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Richard DA Hudson,1 Mahreen Ameen,2 Susannah MC George,3 Catherine A Harwood,4,5 Richard B Weller,6,7 John T Lear,8,9 Rajesh Rout,1 Thishi Surendranathan,1 Milos Petrovic,1 Anthony P Bewley4 1Sanofi, Berkshire, UK; 2Royal Free NHS Foundation Trust, London, UK; 3University Hospitals Sussex NHS Foundation Trust, Brighton, UK; 4Barts Health NHS Trust, London, UK; 5QMUL, London, UK; 6NHS Lothian, Edinburgh, UK; 7University of Edinburgh, Edinburgh, UK; 8Salford Royal NHS Foundation Trust, Salford, UK; 9Manchester Academic Health Science Centre, Manchester University, Manchester, UKCorrespondence: Richard DA Hudson, Sanofi, 410 Thames Valley Park Drive, Reading, Berkshire, RG6 1PT, UK, Email richard.hudson@sanofi.comBackground: Whilst there is international evidence around the high healthcare resource utilization (HRU) associated with atopic dermatitis (AD), there is a lack of published data from the United Kingdom (UK).Methods: A retrospective, descriptive, observational study was conducted to evaluate the burden of moderate-to-severe AD on the National Health Service (NHS) in an adult UK population treated with traditional standard of care prior to the introduction of biologics. Patients (n=59) were recruited from 6 UK NHS Hospital Trusts and observed over three years.Results: 707 dermatology clinic visits were recorded over the observation period, amounting to 6.6 visits per patient-year, most commonly for routine check-ups most of which involved dermatology consultants (n=469, 66%). Physicians were the most consulted healthcare professional (n=652, 92%); emollients were the most common treatment (n=80 courses). 174 flares requiring additional medical advice were recorded in total (1.6 per patient-year).Discussion/Conclusions: Complex treatment pathways for adult patients in the UK with moderate-to-severe AD incur considerable HRU, particularly for those patients non-responsive to systemic therapies with broad immunosuppressant action. Recent advances in biologics-based AD management could possibly have a significant positive impact on HRU through significant reduction in the number of NHS touch points identified in this study.Keywords: atopic dermatitis, healthcare resource use, observational study

This is a case report of an interstitial hernia following previous transverse loop colostomy closure. There are no reported cases in the literature of gangrenous gall-bladder as the content of an interstitial hernia. This condition can present as a diagnostic challenge. We present a case with a previous reversal of a colostomy in the right upper quadrant presenting with a short history of a right iliac fossa mass and tenderness. Clinically, the patient was septic without any peritonitis. Subsequent computed tomography scan suggested the hernial sac contained gall-bladder and loops of bowel. At surgery, a gangrenous gall-bladder was found within an interstitial incisional hernia (between the external and internal oblique muscle). Retrograde cholecystectomy was performed and bowel and hernia were reduced. The hernia was repaired in layers and patient had an uneventful recovery.