Donal O’Kane

• Bachelor of Medicine
• Belfast Health and Social Care Trust

This is a secondary analysis of a multicentre randomised controlled trial of ciclosporin and methotrexate in children and young people (CYP) with severe atopic dermatitis (AD). Longitudinal trough ciclosporin and erythrocyte methotrexate polyglutamates (MTX-PG) concentrations were measured to evaluate their associations with treatment response and...

Background Atopic dermatitis (AD) is the most common inflammatory skin condition which affects all ages. New therapies, including the monoclonal antibody therapy dupilumab, offer excellent efficacy. However, in clinical trials, and emphasised in real-world observations, the unexpected increased frequency of ocular adverse effects became apparent. T...

Ciclosporin (CyA) and methotrexate (MTX) are both frequently prescribed drugs for the treatment of atopic dermatitis in children and young people (CYP). Both can affect renal function and frequent blood monitoring is standard to monitor safety. We show that both CyA and MTX are not associated with decreased renal function and are safe and effective...

Screening for latent tuberculosis (TB) infection is recommended prior to commencing some biologics with QuantiFERON®/interferon gamma-releasing assay (IGRA) and chest x-ray (CXR) recommended on the BAD biologics checklist. QuantiFERON® is highly sensitive while CXR is poorly sensitive and poorly specific. In our cohort of 995 patients, 2.3% had a p...

The British Association of Dermatologists (BAD) 2020 psoriasis biologics guidelines recommend routine screening for latent tuberculosis infection (LTBI) prior to treatment, using a QuantiFERON®/interferon-gamma-releasing assay (IGRA), with consideration of local policy on additional screening using chest X-ray (CXR). QuantiFERON® is highly sensitiv...

Background: Hidradenitis suppurativa (HS) is associated with lower socioeconomic status (SES). The adverse influence of HS on education and employment may explain this. It remains unknown whether HS causes downward social trajectories i.e. social drift, or whether those affected are born into a lower SES. We aimed to assess the influence of HS on...

Background Conventional systemic drugs are used to treat children and young people (CYP) with severe atopic dermatitis (AD) worldwide, but no robust RCT evidence exists regarding their efficacy and safety in this population. While novel therapies have expanded therapeutic options, their high cost means traditional agents remain important, especiall...

Hidradenitis suppurativa (HS) is associated with lower socioeconomic status (SES). Previous studies in Europe, Australia and the USA identified that patients with HS are more likely to be unemployed and have lower mean incomes than the background population. Low SES is inextricably linked with poor health outcomes. The MacArthur scale of subjective...

Patients with hidradenitis suppurativa have a high prevalence of cardiovascular disease risk factors and are at increased risk of major adverse cardiac events. Routine screening for risk factors is recommended but the benefit of this in risk reduction has not been evaluated. In this study of 117 patients attending hospital-based services for HS, th...

This is the first real-world observational study demonstrating the superior efficacy of 2-weekly (Q2W) secukinumab dosing in patients with severe psoriasis greater than 90kg.

This cohort study assesses whether an association exists between biologic treatment for hidradenitis suppurativa and neutrophil-lymphocyte ratio, platelet-lymphocyte ratio, and monocyte-lymphocyte ratio.

Dear Editor, Although mepacrine has been used in the treatment of cutaneous lupus erythematosus (CLE) for over > 50 years,¹ it remains unlicensed in the UK. It bears a degree of structural similarity to hydroxychloroquine (HCQ) and chloroquine, but unlike these medications, mepacrine does not appear to harbour a risk of retinal toxicity. The main a...

Morphoea is a spectrum of disorders characterized by inflammation and sclerosis of the skin and potentially underlying tissues. There are no specific licensed treatments for morphoea and prospective studies on commonly used therapies are lacking. We describe a case of progressive, recalcitrant pansclerotic morphoea with a rapid response to abatacep...

The overall objective of the guideline is to provide up-to-date, evidence-based recommendations for the management of cutaneous lupus erythematosus (CLE) in the presence or absence of systemic lupus erythematosus (SLE) in adults, young people and children. The document aims to: • offer an appraisal of all relevant literature up to December 2020, f...

Background: Dupilumab, a monoclonal antibody against interleukin (IL)-4 receptor alpha that inhibits IL-4/IL-13 signalling is indicated in dermatology for the treatment of moderate-to-severe atopic dermatitis (AD) in adult and adolescent patients 12 years and older and severe AD in children 6-11 years, who are candidates for systemic therapy. Dupi...

EMJ Dermatology EMJ Dermatol. 2020;8[1]:46-47. Abstract Review No. AR2.

Introduction CLE is a chronic inflammatory autoimmune condition of which photosensitivity is a major symptom. Individuals living with CLE are advised to practice photoprotection. Despite the benefits for disease control, many individuals living with CLE do not practice optimal photoprotection. The aim of this study was to gain a deep insight into t...

This study summarises the use of Cutaneous Lupus Disease Area and Severity Index (CLASI) as an outcome measure in clinical studies since its inception. We systematically searched MEDLINE, PubMed, EMBASE and Cochrane databases for papers including the term ‘Cutaneous Lupus Disease Area and Severity Index’ and its abbreviations up to August 2017, ide...

This chapter outlines the basic science and theory of dermatology required for MRCP Part 1, before addressing the clinical aspects of dermatology for MRCP Part 2. To ensure effective revision, material is presented in short sections with bullet lists, tables, and boxes to highlight key facts.

Medicine for MRCP provides a comprehensive review of the material that candidates need to pass the MRCP Parts 1 and 2 written papers. The 27 chapters mapped out to the RCP syllabus, cover all areas from molecular medicine and genetics, through to medical law and ethics. Each chapter begins with the basic science required for Part 1, before covering...

Hydrogel-forming microneedle array patches (MAPs) have been proposed as viable clinical tools for patient monitoring purposes, providing an alternative to traditional methods of sample acquisition, such as venepuncture and intradermal sampling. They are also undergoing investigation in the management of non-melanoma skin cancers. In contrast to dru...

BCC is the most common form of cancer in England and Wales and has an increasing incidence. Black salve is an alternative therapy widely available with reported benefits in skin cancer despite a lack of supporting evidence. We report two patients with resolution of clinical BCC following the use of black salve. A 52‐year‐old gentleman with Gorlin's...

Linked Content This article is linked to Shivaji et al paper. To view this article, visit https://doi.org/10.1111/apt.15097.

Introduction Medical engagement in healthcare organisations can improve service development and patient experience. Doctors in training have limited opportunities to engage in service improvement work and develop leadership skills. Method We describe the Specialist Trainees Engaged in Leadership Programme (STEP), a programme developed to introduce...

Pyoderma gangrenosum (PG) is a rare inflammatory neutrophilic dermatosis often misdiagnosed. It is uncommon in infants and children accounting for 4% of cases. A one-year-old male in paediatric ICU ventilated for bronchopneumonia was referred with ulcerated areas on his neck and axilla corresponding to sites of recent removal of central and arteria...

Epithelial to mesenchymal transition (EMT) is a process whereby epithelial cells undergo transition to a mesenchymal phenotype and contribute directly to fibrotic disease. Recent studies support a role for EMT in cutaneous fibrotic diseases including scleroderma and hypertrophic scarring, though there is limited data on the cytokines and signalling...

Rationale: Increasing epithelial repair and regeneration may hasten resolution of lung injury in patients with the acute respiratory distress syndrome (ARDS). In animal models of ARDS, keratinocyte growth factor (KGF) reduces injury and increases epithelial proliferation and repair. The effect of KGF in the human alveolus is unknown. Objectives:...

Langerhans cell histiocytosis (LCH) encompasses a group of disorders characterized by the proliferation and infiltration of Langerhans cells within internal organs and/or skin. There is often multiorgan involvement; isolated cutaneous LCH is less common. The aetiology of cutaneous LCH remains uncertain, and debate remains as to whether LCH represen...

With a lack of evidence base for individual topical PUVA protocols, treatment is presently based on the consensus of current practice. This audit was designed to investigate the effectiveness of topical PUVA for palmoplantar dermatoses. Phototherapy notes were reviewed on all patients who received hand and/or foot PUVA 2002-2007 in the Northern Hea...