Psoriasis often first presents in young adulthood, with the average age of diagnosis in women being 28 years, thus in the prime reproductive years. In addition, approximately 50% of pregnancies worldwide are unplanned. Although biologic therapies have revolutionized the treatment of moderate-to-severe psoriasis, there are no controlled studies of biologics in pregnant women. The increasing use of these agents in women of childbearing age highlights the need to further assess their safety during pregnancy. Postmarketing experience regarding the safety of these drugs is accumulating and being published, with largely reassuring results. We present our real-world experience of 17 pregnancies occurring in women on treatment with biologic agents for dermatological conditions to further add to the body of knowledge.

Psoriasis is a common disorder that can occur at any age, but the majority occurs before 45 years. We are increasingly seeing women of childbearing age in our systemic medication clinics. Recent BAD guidelines on biologics address issues pertinent to treatment of women during pregnancy1 but there is no reference to preconception advice on Measles Mumps Rubella (MMR) vaccination.

Linked Article: Ingram etal. Br J Dermatol 2018; 178:917-924.

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Histopathological examination of the excised lesion demonstrated a discrete dermal glandular proliferation with peripheral lymphocytic inflammation (Fig. 2a), comprised of nests, solid cords and ductular structures with no connection to the overlying epidermis. Distinctive eosinophilic mucinous secretions with intracytoplasmic vacuoles were also seen (Fig. 2b). Cytological atypia was minimal, with some variability in nuclear size. Rare mitoses (up to 1/mm) were seen, with no atypical mitoses. Immunostaining was positive for CK6, PSA and TTF-1, and negative for S100 and CK20, while SOX-10 showed diffuse nuclear positivity. Rare cells were mammaglobin positive, MUC-4 was multifocally positive and p63 was positive in the ductular component. Negative results were found for ETV6-NTRK3 gene translocation by reverse transcription (RT)-PCR and for ETV6 rearrangement by fluorescent in situ hybridization (FISH) (courtesy of Dr Dmitry Kasakov, Charles University Medical Faculty Hospital, Pilsen, Czech Republic).

A pigmented lesion clinic (PLC) was introduced and Consultant Dermatology posts were increased in the Mid-West of Ireland with the aim of improving early detection of melanoma.

Diseases that directly affect the skin are the fourth most frequent cause of all human illnesses. Despite this, skin diseases continue to receive little attention. Dermatology waiting times in Ireland are longer when compared to other health systems abroad. In this study we highlight a cohort of dermatological patients with inflammatory skin conditions, that require attention with regards to access to dermatological services. Aim of this study was to analyse our patient cohort currently taking biologic therapy to determine how they accessed the hospital system and the time course of transition to systemic and biologics therapy. This was a retrospective study with analysis of patients on biologic agents: etanercept, adalimumab, ustekinumab, infliximab and golimumab for chronic dermatoses from 2006-2012. We identified 157 patients on biologics between this period, with 114 of these patients currently on biologic therapy. Although 55% (62) were seen within 6 months of referral the mean wait from receipt of a GP referral letter to being seen in the outpatient was 11.6 months (range 0-87 months). This study shows that patients with severe inflammatory skin disease face significant delays in accessing the hospital system. This is partly due to inadequate infrastructure and staffing of Dermatology units.

Isotretinoin is used in the treatment of severe acne vulgaris (AV), but has controversially been associated with depression and suicide. Large prospective studies have failed to translate this clinically. We undertook a feasibility study to investigate the parameters of a triple-blind, randomized controlled trial (RCT) assessing the effect of oral isotretinoin on quality of life (QoL) and mood in patients with AV. Patients meeting the inclusion criteria were randomized for 2weeks to isotretinoin or doxycycline. Participants completed verified depression and QoL screening questionnaires at baseline and week 2. In total, 194 patients with AV were screened, with 48 meeting the inclusion criteria and 13 of these being willing to participate. The follow-up rate was 92% and questionnaire response rate was 96%. To our knowledge, this is the first study to demonstrate a successful design for a triple-blind RCT investigating the effects of isotretinoin on mood in patients with AV.

Approximately 15–20 % of the general population have skin diseases and it is therefore clear that inpatients can also present with various skin conditions that require dermatology input and in some cases the primary reason for admission to hospital. Inpatient hospital care is more expensive than outpatient care. Recent trends are moving towards outpatient care, as there is huge pressure on hospital bed availability.

The potential of Electronic Health Records (EHRs) is widely recognised, however studies assessing dermatology end-users expectations and perceived benefits are lacking. We report on a survey of 142 physicians working in Dermatology in Ireland. Eight question stems assess experience with EHRs and expectations of an ideal system for use in Dermatology. 61 (43%) physicians responded, of which 27 (44%) describe their experience with EHRs. 6 (33%) of 18 suggest components of an ideal dermatology EHR (ease of data inputting, integration with laboratory systems and radiology, integration with administrative systems, photography, drawing tools and standardised nomenclature) rate between very important and vital. The usefulness of an ideal dermatology EHR rates between very and extremely useful across all categories proposed, with safety, building a National network and demonstrating the work performed by a department rating highest. This survey highlights the core needs of dermatology end-users, whose integral involvement is essential to ensure successful EHR implementation.