tbuckley/cabot-search huggingface dataset:
P112 The British Hair and Nail Society present a review of our national grand round of challenging nail conditions and the benefits to the wider British Association of Dermatologists membership
Authors: Sonia Sharma, Athina Fonia, Megan Mowbray, Anita Takwale, Leila Asfour, Dhruvkumar Laheru
Journal: British Journal of Dermatology (2024)

Abstract The British Hair and Nail Society (BHNS) was formed in 2011. We currently have 133 members and invite them to submit challenging cases of nail disorders to our grand round (with relevant history, histopathology and photo- graphs) for review by our expert nail panel. This comprises consultants with nail expertise from around the UK, and together we aim to address the referrers’ queries relating to diagnosis, treatment or both. We appreciate the com- plexity of nail conditions and the limited number of special- ists around the country with an interest in nail conditions. Therefore, we have recently offered the opportunity for all British Association of Dermatologists (BAD) members to submit cases once a year. The aim of our review is to pres- ent the type of complex nail conditions and queries that have been referred to our dedicated national nail conditions grand round and to showcase some of the most educational cases. The nail conditions grand round began in 2018, and since then a total of 21 nail cases (three children and 18 adults) have been submitted from various regions. The main aims of referral included diagnostic expertise (n = 7), aid with treatment plans (n = 3) or both (n = 9). Two cases were referred for help with the need for diagnostic nail biopsy. The median age of patients was 45 years (range 12−77). The cases involved 14 female and 7 male patients. The regions of referral include Gloucestershire, Reading, Cambridge and Scotland. The diagnosis was altered in nine cases (43%). The most common nail condition was psoriasis with nail involvement (n = 4), with the possibility of concurrent condi- tions such as chronic paronychia and subungual keratosis. In one of these cases where the extent of psoriatic nail disease was causing huge psychological burden for the patient, but their Psoriasis Area and Severity Index score was &amp;lt; 10, we supported the application of an individual funding request for biologic therapy. Examples of some of our rare diagnoses include nailbed seborrhoeic keratosis presenting as leucox- anthonychia, and a nailbed myxoid cyst following osteoar- thritic degeneration in distal interphalangeal joints. We hope our presentation showcases to the wider BAD membership the value of our national nail conditions grand round in supporting complex diagnostic and therapeutic decisions, as well as offering support for clinicians in the form of independent funding request submissions or trialling novel therapies, which may have limited evidence. We welcome any future submissions.
DS11 Buffering of lidocaine, time for a British Society for Dermatological Surgery position statement?
Authors: Uyen Nguyen, Katrina Habaluyas, Thomas Oliphant
Journal: British Journal of Dermatology (2024)

Abstract Patients often experience pain or discomfort during local anaesthetic administration in Mohs surgery. Buffering local anaesthetics with sodium bicarbonate has been proven as a potential means to mitigate this pain in various research. However, despite the evidence, there are no standardized guidelines in the UK outlining the application of sodium bicarbonate buffering, which results in its limited application in practice and potential to improve patient comfort and quality of healthcare. This study investigates the usage of sodium bicarbonate-buffered Xylocaine solution in Mohs micrographic surgery as a simple, effective technique to reduce discomfort associated with the injection of local anaesthetic at a tertiary centre in the UK. Sodium bicarbonate (2 mL of 8.4% w/v) was mixed with 20 mL of Xylocaine 1% (lidocaine 1% with adrenaline 1 : 200 000) in a ratio of 1 : 10 to create a buffered solution. This buffered mixture was used for anaesthesia during Mohs surgery procedures on the head and neck. Pain assessment was conducted using a numerical rating scale ranging from 0 to 10, with 10 representing the worst pain. Pain scores were collected for each lesion injected in all patients receiving unbuffered Xylocaine and buffered Xylocaine. Unpaired t-tests were used for statistical analysis to compare the average pain score per lesion in both groups. The study included 62 patients, 28 receiving unbuffered Xylocaine and 34 receiving buffered Xylocaine. In total, 37 lesions were injected with buffered Xylocaine, and 47 lesions were injected with unbuffered Xylocaine. The average pain score for each lesion in the buffered Xylocaine group was lower than for the unbuffered Xylocaine group: 0.94 and 1.76, respectively (P = 0.03). For patients receiving injections to the nose (n = 16), 11 received buffered Xylocaine for 12 nose lesions, and five received unbuffered Xylocaine group for six nose lesions. The average pain score per nose lesion in the buffered Xylocaine group (0.75) was notably lower than that in the plain Xylocaine group (3.8) (P = 0.002). Additionally, 17 patients were surveyed regarding their previous experiences with unbuffered Xylocaine injections at the same anatomical location. Out of these, 16 patients reported that buffered Xylocaine injections were less painful, while only one patient perceived no difference in pain. No adverse effects related to sodium bicarbonate were reported. The study demonstrates that buffering Xylocaine 1% with sodium bicarbonate 8.4% is a simple and effective technique to reduce discomfort associated with the injection of local anaesthetic among patients undergoing Mohs micrographic surgery, potentially improving overall patient satisfaction. This highlights the need for comprehensive guidelines to guide its integration into practice with the goal of optimizing patient care.
PD09 Delving deeper into sunburn
Authors: Evangelos A A Christou, Alastair Kerr, Alan Lehmann, Robert Sarkany, Hiva Fassihi, Sally H Ibbotson
Journal: British Journal of Dermatology (2024)

Abstract A 25-year-old woman was referred to a tertiary photodiagnostic service following ‘severe sunburn’ after minutes of sun exposure on an overcast day. She described a prickling sensation on exposed forearms and later developed erythema, vesicles and large unilocular blisters, requiring attendance at accident and emergency and a burns unit. The episode resolved over weeks with exfoliation, but no scarring. With hindsight, she reported five other severe episodes since the age of 7 years, requiring accident and emergency visits and bandaging, so had avidly avoided the sun. She was medically well, on no medications, with no personal or family history of skin cancer. Skin examination was normal, with no skin dyspigmentation or lentigines. Monochromator phototesting showed mild delayed ultraviolet (UV)B and UVA2 sensitivity, with enhanced responses at 48 h. UVB TL-01 minimal erythemal dose, broadband UVA provocation testing, sunscreen photopatch testing, connective tissue disease screen, human leucocyte antigen typing, plasma and red cell porphyrins were normal or negative, and vitamin D levels were markedly deficient. Biopsy of an abnormal phototesting site revealed apoptotic keratinocytes, lymphocytic infiltrate and dermal oedema. Due to the severity of the ‘sunburn’ episodes, functional DNA repair studies were performed and could not rule out xeroderma pigmentosum (XP), although they excluded XP-variant. Genotyping showed homozygosity of an ERCC4 pathogenic variant [NM_005236.2(ERCC4): c.1135C&amp;gt;T (p.Pro379Ser)], consistent with XP complementation group F (XP-F). XP-F is a rare form of XP and is significantly underdiagnosed due to its often milder clinical manifestations. Our case is the fourth case of XP-F that is reported in the UK, and shares similar characteristics with the other three published cases (Fassihi H, Sethi M, Fawcett H et al. Deep phenotyping of 89 xeroderma pigmentosum patients reveals unexpected heterogeneity dependent on the precise molecular defect. Proc Natl Acad Sci U S A 2016; 113: E1236–45). Notably, the identified pathogenic variant has an allele frequency of 0.3%, suggesting that around 10 individuals per million could be homozygous for this variant, equivalent to roughly 600 cases of XP-F currently in the UK. This case raises the importance of not underestimating ‘sunburn’ – attending accident and emergency with severe episodes following relatively minor sun exposure should be a red flag, requiring consideration of DNA repair diseases, even in the absence of any other features of XP. Moreover, it underscores the need to refer patients with abnormal photosensitivity to a specialist photodiagnostic service for comprehensive assessment and, where required, to the national XP service. It is likely that there is a significant number of ‘easy sunburners’, who are not currently recognized as having XP-F due to underdiagnosis, so we wish to raise awareness of this important condition.
P106 Clinical outcomes and quality of life in a cross-sectional study of patients with moderate-to-severe psoriasis treated with bimekizumab in routine clinical practice
Authors: Gemma Wicker, Amanda Tredwell, Joanne Topliffe, Maureen Smith, Jason Vistenia
Journal: British Journal of Dermatology (2024)

Abstract Psoriasis is a chronic, systemic, immune-mediated disease that is associated with severe comorbidities including depression, psoriatic arthritis and cardiovascular disease. As a result, psoriasis impacts on patient wellbeing and quality of life. Biologic therapies are highly effective for psoriasis; however, 11–35% of patients do not respond to their first treatment within the first year. Bimekizumab is a humanized monoclonal antibody that neutralizes the activity of the proinflammatory cytokines interleukin-17A and interleukin-17F, which are pivotal in developing psoriasis. This study assessed changes in disease severity and health-related quality of life in patients with psoriasis who were treated with bimekizumab in routine clinical practice. This cross-sectional study included adult patients with psoriasis who were attending routine clinical practice visits at five hospitals in the UK. Patients may have received prior therapy for psoriasis, and all were subsequently treated with bimekizumab. In total, 66 patients were included in the study; 35 (53%) were women, the mean age was 47.1 years (SD 15.5), the mean duration of disease was 19.6 years (SD 9.9) and the mean body mass index was 31.2 kg m−2 (SD 6.4). At baseline, the majority of patients (38 of 62, 61%) had extensive or widespread psoriasis, and 23 of 58 (40%) had psoriatic arthritis. Seven patients (11%) were treatment naive to biologic therapy, 55 of 65 (85%) had not responded to previous biologic therapy, and 43 of 65 (66%) had received adalimumab. After initiation of bimekizumab, there was a substantial improvement in disease severity at week 16. The mean Psoriasis Area and Severity Index (PASI) at baseline was 17.1, and no patients had a score of 0; the mean PASI at week 16 was 1.7, and 20 of 52 patients (38%) had a score of 0. This improvement in PASI was accompanied by an improvement in quality of life (Table). Qualitative data reported by patients indicated that treatment with bimekizumab improved their daily lives and decreased psychological stresses. In this study, bimekizumab reduced the severity of psoriasis and improved patients’ quality of life and overall wellbeing. These results indicate that bimekizumab should be considered for the treatment of patients with severe psoriasis where rapid and significant clearance of psoriasis is clinically appropriate, including treatment-naive patients and those resistant to previous biologic therapy. Medical writing support was funded by UCB; the study was conducted independently of the sponsor.ParameterPatientsBaselineWeek 16PASI scoreaMean (SD)17.1 (7.3)1.7 (4.1)Median (range)14.8 (4–43)0.5 (0–27)DLQI scorebMean (SD)20.2 (6.1)3.6 (5.4)Median (range)20.0 (10–33)1.0 (0–25)Psoriasis Area and Severity Index: baseline, n = 65; week 16, n = 52. Dermatology Life Quality Index: baseline, n = 64; week 16, n = 51.
CD13 Effect of ciclosporin on serum inflammatory cytokines in patients with allergic contact dermatitis due to the weed <i>Parthenium:</i> a preliminary study
Authors: Kaushal Verma, Braj Mohan, Alpana Sharma
Journal: British Journal of Dermatology (2024)

Abstract Allergic contact dermatitis due to the weed Parthenium is common in India, resulting in high morbidity and significant impact on quality of life in these patients. The allergic response is primarily mediated by a T helper 1 response, and various inflammatory cytokines have been implicated in the pathogenesis of the disease, as well as disease activity. We evaluated the effect of ciclosporin on inflammatory cytokines and disease activity in patients with Parthenium dermatitis. Adult patients with a clinical diagnosis of Parthenium dermatitis, confirmed on patch test, were included in the study. The severity of the disease was determined in each patient using Clinical Severity Score (CSS) and serum proinflammatory [tumour necrosis factor (TNF)-α, interleukin (IL)-17 and IL-6] and anti-inflammatory cytokines [IL-10, transforming growth factor (TGF)-β]. The patients were treated with ciclosporin 2.5 mg kg−1 per day for 12 weeks or until complete remission of the disease. The cytokine levels and disease severity were reassessed following treatment. The study had 35 patients (28 male and 7 female; age range 32–80 years, mean 56.0, SD 11.1), with a disease duration of 1–30 years (mean 10.7, SD 7.8). The pretreatment CSS of these patients ranged from 12.8 to 78.3 (mean 41.7, SD 16.3). The proinflammatory cytokines (TNF-α, IL-6 and IL-17) showed a decreasing trend following ciclosporin treatment. The levels of TNF-α decreased from a mean (SD) 4.0 (9.4) pg mL−1 to 1.4 (1.8) pg mL−1 (P = 0.05); IL-6 from 47.2 (34.7) pg mL−1 to 26.1 (17.6) pg mL−1 (P = 0.005) and IL-17 from 154 (163) pg mL−1 to 75.6 (73.2) pg mL−1 (P = 0.10), with statistically significant changes for TNF-α and IL-6 but not for IL-17. Serum levels of the anti-inflammatory cytokine IL-10 increased from 4.20 (1.20) pg mL−1 to 3.40 (1.10) pg mL−1 (P = 0.05), which was also statistically significant, but serum TGF-β values remained largely unchanged, going from 0.40 (0.27) pg mL−1 to 0.30 (0.23) pg mL−1 (P = 0.08). The mean CSS decreased from 41.7 (16.3) to 1.5 (5.2) (P &amp;lt; 0.001) following treatment. The changes in inflammatory cytokine levels seem to correspond with change in CSS and clinical disease activity. Therefore, this study has shown that the proinflammatory cytokines TNF-α, IL-17 and IL-6 decreased significantly, while the anti-inflammatory cytokine IL-10 increased following ciclosporin therapy in patients with Parthenium dermatitis, with a significant decrease in CSS and excellent control in disease activity.
Oropouche fever cases diagnosed in Italy in two epidemiologically non-related travellers from Cuba, late May to early June 2024
Authors: Concetta Castilletti, Antonio Mori, Andrea Matucci, Niccolò Ronzoni, Lukas Van Duffel, Giada Rossini, Pietro Sponga, Maria Luca D’Errico, Paola Rodari, Francesco Cristini, Ralph Huits, Federico Giovanni Gobbi
Journal: Eurosurveillance (2024)

Oropouche fever is caused by Oropouche virus (OROV), transmitted primarily through the bite of infected midges, particularly of the genus
British Hair and Nail SocietyOral presentationsBH01 (P087) The British Hair and Nail Society present a review of our national grand round of challenging hair disorders and the benefits to the wider British Association of Dermatologists membership
Authors: Sonia Sharma, Alyson Bryden, Nicola Clayton, Paul Farrant, Megan Mowbray, Susan Holmes, Anastasia Therianou, Yusur Al-Nuaimi, Nekma Meah, Leila Asfour, Anita Takwale
Journal: British Journal of Dermatology (2024)

Abstract The British Hair and Nail Society was formed in 2011. We currently have 133 members and invite them to submit challenging cases of hair disorders to our grand round (with relevant history, histopathology and photographs) for review by our expert hair panel. This comprises consultants with hair expertise from around the UK, and together we aim to address the referrers’ queries relating to diagnosis, treatment or both. We appreciate the complexity of hair disorders and the limited number of specialist hair clinics around the country, and therefore we have recently offered the opportunity for all British Association of Dermatologists (BAD) members to submit cases once a year. The aim of our review is to present the types of complex hair disorders that have been referred to our dedicated national hair-­related grand round and showcase some of the most educational cases. The hair disorders grand round began in 2018 and since then a total of 26 hair cases (10 children and 16 adults) have been submitted from various regions. The main aims of referral include diagnostic expertise (n = 4), aid with treatment plans (n = 8) or both (n = 14). The median age of patients was 33 years (range 4–75). There were 14 female and 12 male cases. The regions of referral include Oxford, Brighton, Manchester and Scotland. There were equal numbers of scarring alopecia (n = 13) and nonscarring (n = 13) cases. The most common nonscarring hair condition was alopecia areata (n = 6), with the possibility of other concurrent hair conditions (n = 1) or an underlying genetic disorder (n = 3). The most common diagnosis of scarring alopecia was folliculitis decalvans (n = 6). The diagnosis was altered in 10 cases (38%). Examples of some of our rare diagnoses include keratosis follicularis spinulosa decalvans, genetic hypotrichosis and scalp dermatomyositis. We reviewed cases of recalcitrant disease such as folliculitis decalvans, and novel therapeutics were suggested such as the use of naltrexone, utilizing photodynamic therapy after removing crusts, and even the use of manuka honey and cannabinoid oil. Our grand round has recommended independent funding requests in three cases and supports applications from clinicians for their patients with complex conditions. We hope our presentation showcases to the wider BAD members the value of our national hair disorders grand round in supporting complex diagnostic and therapeutic decisions, as well as offering support for clinicians in the form of individual funding request submissions or trialling novel therapies, which may have limited evidence. We welcome any future submissions.
P091 Surgical management of hidradenitis suppurativa: a 12-month review from a tertiary referral centre on the long-term outcomes of surgical intervention for groin, gluteal, perianal and genital disease
Authors: Sam Hughes, Linda Ferrari, Ellie Rashid, Mia Steyn
Journal: British Journal of Dermatology (2024)

Abstract Despite numerous pharmacological advances in the management of hidradenitis suppurativa (HS), achieving adequate disease control remains challenging. This has led to an increased need for surgical intervention. Representing a tertiary referral centre, run in conjunction with a dedicated colorectal surgery team, we aim to highlight our experience of running a multidisciplinary service and the long-term outcomes achieved with surgical management, in conjunction with traditional medical management. Between October 2022 and October 2023, 28 patients underwent surgical debridement for groin, gluteal, perianal or genital disease. A retrospective cross-sectional analysis was then conducted, comparing their Hidradenitis Suppurativa Physician Global Assessment (HSPGA) scores both pre- and postoperatively. We evaluated the role of patient factors such as body mass index (BMI), smoking status, age at disease onset, number of sites involved and associated inflammatory bowel disease (IBD). Moreover, we assessed whether cotherapy with adalimumab, acitretin or dapsone affected the overall outcome. Within the evaluated 12-month timeframe, 28 patients underwent surgical debridement of groin, gluteal, perianal or genital disease. Most were men (68%), most currently or formerly smoked (75%), the mean BMI was 28.5 kg m−2 and an average of 3 individual body sites were affected. Six patients had associated IBD. At the time of surgery, all patients had an HSPGA score of 3 or above, with 86% having Hurley stage 3 disease. In regard to concomitant medical therapies, 13 were taking adalimumab and seven were taking acitretin. Notably, none of our patients had been prescribed long-term antibiotics. Operatively, all patients underwent debridement of complex fistula (two with the addition of a seton suture). In all cases, wounds healed by secondary intention and no skin grafts were performed. At the 4-month postoperative review, 59% of patients had a reduction in their HSPGA severity score (35% by 1 point and 24% by 2 points). There were no hospital readmissions, no documented postoperative complications and no evidence of disease recurrence. Our collaborative approach with colorectal surgery resulted in a significant reduction in disease severity, emphasizing the impactful role of surgical intervention alongside traditional medical management. This underscores the efficacy of our multidisciplinary service in achieving long-term positive outcomes for patients with complex disease.