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The success of clinical trials in Epidermolysis Bullosa (EB) is dependent upon the availability of a valid and reliable scoring tool that can accurately assess and monitor disease severity. The Epidermolysis Bullosa Disease Activity and Scarring Index (EBDASI) and Instrument for Scoring Clinical Outcomes of Research for Epidermolysis Bullosa (iscorEB) were independently developed and validated against the Birmingham Epidermolysis Bullosa Severity Score (BEBS), but have never been directly compared. Our objective was to compare the reliability, convergent validity and discriminant validity of the EBDASI and iscorEB scoring tools. An observational cohort study was conducted in 15 patients with EB. Each patient was evaluated by six dermatologists with expertise in EB using the EBDASI and iscorEB-clinician scoring tools. Quality of life was assessed using the iscorEB-patient and Quality of Life in EB measures. The intraclass correlation coefficients (ICC) for inter-rater reliability were: EBDASI 0.942 and the iscorEB-clinician 0.852. The ICC for intra-rater reliability was 0.99 for both scores. The two tools demonstrated strong convergent validity with each-other. In conclusion, both scoring tools demonstrate excellent reliability. The EBDASI appears to better discriminate between EB types and disease severities.Copyright © 2021

Vitiligo is a depigmenting condition which presents with white patches of the skin and is estimated to affect 1% of the population worldwide.1 As vitiligo can involve visible areas such as the face, neck, hands and feet, individuals with vitiligo experience significant psychological and social impacts. Current medical treatment includes topical or systemic immunosuppressants, phototherapy or surgical grafting, though results are often delayed or unsatisfactory. Camouflaging therapy involves the use of pigments and dyes to temporary conceal vitiligo and has been recognised to improve self-esteem and quality of life in adults and children with vitiligo2,3. Despite this, there is limited information regarding camouflaging products for vitiligo and its general use by dermatologists and patients with vitiligo. We will present the results from a global survey completed by patients and dermatologists regarding the use of camouflage therapy in vitiligo. The aim of the survey is to investigate the current awareness, usage, barriers and accessibility regarding camouflage products for vitiligo. Implications of this survey will allow a better understanding of the use of camouflage products for vitiligo and any barriers that could be addressed. Results from the survey may also highlight any discrepancies between patients' interest in camouflage products compared to the frequency of recommendation by dermatologists.

Darier's disease is a dominantly inherited acantholytic dermatosis which typically occurs in childhood and adolescence in patients with a positive family history. Sporadic cases and late onset cases are rarely reported in the literature. We present the case of a 75-year-old female who presents with sporadic late onset Darier's Disease as well as a review of the literature. Histopathology showed hyperkeratosis, parakeratosis, papillomatosis and elongation of rete ridges in the epidermis, as well as suprabasal acantholysis. Dyskeratotic cells (corps ronds) were present in the upper malpighian layer, consistent with Darier's disease. The patient was treated effectively with acitretin 10 mg per day, topical betamethasone dipropionate 0.05% ointment, soap free wash and Sorbolene moisturiser. Our atypical case highlights the potential for Darier's Disease, a condition which most commonly presents in early life, to sporadically arise in the elderly. Dermatologists should consider Darier's Disease as a potential differential diagnosis in elderly patients with classical clinical signs.

Camouflage is often considered by dermatologists to be a "fall back" option when medical therapy for vitiligo has been unsuccessful. However as a solution to the primary problem presented by vitiligo - that is a visible discrepancy in skin colour - camouflage should instead be considered as a treatment itself and discussed early on in the medical consultation. The application of skin camouflage requires an understanding of how normal skin is perceived and of the challenges presented by colour matching, surface reflectance and the phenomenon of metamerism. There is an increasing range of camouflage products available, some developed specifically for medical conditions and others closer to standard cosmetics. It is important for dermatologists to be aware of these products, how they are used and their limitations.

Vitiligo is a depigmenting skin condition that affects millions of people worldwide. Current medical and surgical treatments are often unable to provide complete repigmentation. Due to the visible appearance of vitiligo, especially in those with darker skin types, its psychological effect can be devastating. Camouflage is an adjunctive treatment shown to improve the quality of life in children and adults affected by vitiligo. Despite this, dermatologists are mostly unfamiliar with the increasing range of products that can be used to reduce its visual impact. "Medical" camouflage products are designed specifically for conditions such as vitiligo and vary in their ability to achieve a successful colour match and usability. Cosmetic make-up and sunless tanners offer alternative methods that are suitable for some patients. The choice of camouflage is influenced by the application site, gender and colour range of the product. Despite this, there are no published studies on the use of camouflage products amongst patients or dermatologists for vitiligo. We present the results of a global survey of patients and dermatologists regarding the use and recommendation of camouflage therapy in vitiligo. The study aims to investigate the current awareness, usage, benefits and barriers of camouflage products amongst vitiligo sufferers. The survey will help to identify areas that currently limit access to optimal management with camouflage therapy and highlight differences between patients' interest in these products and information provided by dermatologists. We also present the Camouflage Project which aims to create the first complete comprehensive online resource regarding camouflage products for vitiligo. Each specific product will be reviewed for 15 different criteria including colour match, durability, ease of use and cost. It is hoped through increased knowledge and awareness of these products, patients who choose to conceal their vitiligo can be empowered to do so.

Dermatological conditions make up a small component of the patients who present to the emergency department (ED). Although skin conditions may cause physical and psychological distress to the patient, most are not emergencies and are routinely managed in the general practice or outpatient setting. We present a retrospective case-note review of the dermatological presentations to the emergency departments within a major multi-site Victorian hospital network in the month of June 2019. Of a total 20209 presentations to the ED, 527 (2.6%) had a dermatology related presenting complaint or diagnosis, of which 131 (24.9%) were attributed to cellulitis or abscess. Only 47 (14.9%) of the 316 presentations excluding cellulitis, abscess, trauma and non-dermatological final diagnoses were admitted, resulting in a discharge rate of 85%, compared with the Victorian state average of 62% for all emergency presentations (1). We discuss the implications of these ED presentations in relation to the services provided by dermatologists, general practitioners, emergency physicians and the cost to the community.

Darier's disease is a dominantly inherited acantholytic dermatosis which typically occurs in childhood and adolescence in patients with a positive family history. Sporadic cases and late onset cases are rarely reported in the literature. We present the case of a 75-year-old female who presents with sporadic late onset Darier's Disease as well as a review of the literature. Histopathology showed hyperkeratosis, parakeratosis, papillomatosis and elongation of rete ridges in the epidermis, as well as suprabasal acantholysis. Dyskeratotic cells (corps ronds) were present in the upper malpighian layer, consistent with Darier's disease. The patient was treated effectively with acitretin 10 mg per day, topical betamethasone dipropionate 0.05% ointment, soap free wash and Sorbolene moisturiser. Our atypical case highlights the potential for Darier's Disease, a condition which most commonly presents in early life, to sporadically arise in the elderly. Dermatologists should consider Darier's Disease as a potential differential diagnosis in elderly patients with classical clinical signs.

The success of clinical trials in Epidermolysis Bullosa (EB) is dependent upon the availability of a valid and reliable scoring tool that can accurately assess and monitor disease severity. The Epidermolysis Bullosa Disease Activity and Scarring Index (EBDASI) and Instrument for Scoring Clinical Outcomes of Research for Epidermolysis Bullosa (iscorEB) were independently developed and validated against the Birmingham Epidermolysis Bullosa Severity Score (BEBS), but have never been directly compared. Our objective was to compare the reliability, convergent validity and discriminant validity of the EBDASI and iscorEB scoring tools. An observational cohort study was conducted in 15 patients with EB. Each patient was evaluated by six dermatologists with expertise in EB using the EBDASI and iscorEB-clinician scoring tools. Quality of life was assessed using the iscorEB-patient and Quality of Life in EB measures. The intraclass correlation coefficients (ICC) for inter-rater reliability were: EBDASI 0.942 and the iscorEB-clinician 0.852. The ICC for intra-rater reliability was 0.99 for both scores. The two tools demonstrated strong convergent validity with each-other. In conclusion, both scoring tools demonstrate excellent reliability. The EBDASI appears to better discriminate between EB types and disease severities.Copyright © 2021

Vitiligo is a depigmenting condition which presents with white patches of the skin and is estimated to affect 1% of the population worldwide.1 As vitiligo can involve visible areas such as the face, neck, hands and feet, individuals with vitiligo experience significant psychological and social impacts. Current medical treatment includes topical or systemic immunosuppressants, phototherapy or surgical grafting, though results are often delayed or unsatisfactory. Camouflaging therapy involves the use of pigments and dyes to temporary conceal vitiligo and has been recognised to improve self-esteem and quality of life in adults and children with vitiligo2,3. Despite this, there is limited information regarding camouflaging products for vitiligo and its general use by dermatologists and patients with vitiligo. We will present the results from a global survey completed by patients and dermatologists regarding the use of camouflage therapy in vitiligo. The aim of the survey is to investigate the current awareness, usage, barriers and accessibility regarding camouflage products for vitiligo. Implications of this survey will allow a better understanding of the use of camouflage products for vitiligo and any barriers that could be addressed. Results from the survey may also highlight any discrepancies between patients' interest in camouflage products compared to the frequency of recommendation by dermatologists.

Camouflage is often considered by dermatologists to be a "fall back" option when medical therapy for vitiligo has been unsuccessful. However as a solution to the primary problem presented by vitiligo - that is a visible discrepancy in skin colour - camouflage should instead be considered as a treatment itself and discussed early on in the medical consultation. The application of skin camouflage requires an understanding of how normal skin is perceived and of the challenges presented by colour matching, surface reflectance and the phenomenon of metamerism. There is an increasing range of camouflage products available, some developed specifically for medical conditions and others closer to standard cosmetics. It is important for dermatologists to be aware of these products, how they are used and their limitations.

Vitiligo is a depigmenting skin condition that affects millions of people worldwide. Current medical and surgical treatments are often unable to provide complete repigmentation. Due to the visible appearance of vitiligo, especially in those with darker skin types, its psychological effect can be devastating. Camouflage is an adjunctive treatment shown to improve the quality of life in children and adults affected by vitiligo. Despite this, dermatologists are mostly unfamiliar with the increasing range of products that can be used to reduce its visual impact. "Medical" camouflage products are designed specifically for conditions such as vitiligo and vary in their ability to achieve a successful colour match and usability. Cosmetic make-up and sunless tanners offer alternative methods that are suitable for some patients. The choice of camouflage is influenced by the application site, gender and colour range of the product. Despite this, there are no published studies on the use of camouflage products amongst patients or dermatologists for vitiligo. We present the results of a global survey of patients and dermatologists regarding the use and recommendation of camouflage therapy in vitiligo. The study aims to investigate the current awareness, usage, benefits and barriers of camouflage products amongst vitiligo sufferers. The survey will help to identify areas that currently limit access to optimal management with camouflage therapy and highlight differences between patients' interest in these products and information provided by dermatologists. We also present the Camouflage Project which aims to create the first complete comprehensive online resource regarding camouflage products for vitiligo. Each specific product will be reviewed for 15 different criteria including colour match, durability, ease of use and cost. It is hoped through increased knowledge and awareness of these products, patients who choose to conceal their vitiligo can be empowered to do so.

Dermatological conditions make up a small component of the patients who present to the emergency department (ED). Although skin conditions may cause physical and psychological distress to the patient, most are not emergencies and are routinely managed in the general practice or outpatient setting. We present a retrospective case-note review of the dermatological presentations to the emergency departments within a major multi-site Victorian hospital network in the month of June 2019. Of a total 20209 presentations to the ED, 527 (2.6%) had a dermatology related presenting complaint or diagnosis, of which 131 (24.9%) were attributed to cellulitis or abscess. Only 47 (14.9%) of the 316 presentations excluding cellulitis, abscess, trauma and non-dermatological final diagnoses were admitted, resulting in a discharge rate of 85%, compared with the Victorian state average of 62% for all emergency presentations (1). We discuss the implications of these ED presentations in relation to the services provided by dermatologists, general practitioners, emergency physicians and the cost to the community.

Hydroxychloroquine (HCQ) has been used for decades to treat a wide range of medical conditions due to its multiple immunomodulatory effects and low side effect profile. We present a review of the updated recommendations regarding the use of HCQ in dermatology. Latest dosing recommendations suggest the optimal dose to be <5.0 mg/kg actual body weight (ABW), with a maximum of 400 mg daily to reduce risk of retinopathy. The prevalence of HCQ induced retinopathy in long term users (>5 years) is about 7.5%. Daily dose > 5.0 mg/kg ABW, >1000 g total HCQ consumption, duration of use > 5 years, renal dysfunction, history of retinopathy and tamoxifen use increase the risk of retinopathy. Baseline ophthalmologic assessment followed by annual screening after 5 years is recommended, however annual screening can be commenced sooner if risk factors are present. Routine G6PD deficiency testing is not recommended. Whole blood HCQ levels using high-performance liquid chromatography can be used to identify poor compliance (compliant HCQ level > 500 ng/mL). Increasing HCQ doses to reach serum concentrations greater than 750 ng/mL can improve response. HCQ has multiple modes of action and potential therapeutic indications. Recently, potential efficacy has been demonstrated in alopecia areata/totalis, sclerotic skin disease and antiphospholipid syndrome. Smoking can significantly decrease the efficacy of HCQ. HCQ has multiple additional benefits showing anti-lipid, antihypertensive, hypoglycaemic, anti-thrombotic, anti-neoplastic and other cardio-protective effects. We hope that this review will assist dermatologists to safely and effectively prescribe HCQ utilising the latest evidence, and provide insight into its future applications.

Hydroxychloroquine (HCQ) has been used for decades to treat a wide range of medical conditions due to its multiple immunomodulatory effects and low side effect profile. We present a review of the updated recommendations regarding the use of HCQ in dermatology. Latest dosing recommendations suggest the optimal dose to be <5.0 mg/kg actual body weight (ABW), with a maximum of 400 mg daily to reduce risk of retinopathy. The prevalence of HCQ induced retinopathy in long term users (>5 years) is about 7.5%. Daily dose > 5.0 mg/kg ABW, >1000 g total HCQ consumption, duration of use > 5 years, renal dysfunction, history of retinopathy and tamoxifen use increase the risk of retinopathy. Baseline ophthalmologic assessment followed by annual screening after 5 years is recommended, however annual screening can be commenced sooner if risk factors are present. Routine G6PD deficiency testing is not recommended. Whole blood HCQ levels using high-performance liquid chromatography can be used to identify poor compliance (compliant HCQ level > 500 ng/mL). Increasing HCQ doses to reach serum concentrations greater than 750 ng/mL can improve response. HCQ has multiple modes of action and potential therapeutic indications. Recently, potential efficacy has been demonstrated in alopecia areata/totalis, sclerotic skin disease and antiphospholipid syndrome. Smoking can significantly decrease the efficacy of HCQ. HCQ has multiple additional benefits showing anti-lipid, antihypertensive, hypoglycaemic, anti-thrombotic, anti-neoplastic and other cardio-protective effects. We hope that this review will assist dermatologists to safely and effectively prescribe HCQ utilising the latest evidence, and provide insight into its future applications.

My recent travels to being a dermatology examiner for the University of PNG and PNG general hospital in Port Moresby was a fascinating one. I spent my time teaching the two dermatology registrars and marking the written papers and thesis written by the final year registrar. I was also involved in then setting up a final Osce exam with both long and short cases for the registrar to assess her competency in Dermatology. I was also fortunate to sit in with the Dermatologist in their Leprosy clinic where I saw five new cases of Leprosy including both type 1 and type 2 reactions. My talk is about my brief visit to one of the most underprivileged societies in the world.

My recent travels to being a dermatology examiner for the University of PNG and PNG general hospital in Port Moresby was a fascinating one. I spent my time teaching the two dermatology registrars and marking the written papers and thesis written by the final year registrar. I was also involved in then setting up a final Osce exam with both long and short cases for the registrar to assess her competency in Dermatology. I was also fortunate to sit in with the Dermatologist in their Leprosy clinic where I saw five new cases of Leprosy including both type 1 and type 2 reactions. My talk is about my brief visit to one of the most underprivileged societies in the world.