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Summary: Background: Allergic contact dermatitis (ACD) to cosmetics is widely reported. To ensure we are accurately diagnosing ACD, patch test series should be continually reviewed to identify relevant and emerging allergens and highlight those that are outdated. The current British Society for Cutaneous Allergy (BSCA) facial series recommends 26 allergens and was last modified in 2012. Objectives: To review and update the BSCA facial series. Methods: We retrospectively reviewed the results from 12 UK and Ireland patch test centres' facial series from January 2016 to December 2017. We recorded the number of allergens tested in each centre and the detection rate for each allergen. Using a 0·3% positive rate as the inclusion threshold, we established which allergens in the BSCA facial series had positive patch test rates < 0·3% and > 0·3%. Allergens not in the BSCA facial series that had a positive patch test rate > 0·3% were identified. Results: Overall, 4224 patients were patch tested to the facial series. The number of allergens included in individual centres' facial series ranged from 24 to 66, with a total of 103 allergens tested across all centres. Twelve of the 26 allergens in the BSCA facial series had a positive patch test rate < 0·3% and 14 had a rate > 0·3%. Twenty‐five allergens not recommended in the BSCA facial series had a positive patch test rate > 0·3%. Conclusions: This audit has highlighted the significant variation in practice that exists among patch test centres, despite a recommended facial series. The BSCA facial series has been updated and now contains 24 allergens. Fifteen allergens remain, 11 allergens have been dropped and nine new allergens have been added. What is already known about this topic? Facial dermatitis is one of the dominant presenting complaints of allergic contact dermatitis to cosmetics.To ensure we are accurately diagnosing contact allergy, it is important that we patch test with relevant allergens.Reviewing current literature and auditing patch test practice is a vital requirement to ensure we identify relevant and emerging allergens and highlight those that are outdated. What does this study add? Despite recommended patch test series, there is significant variation in practice among different patch test centres.In response to this multicentre audit, the British Society for Cutaneous Allergy facial series has been updated and now contains 24 allergens: 15 allergens remain, 11 allergens have been dropped and nine new allergens have been added. Linked Comment:Boonchai. Br J Dermatol 2021; 184:13. Plain language summary available online [ABSTRACT FROM AUTHOR]

Since March 2020, the UK and Ireland have entered a series of lockdowns in the wake of the coronavirus pandemic with restrictions resulting in the closure of nonessential retail, hospitality and sports with employees encouraged to work from home. In this retrospective study we have demonstrated a significant decrease in DLQI values, increase in the number of 'not relevant' responses (NRRs) in the DLQI and change between DLQI and the modified DLQI‐R during the pandemic. Given the restrictions imposed on our patients, it is important for clinicians to identify the number of NRRs in the DLQI and acknowledge the potential effect on treatment decisions and data collection for disease registries and clinical trials during the pandemic. [ABSTRACT FROM AUTHOR]

Summary: Background: Efficacy data on therapies for patients with psoriasis who have failed tumour necrosis factor (TNF)‐α inhibitor therapy is limited. Objectives: To determine the effectiveness and tolerability of secukinumab, an interleukin (IL)‐17A inhibitor, in patients with moderate/severe chronic plaque psoriasis with documented efficacy failure of TNF‐α inhibitor therapy (SIGNATURE study). Methods: This was a randomized, open‐label, noncomparator study in 53 dermatology centres in the U.K. and Republic of Ireland. Patients were randomized 1 : 1 to receive secukinumab 300 mg or 150 mg subcutaneously every week for 4 weeks, then 4‐weekly thereafter. Patients were stratified by their prior efficacy failure with TNF‐α inhibitors. Only patients who started and stayed on the same dose at each time point were included for efficacy assessments. Results: In total, 233 patients were analysed. The primary end point was met, with a statistically significant improvement in response rates [75% reduction in Psoriasis Area and Severity Index (PASI 75)] from baseline to week 16 in both secukinumab 300 mg and 150 mg dose groups [77 of 118 patients (65·3%) and 51 of 115 patients (44·3%), respectively; P < 0·0001]. After 72 weeks, in patients starting and remaining on 300 mg, 77% (54 of 70) achieved PASI 75. Improvements in Dermatology Life Quality Index from baseline to week 16 occurred and were maintained up to 72 weeks. The safety profile was generally consistent with previous secukinumab studies, although a higher incidence of some adverse events (e.g. candida infections) was observed. Conclusions: This study provides evidence of efficacy and safety of secukinumab for treatment of patients with psoriasis who failed prior TNF‐α inhibitor therapy. This study represents a 'real‐world' population, providing reassurance that secukinumab is a treatment option in this difficult‐to‐treat population. What's already known about this topic? Conventional systemic nonbiological and tumour necrosis factor (TNF)‐α inhibitor therapies for plaque psoriasis have not fully met patients' needs.There is a lack of data to support the treatment pathways for patients with psoriasis who have inadequate responses to TNF‐α inhibitor therapy.Secukinumab, a recombinant high‐affinity fully human monoclonal anti‐human interleukin‐17A antibody of the IgG1/κ‐class, has shown excellent safety and efficacy in the treatment of moderate‐to‐severe psoriasis. What does this study add? This is the first study evaluating treatment with biologics after prior efficacy failure of TNF‐α inhibitor therapy as defined by the U.K. National Institute for Health and Care Excellence criteria.Secukinumab is an effective treatment in this difficult‐to‐treat patient population.This study provides important practical information for clinicians managing psoriasis.Adverse events were consistent with the phase III programme for secukinumab, although some adverse events, e.g. candida, were increased. Linked Comment: Tsai. Br J Dermatol 2020; 183:7–8. Plain language summary available online [ABSTRACT FROM AUTHOR]

We carried out a study looking at the use of biosimilars in the UK and Ireland using data from the British Association of Dermatologists Biologic and Immunomodulators Register (BADBIR), a large multicentre register of patients with severe psoriasis based in the UK and Ireland. Psoriasis is a chronic skin disease that affects 1.5% of the UK population, causing itchy and scaly skin patches. Tumour necrosis factor-alpha inhibitors (TNFi) are effective but previously costly injectable treatments for moderate-to-severe psoriasis. [Extracted from the article]

Https://doi.org/10.1093/bjd/ljac015 Dear Editor, The ichthyoses are rare disorders characterized by thick, scaly skin. Google Scholar Crossref Search ADS PubMed WorldCat 7 Vahlquist A. Pleomorphic ichthyosis: proposed name for a heterogeneous group of congenital ichthyoses with phenotypic shifting and mild residual scaling. The other five had non-ARCI ichthyoses confirmed on molecular testing: Netherton syndrome, trichothiodystrophy, loricrin ichthyosis and epidermolytic ichthyosis (two cases). [Extracted from the article]

Dear Editor, During the COVID-19 pandemic, with the greater need for donning personal protective equipment (PPE) and frequent handwashing, we have noted increasing reports in the UK and abroad of high rates of irritant dermatitis in frontline healthcare workers (HCWs). Workers with a previous history of acne or rosacea appeared especially prone to an exacerbation: 36 of 65 (55%) with previous facial skin problems had acne or rosacea vs. 20 of 100 (20%) with no such history [ SP 2 sp (1 + 1 degree of freedom, 234) = 21-9994; I P i < 0-001]. Predominantly patient-facing roles and past history of atopic eczema or acne are prevalent in HCWs requesting dermatology assessment, respirator wear is associated with facial pressure injury, and all mask wear may exacerbate or precipitate acne. [Extracted from the article]

Concomitant positive reactions between DG and LG were found in 37% of patients. Dear Editor, Alkyl glucosides (AG), of which decyl glucoside (DG) and lauryl glucoside (LG) are those most commonly implicated in causing allergic contact dermatitis (ACD), are surfactants that are increasingly used in a wide range of products, including cosmetics, sunscreens and foam wound dressings.1 DG is also a stabilizer in the ultraviolet light filter methylene bis-benzotriazolyl tetramethylbutylphenol (Tinosorb SP ® sp M) and is occasionally an undeclared constituent.2 The British Society of Cutaneous Allergy (BSCA) performed a retrospective multicentre audit, reviewing January-September 2019 data from clinical databases of 13 dermatology units in the UK and Ireland. Forty-one patients (1-5%) tested positive to at least one glucoside and 15 (37%) had concomitant positive reactions to both DG and LG. [Extracted from the article]

Summary: Background: Patients with psoriasis are often concerned about the risk of serious infection associated with systemic psoriasis treatments. Objectives: To develop and externally validate a prediction model for serious infection in patients with psoriasis within 1 year of starting systemic therapies. Methods: The risk prediction model was developed using the British Association of Dermatologists Biologic Interventions Register (BADBIR), and the German Psoriasis Registry PsoBest was used as the validation dataset. Model discrimination and calibration were assessed internally and externally using the C‐statistic, the calibration slope and the calibration in the large. Results: Overall 175 (1·7%) out of 10 033 participants from BADBIR and 41 (1·7%) out of 2423 participants from PsoBest developed a serious infection within 1 year of therapy initiation. Selected predictors in a multiple logistic regression model included nine baseline covariates, and starting infliximab was the strongest predictor. Evaluation of model performance showed a bootstrap optimism‐corrected C‐statistic of 0·64 [95% confidence interval (CI) 0·60–0·69], calibration in the large of 0·02 (95% CI −0·14 to 0·17) and a calibration slope of 0·88 (95% CI 0·70–1·07), while external validation performance was poor, with C‐statistic 0·52 (95% CI 0·42–0·62), calibration in the large 0·06 (95% CI −0·25 to 0·37) and calibration slope 0·36 (95% CI −0·24 to 0·97). Conclusions: We present the first results of the development of a multivariable prediction model. This model may help patients and dermatologists in the U.K. and the Republic of Ireland to identify modifiable risk factors and inform therapy choice in a shared decision‐making process. What's already known about this topic? Patients and their clinicians are often concerned about the risk of serious infection associated with biological therapies for the treatment of psoriasis.However, there are no current tools available to estimate an individual's risk of serious infection when starting a systemic therapy. What does this study add? This study found that the serious infection risk prediction model had good calibration and moderate discriminationThe model included chronic obstructive pulmonary disease, alcohol intake, number of comorbidities and employment status, in addition to age, sex, Psoriasis Area and Severity Index, choice of starting therapy and body mass index.These are the first results of the multivariable prediction model, which may help patients and dermatologists in the U.K. and the Republic of Ireland to identify modifiable risk factors and inform therapy choice in a shared decision‐making process. Respond to this article Plain language summary available online [ABSTRACT FROM AUTHOR]

Summary: Background: Patients with psoriasis and clinicians are concerned that infliximab may be associated with a risk of serious infections. Objectives: To compare the risk of serious infections associated with infliximab in patients with chronic plaque psoriasis against a cohort on nonbiologic systemic therapies. Methods: A prospective cohort study was performed using data from the British Association of Dermatologists Biologic Interventions Register (BADBIR). Infliximab was compared with nonbiologic systemic therapies, inclusive of any exposure to methotrexate, ciclosporin, acitretin, fumaric acid esters, psoralen‐ultraviolet A or hydroxycarbamide. Serious infections were those associated with hospitalization, the use of intravenous antimicrobial therapy and/or those that led to death. Propensity score inverse probability treatment weights were used to adjust for potential confounding from a priori identified covariates. Cox proportional hazards models were calculated to obtain hazard ratios (HRs). Results: In total, 3843 participants were included for analysis up to October 2016. The incidence rates were significantly higher in the infliximab cohort (47·8 per 1000 person‐years) [95% confidence interval (CI) 35·7–64·0], compared with 14·2 per 1000 person‐years (95% CI 11·5–17·4) in the nonbiologic systemic cohort. Infliximab was associated with an overall increase in the risk of serious infection compared with nonbiologics [adjusted HR (adjHR) 1·95, 95% CI 1·01–3·75] and methotrexate only (adjHR 2·96, 95% CI 1·58–5·57) and a higher risk of serious infection in the first 6 months of therapy (adjHR 3·49, 95% CI 1·14–10·70). Conclusions: Infliximab is associated with an increased risk of serious infections compared with nonbiologic systemic therapies in patients with psoriasis in the U.K. and the Republic of Ireland. What's already known about this topic? Randomized clinical trials are not sufficiently powered to investigate the risk of serious infection in patients with psoriasis who are undergoing treatment with infliximab.Published observational studies have used different methods to adjust for confounding and different comparators.Previous studies also lacked the adequate sample size to obtain a precise estimate of the risk of serious infection for infliximab. What does this study add? Using methods that better address bias and confounding, our study suggests that infliximab is associated with a higher risk of serious infections compared with nonbiologic systemic therapies in patients with psoriasis.Patients should be counselled on the risk of serious infection before infliximab is prescribed. Linked Comment: Puig. Br J Dermatol 2019; 180: 257–258. Plain language summary available online Respond to this article [ABSTRACT FROM AUTHOR]

Allergic contact dermatitis (ACD) is a localised form of dermatitis or eczema which occurs 48‐72 hours after a substance which causes allergy (an allergen) has been in contact with the skin. It affects 20% of people. ACD to cosmetics is widely reported, with facial eczema being the main presenting complaint. ACD to cosmetics is diagnosed by patch testing to the British Society of Cutaneous Allergy (BSCA) facial series. Patch testing is a specialist test performed by a dermatologist which involves applying a series of allergens to the patient's back, which remains in place for 48 hours until they are removed. The patient then returns, 72 hours after the initial application of the allergens, for the final readings to see if they have any positive allergic reactions. To ensure we are accurately diagnosing ACD, patch test series should be continually reviewed to identify relevant and emerging allergens and remove those that are outdated. The BSCA facial series currently recommends 26 allergens and was last modified in 2012. We set out to update the BSCA facial series. We assessed the results from 12 U.K. and Ireland patch test centres', facial series from January 2016 to December 2017. We recorded the number of allergens tested in each centre and calculated the patch test rate for each allergen, using a 0.3% positive patch test rate as the threshold criterion for inclusion. A total of 4224 patients were patch tested to the BSCA facial series. The number of allergens included in individual centres facial series ranged from 24 to 66 with a total of 103 allergens tested across all centres. Twelve of the 26 allergens in the BSCA facial series had a positive patch test rate of less than 0.3% and 14 had a rate more than 0.3%. Twenty‐five allergens not recommended in the BSCA facial series had a positive patch test rate more than 0.3%. Despite a recommended facial series, there is wide variation in practice amongst patch test centres. Using our results, we have updated the BSCA facial series which now contains 24 allergens. Fifteen allergens remain, 11 allergens have been dropped and nine new allergens have been added. Linked Article: Rolls et al. Br J Dermatol 2021; 184:151–155. Linked Article: Rolls et al. Br J Dermatol 2021; 184:151–155. [ABSTRACT FROM AUTHOR]

Psoriasis is a common skin condition affecting approximately 2% of the population, with up to 1.8 million people affected in the U.K. alone. This article reports the work from a group of U.K. and Republic of Ireland based researchers who set out to determine if secukinumab, a medicine known as an IL‐17A inhibitor, was safe and effective in patients with moderate/severe chronic plaque psoriasis for whom previous treatment with a medicine called a TNFα inhibitor had not remained effective. 53 dermatology centres in the U.K. and Republic of Ireland took part. Patients were randomly assigned to to receive secukinumab at a dose of either 300mg or 150 mg subcutaneously (by injection) every week for 4 weeks, then 4‐weekly thereafter. The Psoriasis Area Severity Index (PASI) is used to record the redness, thickness and scaling of a patient's psoriasis and to measure how well a treatment works, as a reduction in the PASI score means a reduction in these symptoms. If a patient achieves PASI 75, it means they had a 75% or more reduction in their PASI score from the start. In total, 233 patients were analysed. 77 of 118 patients (65·3%) in the 300mg dose group and 51 of 115 patients (44·3%) in the 150mg dose group had achieved PASI 75 at week 16. After 72 weeks of treatment, 77.1% of patients in the 300 mg group who remained on that treatment throughout the study achieved PASI 75. Improvements in patients' quality of life were also seen at week 16 and were maintained to week 72. The safety profile of secukinumab was generally consistent with previous secukinumab studies, although a higher incidence of some adverse events, meaning unwanted side effects, were observed (e.g. candida infections, a type of fungal infection). This study has shown evidence of the efficacy and safety of secukinumab for treatment of psoriasis patients for whom prior TNFα‐inhibitor therapy has not been effective. Linked Article: Warren et al. Br J Dermatol 2020; 183:60–70. [ABSTRACT FROM AUTHOR]