BACKGROUND:Paediatric Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) is a rare, severe mucocutaneous reaction requiring coordinated multidisciplinary care. Existing guidelines provide evidence-based recommendations, but implementation across tertiary paediatric hospitals requires practical consensus on local resources. AIM:To develop and evaluate multidisciplinary consensus-informed practical clinical guidance for assessment and management of paediatric SJS/TEN among clinicians from Australasian tertiary referral hospitals. METHODS:A draft guidance document was developed after review of SJS/TEN guidelines, systematic reviews and other relevant literature. Clinicians from one tertiary paediatric centre (Group A) and other Australian and New Zealand tertiary centres (Group B) completed a 130-item questionnaire. Continuous items were scored on a 1-9 Likert scale. Categorical items addressed referral urgency and whether investigations should be routine, reasonable but not routine, or not ordered. Quantitative responses and free-text comments informed revision. RESULTS:Twenty-two multidisciplinary clinicians from the internal centre and nine clinicians from eight external centres participated. Agreement was high for history, examination, supportive care, multidisciplinary involvement, discharge planning and follow-up. Uncertainty remained regarding fluid requirements compared with burns patients, the scope of initial investigations and systemic immunomodulatory therapy. The guidance was revised to emphasise individualised fluid management, directed differential diagnosis and testing, and case-by-case systemic therapy. CONCLUSIONS:This practical multidisciplinary consensus-informed guidance supports paediatric SJS/TEN care in Australasian tertiary referral hospitals. Its contribution is the quantified consultative process and identification of consistent, variable and uncertain practice. It complements, rather than replaces, existing guidelines.

Atopic dermatitis (AD), a chronic inflammatory condition, is the leading cause of global burden from skin disease. Optimal targets for clinician-reported outcomes (ClinROs) and patient-reported outcomes (PROs), including minimal disease activity (MDA; defined as simultaneous achievement of ≥ 1 optimal ClinRO and ≥ 1 optimal PRO), were established following the Aiming High in Eczema/Atopic Dermatitis (AHEAD) initiative. This study evaluated the impact of MDA achievement on flare activity, healthcare resource utilization, and patient-reported disease control in adults with moderate-to-severe AD. This retrospective post hoc analysis used data from the real-world cross-sectional MEASURE-AD study and included adults with moderate-to-severe AD across 28 countries. Three definitions were used to identify achievement of MDA. Outcomes were measured using patient-reported questionnaires evaluating flare activity and healthcare resource utilization over the preceding 6 months, as well as patient-reported disease control assessed at the time of the questionnaire. Statistical analyses compared patients achieving MDA targets with non-MDA groups using Kruskal–Wallis tests. Patients achieving MDA experienced fewer flares (means ranging from 0.8 to 1.4) compared with non-MDA groups (3.8–9.8) over the preceding 6 months. Flares were shorter in duration, with 9.9–13.4

Despite 'Swimmers Itch' having been first reported in the Transactions of the Royal Society of South Australia in 1941, and shortly afterwards in the New Zealand Medical Journal in 1944, there remain few publications in the Australasian dermatology journals.

Eczema is a chronic skin condition, characterised by inflammation, erythema, and pruritus. Usage of topical therapies containing botanical extracts is common, however evidence of efficacy is often lacking. This trial investigated the safety and efficacy of a mānuka-oil based cream, 2

With its chronicity and varied symptomatology, moderate to severe atopic dermatitis (AD) remains a significant challenge for both patients and health care professionals. Novel targeted therapies, including the JAK inhibitors (JAKi) offer significant hope. There are many systematic reviews and meta-analyses of the use of JAKi for the management of atopic dermatitis, but few offer practical advice for the clinician. The aim of this consensus development was to place the current literature for JAKi use in atopic dermatitis within the clinical context of practice in Australasia. The Australasian Medical Dermatology Group (AMDG) reviewed the evidence for the use of JAKi in the management landscape of atopic dermatitis, adding in their cumulative experience, and used an eDelphi process to agree on best practice. In the first round of 133 eDelphi clinical practice statements, consensus was achieved in 117 (88%-complete 27.8%, close 60.1%), with no consensus in 16 (12.0%) of the statements. The 16 clinical practice statements that did not reach consensus were reviewed and revised to 15 statements and then subjected to a second round: complete consensus was achieved in 5/15 statements, close consensus in 6/15, and no consensus in 4/15. Over the two eDelphi rounds, consensus was achieved in 128/132 (97%-complete 32%, close 64%) and no consensus in 4/132 (3%). Statements regarding screening for prior varicella infection, age-appropriate cancer screening intervals, and management of flares did not reach full consensus. This study highlights areas where further research is needed to assist practicing dermatologists in safe prescribing and management of atopic dermatitis with JAK inhibitors.

BACKGROUND:Pivotal clinical trials have assessed the efficacy and safety of fixed-dose upadacitinib 15 mg (UPA15) and 30 mg (UPA30) once daily in atopic dermatitis (AD). OBJECTIVES:To assess the efficacy and safety of dose escalation to UPA30 and dose reduction to UPA15 based on a clinical response [90% reduction in Eczema Area and Severity Index (EASI 90)] after 12 weeks of treatment in adults with moderate-to-severe AD enrolled in a randomized blinded treat-to-target multicentre phase IIIb/IV study. METHODS:A total of 461 patients were randomized in a 1 : 1 ratio to receive oral doses of UPA15 (n = 229) or UPA30 (n = 232) once daily during the 12-week double-blinded period. At week 12, patients on UPA15 not achieving EASI 90 were dose escalated to UPA30 (UPA15/30); patients achieving ≥ EASI 90 continued on UPA15 (UPA15/15). Patients on UPA30 not achieving EASI 90 at week 12 continued on UPA30 (UPA30/30); patients achieving ≥ EASI 90 received a reduced dose of UPA15 (UPA30/15) for 12 additional weeks. The primary efficacy endpoint was EASI 90 achievement at week 24. Results were reported descriptively as observed. Safety outcomes were assessed. RESULTS:At week 24, of patients who received dose escalation (UPA15/30), 48.1% [n = 64/133; 95% confidence interval (CI) 39.6-56.6] achieved EASI 90; of patients who received a dose reduction (UPA30/15), 68.5% (n = 89/130; 95% CI 60.5-76.4) maintained EASI 90. Of patients who continued on their initial dose, 29.3% (n = 24/82; 95% CI 19.4-39.1) on UPA30/30 achieved EASI 90 and 74.6% (n = 53/71; 95% CI 64.5-84.8) on UPA15/15 maintained EASI 90. At week 24, 32.5% (n = 27/83; 95% CI 22.5-42.6) and 38.0% (n = 38/100; 95% CI 28.5-47.5) of patients on UPA15/30 and UPA30/15, respectively, achieved a worst pruritus numerical rating scale score of 0 or 1 (WP-NRS 0/1), and 20.7% (n = 17/82; 95% CI 12.0-29.5) and 35.0% (n = 35/100; 95% CI 25.7-44.3), respectively, achieved combined EASI 90 and WP-NRS 0/1. At week 24, treatment emergent adverse events were reported in 43.1% (n = 31/72; UPA15/15), 54.2% (n = 78/144; UPA15/30), 61.5% (n = 56/91; UPA30/30) and 48.9% (n = 65/133; UPA30/15) of patients. No malignancies, adjudicated venous thromboembolic events or deaths were reported. CONCLUSIONS:Treatment of moderate-to-severe AD with UPA15 or UPA30, with dose escalation or dose reduction based on achievement of the optimal treatment target of EASI 90 at week 12, demonstrated that both approaches support the achievement and maintenance of EASI 90 at week 24. Overall safety findings were consistent with the known UPA safety profile, with no new safety signals identified.

The presence of global threats such as coronavirus disease 2019 (COVID-19) pandemic could potentially affect the research landscape, particularly that of systematic reviews. The aim of this study was to examine disparities between countries and the role of funding availability in the publication of health-themed systematic reviews. Metadata of published literature was collected from the Scopus database as of June 30, 2023. The dataset was divided into ‘pre-COVID-19 (2017–2019)’ and ‘during COVID-19 (2020–2022)’ by utilizing filter feature of the Scopus search engine. Network visualization of co-authorship was carried out on VoSviewer to identify collaborative patterns between countries. Our results suggest that most of the systematic reviews were published by authors from the United States of America (USA), both in pre-COVID-19 (n=29,463; Total link strength, TLS=32,832) and during COVID-19 (n=35,520; TLS=45,616). During COVID-19, the trend was not much different with the USA (14.6%), the UK (8.8%), and Australia (5%) in the top position among high-income countries. China (12.3%) and Iran (2.4%) topped the upper-middle-income and low-income countries groups. Publications by those who were from low-income countries were in a concerning low number; Ethiopia ranked first in this group only occupied 0.4% of the total publications (n=1,047). Furthermore, the number of publications was proportional to the number of funded studies (as observed in the top countries). However, during COVID-19 pandemic, the proportionality between funded publications and total publications was observed less. Taken altogether, our findings stress the importance of capacity building and providing more funds for on-desk research to close the disparity among countries.

OBJECTIVES:To describe disease burden in individuals with moderate-to-severe atopic dermatitis (AD) in Australia and New Zealand (ANZ) and compare it with other geographic regions. METHODS:This multicentre, cross-sectional, observational study (MEASURE-AD) recruited consecutive adolescent and adult patients attending dermatology clinics in 28 countries. Data collected included scores of pruritus, disease severity, sleep, pain, disease control, work and quality of life. RESULTS:This study included 112 ANZ participants (Australia n = 72; New Zealand n = 40) from December 2019 to December 2020. Treatments included topicals (85.7% of patients), non-biologic systemic therapy (28.6%), phototherapy (9.8%) and dupilumab (4.5%). Mean Eczema Area and Severity Index (EASI) score was 22.3 (95% CI 19.6-25.0) and Patient-Oriented Eczema Measurement (POEM) score was 18.4 (95% CI 16.8-20.0). Pruritus Numerical Rating Scale (NRS) was 6.0 (95% CI 5.5-6.6) (50% had severe pruritus) and Dermatology Life Quality Index (DLQI) 14.3 (95% CI 12.8-15.8). ADerm-Impact sleep domain score was 15.1 (95% CI 13.2-16.9). ADerm-Symptom Scale worst skin pain domain score was 5.0 (95% CI 4.3-5.6). Work Productivity and Activity Impairment (WPAI) percentages indicated work and productivity impairment. Inadequately controlled AD was self-reported by 41%, with 9.7 flares in the past 6 months. Scores of pruritus, disease severity, sleep, pain, disease control and quality of life in ANZ were often the highest of all the geographic regions studied. CONCLUSION:ANZ patients with AD have a high disease burden, which extends across multiple facets of daily life. Many are inadequately controlled with existing therapies.

IntroductionSolid organ transplant recipients (SOTRs) are believed to have an increased risk of metastatic cutaneous squamous cell carcinoma (cSCC), but reliable data are lacking regarding the precise incidence and associated risk factors.MethodsIn a prospective cohort study, including 19 specialist dermatology outpatient clinics in 15 countries, patient and tumor characteristics were collected using standardized questionnaires when SOTRs presented with a new cSCC. After a minimum of 2 years of follow-up, relevant data for all SOTRs were collected. Cumulative incidence of metastases was calculated by the Aalen-Johansen estimator. Fine and Gray models were used to assess multiple risk factors for metastases.ResultsOf 514 SOTRs who presented with 623 primary cSCCs, metastases developed in 37 with a 2-year patient-based cumulative incidence of 6.2%. Risk factors for metastases included location in the head and neck area, local recurrence, size > 2 cm, clinical ulceration, poor differentiation grade, perineural invasion, and deep invasion. A high-stage tumor that is also ulcerated showed the highest risk of metastasis, with a 2-year cumulative incidence of 46.2% (31.9%-68.4%).ConclusionsSOTRs have a high risk of cSCC metastases and well-established clinical and histologic risk factors have been confirmed. High-stage, ulcerated cSCCs have the highest risk of metastasis.

BACKGROUND:A potential link between isotretinoin and sexual dysfunction has been reported in various studies. However, such an association has not been explored within the context of a literature review until now. OBJECTIVES:To evaluate the methodology and quality of studies investigating this association, and to examine the definitions of sexual dysfunction used. METHODS:A scoping review approach was used to identify peer-reviewed research articles. The search terms used were 'isotretinoin', 'sexual dysfunction', 'erectile dysfunction', 'ejaculatory disorders', 'decreased libido', 'female sexual interest', 'female arousal disorder', 'libido', 'pelvic pain', 'dyspareunia', 'orgasmic disorder', 'impotence', 'ovaries', 'fertility' and 'menstrual irregularity'. RESULTS:In total, 55 peer-reviewed manuscripts were included, consisting of 8 animal studies and 46 human studies with 2420 patients. Of the studies in humans, there were 18 case reports or case series, 2 case-control studies, 4 cross-sectional studies, 6 longitudinal studies, 3 pharmacovigilance reports and 13 cohort studies. The most frequently observed dose range of isotretinoin was 0.5-1.0 mg kg-1 per day, usually for a duration of 1-6 months. More than half of the studies (54%, n = 25) reported a beneficial or neutral effect of isotretinoin on sexual function. The majority of studies (89%, n = 41) were categorized as Oxford Evidenced-Based Medicine level 4. CONCLUSIONS:This scoping review revealed very weak evidence supporting a link between isotretinoin and sexual dysfunction. Notably, the diverse definitions of sexual dysfunction pose a significant challenge for comparative analysis. The authors advocate for a standardized definition of sexual dysfunction and a framework for determining causality in order to contribute to a more comprehensive understanding of the relationship between isotretinoin and sexual dysfunction.

Background Eczema is a chronic, relapsing skin condition commonly managed by emollients and topical corticosteroids. Prevalence of use and demand for effective botanical therapies for eczema is high worldwide, however, clinical evidence of benefit is limited for many currently available botanical treatment options. Robustly-designed and adequately powered randomised controlled trials (RCTs) are essential to determine evidence of clinical benefit. This protocol describes an RCT that aims to investigate whether a mānuka oil based emollient cream, containing 2% ECMT-154, is a safe and effective topical treatment for moderate to severe eczema. Methods This multicentre, single-blind, parallel-group, randomised controlled trial aims to recruit 118 participants from community pharmacies in Aotearoa New Zealand. Participants will be randomised 1:1 to receive topical cream with 2% ECMT-154 or vehicle control, and will apply assigned treatment twice daily to affected areas for six weeks. The primary outcome is improvement in subjective symptoms, assessed by change in POEM score. Secondary outcomes include change in objective symptoms assessed by SCORAD (part B), PO-SCORAD, DLQI, and treatment acceptability assessed by TSQM II and NRS. Discussion Recruitment through community pharmacies commenced in January 2022 and follow up will be completed by mid-2023. This study aims to collect acceptability and efficacy data of mānuka oil based ECMT-154 for the treatment of eczema. If efficacy is demonstrated, this topical may provide an option for a novel emollient treatment. The community-based design of the trial is anticipated to provide a generalisable result. Ethics and dissemination Ethics approval was obtained from Central Health and Disability Ethics Committee (reference: 2021 EXP 11490). Findings of the study will be disseminated to study participants, published in peer-reviewed journal and presented at scientific conferences. Trial registration Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12621001096842. Registered on August 18, 2021 ( https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=382412&isReview=true ). Protocol version 2.1 (Dated 18/05/2022).

The Commission on Human Medicines (CHM) Isotretinoin Expert Working Group recently released a report with several major recommendations. The authors scrutinized the evidence cited by the CHM and presented the case that their recommendations undermine evidence-based medicine and scientific thinking.

Essential oils can be a beneficial adjuvant therapy in managing coronavirus disease 2019 (COVID-19). This systematic review aims to evaluate the efficacy of essential oils in ameliorative COVID-19-related symptoms. Published studies reporting the efficacy of essential oils as adjuvant therapy for COVID-19 were screened on Scillit, Scopus, SciFinder, and PubMed (December 7th, 2022). Inclusion criteria include the randomized controlled trials (RCTs) participated by those diagnosed with COVID-19 and treated with essential oils as adjuvant therapy. Quality assessment was carried out using Cochrane ‘risk-of-bias’ 2.0 tool. A total of 2112 records were retrieved from the initial screening, which was reduced to four publications (n=344 individuals). The foregoing studies reported that essential oils could improve the recovery rate, alleviate post-COVID-19 fatigue, and prevent disease progression. Regarding their potential antiviral activity, better designed studies are needed. In conclusion, essential oils as adjuvant therapy are beneficial in ameliorating mild COVID-19 symptoms.

Australasian Journal of DermatologyVolume 64, Issue 4 p. 579-580 LETTER Burden of proof—Critical flaws in the recommendations from the commission on human medicines Isotretinoin expert working group Eugene Tan MBChB, FACD, Corresponding Author Eugene Tan MBChB, FACD [email protected] orcid.org/0000-0001-7935-9179 Department of Dermatology, Skintel, Auckland, New Zealand Correspondence Eugene Tan, Department of Dermatology, Skintel, 11 Apollo Drive, Rosedale, Auckland 0632, New Zealand. Email: [email protected]Search for more papers by this authorHarriet Kennedy MBChB, FNZDS, Harriet Kennedy MBChB, FNZDS Auckland City Hospital, Te Whatu Ora, New Zealand Faculty of Medical and Health Sciences, University of Auckland, Auckland, New ZealandSearch for more papers by this authorMarius Rademaker DM, FACD, Marius Rademaker DM, FACD orcid.org/0000-0003-3393-6748 Clinical Trials New Zealand, Waikato Hospital Campus, Hamilton, New ZealandSearch for more papers by this author Eugene Tan MBChB, FACD, Corresponding Author Eugene Tan MBChB, FACD [email protected] orcid.org/0000-0001-7935-9179 Department of Dermatology, Skintel, Auckland, New Zealand Correspondence Eugene Tan, Department of Dermatology, Skintel, 11 Apollo Drive, Rosedale, Auckland 0632, New Zealand. Email: [email protected]Search for more papers by this authorHarriet Kennedy MBChB, FNZDS, Harriet Kennedy MBChB, FNZDS Auckland City Hospital, Te Whatu Ora, New Zealand Faculty of Medical and Health Sciences, University of Auckland, Auckland, New ZealandSearch for more papers by this authorMarius Rademaker DM, FACD, Marius Rademaker DM, FACD orcid.org/0000-0003-3393-6748 Clinical Trials New Zealand, Waikato Hospital Campus, Hamilton, New ZealandSearch for more papers by this author First published: 11 October 2023 https://doi.org/10.1111/ajd.14169Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat No abstract is available for this article. REFERENCES 1 Australasian College of Dermatologists. The ACD position statement on isotretinoin for treatment of acne – updated Aug 2023. 2023. Available from: https://www.dermcoll.edu.au/wp-content/uploads/2023/08/ACD-Position-Statement-Isotretinoin-August-2023-Final-version.pdf. Accessed Aug 2023. 2 Commission on Human Medicines. Report of the Commission on Human Medicines Isotretinoin Expert Working Group. 2023. Available from: https://www.gov.uk/government/publications/report-of-the-commission-on-human-medicines-isotretinoin-expert-working-group. Accessed Jul 2023. 3Allen RJ. Burdens of proof. Law Probab Risk. 2014; 13: 195–219. 4Sagan C. The demon-haunted world: science as a candle in the dark. New York, NY: Random House; 1996. p. 160–162. 5Namita K, Ida-Lina D, Allen B, Shewit B, Mark A, Dal Pan G. Progressive multifocal leukoencephalopathy associated with efalizumab use in psoriasis patients. J Am Acad Dermatol. 2011; 65: 546–551. Volume64, Issue4November 2023Pages 579-580 ReferencesRelatedInformation

The recently emerged novel coronavirus, “severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2),” caused a highly contagious disease called coronavirus disease 2019 (COVID‐19). It has severely damaged the world's most developed countries and has turned into a major threat for low‐ and middle‐income countries. Since its emergence in late 2019, medical interventions have been substantial, and most countries relied on public health measures collectively known as nonpharmaceutical interventions (NPIs). We aimed to centralize the accumulative knowledge of NPIs against COVID‐19 for each country under one worldwide consortium. International COVID‐19 Research Network collaborators developed a cross‐sectional online survey to assess the implications of NPIs and sanitary supply on the incidence and mortality of COVID‐19. The survey was conducted between January 1 and February 1, 2021, and participants from 92 countries/territories completed it. The association between NPIs, sanitation supplies, and incidence and mortality were examined by multivariate regression, with the log‐transformed value of population as an offset value. The majority of countries/territories applied several preventive strategies, including social distancing (100.0%), quarantine (100.0%), isolation (98.9%), and school closure (97.8%). Individual‐level preventive measures such as personal hygiene (100.0%) and wearing facial masks (94.6% at hospitals; 93.5% at mass transportation; 91.3% in mass gathering facilities) were also frequently applied. Quarantine at a designated place was negatively associated with incidence and mortality compared to home quarantine. Isolation at a designated place was also associated with reduced mortality compared to home isolation. Recommendations to use sanitizer for personal hygiene reduced incidence compared to the recommendation to use soap. Deprivation of masks was associated with increased incidence. Higher incidence and mortality were found in countries/territories with higher economic levels. Mask deprivation was pervasive regardless of economic level. NPIs against COVID‐19 such as using sanitizer, quarantine, and isolation can decrease the incidence and mortality of COVID‐19.

https://data.mendeley.com/datasets/c3pytzc4fz/2 (Open access). Table S1 Table S2 Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

Intelligent measurement nodes offer the opportunity to perform advanced soundscape analysis, instead of just logging the sound pressure level. A model which mimics human auditory system is proposed and applied to analyze urban soundscapes. It is constructed as a combination of two types of neural networks: a Self Organizing Map that allows –after extensive training– to identify cooccurring sound features and a Locally Excitatory Globally Inhibitory Oscillator Network that is able to segregate them. The model takes into account the context of the listener and can be tuned to classify typical sounds of the soundscape at the location of the microphone.