tbuckley/cabot-search huggingface dataset:
DE07 Dermatology Dungeons and Dragons: simulation in dermatology education
Authors: Kate Lawlor, Avad Mughal
Journal: British Journal of Dermatology (2024)

Abstract It has been shown that dermatology is poorly understood among medical students and doctors of all grades (Chiang YZ, Tan KT, Chiang YN et al. Evaluation of educational methods in dermatology and confidence levels: a national survey of UK medical students. Int J Dermatol 2011; 50: 198–202). A scoping review within dermatology showed better learning effects when the interventions activate students, involve feedback, and are built on case-based learning (Bernges F, Zielbauer S, Weberschock T, Ochsendorf F. Teaching dermatology to medical students: a scoping review of published interventional studies. J Dtsch Dermatol Ges 2022; 20: 1077–87). Unlike more rigid direct case-based teaching, simulation learning allows the student to help build the zone of learning and explore areas of education that may not have previously considered. A novel approach is currently being utilized with year 3 medical students. There are approximately 12 students in each 2.5-h session. They are split into three or four groups, with students with previous dermatology experience allowed to ask fewer questions and those with no previous dermatology experience allowed to ask unlimited questions. Each group is asked to roll a 10-sided die to choose their case. They are then given a clinical scenario that includes a brief history and clinical photographs. The facilitator acts as the patient answering the students’ questions. The clinical scenarios cover the commonly encountered conditions in dermatology. When the students reach a certain point in the decision-making process, they again roll a die to determine the outcome of that choice. This demonstrates the element of chance and multiple potential outcomes in real-life decision making within clinical practice. The students can come up with any of many appropriate management plans, but their success is left up to chance. The crucial step is that the students then follow up that case again and evaluate the consequences of their decision making and the rationale for success or failure. This can be repeated as many times as the session allows, and other students learn from watching their colleagues. The students are provided with feedback forms at the end of the session to gain insight into the positive and negative aspects and whether they felt the session improved their knowledge of diagnosing and managing dermatology conditions. Feedback has been consistently positive including, ‘That is the best teaching I have ever had’. The freedom to make errors is vital and allows the student to reach the highest level of Maslow’s hierarchy. The consequences then ground this in learning.
GD03 (P095) Ten cases of scabies successfully treated with topical ivermectin
Authors: Jaimie Oldham, Anshoo Sahota, Edel O’Toole, Malvina Cunningham
Journal: British Journal of Dermatology (2024)

Abstract Scabies is an increasing problem in the UK with a surge in cases reported by dermatologists and the media. It is intensely itchy and caused by the highly contagious mite Sarcoptes scabiei. There are many theories regarding the increased prevalence, including global warming, increased poverty, reduced treatment availability and resistance. The standard treatments in the UK include topical malathion, topical permethrin and oral ivermectin. All have had significant supply issues as reported by the British Association of Dermatologists. There have also been concerns of permethrin resistance. Oral ivermectin is expensive, with four tablets listed at £116.84 in the British National Formulary (BNF). Finally, oral ivermectin is not licensed in children weighing &amp;lt; 15 kg (although data seem to suggest this is safe). One option that is less used but reported is topical ivermectin. This was in the 2018 Cochrane review looking at the efficacy of topical permethrin, and oral and topical (as 1% lotion) ivermectin. This showed no difference in efficacy and few or mild adverse events. These findings are also replicated in recent studies and there are case reports of topical ivermectin to treat neonatal scabies that seems resistant to permethrin. In our centre, we have used topical ivermectin (as the 10 mg g−1 cream Soolantra) to treat 10 patients, with great success. The first was a 14-month-old child who weighed 9.2 kg. She had previously had three courses of permethrin and two courses of malathion with ongoing signs and symptoms of scabies, including burrows. The entire family had been treated every time and the entire family (except this patient) was treated with oral ivermectin during the final treatment before topical ivermectin. The patient was treated top to toe with two applications of topical ivermectin cream 1 week apart, with resolution after one application. Subsequently we have had success using the same protocol to treat a 21-year-old man (with no response to four courses of permethrin) and his 53-year-old mother (with no response to three courses of permethrin). We have also treated a 31-year-old man, a 48-year-old man and his partner (all of whom had not responded to one course of permethrin), and a 68-year-old man and his family who had no previous treatment. We have had no adverse effects and no treatment failures. We report on 10 patients who we treated successfully with topical ivermectin. Topical ivermectin provides an exciting option for treatment and, of note, one tube is listed at £27.43 in the BNF, making it significantly cheaper than the oral alternative.
PS03 Psychiatric comorbidity in patients with hidradenitis suppurativa: a retrospective review of a tertiary centre clinic
Authors: Lucy Webber, Emma Clark, Natalie King, Hannah Wainman, Aparna Sinha
Journal: British Journal of Dermatology (2024)

Abstract Hidradenitis suppurativa (HS) is closely linked to psychiatric comorbidities, elevated suicide risk, stigmatization and body image impairment (Patel K, Lee, H, Rastogi S et al. Association between hidradenitis suppurativa, depression, anxiety, and suicidality: a systematic review and meta-analysis. J Am Acad Dermatol 2020; 83: 737–44). We conducted a retrospective review of the first 100 patients referred to our tertiary HS service from August 2020 to identify those receiving psychiatric input. We assessed patient characteristics, underlying mental health diagnoses, treatment, mental health and HS severity scores, and referral outcomes. Among the 100 patients, 25 were referred to a tertiary psychodermatology service and 6 were already receiving psychiatric care. Of these 31 patients, 81% were female, the average age was 34 years and the mean body mass index was 35.6 kg m−2. Overall, 60% currently smoked and 93% had Hurley scores of 2 or 3. Compared with those not referred for psychiatric input, these 31 patients exhibited higher baseline abscess and inflammatory nodule (AN) counts of &amp;gt; 5 (50% vs. 28%), severe pain scores &amp;gt; 7 out of 10 (48% vs. 21%), severe General Anxiety Disorder-7 (GAD-7) scores &amp;gt; 15 (44% vs. 37%), severe Patient Health Questionnaire-9 (PHQ-9) scores &amp;gt; 20 (40% vs. 21%) and high Dermatology Life Quality Index (DLQI) scores &amp;gt; 10 (81% vs. 68%). Of those referred for or already receiving psychiatric care, 94% had received a formal mental health diagnosis, with 62% having more than one diagnosis. The most common diagnosis was anxiety and depression, followed by post-traumatic stress disorder, eating disorders and emotionally unstable personality disorder. One-third reported thoughts of suicide or self-harm, with 19% of patients experiencing this on several days and 10% nearly every day. While no significant difference in systemic or biologic therapy usage was observed, treatment led to improved AN counts, and reductions in GAD-7, PHQ-9 and DLQI scores. No change was noted in severe pain scores (47% vs. 48%). Of the 25 patients referred for psychiatric input, 8 were seen, 3 did not attend and 14 await review. Overall, 55% (17 of 31) were encouraged to self-refer for psychological support, including National Health Service talking therapies, cognitive behavioural therapy and bereavement support. Identifying underlying mental health diagnoses and addressing psychological burden alongside medical treatment are essential to comprehensively manage HS. Many HS services do not have links to psychiatry, and the demand for psychological support for patients with HS exceeds available capacity. The introduction of HS-specific community interventions could enhance patients’ access to timely and effective psychological care while increasing our understanding of patients’ needs.
GD04 Erythroderma: uncovering the culprit
Authors: Namiz Damani, Adam Gold, S Krishnakumar, Paul Devakar Yesudian
Journal: British Journal of Dermatology (2024)

Abstract A middle-aged man presented to clinic in South India with a 1-year history of a widespread rash involving his whole body. There was no pre-existing skin condition. It appeared to be a possible inflammatory dermatosis and he was prescribed fixed-dose combination topical agents, including topical steroids (clobetasol propionate), topical antibiotics (gentamicin and neomycin), and a combination of an oral antifungal (terbinafine) and topical antifungals (clotrimazole and miconazole). On examination, there were numerous large, scaly plaques coalescing to an erythrodermic morphology. He was reviewed by two dermatologists, who commenced him on a reducing course of prednisolone. Due to nonresponse he was then started on ciclosporin 2.5 mg kg−1 per day. However, the condition continued to worsen. A skin biopsy was taken; this demonstrated hyperkeratosis with multiple fungal filaments consistent with extensive dermatophytosis. Over the past decade, there has been a significant increase in recalcitrant dermatophytosis seen in India. A recent multicentre study notes that the inaccessibility of adequate antifungal susceptibility testing results in excessively long treatment durations with poorly selected drugs and experimentation in medication dosage and frequency, which in turn contribute to drug resistance and the emergence of new strains (Ebert A, Monod M, Salamin K et al. Alarming India-wide phenomenon of antifungal resistance in dermatophytes: a multicentre study. Mycoses 2020; 63: 717–28). Trichophyton indotineae (previously known as Trichophyton mentagrophytes genotype VIII) is a newly identified dermatophyte species and has outpaced Trichophyton rubrum as the major causative agent of tinea cruris, tinea corporis and tinea faciei in India (Uhrlaß S, Verma SB, Gräser Y et al. Trichophyton indotineae – an emerging pathogen causing recalcitrant dermatophytoses in India and worldwide – a multidimensional perspective. J Fungi 2022; 8: 757). It has since spread to many countries globally. It is particularly problematic due to its resistance to terbinafine as a result of point mutations within the squalene epoxidase gene. Clinically, T. indotineae infections are extensive, involving multiple sites with symptoms of pain, pruritis and localized burning. Infection characteristically follows a chronic and relapsing clinical course, with an average duration of 9 months. The drug of choice is itraconazole 100 mg twice daily for 4–8 weeks, with fluconazole and griseofulvin as second-line options. Adequate hygiene measures are crucial to avert transmission and reinfection. This case highlights the issue of recalcitrant dermatophytosis in the subcontinent, emphasizing the need for improved antifungal susceptibility testing and judicious use of medications to curb drug resistance.
Global Health DermatologyOral presentationsGD01 Comparative efficacy of <i>Mycobacterium indicus pranii</i> and bacille Calmette–Guérin as immunotherapeutic adjuncts in multibacillary leprosy: a clinical and molecular randomized controlled trial
Authors: Sejal Jain, Seema Chhabra, Sunil Dogra, Rakesh Yadav, Debajyoti Chatterjee, Tarun Narang
Journal: British Journal of Dermatology (2024)

Abstract Immunotherapy may be a useful tool in the management of leprosy, especially in highly bacillated patients because of immunological memory. This open-label randomized controlled trial assessed changes in the molecular viability assay (esxA and hsp18 transcript expression) and serology (anti-ND-O-BSA levels) in patients with multibacillary leprosy treated with multibacillary multidrug therapy (MB-MDT) with Mycobacterium indicus pranii (MIP) vaccine or MB-MDT with bacille Calmette–Guérin (BCG) vaccine. Secondary outcomes were changes in histopathological parameters (granuloma fraction and bacillary index of the granuloma), differences in the incidences of type 1 and type 2 lepra reactions, and incidence of immunotherapy-associated adverse drugs reactions among the two groups. The study included 40 patients with multibacillary leprosy randomized into the MIP + MB-MDT and BCG + MB-MDT groups. Thirty patients (15 in each group) completed the 12-month follow-up. Molecular viability assays based on esxA and hsp18 transcript expression, and anti-NO-O-BSA levels were measured in 23 of 30 patients (13 in the MIP group and 10 in the BCG group). In the MIP group, 77% of patients (10 of 13) and in the BCG group, 50% (5 of 10) showed decreased esxA (P = 0.09) and hsp18 transcript expression (P = 0.4). The median decrease in bacteriological index was 1 (interquartile range 0–2) in the MIP group and 1 (interquartile range 0–1) in the BCG group (P = 0.9). A decrease in IgM anti-ND-O-BSA levels was seen in 77% of patients (10 of 13) in the MIP group and 80% (8 of 10) in the BCG group (P = 0.9). Histopathological upgrading was noted in 85% of patients (11 of 13) in the MIP group and 90% (9 of 10) in the BCG group (P = 0.3). Most of the patients had clinical improvement (26 of 30, 87%), which was comparable between the two groups (P = 0.5). None of these patients had primary drug resistance to the first-line MDT drugs. Two patients in the MIP group (13%) and five in the BCG group (33%) had reactional episodes, but only one had an increase in disability. The adverse effect profiles of both vaccines were similar, the majority being injection-site reactions. BCG was associated with neuritis in two patients (12%). This study demonstrates the usefulness of immunotherapy in reducing bacillary viability, improving histopathological and serological markers, and potentially preventing lepra reactions and associated disability. The comparability of MIP and BCG is noteworthy, especially considering BCG’s wider availability and lower cost. The use of molecular viability assays and anti-ND-O-BSA enzyme-linked immunosorbent assay as diagnostic and predictive tools for reactions and/or relapse could advance future research in leprosy.
BT08 Outcomes of urgent suspected cancer, urgent and routine skin lesion referrals assessed via teledermoscopy service
Authors: Sirag Elaribi, Ausama Atwan
Journal: British Journal of Dermatology (2024)

Abstract This retrospective study examines the outcomes of referrals from primary care to our skin lesion service following the assessment of high-resolution clinical and dermoscopic images taken by medical photographers. The study investigates the prevalent diagnoses and outcomes of referrals in relation to the referral pathways, namely urgent suspected cancer (USC) vs. urgent vs. routine referrals. Referral letters along with clinical and dermoscopic images of 1203 patients referred between September 2022 and December 2023 were reviewed by a consultant dermatologist with an interest in dermoscopy and skin cancers. The urgency of referrals, clinical diagnoses and management plans were recorded in a spreadsheet for data collection. Most of the referrals (44.9%) were sent as USC. The others were referred as urgent (23.1%) and routine (32%). The most common diagnosis in all the groups was seborrhoeic keratosis, followed by basal cell carcinoma (Table). Surprisingly, there was no significant difference in the occurrences of these conditions between the three groups. Of all the USC referrals, 41.8% were discharged, 23% were directly booked for minor operative procedures (MOPs) and 24.4% required face-to-face (FTF) assessment for review or diagnostic biopsies. In the urgent group, 46.2% were discharged, 21.9% were booked for MOP, and 23.7% were invited for FTF assessment. Among the routine referrals, 59.1% were discharged, 19.3% were booked for MOP, and 17% were advised FTF assessment. In all the groups, 2–3% of the referrals were directly forwarded to other specialties (plastic, maxillofacial or oculoplastic surgery). Digital monitoring (by arranging for repeated photographs 3 months later for comparison) was requested for 8% of USC, 5.7% of urgent, and 1.8% of routine cases. Most of the digital monitoring cases (35.7%) were for melanocytic lesions, whereas the others were for suspected lichenoid keratoses and irritated seborrhoeic keratoses. Seborrhoeic keratosis was diagnosed in over one-quarter of all pathways of skin lesion referrals. In total, 84% of cases referred as USC were either benign or nonurgent, whereas 5% of routine referrals were suspected to be melanomas or squamous cell carcinomas (SCCs). This highlights the urgent need for improved diagnostic skills when recognizing common skin lesions in primary care. High-resolution clinical and dermoscopic images in a teledermoscopy service provide a helpful tool to prioritize patients effectively and facilitate standardized digital monitoring in selected cases.DiagnosesUSC (n = 540, 44.9%)Urgent (n = 279, 23.1%)Routine (n = 384, 32%)Seborrhoeic keratosis25.9%27.6%25.8%Basal cell carcinoma15%18.6%19%Benign naevi14.4%9.3%8.8%Actinic keratosis5.4%7.2%9%Melanoma/SCC15.9%8.2%5%
GD02 An Indian study of various unusual presentations of cutaneous tuberculosis: challenges in its diagnosis and management
Authors: Shashank Bhargava, Ujjwal Kumar
Journal: British Journal of Dermatology (2024)

Abstract Extrapulmonary tuberculosis (EPTB) is a serious health problem in both developing and developed countries. In India, cutaneous tuberculosis (TB) constitutes about 0.1–2% of all outpatients with skin diseases. We were surprised to see many cases of TB with unusual presentations, which led to a diagnostic dilemma. All suspected cases of cutaneous TB were studied over a period of 5 years (2017–2021). Written consent was obtained from all patients. Thorough dermatological examinations and later skin biopsy, Mantoux test, chest X-ray and other supporting tests were performed to confirm the diagnosis of TB. The treatment outcomes were also analysed. In total 88 patients were confirmed to have cutaneous TB. There were more female patients (58 of 88) than male. Lupus vulgaris (46 of 88) was the most common presentation, followed by TB verrucosa cutis (TBVC). Lupus vulgaris had head and neck involvement in the majority of the cases. Mantoux positivity was observed in 80% of patients (70 of 88), while raised erythrocyte sedimentation rate (ESR) was seen in 89% (78 of 88). A few cases of lupus vulgaris were very confusing and presented similarly to deep fungal infections, hypertrophic lichen planus, mycetoma, subacute lupus and cutaneous lupus erythematosus, to name a few. Other variants of EPTB also had very close differentials and were managed with antitubercular therapy (ATT). Seven patients had serology positive for HIV. Histopathology was conclusive in 93% of cases (82 of 88). All of the variants of cutaneous TB such as lupus vulgaris, scrofuloderma and TBVC responded excellently to ATT. In conclusion, the present study emphasizes the importance of clinicopathological correlation and therapeutic response in cutaneous TB. Although positive results of ESR, Mantoux reactivity and TB cultures facilitate the clinical diagnosis, negative results should not exclude the diagnosis of cutaneous TB. Also, cutaneous TB is a great mimicker in dermatology, especially in a tropical countries like India.
H16 Fake or bake…the history of tanning in the worlds of medicine and fashion
Authors: Sana Ashraf, Alicia Goh, Laura Surgenor, Kevin McKenna
Journal: British Journal of Dermatology (2024)

Abstract Over the years, the perception of health, beauty and status has been associated with skin colour. Influential figures over the ages, from Queen Elizabeth I to Kim Kardashian, have dictated social standards of beauty including the ‘ideal’ skin colour. In parallel, advancements in medicine and science have led to the use of light therapy as a treatment for many medical conditions. The history of tanning and the basis for society’s obsession are important to understand. During the Elizabethan era, Queen Elizabeth I used heavy layers of ‘Venetian ceruse’, a deadly concoction of white lead and vinegar, to achieve the porcelain skin that was desirable at the time. Members of high society followed suit, as tanned skin was associated with outdoor manual labour. During the Industrial Revolution, social perception turned on its head as the rural poor moved to work in mills and factories in the 18th century. Working in sunlight-depleted environments resulted in pallor being associated with low social status. In the 1920s, the French designer and fashion icon Coco Chanel famously returned from the French Riviera with a suntan and announced in Vogue magazine that, ‘the 1929 girl must be tanned…a golden tan is the index of chic’, leading to her accreditation for beginning the fashionable trend of a suntan in modern history and the present day. From ‘Malibu Barbie’ dolls in the 1970s to Kim Kardashian showing off her office sunbed in 2024, the Western beauty ideal of tanned skin is continually perpetuated. Parallel to the beauty world, the novel idea of phototherapy and its successful treatment of lupus vulgaris resulted in Niels Finsen receiving the Nobel Prize for Medicine in 1903. Further development of indoor tanning devices in the 1920s led to their promotion as treatment for diverse conditions from rickets to pneumonia. In the 1970s, the first commercial sunbed was invented by European scientist Friedrich Wolff, culminating in 1977 with the world’s first tanning salon in Berlin. By the 1980s the association of sunbed use and skin cancer was observed. As a result, nonultraviolet tanning methods were popularized, from teabags in the 1950s to the revolutionary discovery of dihydroxyacetone in the 1960s, resulting in ‘fake tan’ as we know it today and allowing for safer methods of attaining the desired glow. Ultimately, tanned skin rose from a hallmark of low socioeconomic status in history, to now reflect the opposite: wealth, health and beauty.