Burden of treatment in vulval lichen sclerosus.

Lichen sclerosus (LS) is a chronic inflammatory dermatosis predominantly affecting the anogenital region, which can have significant impact on quality of life. Burden of treatment (BOT) is defined as the workload of healthcare experienced by patients and consequences on well-being. In this prospective study, 35 women with vulval LS completed a detailed Treatment Burden Questionnaire to assess their BOT. Nineteen (54.3%) achieved a score of 35 or less, signifying low BOT; ten (28.6%) between 36 and 65, signifying moderate BOT; and six (17.1%) above 65, signifying high BOT. Seven (20%) patients reported BOT scores of greater than 59, which has been designated as a cut-off for increased risk of treatment-related burnout. Higher BOT scores were moderately correlated with higher DLQI scores (r = 0.47, p < 0.01). BOT in LS is low for most patients, although a minority are at risk of treatment-related burnout. BOT should be considered when forming treatment guidelines for LS.

Spotting fake news: a qualitative review of misinformation and conspiracy theories in acne vulgaris.

Acne vulgaris is an extremely common disorder of the pilosebaceous unit, typically manifest as a highly visible facial and upper trunk dermatosis, with teenagers most frequently affected. This cohort is markedly susceptible to misinformation, given their impressionable age, distress about their appearance and high internet usage. This study aimed to assess the content of acne-related misinformation available online. A formal review of PubMed was performed in March 2022, using the terms 'acne' AND 'misinformation' OR 'disinformation' OR 'conspiracy theory', along with an informal Google search using combinations of these terms, and further targeted searches on TikTok, Twitter, Facebook and Instagram. Key themes of acne-related misinformation included diet and other 'causes' of acne, unconventional acne 'cures' and a distrust of conventional acne treatments. Websites promoting misinformation were frequently affiliated with companies selling products that promised to cure acne, often in a remarkably short time. Dermatologists should be aware of the nature of acne-related misinformation available online and be prepared to counter it with scientific principles and facts.

High Levels of Psychological Distress, Sleep Disturbance, and Alcohol Use Disorder in Adults With Atopic Dermatitis.

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.

Refractory pemphigus foliaceous treated with rituximab.

Autoimmune blistering diseases are rare but potentially life-threatening conditions. Pemphigus foliaceus is one of these conditions, characterised by superficial erosions of the skin without mucosal involvement. We report the case of a 57-year-old woman who presented with a 4-week history of rash affecting her scalp with associated hair loss. Clinical and histopathological findings were in keeping with pemphigus foliaceus. She was successfully treated with rituximab, a chimeric monoclonal antibody against CD20, leading to a transient depletion of B cells. After 5 months of follow-up, her rash had cleared, and her hair had completely regrown.