Ashling Courtney

Background: Atopic dermatitis (AD) significantly impacts quality of life, with well‐documented physical and psychological consequences. While disease burden is well characterised, the influence of psychosocial determinants on AD outcomes remains underexplored. This study examines these factors in an Australian paediatric population.Objectives: To investigate whether children from populations at risk of health inequities—such as those from rural areas, culturally diverse backgrounds, First Nations communities, socioeconomically disadvantaged postcodes, those with neuropsychiatric conditions and ‘Vulnerable’ children (defined as those under state or relative care or with a history of familial abuse or neglect)—experience more severe disease.Methods: This retrospective cross‐sectional study included children ≤ 16 years with confirmed AD attending a tertiary paediatric referral centre in Melbourne (Aug 2022—Aug 2023). Risk factors were defined by social determinants of health, including economic, cultural and geographic influences. Disease outcomes (severity, hospitalisations, emergency department visits treatment patterns) were analysed using univariate and multivariate methods. A total of 454 at‐risk children were compared to 454 controls.Results: Children from at‐risk groups were more likely to have severe AD (43.8% vs. 28.3%, p < 0.001), higher annual rates of hospital admissions, increased antibiotic use, and greater prednisolone use for flares (p < 0.001). Multivariate analysis revealed significantly higher odds of severe AD (aMOR 4.72, p < 0.001) and hospitalisation (aIRR 2.73, p < 0.001) in the at‐risk cohort.Conclusion: Psychosocial determinants of health are associated with increased AD severity and healthcare use in children. These findings highlight the need for targeted, equity‐focused interventions to reduce disparities in AD care in Australia.

A 63-year-old man was referred to the dermatology clinic with a 10-month history of progressive erythema, scaling, swelling and pain of his right index finger after a minor gardening injury. This began at the fingertip, extended proximally and led to a reduced range of motion in the distal interphalangeal joint, nail dystrophy and pustulation. What is the most likely diagnosis?

Topical corticosteroids (TCS) have been a cornerstone in managing atopic dermatitis (AD) since their introduction in 1952. Though there are well‐documented adverse effects attributed to their use, the existence of some complications of TCS use, including topical steroid withdrawal (TSW) syndrome, characterised by TCS dependence and skin disease worsening after TCS discontinuation, are more controversial within the dermatology community. There is no consensus on diagnostic criteria for TSW or clarity on its prevalence, natural history and management. Media reports are common and TSW overdiagnosis may lead to steroid phobia, poor adherence to TCS therapy, and unnecessary, increased, and protracted AD flares. This paper reviews the historical context, clinical presentations, challenges in diagnosis and the ongoing debate regarding TSW, with a focus on the implications for patient management and the potential consequences of steroid phobia on treatment adherence.

Objectives: This case series aims to evaluate the demographic features, disease characteristics, and treatment outcomes of 8 patients receiving subcutaneous (SC) adalimumab for severe, refractory vulval lichen sclerosus (VLS) and/or vulval lichen planus (VLP). Both conditions are chronic inflammatory dermatoses that significantly impair quality of life, and although first-line treatment typically involves potent to ultrapotent topical corticosteroids, managing severe cases is challenging due to a lack of FDA-approved systemic therapies. Adalimumab, a TNF-α inhibitor, may offer a promising alternative by targeting the inflammatory cytokine implicated in the pathogenesis of both conditions. Methods: Eight patients received SC adalimumab for VLS and/or VLP at a tertiary referral vulvar disorders clinic from September 2020 to June 2024. Among the 8 patients, 4 had VLS/VLP clinical overlap, 2 had VLP, and 2 had VLS. Evaluation included patient-reported outcome measures (PROMs) namely the vulval life quality index (VLQI) and numerical rating scales for itch and pain, and objective clinical severity was assessed by a vulvar dermatologist based on cutaneous signs and architectural features. Results: Adalimumab was well tolerated by 6 of 8 patients who received treatment for at least 9 months. Varying degrees of clinical improvement were observed in cutaneous signs and PROMs, including significant reductions in vulval life quality index scores for 6 patients. Architectural changes remained stable throughout treatment for all patients. Conclusion: This case series indicates that SC adalimumab may be a treatment option for patients with severe, refractory VLS and VLP, as demonstrated by significant improvements in PROMs. The observed clinical benefits suggest that adalimumab targets key inflammatory pathways in these conditions. Controlled trials are necessary to further validate these findings and define adalimumab's role in managing severe refractory VLS and VLP. Future research should also investigate long-term efficacy and safety, as well as potential predictors of treatment response, to optimize care for this challenging patient population.

Alopecia areata (AA) presents a challenging and unpredictable condition associated with substantial psychosocial and financial burdens. A chronic, relapsing form of non-scarring hair loss, it affects approximately 0.1–0.2% of the population worldwide with a lifetime risk of 1.0% to 2.1%. The psychosocial implications of AA, including its association with depression, anxiety, social phobia, employment disruption, and relationship challenges are well described. Significant economic costs of AA include those of healthcare, lost income, transportation, psychotherapy, and cosmetic accessories (wigs and hairpieces). However, wigs and hairpieces can contribute to enhanced self-esteem, confidence, and overall quality of life (QOL) in AA patients; these positive outcomes correlating with satisfaction in appearance. This article explores the role of wigs in addressing the aesthetic and emotional impact of AA, emphasizing their importance as potential coping mechanisms for individuals facing hair loss whilst also acknowledging possible barriers to their use. Different types of wigs and hairpieces, their respective advantages and disadvantages, and methods of attachment are thoroughly discussed, providing a comprehensive overview for both patients and healthcare professionals. Considering the economic impact of AA, this article explores the cost of wigs in Australia and available financial assistance programs. Wigs can play a pivotal role in rapidly addressing the multifaceted challenges posed by AA, offering time for psychosocial adaptation and delayed response to medical therapies. This review aims to provide valuable insights to inform evidence-based, practical, and personalized counselling of patients with AA and enable shared decision making about the utility of wigs and other cosmetic interventions for hair loss. Further research is warranted to explore differences in the optimal utilization of wigs between diverse sub-populations with AA.

Atopic dermatitis (AD) is a common chronic inflammatory skin condition characterised by pruritus and recurrent eczematous patches and plaques. It impacts sleep and its visibility can lead to stigmatisation, low self-esteem, social withdrawal, reduced quality of life (QOL), and psychological burden. This study explores the relationship between AD and mental health, including possible causation pathways. A literature review was conducted in PubMed without using limiters. AD carries higher odds of suicidality and an increased risk of depression, anxiety, alexithymia, and obsessive–compulsive disorder (OCD) across all severities. While some studies report an association of AD with attention deficit hyperactivity disorder (ADHD), and possibly autism spectrum disorder (ASD), others do not. There is increasing evidence that AD contributes to chronic low-grade inflammation and cognitive impairment (CI). Causative factors for mental health complications of AD likely include both psychosocial and biological variables. AD is associated with higher levels of cutaneous and circulating proinflammatory cytokines; these can breach the blood–brain barrier and trigger central nervous system events, including oxidative stress, neurotransmitter breakdown, altered serotonin metabolism, and reduced neurogenesis in several brain regions. Excessive inflammation in AD may thus contribute to CI, depression, and suicidality. AD providers should be vigilant about mental health.

Atopic dermatitis (AD) is a common, chronic, inflammatory skin disease affecting Australians of all ages, races, ethnicities, and social classes. Significant physical, psychosocial, and financial burdens to both individuals and Australian communities have been demonstrated. This narrative review highlights knowledge gaps for AD in Australian skin of colour. We searched PubMed, Wiley Online Library, and Cochrane Library databases for review articles, systematic reviews, and cross-sectional and observational studies relating to AD in Australia for skin of colour and for different ethnicities. Statistical data from the Australian Institute of Health and Welfare and the Australian Bureau of Statistics was collected. In recent years, there has been substantially increased awareness of and research into skin infections, such as scabies and impetigo, among various Australian subpopulations. Many such infections disproportionately affect First Nations Peoples. However, data for AD itself in these groups are limited. There is also little written regarding AD in recent, racially diverse immigrants with skin of colour. Areas for future research include AD epidemiology and AD phenotypes for First Nations Peoples and AD trajectories for non-Caucasian immigrants. We also note the evident disparity in both the level of understanding and the management standards of AD between urban and remote communities in Australia. This discrepancy relates to a relative lack of healthcare resources in marginalised communities. First Nations Peoples in particular experience socioeconomic disadvantage, have worse health outcomes, and experience healthcare inequality in Australia. Barriers to effective AD management must be identified and responsibly addressed for socioeconomically disadvantaged and remote-living communities to achieve healthcare equity.