow trephine and PET-CT ruled out systemic involvement. The patient was listed for surgical resection and monitored clinically by the dermatology and haematology teams. Amyloidosis represents a spectrum of disease including systemic and localized cutaneous subtypes. There is much discussion regarding the nosology of AL amyloidosis; however, there is consensus among clinicians, who consider cutaneous amyloidoma to be a rare variant (&amp;lt; 1%) of primary cutaneous marginal zone lymphoproliferative disorder. Cutaneous amyloidoma presents as small waxy nodules and/or plaques usually located on the extremities, and is histologically characterized by prominent amyloid deposition and few perivascular plasma cells. Surgical excision is the treatment of choice. AL amyloidosis presents in an older population and has a more indolent clinical course compared with the systemic subtype, leading to the proposal that cutaneous amyloidosis (AL type) may represent a precursor to the systemic process. Although progression to high-grade lymphoma or systemic amyloidosis is rare, it is recommended that patients undergo staging of the disease, eradication of the cutaneous disease and close clinical follow-up. Classification of cutaneous AL amyloidosis is hindered by its rarity; however, the authors hope that this case will add to the growing literature available on the condition.
P017 Localized penile bullous pemphigoid: a case report
Authors: Rory Barry, Jennifer Boggs, Lisa Mellerick, Rupert Barry
Journal: British Journal of Dermatology (2024)

Abstract A 69-year-old man presented with a 3-month history of recurrent, itchy blisters on the penile shaft. Past medical history included ischaemic heart disease and hypertension. Medications included amlodipine, aspirin, atorvastatin, bendroflumethiazide and bisoprolol. Examination revealed discrete, deroofed bullae on a slightly eroded base on the penile shaft, with evidence of postinflammatory pigmentary changes. The penile glans and scrotum were unaffected. The remaining full-skin examination, including oral mucosa, was noncontributory. Histological analysis by punch biopsy showed skin with dermal eosinophils and scattered intraepidermal eosinophils. A rare eosinophil was seen at the base of the epidermis. No definite neutrophils were seen. No bulla was identified. Direct immunofluorescence analysis of perilesional skin showed strong linear C3, linear IgG and patchy linear IgA deposition on the dermoepidermal junction, suggestive of a bullous disease. Serum indirect immunofluorescence was negative for anti-BP180 and anti-BP230 antibodies, with normal full blood count and renal and liver profiles. Clinically, the working diagnosis was a localized bullous pemphigoid (BP), and the patient was prescribed clobetasol propionate ointment topically once daily for 4 weeks and oral doxycycline 100 mg once daily and nicotinamide 500 mg three times daily for 3 months. After 2 weeks the bullae had resolved, with no new bulla development. Two months following treatment initiation the patient remains symptom free, and clinically without disease recurrence and no reported adverse drug event. BP is the most common autoimmune subepidermal blistering skin disease, with autoantibodies targeting BP180 or BP230 proteins. BP usually presents in older patients, with an increased prevalence in those with a history of stroke, Parkinson disease and dementia. Clinical presentation typically describes painful, itchy, tense bullae of the skin, either localized or widespread across the trunk and proximal limbs. Genital BP is a rare subgroup of localized BP, typically affecting women and children. Differential diagnoses for BP include fixed drug eruptions, contact dermatitis, dermatitis herpetiformis, linear IgA disease and infective causes such as bullous tinea. From a literature search, this is the fifth case of BP localized solely to the male genitalia. Dermatologists should consider localized BP in male patients presenting with bullae on the penis with confirmation by skin biopsy and immunofluorescence analysis, to initiate prompt treatment and disease control and avoid significant morbidity for this patient group.
P047 Dermatology Life Quality Index used as a standard in validation of 101 quality-of-life instruments: a systematic review
Authors: Jui Vyas, Jeffrey Johns, Yasmina Abdelrazik, Faraz M Ali, John R Ingram, Sam Salek, Andrew Y Finlay
Journal: British Journal of Dermatology (2024)

Abstract Over the last 30 years many new quality-of-life measures have been described in dermatology; a critical aspect of their validation is demonstrating correlation with an instrument measuring a similar construct. The aim of this systematic review was to analyse peer-reviewed publications describing use of the Dermatology Life Quality Index (DLQI) in validation of other patient-reported outcome (PRO) and quality-of-life (QoL) measures. Seven databases were searched for papers published between January 1994 and December 2022 for articles containing data using DLQI in validation of other PRO or QoL measures. Methodology followed the PRISMA guidelines. The protocol was prospectively registered in PROSPERO. Of 1717 screened publications, 122 articles including 33 969 patients from 34 different countries with 38 diseases met the inclusion criteria. The DLQI was used in validation of 80 different dermatology-specific QoL measures, mostly disease specific, and of 21 generic measures. Of these studies, 42 were cross-cultural adaptations, 112 were single arm, 100 were cross-sectional, 18 were longitudinal and six were randomized controlled. DLQI was used for 14 known-group, 10 construct, 101 convergent, 10 concurrent, 10 divergent/discriminant and three criterion validity tests using the Mann–Whitney U-test (2), Spearman’s correlation (80), Pearson’s correlation (25) and Student’s t-test (1). The DLQI was used in responsiveness analysis in 13 studies. This review identified widespread use of DLQI in validation of other dermatology PRO and QoL measures, which confirms the central role DLQI plays in instrument development and validation across dermatology and beyond. The use of the DLQI by so many developers of other instruments has provided a common standard for comparability.
P049 Best foot forward: awareness of melanoma of the foot among podiatrists
Authors: Brian Nolan, Cathal O’Connor, Michelle Murphy
Journal: British Journal of Dermatology (2024)

Abstract Melanoma of the foot can masquerade as ulcerative conditions, congealed blood and trauma. Thus, even for experienced clinicians, diagnosis can prove challenging. There is a paucity of evidence about the role that podiatrists, who are routinely exposed to patients’ lower limbs, play in melanoma detection. The aim of this study was to assess the awareness and knowledge of melanoma among podiatrists, and to investigate whether podiatrists examine and assess suspicious pigmented lesions of the foot. An anonymous 18-question survey was designed assessing podiatrists’ knowledge of melanoma of the lower limb, and exposure to suspicious pigmented lesions. Ethical approval was granted by the local research ethics committee. This survey investigated the frequency of examination of suspicious pigmented lesions, insight into what constitutes a suspicious pigmented lesion, actions taken upon detection of such lesions, and suggestions for helping to improve early detection of melanoma. The survey was distributed anonymously by the national podiatrists’ association to 400 registered members over a 3-month period. The survey generated 247 responses (62% response rate, n = 400). Most podiatrists (81%) had over 20 years’ experience, and saw an average of 30 patients weekly. Over two-thirds (68%, n = 167) had been asked to examine suspicious pigmented lesions on the lower limb, of whom almost two-thirds (61%, n = 102) reported being frequently asked to examine suspicious pigmented lesions. Over two-thirds of podiatrists (71%, n = 175) reported identifying a lesion that they felt could represent melanoma, of whom 79% advised presentation to the general practitioner (GP), 8% advised dermatology review, 6% took photographs for skin-mapping, 6% contacted the patient’s GP directly, and one took a biopsy. Most (81.9%) did not receive subsequent feedback from the patients or GP. Just over a third (34.4%, n = 83) reported not feeling comfortable contacting a GP surgery directly to refer a patient, while 55.8% (n = 135) did not feel comfortable discussing sunscreen and photoprotection with patients. Most (81.7%, n = 196) did not feel they received satisfactory undergraduate education in melanoma. Suggestions for improving early detection of melanoma of the foot among podiatrists included enhanced undergraduate training, a clear referral pathway for podiatrists, and feedback from their referrals to GP or dermatologists. There is a concerning gap between the reported frequency of suspicious pigmented lesions in podiatry practice and the lack of formal training in melanoma detection and assessment. Improved training, clearer referral guidelines, and enhanced interprofessional communication strategies may improve early detection of melanoma of the foot among podiatrists.
CD04 The dermal–dental nexus
Authors: Fazleenah Ajmul Hussain, Jeremy Williams, Alison Godwin, Paul Devakar Yesudian
Journal: British Journal of Dermatology (2024)

Abstract Allergic contact dermatitis (ACD) from acrylates is frequently observed in occupational settings, particularly among dental workers, nail technicians and beauticians. In the last 2 decades, there has been a shift in the types of products causing ACD related to acrylates, transitioning from conventional sources like dental materials, glues, sealants, adhesives, paints and printing inks, to increasing prevalence in nail cosmetics. Recent studies indicate that 64% to &amp;gt; 80% of reactions to acrylates were related to cosmetic nail products. In dermatological practice, patients undergo patch testing for oral reactions following dental procedures involving acrylates. In these patients, previous nail acrylate sensitization is thought to play a role. Systemic contact dermatitis (SCD) refers to a condition where sensitization via the skin leads to subsequent reactions to the same or crossreacting allergens systemically. Recognizing the significance of this phenomenon, we conducted a survey among dental workers in the UK to gauge their awareness of this association. We received 49 responses, of which 39 (80%) were from general dental practitioners. Our cohort was highly experienced, with 21 (43%) having &amp;gt; 20 years’ experience. Most respondents (31, 63%) were from Wales, and 30 (61%) spent &amp;gt; 75% of their time working with the NHS. Overall, 26 (53%) responders reported that 5 to 10 patients a day required acrylate as part of their treatment, while 14 (29%) stated that they use it in fewer than 5 patients a day seeking dental treatment. In total, 34 (69%) did not routinely enquire about patients’ past allergy or sensitivities to nail acrylates before undertaking acrylate-related dental procedures. One responder asked this routinely and two (4%) responders felt that there was no evidence for this. Nineteen (39%) expressed uncertainly about encountering oral reactions following exposure to dental acrylates in patients with nail acrylate allergy as they were not aware of this association. Seventeen (35%) did not experience any such reaction, while eight (16%) encountered this, albeit rarely. In total, 32 (65%) were unaware that nail acrylate sensitization could lead to oral reactions following dental acrylate exposure, and a significant majority (47, 96%) had never received education on this association. The survey underscores a lack of awareness among dental practitioners regarding the potential for SCD causing oral reactions after nail acrylate sensitization. Given the relevance of these findings, it is imperative to incorporate this knowledge into dental undergraduate curricula.
BH05 (P049) Best foot forward: awareness of melanoma of the foot among podiatrists
Authors: Brian Nolan, Cathal O’Connor, Michelle Murphy
Journal: British Journal of Dermatology (2024)

Abstract Melanoma of the foot can masquerade as ulcerative conditions, congealed blood and trauma. Thus, even for experienced clinicians, diagnosis can prove challenging. There is a paucity of evidence about the role that podiatrists, who are routinely exposed to patients’ lower limbs, play in melanoma detection. The aim of this study was to assess the awareness and knowledge of melanoma among podiatrists, and to investigate whether podiatrists examine and assess suspicious pigmented lesions of the foot. An anonymous 18-question survey was designed assessing podiatrists’ knowledge of melanoma of the lower limb, and exposure to suspicious pigmented lesions. Ethical approval was granted by the local research ethics committee. This survey investigated the frequency of examination of suspicious pigmented lesions, insight into what constitutes a suspicious pigmented lesion, actions taken upon detection of such lesions, and suggestions for helping to improve early detection of melanoma. The survey was distributed anonymously by the national podiatrists’ association to 400 registered members over a 3-month period. The survey generated 247 responses (62% response rate, n = 400). Most podiatrists (81%) had over 20 years’ experience, and saw an average of 30 patients weekly. Over two-thirds (68%, n = 167) had been asked to examine suspicious pigmented lesions on the lower limb, of whom almost two-thirds (61%, n = 102) reported being frequently asked to examine suspicious pigmented lesions. Over two-thirds of podiatrists (71%, n = 175) reported identifying a lesion that they felt could represent melanoma, of whom 79% advised presentation to the general practitioner (GP), 8% advised dermatology review, 6% took photographs for skin-mapping, 6% contacted the patient’s GP directly, and one took a biopsy. Most (81.9%) did not receive subsequent feedback from the patients or GP. Just over a third (34.4%, n = 83) reported not feeling comfortable contacting a GP surgery directly to refer a patient, while 55.8% (n = 135) did not feel comfortable discussing sunscreen and photoprotection with patients. Most (81.7%, n = 196) did not feel they received satisfactory undergraduate education in melanoma. Suggestions for improving early detection of melanoma of the foot among podiatrists included enhanced undergraduate training, a clear referral pathway for podiatrists, and feedback from their referrals to GP or dermatologists. There is a concerning gap between the reported frequency of suspicious pigmented lesions in podiatry practice and the lack of formal training in melanoma detection and assessment. Improved training, clearer referral guidelines, and enhanced interprofessional communication strategies may improve early detection of melanoma of the foot among podiatrists.
Poster presentationsBC04 Clinical efficacy of oral tranexamic acid in lichen planus pigmentosus: case series
Authors: Mala Bhalla, Astha Arora, Aashali Kalia
Journal: British Journal of Dermatology (2024)

Abstract Lichen planus pigmentosus (LPP) is a rare pigmented variant of lichen planus first described in India in 1974. It has an insidious onset and predominantly affects the photoexposed areas of darker skin phenotypes. The blue grey pigmentation is of great cosmetic concern and extremely difficult to treat. Various topical agents have been tried without much success, probably because the pigment is deeper in the dermis. The aim of this study was to assess the clinical efficacy of oral tranexamic acid 250 mg twice daily in LPP. In total 10 consecutive patients clinically diagnosed with LPP were included. A detailed history was taken to ascertain the onset and any possible risk factors. A skin biopsy was done in the patients who consented, to establish the histopathological diagnosis. All the patients were started on oral tranexamic acid 250 mg twice a day after excluding the risk factors for coagulopathy along with strict photoprotection. No other topical treatment was given. All patients were assessed for improvement in the pigmentation every 4 weeks until 12 weeks according to the following scale: no improvement (0%), mild improvement (0–25%), moderate improvement (26–50%), good improvement (51–75%) or very good improvement (76–100%). Photographs were taken and the patient’s satisfaction was also noted. Six of the 10 patients consented for biopsy and their histopathology was consistent with LPP. At the 4-week follow-up, four patients showed mild improvement, four had moderate improvement and two had good improvement. All the patients showed improvement and fading of pigment. Oral tranexamic acid seems to be effective in LPP, but more studies are required to establish the optimum dose and duration of treatment.