tbuckley/cabot-search huggingface dataset:
P007 Secretory carcinoma arising from axillary accessory breast: a rare presentation
Authors: Chia-Lun Li, Chi-Cheng Huang, Tzu-Hang Kao, Tsung-Hsien Chang
Journal: British Journal of Dermatology (2024)

Abstract A 61-year-old woman presented with a 7-month history of a subcutaneous nodule in her left axilla. On examination, a 1.5 × 1.5-cm mobile rubbery nodule was noted in her left axilla. Biopsy of the lesion revealed neoplastic cuboidal epithel­ial cells in a microcystic and papillary-cystic pattern adjacent to non-neoplastic accessory breast tissue in the deep subcutaneous layer. The cells had monotonous nuclei, eosinophilic cytoplasm and distinct nucleoli. Immunohistochemically, the tumour cells were diffusely positive for S100, CK5/7, GATA3 and pan-TRK, while oestrogen receptor, progesterone receptor and human epidermal growth factor receptor 2 (HER2) stained negative. Further image investigation revealed no evidence of malignancy in the breasts, lymph nodes or salivary glands. A diagnosis of secretory carcinoma (SC) arising from the accessory breast was made based on the clinicopathological correlation. The main differential diagnoses included primary cutaneous SC (PCSC), metastatic breast SC, and metastatic salivary SC. In this case, the presence of accessory breast tissue adjacent to the neoplasm, tumour involvement in the deep dermal–subcutaneous layer, and negative primary tumour in the breast and salivary glands favoured SC of the accessory breast. A wide excision with 1-cm safety margin was performed. The next-generation sequencing analysis confirmed presence of neurotrophic tyrosine receptor kinase 3 (NTRK3) fusion genes. SC of the breast is a very rare subtype of breast carcinoma, accounting for only 0.15% of all breast cancers. Clinically, it manifests as an indolent subcutaneous mass on the breast. Pathologically, SC is characterized by tumour cells exhibiting intracellular and extracellular secretory materials, forming patterns including cribriform, papillary-cystic, lobulated and microcystic. Immunohistochemically, SC expresses S100, basal-like markers (such as CK5/6), epidermal growth factor receptor and pan-TRK, and is usually negative for oestrogen receptor, progesterone receptor and HER2. Studies have shown that these carcinomas develop due to t(12,15) ETV6–NTRK3 gene translocation. Notably, the genetic alteration is not exclusive to a specific origin site, emphasizing the importance of clinicopathological correlation for accurate diagnosis. Furthermore, while most PCSCs are superficially located in the dermis, SC originating from accessory breast is found in the deeper subcutaneous layer, often adjacent to breast tissue. To our knowledge, this is the third report of SC arising from the axillary accessory breast. Our patient highlights the significance of considering SC of the accessory breast as a potential differential diagnosis for indolent axillary masses.
H04 A historical journey of the structure, texture, and identity of afro-textured hair
Authors: Kemi Fabusiwa, Aparna Vyas, Kate Dear
Journal: British Journal of Dermatology (2024)

Abstract ‘Braids of strength, history’s embrace, afro crown, a legacy we trace. Braids hold secrets, whispers of pride, Afro hair, a heritage we can’t hide’ – Anonymous. Understanding the history of afro-textured hair takes us on a journey, illuminating the complex structure of the hair follicle, its unique texture, and the various sociocultural and political implications it has carried throughout the centuries. The journey begins in the ancient African kingdoms and stretches into the contemporary era, exposing the shifting attitudes, practices and perceptions of afro-textured hair. It paves the way for an understanding of maladaptive hairstyling practices that can lead to hair conditions such as traction alopecia, central centrifugal cicatricial alopecia, and trichorrhexis nodosa, and it helps us to create a path for healthier hairstyling practices. The ancient African kingdoms, with their diverse cultures and traditions, held afro-textured hair in high esteem. The structure and texture of afro-textured hair, characterized by its tightly coiled strands and curved follicle, were not mere biological attributes but were integral to identity, status, and societal roles. Bantu knots from the Zulu tribe of South Africa were symbols of femininity and beauty. The braided crown, native to the Mangbetu people of Congo, were symbols of wealth and status, where beauty standards highlighted the elongation of the skull. And the Amasunzu style worn by the Hutu and Tzutzi population of Rwanda were worn in preparation for battle and therefore in preparation for death. Hairstyles were an art form, rich with symbolism, a canvas that depicted the individual’s life journey from birth to death. However, these hairstyles, handed down over centuries and once revered as symbols of status, strength and beauty, became a tool for racial segregation with the advent of slavery in the 1400s. Protective styles like braids were replaced with damaging hair-straightening practices including hot combs, flat irons and relaxing agents, to mimic European hair textures. These practices, often painful and damaging, were introduced in a bid to emulate European hair textures, reflecting the pervasive influence of racial hierarchies on self-perception and aesthetics. In conclusion, understanding the history of afro-textured hair provides a background that enables us to appreciate its natural structure and texture. It also underscores the importance of incorporating historical understanding into dermatological consultations and treatments, thereby ensuring culturally competent care. The history of afro-textured hair is more than a tale of evolving hairstyles; it is a reflection of the broader sociopolitical transformations experienced by ­people of African descent. Recognizing this historical context can change our attitudes, promote healthier hair practices, and encourage acceptance of afro-­textured hair in all its forms.
SG15 A topical matter: iatrogenic adrenal crisis following excessive prescription corticosteroid use
Authors: Divya Khanna, Ajoy Bardhan, Adrian Heagerty, Natasha Harper
Journal: British Journal of Dermatology (2024)

Abstract A 39-year-old man with intermediate junctional epidermolysis bullosa (EB) was admitted with a 2-week history of nausea, vomiting, diarrhoea, weakness, loss of appetite and abdominal pain. He described worsening pain within his chronic wounds, which were widespread, crusted and producing extensive green exudate. On admission, he was hypotensive, tachycardic and pyrexial. Investigations showed anaemia (haemoglobin 86 g L−1), hyponatraemia (132 mmol L−1), hypokalaemia (3.3 mmol L−1), raised lactate (3.29 mmol L−1), raised C-reactive protein (263 mg L−1), and leucocytosis (white cell count 22.2 × 109 L−1, neutrophils 10.5 × 109 L−1, and eosinophils 1.88 × 109 L−1). Despite treatment for sepsis secondary to cutaneous infection, inflammatory markers remained high, and the wounds deteriorated, with continuous production of yellow exudate, increasing pain and new blistering. Additionally, medical interventions failed to resolve persistent abdominal symptoms, haemodynamic compromise and pyrexia. On further review, the dermatology team noted that, unbeknownst to them, the patient had been prescribed 100 g of clobetasol propionate monthly by his general practitioner for at least the last year. Adrenal insufficiency was suspected and subsequently confirmed by a 09.00 h cortisol test (79 nmol L−1). The dermatology team initiated a 100-mg intravenous hydrocortisone bolus, followed by a 6-hourly 50-mg regimen, with consequent resolution of hypotension, tachycardia, pyrexia, hyponatraemia and eosinophilia. Targeted antibiotic therapy (tazobactam and vancomycin), 50 : 50 ointment and wound management improved inflammatory signs. The endocrinology team confirmed secondary adrenal insufficiency and provided a steroid emergency kit and advice on sick day rules at point of discharge. Adrenal crisis in secondary adrenal insufficiency is a life-threatening medical emergency requiring immediate intervention. In this case, adrenal insufficiency was caused by repeated exposure to excessive exogenous topical corticosteroids, and acute wound infection precipitated adrenal crisis. Given the nonspecific presentation, adrenal crisis is frequently overlooked in favour of other more common differential diagnoses. However, eosinophilia, hypotension, unresolving pyrexia and ongoing acute systemic inflammatory response symptoms aid accurate diagnosis. This patient’s hypokalaemia was likely secondary to vomiting, highlighting the importance of clinical context, as hyperkalaemia is more commonly noted during adrenal crisis. Most importantly, this case highlights the importance of clinician-led corticosteroid stewardship and the need for a higher index of suspicion for adrenal insufficiency in patients with a history of significant topical corticosteroid use.
The genetic architecture of biological age in nine human organ systems
Authors: Junhao Wen, Ye Ella Tian, Ioanna Skampardoni, Zhijian Yang, Yuhan Cui, Filippos Anagnostakis, Elizabeth Mamourian, Bingxin Zhao, Arthur W. Toga, Andrew Zalesky, Christos Davatzikos
Journal: Nature Aging (2024)
H14 Francois Henri Hallopeau: pulling out the hair and picking out the spots
Authors: Alphonsus Yip, Nandini Roy, Janakan Natkunarajah
Journal: British Journal of Dermatology (2024)

Abstract Francois Henri Hallopeau was born in Paris in 1842. He entered the Paris medical school aged 24, studying under Alfred Vulpian and Sigismond Jaccoud, eventually ranking second among a large cohort of candidates for medical internships. He received his doctorate aged 29, after submission of his thesis on convulsive symptoms in disorders of the spinal cord. Francois was affiliated with the hospitals of Tenon and St Antoine, before becoming a physician at the Hôpital Saint Louis in 1884, where he remained until he retired in 1907. At the Hôpital Saint Louis, he initially practised as a neurologist, before exclusively focusing his efforts on dermatology. The variety of the patients who he cared for enabled him to report a number of important descriptions on cutaneous diseases, which formed the basis of the first edition of his Practical Treatise on Dermatology. Hallopeau was the first to describe acrodermatitis continua of Hallopeau, a painful acral pustular disease characterized by sterile pustules on erythematous skin of the distal fingers and toes, in 1890. He is also credited as being the first to describe lichens planus atrophique, now known as lichen planus sclerosus et atrophicus sclerosis, in a clinical lecture in 1887. Since then, World Lichens Sclerosis Awareness Day is celebrated on his birthday – 17 January. Hair pulling has been widely described throughout history, first documented by Aristotle (4th century Bc), when he referenced plucking out hair in the context of self-control and vices in Nicomachean Ethics. In 1889, after encountering a young male patient who had torn out tufts of his hair, Hallopeau was the first to coin the term trichotillomania, derived from the Greek thrix (hair), tillein (pulling) and mania (madness). In 1890, he cofounded the French Society of Dermatology and Syphiligraphy, of which he eventually became secretary general in 1893. He also remained an established member of the Academy of Medicine from this point. In 1907, after his retirement from Saint Louis due to the age rule, he continued working as the consulting physician at the Maison Départmentale of Nanterre until 1918, when his sight among other comorbidities led him to fully retire. Francois Henri Hallopeau’s impact in the field of dermatology persists to this day, and he continues to be remembered for his descriptions featured in his collection of over 800 publications.
P013 Eruptive seborrhoeic keratoses in late-onset constitutional mismatch repair deficiency
Authors: William Fostier, Georgie Holt, Akhtar Husain, James Tellez, Katharina Wimmer, Richard Martin, John Burn, Richard Gallon, Neil Rajan
Journal: British Journal of Dermatology (2024)

Abstract Constitutional mismatch repair deficiency (CMMRD) is a rare autosomal recessive condition typically diagnosed in childhood. It is caused by biallelic inheritance of pathogenic variants within the MLH1, MSH2, MSH6 and PMS2 genes (DNA mismatch repair pathway). It confers a high risk of cancer, with many patients developing brain, gastrointestinal or haematological malignancy in the first two decades of life. The cutaneous features of CMMRD share similarities with neurofibromatosis, with café au lait macules, Lisch nodules, neurofibromas and axillary/inguinal freckling reported. Herein, we report a case of a 31-year-old woman with colorectal polyposis and multiple primary cancers presenting with an eruption of seborrhoeic keratoses (SKs), consistent with the paraneoplastic sign of Leser–Trélat (LTS). Aged 23 years, the proband underwent a prophylactic subtotal colectomy for multiple adenomatous large-bowel polyps. During colectomy, analysis of an enlarged mesenteric lymph node revealed a synchronous diffuse large B-cell lymphoma. This was treated with excision and chemotherapy. When she was aged 24 years, an ampulla of Vater adenoma was excised. Aged 29 years, she developed triple-negative invasive ductal carcinoma of the breast, treated with surgery and chemotherapy. The proband also developed basal cell carcinoma on her forehead and the tarsal edge of her right eye at ages 28 and 31 years, respectively. Her family history revealed that her father died at age 33 years of colorectal cancer, while her mother died at age 60 years due to cerebral haemorrhage. Concurrently to the proband’s breast cancer diagnosis, cutaneous examination revealed widespread small skin-coloured and brown plaques, which were confirmed on biopsy to be SKs in a predominantly acral distribution, with sparing of the trunk. Immunohistochemical assessment of the SKs demonstrated loss of expression of PMS2, with loss of expression also seen in normal perilesional skin. Microsatellite instability (MSI) analysis of peripheral leucocyte DNA revealed high levels of constitutional MSI, indicative of CMMRD. Germline genetic testing revealed compound heterozygous pathogenic variants in PMS2, confirming the diagnosis. LTS is characterized by an eruption of SKs in association with concurrent development of cancers arising from the breast, lung and gastrointestinal tract. A putative mechanism is that tumour-secreted factors, such as epidermal growth factor, drive SK growth. The responsible tumour may be difficult to determine in patients with multiple primary cancers; however, temporally, the breast cancer in our patient was most closely linked to her presentation of LTS. This case emphasizes the importance of recognizing the sign of LTS, a novel feature in the context of CMMRD.
PS06 Mindfulness-based stress reduction alleviates flushing and negative emotions in rosacea: an exploratory study
Authors: Deyu Song, Xian Jiang
Journal: British Journal of Dermatology (2024)

Abstract Rosacea is commonly associated with a significant psychosocial burden. Mindfulness-based stress reduction (MBSR) has shown promising prospects in inflammatory skin diseases, including psoriasis and atopic dermatitis (Kishimoto S, Watanabe N, Yamamoto Y et al. Efficacy of integrated online mindfulness and self-compassion training for adults with atopic dermatitis: a randomized clinical trial. JAMA Dermatol 2023; 159: 628; Muftin Z, Gilbert P, Thompson AR. A randomized controlled feasibility trial of online compassion-focused self-help for psoriasis. Br J Dermatol 2022; 186: 955–62). To evaluate the efficacy of MBSR on clinical symptoms and negative emotions in rosacea, we conducted an exploratory, open-label trial and qualitative research. In this study, 14 patients with rosacea participated in an 8-week online MBSR programme in small groups. The Global Flushing Severity Score (GFSS), erythema visual analogue scale, Dermatology Life Quality Index, Self-Rating Depression Scale (SDS), Self-Rating Anxiety Scale (SAS) and Stigma Scale were applied to evaluate the clinical symptoms and emotional wellbeing. Statistical analysis was performed with the t-test and Wilcoxon signed-rank test. At week 9, in-depth semistructured interviews were conducted with eight enrolled patients to gain insight into their subjective experiences and perceptions. Thematic analysis was applied to analyse the interview data. Statistically significant reduction in the score of GFSS was observed after 8 weeks of mindfulness training, with a median decrease of −2.0 points (interquartile range −2.0 to 0.0; P = 0.02). Additionally, there were also significant reductions in the SDS, SAS and Stigma Scale scores. Qualitative analysis showed that patients were more likely to develop positive emotions, and recognized that avoiding confrontation with the disease can alleviate negative emotions (Table). Our study is the first to evaluate the efficacy of MBSR on rosacea and to delve into the subjective experiences of patients regarding MBSR. This suggests significant therapeutic potential. Larger randomized controlled studies are needed to clarify the efficacy of MBSR in rosacea.ThemesVerbatim transcript extractsBetter emotional regulation‘I feel extremely anxious when flushing comes; mindfulness helps me calm down and alleviate the anxiety’ (MG02)Self-acceptance‘I feel much more relaxed now. I no longer focus on my facial redness or worry about how others perceive me’ (MG11)‘I used to think that having rosacea made me a loser in life. I thought everyone else was beautiful except for me’ (MG12)More exercise is needed‘This process is like stepping into a mental fitness studio, where each practice session helps me observe my inner self’ (MG05)
H13 One scar too far: the perception of scarring through time
Authors: Alison Long, Amy Long
Journal: British Journal of Dermatology (2024)

Abstract The English word, ‘scar,’ has roots in several languages: Latin (eschara), Old French (escharre), Greek (έσχάρα or eskhara), Middle English (skar) and Old Norse (skarð). Ancient civilizations such as the Romans, Greeks and Egyptians viewed scars in a sacred light, as scars were often linked to ritualistic practices. The Ancient Egyptians even employed scarring as a mark of authentication, to be displayed and observed. In Ancient Rome, the symbology of scarring was a practical element in ratifying democratic office after the fall of the Tarquin kings; scars demonstrated that these politicians were not godly as kings wished to be. If scars were to be treated in ancient times it was for symptomatic relief of pain or itching, rather than for aesthetic reasons. In more recent times, society has grown less accepting of facial imperfections and scarring. One example we often see is how scarring is portrayed on screen, highlighting the dichotomy between good and evil. There is a statistically higher preponderance for scarring in antagonistic characters vs. protagonists. Some movies go as far as to name the villain after their imperfections, such as Scar in The Lion King, and Al Pacino’s Scarface. When the ‘good guys’ are shown to have scarring it typically highlights their virtuousness, and can underpin an image of bravery, such as Harry Potter’s famous forehead scar. Recently, films have been criticized by their use of facial scarring on villains. In the James Bond film No Time To Die, the villain played by Rami Malek once again displays facial disfigurement. This was met with backlash for the villain cliché, resulting in the British Film Institute no longer funding films with facially scarred villains from 2018. Scars are often used as a shorthand for villainy, repeatedly exaggerated to depict a character flaw or convey an element of disquiet. Perpetuating these negative ideas will serve to bolster unsavoury views, foster prejudices and deepen the psychological impact that scarring can have. We now have various treatments that can be utilized to improve the appearance of scars, including medicated dressings, corticosteroid injection, laser therapy and surgery. However, scarring cannot be cured and so we must endeavour to promote a more accepting landscape for patients struggling with distressing scars.
H08 Post vacancy: Dublin’s first dermatologist
Authors: Claudine Howard-James
Journal: British Journal of Dermatology (2024)

Abstract William Wallace (1791–1837), later known internationally as ‘Wallace of Dublin’, was Dublin’s first dermatologist. Born in County Down, he studied at the Royal College of Surgeons in Ireland (RCSI) from 1810 to 1813. During his time at RCSI, he was apprenticed to Charles Hawkes Todd, lecturer and surgeon in the Richmond and Lock Hospitals, both institutions experiencing high volumes of venereal and skin disease. Following receipt of his licence from RCSI in June 1813, Wallace travelled to London. Here he studied under established dermatologist Thomas Bateman (himself a pupil of Robert Willan), surgeon John Pearson, and expert venereal disease physician Joseph Adams, among others. Gaining significant experience in cutaneous and venereal disease during this time, he returned to Dublin in 1817 with the intention of utilizing this knowledge to establish a hospital. In his own words, the hospital’s mission was to ‘at once afford relief to the poor; supply the means of extending our knowledge of cutaneous diseases, by accurate clinical investigation and extensive observation; and establish a school for the instruction of medical students’. The following year, he personally founded and funded the Dublin Infirmary for Diseases of the Skin at 20 Moore Street, the first hospital in Europe or the British Empire exclusively devoted to skin disease. By 1837, an estimated 25 000 cases had been treated in the Dublin Skin Infirmary. Wallace made two internationally recognized contributions to medicine: introducing potassium iodide to the materia medica for treatment of syphilitic lesions and demonstrating the infectivity of secondary syphilis. The latter he proved unethically by the inoculation of ‘secretions from exanthematic sores’ into healthy individuals, demonstrating its transmissibility and incubation period. His publications include Observations on Sulphurious Fumigations as a Remedy in Rheumatism and Diseases of the Skin (1820) and A Treatise on the Venereal Disease and its Varieties (1833). During this time he was also appointed surgeon at Jervis Street Hospital, where he does not appear to have been an easy colleague; there were public rows with fellow surgeon James O’Beirne, complaints about the hospital’s cleanliness, and an increase in skin-related admissions while Wallace was on service, with a colleague commenting ‘certainly not one case of diseases of the skin was fit for an hospital’. While his ethics and behaviour as a colleague are at times questionable, his contribution to modern dermatology is undeniable. His sudden and untimely death in 1837 from typhus brought an end to the Dublin Skin Infirmary as his post lay vacant, owing to his habit of independence.