Abstract Morphoea is a rare inflammatory sclerosing disorder associated with significant cosmetic, functional and psychosocial morbidity. Despite this burden, no national Irish cohort of patients with morphoea has previously been described. We aimed to characterize the demographic and clinical features of adult- and paediatric-onset morphoea in Ireland, within the IMAGINE study. We conducted a multicentre, cross-sectional study of adults and children with morphoea across the Republic of Ireland. Participants were recruited over a 6-month period through dermatology clinics in Cork, Galway, Mayo and Dublin, supplemented by national dermatology networks and social media outreach. Data on demographics, disease subtype, clinical features, potential triggers, extracutaneous involvement and treatment history were collected using REDCap. Data collection tools were adapted from the Morphea in Adults and Children cohort to facilitate international comparison. Statistical analyses were performed in R. Ethical approval was obtained at all participating centres. Fifty-four patients were enrolled, including 25 with adult-onset and 29 with paediatric-onset disease. Subtypes comprised linear (n = 29; including 13 en coup de sabre), plaque (n = 12) and generalized morphoea (n = 13). The female-to-male ratio was 6 : 1. The mean age at paediatric disease onset was 9.6 years. A personal history of autoimmune disease was reported by one-third of patients, while over one-half reported a family history of autoimmunity. Systemic therapy was required in over two-thirds of patients, most commonly methotrexate with or without cortico­steroids. Extracutaneous involvement was observed in 40%, and functional impairment was reported by 16%. This is the first national, multicentre study of morphoea in Ireland and represents the largest Irish cohort reported to date. Despite its rarity, morphoea is associated with substantial morbidity, underscoring the need for early recognition, multidisciplinary care and timely systemic treatment.

Abstract Exercise-induced capillaritis is an under-recognized variant of pigmented purpuric dermatoses, characterized by transient petechial or purpuric eruptions precipitated by physical exertion. We report the case of reproducible, exercise-associated capillaritis, with histopathological findings supporting the diagnosis and highlighting the role of biopsy in distinguishing this benign condition from other vasculopathic dermatoses. A 65-year-old woman with no significant past medical history presented with a several-­year history of a recurrent, asymptomatic rash affecting the lower extremities. The eruption persistently recurred after prolonged walking and resolved over a period of days to weeks without residual pigmentation. She denied systemic symptoms, new medications, infections, or personal or family history of autoimmune or vasculitic disease. Physical examination performed shortly after an exercise-induced episode revealed scattered, nonblanching erythematous-to-violaceous macules and petechiae on the bilateral lower legs, without oedema, ulceration or livedoid change. Given concern for possible small-vessel vasculitis or pigmented purpuric dermatosis, a punch biopsy was obtained from an active lesion. Histopathological examination showed an inflammatory infiltrate in the superficial dermis, comprised of an admixture of eosinophils and lymphocytes, with occasional neutrophils and nuclear dust, in a predominantly perivascular distribution. There was swelling of the endothelial cells with evidence of fibrin deposition. The overlying epidermis was unremarkable. This was consistent with findings in other reported cases of exercise-induced vasculitis. Exercise-induced capillaritis, also referred to as golfer’s purpura, is thought to result from increased hydrostatic pressure and capillary fragility during prolonged ambulation, particularly in warm conditions. It may mimic vasculitis, thrombocytopenic purpura or early pigmented purpuric dermatoses, often prompting biopsy. Recognition of its characteristic clinicopathological features is essential to avoid unnecessary laboratory evaluation and treatment. This case underscores the importance of clinicopathological correlation in transient purpuric eruptions. Awareness of exercise-induced capillaritis among dermatopathologists can facilitate accurate diagnosis and prevent misclassification as vasculitis or systemic disease.

Abstract Interstitial lung disease (ILD) is not a side effect of biologics recognized by dermatologists. It is not listed in patient information leaflets. We report three patients with psoriasis receiving biologic therapy who were diagnosed with drug-induced ILD by respiratory physicians. Case 1: a 74-year-old woman developed ILD while on ixekizumab (started 31 months prior – October 2020). She had previously been treated unsuccessfully with adalimumab (March 2019 to June 2020), secukinumab (June 2020 to October 2020), ixekizumab (October 2020 to January 2023 and May 2023 to January 2024) and ustekinumab (February 2023 to May 2023). She had a normal chest X-ray prior to biologic therapy. She had breast cancer treated with lumpectomy, radiation and hormone therapy in 2009 and 2022. Respiratory physicians had diagnosed chronic obstructive pulmonary disease in May 2019 and implicated ixekizumab in her new lung disease. She passed away from her ILD in April 2025. Case 2: a 72-year-old woman developed ILD while on adalimumab (commenced 4 years prior). She was previously treated with acitretin (September 2006 to March 2007), methotrexate (April 2007 to June 2019), ustekinumab (August 2018 to June 2019), adalimumab (June 2019 to December 2024) and secukinumab (December 2024 to present). She had a normal chest X-ray prior to biologic therapy. ILD was diagnosed in December 2024 and adalimumab was stopped; she now requires home oxygen. Case 3: a 66-year-old woman developed ILD while on guselkumab for plantar psoriasis. It was noticed incidentally on computed tomography investigating a shoulder injury. She was treated with adalimumab (November 2021 to April 2023), guselkumab (April 2023 to April 2024) and ixekizumab (April 2024 to present). Her lung changes have resolved and she was discharged. A 2025 publication from the VigiBase database showed that ILD was predominantly associated with tumour necrosis factor inhibitors, although causality could not be excluded. Case reports exist across IBD and respiratory literature, and controversy remains in rheumatology. Our cases highlight this contentious issue.

Abstract The City of Dublin Skin and Cancer Hospital was founded in 1911 with an initial emphasis on the treatment of cancer. Dermatologists were not appointed until 1934, but by the 1970s to the 1980s, the hospital functioned primarily as a specialist dermatology centre. This continued until its closure in 2006 and dermatology services were transferred to St Vincent’s University Hospital (SVUH). Dr Paul Collins (1961–2018) and Professor Sarah Rogers (1946–2023) worked in Hume Street Hospital and subsequently in SVUH and contributed hugely to modernizing dermatological medicine in Ireland. They, in particular Professor Rogers, created the first dedicated outpatient clinics for the investigation and management of contact dermatitis (May 1980). She also instigated a study on setting up a clinic for the treatment of contact dermatitis. Professor Rogers, one of the first female consultants in Ireland, graduated from the Royal College of Surgeons in Ireland in 1968 and obtained her MRCPI in 1971. She pursued dermatology in Leeds, Belfast and Newcastle upon Tyne, where her Medical Research Council-funded clinical trial comparing psoralen plus ultraviolet A vs. dithranol for psoriasis was published in The Lancet. Dr Collins graduated in medicine from University College Dublin in 1984 and pursued a career in dermatology. His higher specialist training was completed in Hume Street Hospital. He completed fellowship at the University of Minnesota, before he took a consultant post in Hume Street Hospital/SVUH in 1997. Dr Collins’ most cited publication (2013) in patch testing is currently ‘The relevance of 7-day patch test reading’, with 47 citations. He and Professor Rogers also had two further 2015 publications in Dermatitis and published numerous case reports. The Dr Paul Collins Fellowship supports Irish dermatology trainees undertaking overseas patch-testing fellowships, while the Rogers Prize recognizes her contribution to dermatology research. They both contributed enormously to dermatology in Ireland both clinically and academically.

The rapid expansion of biologic therapies for immune-mediated inflammatory diseases has raised significant clinical concerns regarding malignancy risk, particularly for patients with a history of cancer. This narrative review explores the safety of targeted therapies across dermatology, rheumatology, respiratory medicine, and gastroenterology to guide clinicians in these therapeutic dilemmas. We conducted a non-systematic review of the literature, prioritising longitudinal registry and real-world cohort data over clinical trials to better capture malignancy outcomes with long latency periods. Results indicate that tumour necrosis factor (TNF) inhibitors, which have the most extensive evidence base, do not consistently demonstrate an increased risk of overall incident malignancy or recurrence across specialties. Newer agents, including interleukin (IL)-17 and IL-23 inhibitors, show reassuring safety profiles in both trial and registry data. While dupilumab is associated with the potential diagnostic ‘unmasking’ of pre-existing cutaneous T-cell lymphoma, overall cancer rates remain stable among users. Most clinical guidelines support an individualised, multidisciplinary approach involving oncology consultation. We conclude that biologic agents can be used cautiously in certain patients with a history of malignancy following multidisciplinary discussion; however, in those with active malignancy there are no meaningful data that exist. Most evidence is heterogenous and excludes patients with a history of malignancy. Future management requires validated decision frameworks and mandatory participation in real-world patient co-created registries which leverage developing artificial intelligence tools to refine long-term safety assessments.

Background While photopatch testing is recognized as the investigation of choice for photoallergic contact dermatitis, changes in potential photoallergen exposure and variables within the photopatch test technique have led to challenges in its usage within dermatology.Objectives The main objectives of this study were to determine the nature and prevalence of topical photoallergens in Europe and to investigate the variable of photoallergen occlusion time before irradiation on photopatch testing outcomes.Methods A prospective multicentre study of photopatch testing to sunscreens, nonsteroidal anti-inflammatory drugs (NSAIDs) and other agents was conducted in 10 centres across seven European countries. A within-participant comparison of a 24-h and 48-h occlusion period prior to irradiation was included in the study design, to investigate the effect of this variable on photopatch testing outcomes.Results Of study participants, 28 photoallergic reactions were seen, with 10% (13 of 132) of participants reacting to sunscreen chemicals and 9% (9 of 101) to NSAIDs. The most prevalent photoallergens were ketoprofen (n = 6), promethazine (n = 4), butylmethoxydibenzoylmethane (avobenzone/parsol 1789) (n = 4), benzophenone-3 (oxybenzone) (n = 3) and etofenamate (n = 3). Contact allergies were less frequent (14 reactions). When a 24-h occlusion was used prior to irradiation, 53% of sunscreen photoallergic reactions and 36% of NSAID reactions were missed compared with the 48-h occlusion. Most participants had a history of photoexposed site dermatitis or sunscreen/NSAID reaction or had a photosensitivity disease, and 49% of participants had a history of dermatological conditions. All indications for photopatch testing were represented in those with positive photopatch tests, with no specific indicator of those most at risk.Conclusions Photopatch testing remains an essential investigation for people with suspected photocontact allergies. Based on these study findings, the nature of topical photoallergens appears to be stable, but vigilance and ongoing review are required. To optimize the pick-up rate of photoallergy, we recommend a 48-h occlusion period prior to irradiation, if practicable. Photoallergic contact dermatitis occurs when certain substances on the skin react with sunlight and cause a rash. To diagnose this skin condition, a method called photopatch testing can be used. Photopatch testing is considered the best way to diagnose photoallergic contact dermatitis. However, there have been changes in the types of chemicals people are exposed to. There are also differences in how the test is done. This makes it harder for doctors to use it confidently.This study was carried out by researchers from 10 medical centres in 7 European countries. The aim was to investigate the photopatch testing method. We tested study participants using products like sunscreens, non-steroidal anti-inflammatory drugs (NSAIDs), and other substances known to cause photoallergic reactions. We also wanted to see whether the time the test patches stayed on the skin before light exposure (either 24 h or 48 h) affected the test results. We found that photoallergic reactions were fairly common. In total, 10% of participants reacted to sunscreen chemicals, and 9% reacted to NSAIDs. The most frequent problem substances were ketoprofen, promethazine, avobenzone, oxybenzone and etofenamate. Contact allergies unrelated to light were less common. We also found that using 24 h of skin contact before light exposure missed many reactions. This applied to over half of the sunscreen-related reactions and more than one-third of the NSAID reactions. This finding suggests that a 48-h occlusion time makes the test more accurate.Overall, our study results suggest that photopatch testing is an important investigation. The types of substances causing reactions seem stable, but doctors should remain alert. When possible, using a 48-h skin contact period is recommended. Photopatch testing is used to investigate photoallergic contact dermatitis but variables in the technique have led to challenges in its use. We investigated the nature of topical photoallergens and the effect of photoallergen occlusion time on photopatch testing outcomes in a prospective study in seven European countries. Topical sunscreen and nonsteroidal anti-inflammatory drugs (NSAIDs) photoallergy was seen in 10% and 9% of participants respectively. The main photoallergens were ketoprofen, promethazine, avobenzone, oxybenzone and etofenamate. Photoallergy to sunscreens and NSAIDs would be missed in 53% and 36%, respectively, if a 24-h photoallergen occlusion period was used rather than 48 h. We highlight the importance of photopatch testing and of considering the use of a 48-h photoallergen occlusion period.

The rapid expansion of biologic therapies for immune-mediated inflammatory diseases has raised significant clinical concerns regarding malignancy risk, particularly for patients with a history of cancer. This narrative review explores the safety of targeted therapies across dermatology, rheumatology, respiratory medicine, and gastroenterology to guide clinicians in these therapeutic dilemmas. We conducted a non-systematic review of the literature, prioritizing longitudinal registry and real-world cohort data over clinical trials to better capture malignancy outcomes with long latency periods. Results indicate that tumor necrosis factor (TNF) inhibitors, which have the most extensive evidence base, do not consistently demonstrate an increased risk of overall malignancy or recurrence across specialties. Newer agents, including interleukin (IL)-17 and IL-23 inhibitors, show particularly reassuring safety profiles in both trial and registry data, with some evidence suggesting a potential reduction in certain cancer incidences. While dupilumab is associated with the potential unmasking of cutaneous T-cell lymphoma, overall cancer rates remain stable among users. Most clinical guidelines support an individualized, multidisciplinary approach involving oncology consultation. We conclude that current biologic therapies generally pose a lower malignancy risk compared to older systemic treatments. Future management requires validated decision frameworks and mandatory participation in real-world registries to refine long-term safety assessments.

Abstract Allergy to diabetic devices, particularly acrylates and colophonium derivatives, is a growing problem. There is a paucity of literature on the constituents of the devices currently on the market, which makes it difficult to advise patients and their physicians. We have previously reported our experience in patch testing patients with reactions to a variety of devices (Sexton F, O’Mahony J, Sumera S et al. Culprit allergens in diabetes technology-­associated allergic contact dermatitis: investigation remains challenging. Br J Dermatol 2025; 193: 792–4). Dendooven et al. have recently reported analysis of several devices used in the Netherlands (Dendooven E, Haentjens F, Kanokrungsee S et al. 1,6-Hexanediol diacrylate, isocyanates and other skin sensitizers are emerging contact allergens in guardian glucose sensors. Contact Dermatitis 2025; 93: 514–26). The aim of this study was to analyse devices used in Ireland in 2025 and their significance for our patients. A validated gas chromatography–mass spectrometry method was developed for the targeted semiquantitative analysis of known acrylates, Myroxylon pereirae constituents and colophonium derivatives, while untargeted analysis enabled the screening of additional potentially relevant allergens. Components of wearable diabetes devices (e.g. sensors and overpatches) were extracted in acetone containing an internal standard. Multiple extraction procedures were tested and compared. As with previous methods, we detected benzyl alcohol, methyl dehydroabietate and isobornyl acrylate (IBOA) in some, or all, of the devices tested. We also detected several potential sensitizers including linalool, isopropyl myristate, tert-butylphenol and isopropyl palmitate. We have confirmed the work of others in detecting colophonium derivatives and IBOA. A number of new allergens have also been identified including linalool, isopropyl myristate, tert-butylphenol and isopropyl palmitate. The presence of a variety of adhesive agents is expected. The presence of fragrance allergens has been highlighted previously and may relate to colophonium. As far as we are aware, this is the first report of the presence of linalool, isopropyl myristate, tert-butylphenol and isopropyl palmitate in diabetic devices and may have implications for patients for the future.

Abstract Propylene glycol (PG) is a common excipient found in numerous topical, oral and injectable medications, as well as in cosmetics and personal care products. Although PG is considered a weak sensitizer, it can elicit clinically significant reactions, and reports of allergic contact dermatitis due to PG in prescription topical therapies remain relatively uncommon. A 48-year-old woman presented to dermatology with a 4-year history of an erythematous, burning facial rash localized predominantly to the central cheeks, chin and perinasal area. She presented with facial erythema, for which her general practitioner had prescribed Soolantra® cream (ivermectin 1%) to treat a presumed diagnosis of rosacea. Over subsequent months, she developed increasing erythema, oedema and pruritus in the treated areas. The patient had a past history of hay fever and a family history of eczema in her brother. She had not recently changed her skincare or cosmetic products, using ‘Kiehl’s face wash’, but reported a previous flare following the application of ‘Kiehl’s calendula cream’. She was a waitress but reported no occupational or hobby exposures to common allergic contact dermatitis precipitants. The patient underwent standardized patch testing. Additional testing with the patient’s own products including Soolantra cream, Kiehl’s calendula cream, and Kiehl’s calendula wash was conducted. She demonstrated a strong (+2 reaction) to propylene glycol and Kiehl’s calendula cream, and a +1 reaction to Soolantra cream. Based on the clinical course and patch test findings, a diagnosis of allergic contact dermatitis to PG in Soolantra cream was made. Of note, Kiehl’s calendula cream and Lancome foundation also contain PG in their listed ingredients. Allergic contact dermatitis to PG can occur following use of Soolantra cream for rosacea. Clinicians should maintain a high index of suspicion for excipient allergy in patients presenting with new-onset dermatitis at application sites, and patch testing remains the gold standard for diagnosis.

Colophonium derivatives are the predominant allergens causing allergic contact dermatitis (ACD) in our population in Cork, Ireland. The British Society for Cutaneous Allergy standard series does not identify many of these derivatives, potentially resulting in misdiagnosis and underdiagnosis of ACD in people using diabetes technology.

Friar's Balsam or compound benzoin tincture is used for its antiseptic and protective properties for treating abrasions and minor lacerations. In some clinical situations, Friar's Balsam is also used in surgical dressings for its combined antiseptic and adhesive properties. We report a case of severe allergic contact dermatitis in a patient due to Friar's Balsam used to improve skin adhesion of dressings after varicose vein surgery. A 40-year-old female was referred to the dermatology clinic in July 2022 for assessment of a cutaneous reaction on her right lower limb (Figure 1). A rash developed within 48 h of routine varicose vein surgery. She underwent patch testing to the British Society for Cutaneous Allergy (BSCA) standard, facial, fragrance, medicaments and methacrylates series. Patch tests were applied with IQ Ultra chambers with medical-grade adhesive tape and read at 48 and 96 h. She was additionally tested to steristrips and cicaplaie dressing. She had 1+ positive patch test reactions to fragrance mix I (8.0% wsp), Myroxylon pereirae (25% wsp), cinnamic alcohol (2.0% wsp) and jasmine absolute (2.0% wsp), but not to the aforementioned dressings. Based on these results, she was diagnosed with fragrance allergy and irritant reactions to dressings. In 2024, she was referred again by vascular surgery following a similar, more severe reaction on the left lower limb following varicose vein surgery. She underwent repeat patch testing to the BSCA standard series, in addition to facial, fragrance and medicaments series. We also patch tested with honeycomb dressing, which was used instead of Mepore dressing on this occasion. Following careful review of the dressing procedure with the vascular surgeon, we ascertained that no glues were used in the surgical procedure but that Friar's Balsam was applied to the skin before the overlying dressing. On this occasion, she had 1+ positive patch test reactions to Myroxylon pereirae (25% wsp), fragrance mix I (8.0% wsp), oxidised linalool (0.5% wsp), cinnamic alcohol (2.0% wsp), isoeugenol (2.0% wsp), narcissus absolute (2.0% wsp) and jasmine absolute (2.0% wsp), and a (3+) reaction to a sample of neat Friar's Balsam applied to the abdomen (Figure 2). There was no reaction to neat Friar's Balsam applied to the abdomen of 10 control subjects. Friar's Balsam is a traditional topical and inhaled topical medication made from a mixture of benzoin resin, tincture of benzoin, and other ingredients [1]. It was once widely used in surgery and wound care, before advancements in antiseptic and antimicrobial therapies. It was thought to reduce the risk of infection and improve dressing adherence. It is also known for its use as a home inhaled remedy for respiratory conditions [2]. Friar's Balsam or Compound Tincture of Benzoin is derived from natural resins. The main constituents are benzoin resin (contains benzoic acid, benzyl benzoate, and vanillin), Balsam of Tolu (contains cinnamic acid derivatives) and storax (styrene-based compounds). Essential oils such as myrrh and aloe feature, in addition to ethanol, which acts as a solvent for dissolving resins and enhancing compound preservation. The plant origins of Friar's Balsam trace back to tropical trees like Styrax benzoin (benzoin resin) and Myroxylon balsamum (balsam of Tolu and Peru). These trees are native to Southeast Asia and Central/South America, respectively [3]. There are previous case reports of contact allergy to Friar's Balsam in the literature. One such report describes an anaesthetist who developed an acute blistering reaction to aerosolized Friar's Balsam when spraying it to improve dressing adherence following a spinal anaesthetic procedure [4]. There are also reports of allergy to tincture of benzoin [5, 6], with additional reports of cross-reactivity to similar allergens such as fragrance mix, balsam of Peru, colophony and tea tree oil [7]. In our case, it is likely that prior sensitisation to fragrances resulted in a cross reaction to the allergens in Friar's Balsam. Julia O'Mahony: writing – original draft, investigation, methodology, writing – review and editing, project administration. YiXuan Goh: writing – review and editing. Anne Lonergan: resources, investigation. John Bourke: writing – review and editing, supervision, investigation, methodology. Patient consent has been given to include images in the case report for publication. The authors declare no conflicts of interest.

The management of moderate-to-severe psoriasis in patients with concurrent or previous malignancy presents a unique clinical challenge. Despite the transformative impact of biologic therapies on psoriasis treatment, the exclusion of patients with malignancy from clinical trials has led to a paucity of data regarding the safety and efficacy of systemic and biologic agents in this subgroup. Clinicians are thus often compelled to rely on registry data, real-world evidence and expert opinion when navigating these complex cases. Our objective was to investigate prescribing practices among psoriasis experts for systemic and biologic therapies in patients with severe psoriasis and concomitant malignancy. The study aimed to elucidate trends in decision making, perceptions of treatment risks, and adherence to multidisciplinary approaches. An electronic survey was disseminated to 141 members of the International Psoriasis Council (IPC) between December 2023 and June 2024. The self-administered questionnaire examined respondents’ demographics, guideline familiarity and preferences for systemic and biologic therapies across five malignancy types (breast cancer, melanoma, prostate cancer, lymphoma, and metastatic renal cell carcinoma) at varying remission intervals. Data were analysed descriptively. Fifty-seven IPC councillors completed the survey (40%). Anti-interleukin-17 agents were the most commonly selected therapies across all malignancy scenarios for patients in remission, reflecting growing confidence in their safety profiles. For active malignancies, apremilast was the most frequently chosen agent, particularly for breast cancer (61%), melanoma (56%) and metastatic renal cell carcinoma (49%). Tumour necrosis factor-α inhibitors and fumaric acid esters were the least frequently selected treatments for active malignancies. The majority of respondents (70%) believed current guidelines lacked clarity on treating psoriasis in the context of malignancy. Nearly half (49%) reported always consulting oncology teams before initiating systemic therapy for patients with recent malignancy diagnoses, underscoring the importance of a multidisciplinary approach. This study highlights significant variability in prescribing practices and a strong preference for biologics such as anti-interleukin-17 agents and apremilast. The findings underscore the urgent need for malignancy-specific guidelines informed by robust long-term safety data to support optimal decision making and improve patient outcomes.

We aimed to investigate the systemic and biologic agent choices of dermatologists in Ireland for those patients with psoriasis and a cancer diagnosis. An electronic questionnaire was circulated to the Irish Association of Dermatology members using the survey platform, Jotform, between December 2023—June 2025. In total there were 27 responses. Methotrexate was selected most commonly for all scenarios > 5 years remission. In all clinical scenarios, fumaric acid esters were the least frequently selected agents. In general, tumour necrosis factor-alpha inhibitors were the next least commonly selected. Apremilast was selected most commonly for a current malignancy of stage 1 breast cancer (26

Continuous subcutaneous insulin infusion (CSII) and continuous glucose monitors (CGM) are integral to the management of type 1 diabetes mellitus (T1DM), improving glycaemic control and quality of life. However, allergic contact dermatitis (ACD) associated with these technologies is increasingly reported but remains underinvestigated due to the difficulty in identifying causative allergens. The British Society for Cutaneous Allergy (BSCA) standard series does not include several allergens found in medical devices, particularly colophonium derivatives, which have emerged as key allergens. The objective of this study was to identify allergens responsible for ACD in patients using CSII and CGM devices and to assess the limitations of the BSCA standard series in diagnosing device-related allergies. We studied 17 paediatric patients with adverse skin reactions to diabetes devices. All patients were patch tested with the BSCA standard series, methacrylate series and a medical device series, which included extra acrylates and colophonium derivatives. Additionally, we tested acetone extracts of six devices (Freestyle Libre 1, Freestyle Libre 2, Medtronic Guardian Sensor 3, Tandem T:slim X2, Dexcom G6 and Dexcom G7) using gas chromatography–mass spectrometry (GC-MS). The study cohort included nine male patients, aged 1–16 years. Patch tests were performed on day 0 with readings on days 4 and 7. Twelve patients tested positive for device-related allergic reactions, with nine reacting to Dexcom G7, one to Dexcom G6, and two to Tandem T:slim X2. Colophonium derivatives were identified as the primary allergens, with 10 patients testing positive to a combination of colophonium 60%, methyl hydrogenated rosinate 20% and glyceryl hydrogenated rosinate 20% in the medical device series. Only one reacted to colophonium 20% in the standard series. One reacted to hexanediol diacrylate and one to N,N-dimethylaminoethyl acrylate. Isobornyl acrylate (IBOA) was confirmed as a causative allergen, with positive reactions in two patients (one to IBOA 0.1% and 0.3%, and one to IBOA 0.3%). None reacted to 2-hydroxyethyl methacrylate in the standard series. GC-MS analysis confirmed the presence of IBOA and methyl dehydroabietate in multiple devices. In conclusion, colophonium derivatives are a key cause of ACD in patients using diabetes technology. Our findings demonstrate that the BSCA standard series may fail to identify relevant allergens in such cases, emphasizing the need for more comprehensive testing, including device-specific allergens, to improve diagnosis. GC-MS is a valuable tool but further research is required to quantify the exact contribution of these compounds. Manufacturers must be more transparent about the materials in their devices to aid diagnosis and prevent further allergic reactions.

Contact allergy (CA) is not uncommon in the population, including to various fragrance allergens. If not diagnosed correctly, allergic contact dermatitis (ACD) may ensue, because targeted allergen avoidance is not possible. The primary objective of the study is to estimate the prevalence of CA to seven fragrance materials in patients with suspected ACD across Europe. Based on the outcome, a conclusion will be drawn as to whether present risk management regarding maximum recommended concentrations of each of these, based on quantitative risk assessment (QRA2), is adequate. The planned study is a surveillance study based on consecutive patients, patch tested in 10 European departments of dermatology with a series of allergens as indicated by their personal history, including the European baseline series, supplemented with the seven additional fragrance ingredients. The patch test procedure will follow the guideline of the European Society of Contact Dermatitis (ESCD) with additional standardization procedures. The envisaged sample size is 8100; recruitment will be in three data cycles with brief intervals allowing for descriptive interim analyses. Those patients reacting positively to any of the study allergens will be followed-up specifically to identify the source of sensitizing and/or eliciting exposure(s). Results will inform risk reassessment and subsequent risk management measures. Study results will be published in an open-access peer-reviewed scientific journal. Structured post-marketing surveillance of consumer risk of contact allergy by monitoring prevalences of positive patch test reactions in a dedicated European expert network is developed which can serve as a model for further chemicals. Important outcomes will be either a confirmation of effectiveness of risk management measures in place, or alternatively identifying aspects needing improvement (for certain cosmetic product categories). DRKS registration (DRKS00033263) 16.09.2024, mirrored at https://trialsearch.who.int.

Novel diabetic devices have become increasingly popular in recent years, circumnavigating the need for regular finger pricking to order to obtain capillary blood glucose levels (1). These technological advances have led to improved quality of life and reduced frequency of complications such as hypoglycaemia and ketoacidosis (2,3,4,5). Devices such as subcutaneous insulin pumps and interstitial glucose monitors are convenient, long-lasting, and discrete options for patients (3). However, as they require prolonged contact time with skin as well as the use of strong external cutaneous adhesives, they can be associated with a variety of localised unwanted cutaneous reactions, including irritant contact dermatitis, and allergic contact dermatitis (1,3,5). We report a case series of 5 patients with diabetes mellitus referred for patch testing with localised skin reactions at the sites of their diabetic devices. Diabetic devices in use at time of patch testing included: 1 subcutaneous insulin pump (Medtronic 640), and 4 glucose monitoring devices (DexCom G6 (n = 3), and DexCom G7 (n = 1)). Two patients had allergic contact dermatitis – one to the dressing, scrapings, colophonium and Eurax cream (with negative acrylate series), and one to isobornyl acrylate. Skin reactions including allergic contact dermatitis are being increasingly observed with diabetic devices. Healthcare professionals may need to consider patch testing in patients experiencing skin reactions to GMDs. Manufacturers of GMDs should supply an inclusive list of all the components in their devices and adhesives, including possible allergens such as isobornyl acrylate & colophonium.

Background:The incidence of melanoma continues to rise in Ireland. Skin cancer prevention campaigns rely on promoting knowledge to improve sun-related behaviour. Objectives:To explore beliefs, behaviours, and attitudes towards tanning, and confidence in identifying signs of melanoma in the Irish population. Methods:A cross-sectional study was performed via an online questionnaire, with questions related to tanning, sun exposure, and skin cancer behaviours. Respondents were recruited according to gender, age and geographic region. Results:The questionnaire was completed by 1043 respondents (response rate 85%). Mean age was 41 years (range 20-72 years). Participants had mixed awareness of risk reduction strategies for melanoma but had high perceived concerns about developing melanoma. However, 48.9% regularly sunbathed when sunny in Ireland and 41.5% had used tanning beds. The most common reason for not photoprotecting while sunbathing was because it prevented tanning. Nearly half (45.9%) of those who sunbathed agreed that it was worth getting sunburned to get a tan, and 69.4% reported feeling and looking better with a tan. Less than half (42.4%) felt confident about what to look for when checking their skin for melanoma. Conclusions:This study underscores the importance of addressing the cultural and aesthetic aspects of sun-tanning behaviour in skin cancer prevention efforts, as well as increasing awareness of skin cancer signs and self-examination. Further research into the potential addictive nature of UV-seeking behaviour may offer new avenues for intervention and support for individuals who are addicted to tanning.

AbstractBackgroundRituximab (RTX) has been utilised off‐label for a variety of dermatological indications beyond pemphigus vulgaris. Efficacy has been reported in other immunobullous disorders, inflammatory dermatoses and connective tissue diseases.ObjectivesTo assess the off‐label use of RTX in our centre with respect to indications, frequency and duration of treatment, efficacy, and adverse events.MethodsCharts were retrospectively reviewed for all patients who received dermatologist‐prescribed RTX infusions off‐label at our centre between 2009 and 2022. Efficacy was categorised based on reported percentage reduction of disease activity: very good (75%–100%), good (50%–74%), partial (25%–49%) and none (0%–24%).ResultsTwenty‐nine patients received RTX off‐label during this time period. Infusions were discontinued in 28% (n = 8), due to insufficient clinical response. Median treatment duration for those on 6‐12‐monthly regular infusions was 2.4 years (range 0.5–11 years). Indications included cutaneous lupus (n = 9), mucous membrane pemphigoid (n = 5), pyoderma gangrenosum (n = 6), lichen planus (n = 2), dermatomyositis (n = 1), livedoid vasculitis (n = 1), sarcoidosis (n = 1), bullous pemphigoid (n = 1), pemphigus vulgaris, foliaceus and vegetans (n = 1 each). Clinical improvement was documented in 79% (n = 23); very good in 48% (n = 14), good in 17% (n = 5), and moderate in 14% (n = 4). Clinical efficacy in immunobullous disorders was 100% (9/9), 67% in cutaneous lupus (6/9), 33% in pyoderma gangrenosum (2/6), and 50% in lichen planus (1/2). No side effects were documented for 79% (n = 23). Adverse peri‐infusion events were seen in three patients (10%). Four patients died during follow up; one due to neutropenic sepsis with a background of advanced malignancy, and three due to Covid‐19. ConclusionsRTX was prescribed for multiple off‐label dermatological indications, often for recalcitrant disease. Responses were good overall, with a reassuring safety profile. Three patients died of Covid‐19; knowledge of the impact of RTX on the immune response and efficacy of vaccines is expanding and will continue to inform guidelines for RTX use in the post‐Covid era.

Abstract Rapid-access clinics are designed to improve the early detection and prognosis of melanoma, but there is little hard evidence in the literature of their effectiveness. We established a pigmented lesion clinic (PLC) in 2002 and have previously demonstrated a subsequent reduction in melanoma thickness at our hospital. We undertook a retrospective cohort study to assess the long-term effects. Data for all melanomas diagnosed in the Republic of Ireland between 1 January 1998 and 31 December 2019 were provided by the National Cancer Registry Ireland (n = 15 619). We excluded T0 and Tis and unknown T melanomas. Our PLC was found to have a higher proportion of tumours diagnosed at an earlier stage of T1 (51.6%) vs. the region/county where the PLC is based (37.8%) and Ireland (40.3%). Following the introduction of the PLC, from 2003 to 2007, a significant difference was noted between our PLC and the rest of Ireland, with a higher proportion of T1 tumours diagnosed (41.6% vs. 29.7%; P < 0.001). For the region, the percentage of T1 tumours was lower than for the rest of the country, but this difference fell short of significance (34.5%; P = 0.057). In the two 5-year periods following this (2008–2013 and 2014–2019), our PLC had significantly more early tumours (44.4% and 62.1%, respectively) than the rest of Ireland (35.9% and 52.2%, respectively; P < 0.001 for both time periods). More PLCs have been established across the country, probably accounting for the higher proportion of early-stage melanomas diagnosed in 2014–2019. The figures for the region were also significantly better than those for the rest of the country [40.7% and 55.7% (P = 0.008 and P = 0.039), respectively], suggesting that the PLC has had an effect on prognosis, resulting in a greater proportion of early melanomas in the region vs. Ireland. Preliminary analysis found a hazard ratio (HR) of 0.78, or a 22% reduced risk death, at 5 years (unadjusted Cox proportional hazard regression on all nonmetastatic melanoma with known T diagnosed 1998–2019, n = 16,489) for those attending the PLC vs. the rest of Ireland. Patients in the rest of the region were found to have a higher HR (1.15) vs. the rest of Ireland. The PLC appears to have contributed to improved prognosis in the region in the years following its establishment. This study supports the long-term benefits of a PLC over the course of more than 20 years.