Explore the vast range of titles available.

•The specific dermatoses of pregnancy include AEP, PEP, PG and PPP. In most cases, symptoms resolve after delivery.•Pruritus is a common feature of all four PSDs and treatment is generally supportive with antihistamines, topical emollients and topical corticosteroids.•Many parents are anxious about the safety of medications. Educating patients about the use of certain medications in pregnancy can aid with compliance.•A helpful resource is the BUMPS website (https://www.medicinesinpregnancy.org/) which provides evidence-based information about use of medicines in pregnancy and the British Association of Dermatologists patient information leaflets (https://www.bad.org.uk/patient-information-leaflets/).•Always consider early referral to your local dermatology and obstetric departments for advice and guidance. Pregnancy is associated with a wide range of cutaneous changes. Some are physiological and triggered by normal hormonal fluctuations during pregnancy. There are also a small number of pathological pruritic eruptions that exclusively occur during pregnancy, known as pregnancy-specific dermatoses (PSDs). In patients presenting with a PSD, features often include severe pruritus and characteristic inflammatory skin changes differing in onset, morphology and configuration. This article gives an overview of benign dermatological changes during pregnancy and the most important presentations of PSDs in order of prevalence: atopic eruption of pregnancy, polymorphic eruption of pregnancy, pemphigoid gestationis and pustular psoriasis of pregnancy. Importantly, we outline how a resident physician can identify these disorders, how to initiate management and when a specialty referral for further investigations and monitoring of the mother and unborn fetus is warranted.

Dermatophytosis (or ringworm) is a highly infectious zoonotic disease commonly found in humans and multiple animal species globally. With children under 5 years of age being the most at risk human patient group, and dermatophytosis the zoonosis most frequently contracted by veterinary professionals in the UK from their patients, it is of significance to both human and animal patients. Little is known as to whether there is recognition in both human medical and veterinary guidance of the importance of their opposite clinical counterpart. In addition, it is unknown whether the recommendations for zoonotic disease management and prevention are complementary between the two disciplines. The aim of this scoping review was to assess all human medical and veterinary guidelines pertaining to zoonotic dermatophytosis, to explore how the zoonotic aspects of the disease were reported and to determine if there was conflicting or complementary advice between the two disciplines on disease management and prevention. Sources of evidence: Medline, CAB Abstracts, and Embase were searched for relevant literature and the results assessed and filtered using inclusion and exclusion criteria. A targeted grey literature search was also performed. To be included, broadly all publications had to mention dermatophytes or specifically named dermatophyte species, and mention 'guidelines' or 'protocols'. Publications needed to also mention terms relating to 'zoonoses'; for veterinary publications, be focused on cattle, dogs and cats and for human medical publications, mention the clinical manifestation of dermatophytosis (e.g. tinea capitis). Some mention of risk factors for zoonotic transmission needed to also be included. A data charting form was used to extract data pertaining to dermatophyte species discussed, animal species discussed, prevalence and risk factors, zoonotic risk factors, zoonotic recommendations for humans, transmission, diagnostic testing, treatment, monitoring response to treatment, and prevention and management from the included studies. A critical appraisal process using the AGREE II tool was conducted to identify the common limitations of the shortlisted published papers. Of the 554 human and 137 veterinary publications screened, 5 of each publication source met the inclusion criteria. Although data were charted across several variables, none of the publications used an evidence-based guideline approach in their construction (e.g. GRADE, AGREE processes) and a significant proportion of papers provided limited supporting evidence for their recommendations. There were significant gaps and minimal synergies between veterinary and human medicine recommendations. The human literature had limited information pertaining to zoonotic recommendations. A minimal number of studies have been conducted regarding zoonotic dermatophytosis, both in human medical and veterinary disciplines. There is a lack of good quality, detailed information about the prevention and management of the zoonotic aspects of the disease, indicating that there is a need for the development of evidence-based guidelines to support human and veterinary clinicians making decisions about these patients. Evidence-based guidelines, inclusive of high quality information pertaining to the zoonotic aspects of the disease for both humans and animals, should be generated. Ideally human and veterinary representatives would work together to generate cohesive and complementary guidance.

IntroductionCellulitis is a common bacterial skin infection causing significant pain, swelling and impact on daily activities, frequently leading to emergency department presentations and hospital admissions. While antibiotics are the mainstay of treatment, they do not directly address inflammation, often resulting in persisting or worsening symptoms in the initial days. Corticosteroids, with their potent anti-inflammatory effects, have shown benefit in other acute infections but are not currently standard care for patients with cellulitis. This trial aims to determine if adjunctive oral dexamethasone can reduce pain and improve outcomes in adults with cellulitis presenting to UK urgent secondary care settings.Methods and analysisThis is a pragmatic, multicentre, double-blind, placebo-controlled, randomised, parallel group, phase 3 superiority trial, with an internal pilot and parallel health economic evaluation. Adult patients (≥16 years) with a clinical diagnosis of cellulitis (at any body site except the orbit) presenting to urgent secondary care will be screened for eligibility. 450 participants will be randomised (1:1) to receive either two 8 mg doses of oral dexamethasone or matched placebo, administered approximately 24 hours apart, in addition to standard antibiotic therapy. The primary outcome is total pain experienced over the first 3 days postrandomisation, calculated using the standardised area under the curve from pain scores (Numerical Rating Scale 0–10) across up to seven timepoints. Secondary outcomes include health-related quality of life (EuroQol 5 Dimension 5 Level), patient global impression of improvement, analgesia and antibiotic usage, hospital (re)admissions, complications, unscheduled healthcare use, cellulitis recurrence and cost-effectiveness at 90 days. The primary estimand will apply a treatment policy approach to intercurrent events.Ethics and disseminationThe trial has received ethical approval from South Central—Oxford B Research Ethics Committee (reference: 24/SC/0289) and will be conducted in compliance with Good Clinical Practice and applicable regulations. Informed consent will be obtained from all participants. A model consent form can be seen in online supplemental file S1. Findings will be disseminated through peer-reviewed publications and conference presentations, and to patient groups and relevant clinical guideline committees.Trial registration numberISRCTN76873478.

We aimed to capture UK medical students’ preferences regarding skin color terminology in medical education and in relation to how they describe their own skin tone, to better understand how we can develop more inclusive, diverse medical language for both educational and clinical settings.

Doctors-in-training often receive an inadequate dermatology education. Furthermore, studies have highlighted the under-representation of skin of colour (SOC) in dermatological teaching, learning resources and research. Our image-based questionnaire, distributed to all internal medicine trainees in southwest England, highlighted knowledge gaps regarding SOC among training physicians. It is intrinsically more challenging for clinicians to confidently formulate dermatological diagnoses in SOC. In this review, we provide guidance for physicians to help make the diagnostic process more straightforward. First, we outline how skin colour is determined and classified. We discuss how inflammation presents in SOC, with the typical 'erythema’ that physicians often associate with inflammation being a less prominent feature in darker skin tones. We then summarise nine important conditions that we believe physicians working in all specialties should be able to identify in patients with SOC, covering both conditions encountered on the medical take and conditions disproportionately affecting individuals with SOC. The population of the UK is rapidly diversifying; thus, as physicians, we have a professional duty to educate ourselves on dermatological conditions in SOC to provide the best quality of care for all our patients, regardless of their skin type.

BackgroundStevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are rare but potentially life-threatening skin reactions, commonly associated with drugs. They are part of the same disease spectrum and characterised by painful blistering and shedding of the skin. There is currently no systematic review assessing non-genetic risk factors for the development of drug-induced SJS/TEN. This is important because SJS/TEN has high mortality and morbidity.The primary objective of this systematic review was to pool the relative risk of non-genetic risk factors for the development of drug-induced SJS/TEN. The secondary objective was to provide separate pooled estimates for males and females.MethodsThe protocol was prospectively registered on PROSPERO on 2nd September 2022. Medline, EMBASE, and grey literature databases were searched, with no language or date restrictions. Cohort, cross-sectional and case-control studies were included. A control group, such as people with a different skin condition, was part of the inclusion criteria. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were adhered to. Title and abstract screening, full-text screening and quality assessment were conducted by two researchers independently. Critical appraisal was conducted using the Joanna Briggs Institute criteria. Three domains, indicative of exposure validity, outcome validity and confounding were used to identify high-quality studies. Random-effects meta-analysis was conducted for each risk factor with two or more sufficiently homogeneous studies. Heterogeneity was assessed with I2.ResultsThis systematic review included 15 papers, and these all had a high risk of bias. Of the 15, five were included in meta-analysis. The control groups were patients with Erythema Multiforme (EM) or Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS). In the five papers, the number of cases of SJS/TEN ranged between 48 and 384. We found male gender and positive HIV status to significantly increase the risk of development of SJS/TEN, compared to EM, with pooled risk ratios of 1.24 (95% CI 1.01–1.54) and 1.70 (95% CI 1.32–2.20), respectively. I2 was low for both meta-analyses. Gender, diabetes, liver disease, chronic kidney disease, infection, malignancy, and hypertension were not significant risk factors (p>0.05) when the control group was patients with DRESS. There was insufficient data to estimate separate risk ratios for males and females.ConclusionMales and people with HIV have a statistically significant, increased risk of developing SJS/TEN following drug administration, compared to developing EM. Further research is required at a population-level with large sample size, healthy controls, and appropriate study design, to minimise bias.

IntroductionDecentering describes the ability to voluntarily adopt an objective self-perspective from which to notice internal, typically distressing, stressors (eg, difficult thoughts, memories and feelings). The reinforcement of this skill may be an active ingredient through which different psychological interventions accrue reductions in anxiety and/or depression. However, it is unclear if decentering can be selectively trained at a young age and if this might reduce psychological distress. The aim of the current trial is to address this research gap.Methods and analysisAdolescents, recruited from schools in the UK and Ireland (n=57 per group, age range=16–19 years), will be randomised to complete 5 weeks of decentering training, or an active control group that will take part in a combination of light physical exercise and cognitive training. The coprimary training outcomes include a self-reported decentering inventory (ie, the Experiences Questionnaire) and the momentary use of decentering in response to psychological stressors, using experience sampling. The secondary mental health outcomes will include self-reported inventories of depression and anxiety symptoms, as well as psychological well-being. Initial statistical analysis will use between-group analysis of covariance to estimate the effect of training condition on self-rated inventories, adjusted for baseline scores. Additionally, experience sampling data will be examined using hierarchical linear models.Ethics and disseminationThis study was approved by the Cambridge Psychology Research Ethics Committee, University of Cambridge (PRE.2019.109). Findings will be disseminated through typical academic routes including poster/paper presentations at (inter)national conferences, academic institutes and through publication in peer-reviewed journals.Trial registration numberISRCTN14329613.