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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]

Summary Background There are limited data on the use of ustekinumab outside of clinical trials. Objectives To assess the efficacy and safety of ustekinumab in patients with severe psoriasis attending 10 dermatology centres in the U.K. and Ireland. Methods A retrospective case-note review of 129 patients with psoriasis treated with ustekinumab. Results Baseline Psoriasis Area and Severity Index (PASI) was 22·9 ± 10·1 (mean ± SD). After 16 weeks of treatment with ustekinumab PASI 75 (75% reduction in PASI) was observed in 63·0% ( n = 80/127) of patients, although four patients required concomitant therapy at the 16-week time point. Previous biologic use did show a small, non-significant trend towards treatment failure. A PASI 75 response was seen in 29·4% ( n = 5/17) of individuals weighing 90-100 kg and treated with the standard 45 mg ustekinumab dose compared with PASI 75 of 70·3%, 71·4%, 75·0% and 55·6% for weight groups < 80, 80-90, 100-110 and > 110 kg, respectively ( P = 0·024). Ustekinumab therapy was well tolerated; serious adverse events were observed in 2·3% ( n = 3/129) of patients. Conclusions Ustekinumab is a novel biologic agent for psoriasis. When used in everyday clinical practice it demonstrates high levels of short-term therapeutic efficacy with an acceptable short-term safety profile. [ABSTRACT FROM AUTHOR]

Summary: The traditional way of finding out which bacteria are present in the skin is to take a sample using a swab. One limitation of this is that swab samples are taken from the skin surface only, whereas bacteria may be present in the deeper layers of the skin as well. Researchers from Sweden, Ireland and the UK looked at the difference between the results of swabs and actual biopsies (tissue samples) of the skin. One swab sample and one 2 mm punch biopsy from the same site were taken from each of 16 patients who were having lesions on their trunk or limbs excised (surgically removed) anyway. The swab used was moistened first, and the biopsy was taken down to the fat layer. A technique called 16S rRNA gene sequencing was used on the biopsy samples to search for the presence of bacteria. This is a very sensitive technique that can pick up the presence of bacterial DNA even if bacteria cannot be cultured (grown). The biopsies showed a significant increase in the groups of bacteria called Clostridiales and Bacteroidetes. Clostridiales do not need oxygen to live, and so might be expected to be found in the deeper layers of the skin. Other bacteria such as the common Staphylococcus aureus, on the other hand, were more abundant in the swab samples. Knowing more accurately which bacteria live in the skin is important because these bacteria can trigger the immune system responses that are important in skin diseases like atopic dermatitis, psoriasis and hidradenitis suppurativa. Linked Article: Prast‐Nielsen et al. Br J Dermatol 2019; 181:572–579 [ABSTRACT FROM AUTHOR]

Background: The burden of illness associated with atopic dermatitis (AD) is significant and multidimensional, especially in those with moderate to severe disease., Objective: Our objective was to evaluate the disease burden of patients with AD in relation to psychological distress, sleep disturbance, and alcohol misuse., Methods: Patients with AD, attending 2 tertiary referral centers in Dublin, Ireland, were recruited. A series of validated questionnaires were used including the Patient-Oriented Eczema Measure, Dermatology Life Quality Index (DLQI), Center for Epidemiologic Studies-Depression Scale, Quality of Life in Atopic Dermatitis Questionnaire, Alcohol Use Disorders Identification Test, and Pittsburgh Sleep Quality Index. The Eczema Area and Severity Index was calculated contemporaneously with the questionnaire completion., Results: One hundred patients completed the questionnaire, of whom 52% were female. Sixty-three percent of patients experienced impaired quality of life as measured by the DLQI. Higher DLQI scores correlated with decreasing age (r = 0.3277, P < 0.0009). Thirty percent were found to be at risk of clinical depression, and higher Center for Epidemiologic Studies-Depression Scale scores correlated with a younger age and eczema severity. Sleep disturbance was greater in those at risk of depression (mean = 10.40 vs 5.79, P < 0.0001). Patients with moderate to severe AD were more likely to score higher on the Alcohol Use Disorders Identification Test, and 25% met the criteria for alcohol use disorder. In relation to sleep, 73% of patients scored higher than 5 on the Pittsburgh Sleep Quality Index, which signifies poor sleep quality., Conclusions: Patients with AD endure a significant burden on health with regard to mental well-being, alcohol use, and sleep quality. Clinicians should consider screening patients for these comorbidities., Competing Interests: The authors have no funding or conflicts of interest to declare., (Copyright © 2020 American Contact Dermatitis Society. All Rights Reserved.)

This report describes the first clinical case, in Europe, of a high-level gentamicin-resistant and vancomycin-resistant Enterococcus faecium infection in a dog. The aim of this report is to alert the veterinary profession to high-level gentamicin-resistant and vancomycin-resistant Enterococcus faecium in companion animal patients. Multi-drug resistant strains of this pathogen are the cause of considerable problems in human hospitals and for community healthcare professionals worldwide. The potential for a similar impact within veterinary medicine is discussed.

Background: Contact allergy to a steroid enema leading to worsening of inflammatory bowel disease (IBD) has recently been reported. This study was designed to look for evidence of steroid allergy in patients with IBD., Objectives: To look for the presence of steroid allergy in general, and steroid enema allergy in particular, in a cohort of IBD patients prepared to attend for patch testing., Methods: Patients with IBD in two gastroenterology units at Dublin and Cork were asked to take part in the study. Those who agreed to take part were tested to the British Contact Dermatitis Society standard and steroid batteries. Patients with positive tests to steroids were subsequently asked to attend for intradermal testing with prednisolone, and patch testing to the two commercially available steroid enemas in Ireland and an extended battery of steroids. Reactions were read at days 2 and 4., Results: In total, 44 patients from the two units were patch tested. Four patients had positive patch tests to one or more steroids in these batteries: budesonide (n = 2), triamcinolone acetonide (n = 1), tixocortol pivalate (n = 1) and prednisolone (n = 1). Of these, three underwent further testing. All three had positive reactions to intradermal prednisolone and one had a positive test to steroid enema., Conclusions: Four (9%) of our patients were found to have steroid allergy. This has important implications for the local and systemic treatment of their IBD.

This study was undertaken to examine the prevalence of bronchitis (cough with phlegm) symptoms in teenagers who either smoked cigarettes on a regular basis (active smokers) or were non-smokers but who are exposed to passive smoking (passive smokers) in the home. The study was undertaken in 1995 and repeated in 1998. The 1995 study was a cross sectional questionnaire survey of smoking habits in secondary school children aged 13-14 years and was undertaken as part of the ISAAC questionnaire survey. Thirty representative and randomly selected schools from throughout the Republic of Ireland took part in the study. In the 1995 study, 3066 students completed a questionnaire on their current smoking habits and symptoms of cough and phlegm. We found that 634 (20.7%) of these young teenagers actively smoked cigarettes with significantly more females smoking than males with 23.3% of girls compared to 17.6% boys (p = 0.0001). We found that 46.3% of non-smoking children were exposed to smoking in the home (passive smokers) with parental smoking accounting for most of the passive smoking. Bronchitis symptoms were more commonly reported in active smokers compared to non-smokers with an odds ratio of 3.02 (95% CI 2.34-3.88) (p < 0.0001) or in passive smokers compared to those not exposed to smoking with odds ratio of 1.82 (95% CI 1.32-2.52) (p < 0.0001). The 1998 study showed similar results for smoking habits, passive smoking and prevalence of bronchitis symptoms as with the 1995 study. These results document that increased bronchitis symptoms occur in teenagers exposed to active or passive smoking.

The national prevalence of asthma, hay fever and eczema, employing the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire, was determined during 1995 in 3148 Junior Certificate secondary school children aged 13-14 years throughout the Republic of Ireland. The prevalence values for asthma, hay fever and eczema were 15.2%, 24.8% and 9.4% respectively. Although 5.4% reported having both asthma and hay fever, combinations of the other allergic conditions were less than 2%. Sex difference in prevalence rates for the various conditions occurred with asthma prevalence being higher for males, eczema in females, but hay fever was almost equally reported between males and females. This data documents the prevalence of teenage asthma with associated allergic conditions in the Republic of Ireland and will allow for present and future comparisons of these conditions with other countries world-wide using the ISAAC protocol.