Michelle Murphy

University College Cork | UCC · Department of Medicine

Background Lichen sclerosus (LS) is a chronic inflammatory skin condition that most commonly affects the vulva and can significantly affect quality of life. While websites and social media can offer helpful information, there is little known about the content of misinformation on LS online. Objectives This study aimed to qualitatively assess the c...

Background: Alopecia is common and can lead to significant distress for patients. Patients often seek medical information on the Internet, which may leave them susceptible to misinformation from poor-quality sources. The aim of this study was to qualitatively assess misinformation available online related to alopecia. Summary: Several alopecia-rela...

This book is dedicated to everyone affected by vulvar lichen sclerosus (LS). Our aim is to provide comprehensive education and support to all who navigate this condition, emphasizing the importance of inclusive and respectful healthcare. Throughout the book we have referred to women and girls, reflecting that most people affected by vulvar LS ident...

Melanoma of the foot can masquerade as ulcerative conditions, congealed blood and trauma. Thus, even for experienced clinicians, diagnosis can prove challenging. There is a paucity of evidence about the role that podiatrists, who are routinely exposed to patients’ lower limbs, play in melanoma detection. The aim of this study was to assess the awar...

Atopic dermatitis (AD) commonly presents in infancy and is characterized by dermatitis, itch and sleep disturbance. The burdens of disease and treatment in AD are very high. Caregivers of infants with AD are loaded with provision of medical care, emotional distress and sleep disruption. The aim of this study was to assess the sleep of parents of in...

Hair loss, or alopecia, is a major issue worldwide, and can be associated with negative psychological effects. Patients often use the internet and social media to research health-related issues. Health misinformation can confuse patients and have a negative impact on decision making, leading patients to search for illogical ‘causes’ and seek ground...

Melanoma of the foot can masquerade as ulcerative conditions, congealed blood and trauma. Thus, even for experienced clinicians, diagnosis can prove challenging. There is a paucity of evidence about the role that podiatrists, who are routinely exposed to patients’ lower limbs, play in melanoma detection. The aim of this study was to assess the awar...

Background The incidence of melanoma continues to rise in Ireland. Skin cancer prevention campaigns rely on promoting knowledge to improve sun‐related behaviour. Objectives To explore beliefs, behaviours, and attitudes towards tanning, and confidence in identifying signs of melanoma in the Irish population. Methods A cross‐sectional study was per...

The burden of treatment (BOT) related to propranolol treatment for infantile hemangiomas (IH) has never previously been explored. A modified validated questionnaire, the Treatment Burden Questionnaire, and one‐on‐one semi‐structured interviews were used to assess the BOT for propranolol for IH. Out of 80 caregivers, the overall burden score was ver...

Background Rituximab (RTX) has been utilised off‐label for a variety of dermatological indications beyond pemphigus vulgaris. Efficacy has been reported in other immunobullous disorders, inflammatory dermatoses and connective tissue diseases. Objectives To assess the off‐label use of RTX in our centre with respect to indications, frequency and dur...

Background Targeted biologic therapies have revolutionised the treatment of severe atopic dermatitis (AD). Objectives To assess effects of dupilumab on patient re‐engagement, quality of life (QOL), and burden of treatment (BOT) in severe AD. Methods Adults on dupilumab for AD completed questionnaires on QOL, BOT, and provided qualitative reflecti...

Introduction/Background Atopic dermatitis (AD) is a common chronic inflammatory skin disease with significant unmet needs globally.¹ European prevalence rates range from up to 8% and 20% of adults and children respectively.² In the E.U., a 12-month prevalence of AD has been reported at 4.4%.⁴ Self-reported moderate-to-severe AD affects between 46-6...

Introduction Atopic dermatitis (AD) is associated with sleep disruption due to pruritus, inflammation, increased transepidermal water loss (TEWL) and circadian alterations. Little is known about the impact of AD on sleep in early infancy, a critical time for neurodevelopment. The aim of this study was to deeply characterise the sleep architecture o...

This letter to the editor explores artificial intelligence as it intersects with dermatology as a speciality. While we may readily imagine a dermatoscope that picks up melanoma, how will the robots fare with vulval dermatoses? We explore the current landscape and make suggestions for how we can control what the future looks like.

Health misinformation is pervasive on the internet and social media, and can have wide-ranging and devastating repercussions. Burn injuries are highly prevalent, especially in resource-poor countries with less rigorous health and safety regulations and reduced access to quality healthcare, and especially among the pediatric population who rely on c...

Introduction The chronic inflammatory skin disease Hidradenitis suppurativa (HS) is strongly associated with Crohn’s Disease (CD). HS and CD share clinical similarities and similar inflammatory pathways are upregulated in both conditions. Increased prevalence of inflammatory disease in industrialised nations has been linked to the Western diet. How...

Background Acne is associated with a significant burden of disease related to the visual impact of facial lesions, symptoms such as pain, and sequelae such as scarring. However, little research has been performed on the acne‐specific burden of treatment (BOT), defined as the workload of healthcare as well as its impact on functioning and well‐being...

Rosacea is a common chronic inflammatory skin disease with a complex etiology and major psychological impact, rendering patients susceptible to misinformation. We aimed to assess the content of rosacea-related misinformation online. A formal review of PubMed was performed, using the terms 'rosacea' AND 'misinformation' OR 'disinformation' OR 'consp...

Swimming is an excellent form of aerobic exercise and is an essential life skill. Many children with atopic dermatitis (AD) are advised not to swim because of concerns about negative impacts on their skin disease, and some children with AD do not swim because they are self-conscious about the appearance of their skin. We aimed to review the availab...

A 5-month-old infant presented with a 3-month history of a dramatic periorofacial and acral dermatitis associated with recurrent infections, increasing lethargy and poor feeding. He was born at full term, breastfed exclusively, and had no family history of skin disease. Serum alkaline phosphatase was 41 (range 82–383) and zinc levels were undetecta...

Misinformation in healthcare is now at crisis level worldwide, with the internet as the primary source of prevarication. Topical corticosteroids (TCS) are a safe and effective treatment used in multiple conditions in paediatric dermatology. Nonadherence to prescribed TCS can be due to phobia secondary to misinformation, and poor compliance is a com...

Lichen sclerosus (LS) of the vulva is a chronic inflammatory disease that can severely impact the quality of life. Ultrapotent topical corticosteroids are the mainstay of treatment. Hesitancy to use topical corticosteroids adequately and uncertainty around the correct treatment application can lead to failure. We sought to address this by introduci...

Acne vulgaris is a common skin condition resulting in a significant personal burden to patients. Although the burden associated with the disease itself has been well reported, there is a paucity of data examining the burden of treatment (BOT) in acne. We performed a prospective single-centre study in a tertiary dermatology department in Ireland. Pa...

Atopic dermatitis (AD) has a devastating impact on quality of life, and persistent AD affects at least 7% of adults. Until recently, options for severe AD beyond topical therapies were limited to phototherapy and conventional immunosuppressive systemic drugs. With the advent of highly effective targeted treatments such as dupilumab and Janus kinase...

Moderate-to-severe atopic dermatitis (AD) has a significant impact on quality of life (QoL). The emergence of biologic agents has changed the treatment landscape for those with severe disease. Adult patients on biologic treatment for moderate-to-severe AD were invited to complete written questionnaires during scheduled clinical care. Questionnaires...

Trisomy 21 (T21) is strongly associated with autoimmune disease, including psoriasis. Little is known about biologic outcomes for severe psoriasis in T21. T21-associated immune dysregulation has implications for efficacy, safety and drug survival of biologic medications. The aim was to review the outcomes of patients with T21 and severe psoriasis t...

Rapid-access clinics are designed to improve the early detection and prognosis of melanoma, but there is little hard evidence in the literature of their effectiveness. We established a pigmented lesion clinic (PLC) in 2002 and have previously demonstrated a subsequent reduction in melanoma thickness at our hospital. We undertook a retrospective coh...

Little is known about biological outcomes for severe psoriasis in trisomy 21 (T21). Our aim was to review outcomes of patients with T21 and severe psoriasis treated with biologic or Janus kinase inhibitors (JAKi). Information on demographics, co-morbidities, and therapeutic responses was retrospectively collated. Twenty-one patients were identified...

Background: Lupus comprises a complex group of inflammatory disorders including cutaneous lupus erythematosus (CLE) and systemic lupus erythematosus (SLE). The issue of health misinformation is increasingly problematic, although the content of misinformation related to lupus available online has not been deeply explored. This study aimed to qualit...

A second‐born breastfed infant presented with zinc deficiency. His mother had a novel heterozygous mutation in SLC30A2. A previous baby did not have zinc deficiency but the mother had taken a proton pump inhibitor (PPI) during the second pregnancy. Antenatal PPI exposure may plausibly contribute to transient infantile zinc deficiency. image

Swimming is an excellent form of aerobic exercise and is an essential life skill. Many children with atopic dermatitis (AD) are advised not to swim because of concerns about negative impacts on their skin disease, and some children with AD do not swim because they are self-conscious about the appearance of their skin. We aimed to perform a narrativ...

We present a case of a second-born breastfed infant presenting with zinc deficiency whose mother was found to have a novel heterozygous mutation in SLC30A2. A previous baby did not have manifestations of zinc deficiency but the mother had taken a proton pump inhibitor during the second pregnancy.

Misinformation in healthcare is at crisis level worldwide, with the internet as primary source of prevarication. Topical corticosteroids (TCS) are a safe and effective treatment used in multiple dermatological conditions. Nonadherence to prescribed TCS can be due to phobia secondary to misinformation. TCS phobia is a complex multifaceted phenomenon...

Background: Poor oral health (OH) is a risk factor for systemic disease and lower quality of life (QoL). Patients with inflammatory dermatologic/rheumatologic diseases report more oral discomfort, dry mouth, and periodontal disease than controls. Medications used to treat these conditions can also adversely affect OH. Objectives: The aim was to...

Background Atopic dermatitis (AD) is the most common chronic inflammatory skin condition in childhood. Most (50-60%) children with AD report sleep disturbance, which is secondary to itch, dry skin, inflammation, and abnormal circadian rhythm. Sleep is essential for brain development, learning, and growth. Sleep disruption in early life is associate...

Oral

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 deta...

Misinformation is a worldwide threat and can lead to worse outcomes for patients with skin cancer. The aim of this study was to qualitatively assess the content of online misinformation related to skin cancer. Searches were performed via PubMed and Google using the terms “skin cancer” OR “melanoma” OR “non‐melanoma skin cancer” OR “SCC” OR “BCC” AN...

Dear Editor, ‘Bailíonn brobh beart’ – small investments yield riches (Irish proverb). The City of Dublin Skin and Cancer Hospital Charity (CDSCHC) was established in 2006 following the closure of the City of Dublin Skin and Cancer Hospital on Hume Street in Dublin, Ireland.¹ In 2008, the CDSCHC, in partnership with University College Dublin, founde...

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 regarding their appearance, and high internet usage. This study ai...

Background Burden of treatment (BOT) is the workload of healthcare experienced by patients with chronic conditions and consequences on well-being. This study aimed to assess the BOT of atopic dermatitis (AD) on children and caregivers using mixed methods. Methods The quantitative component of this mixed methods study involved the Treatment Burden...

Psoriasis is a chronic, hereditary disease with a complex immunopathogenesis rendering it susceptible to misinformation. Misinformation related to psoriasis can have negative effects on both the public perception of psoriasis and patients’ knowledge of psoriasis. To characterize misinformation related to psoriasis available online, we performed a f...

The COVID‐19 pandemic has required new ways of working in dermatology. 1 Men over 50 years of age are at higher risk of mortality from melanoma, potentially due to poorer engagement with awareness and prevention campaigns, and delayed presentation. 2 Skin cancer clinical nurse specialists (SCCNS) provide an essential role in education, guidance, an...

We describe the cases of two immunocompetent children who developed mucositis with oral, ocular, and genital involvement during acute COVID-19 illness. The pattern of mucosal involvement with no other cutaneous involvement was consistent with reactive infectious mucocutaneous eruption (RIME). No other intercurrent infections or new medications were...

To assess Irish dermatologists’ confidence with dermatology in patients with skin of colour (SOC), an online survey was distributed to all members of the Irish Association of Dermatology (IAD) by email. Half (50%) of respondents were ‘not confident’ or ‘not at all confident’ in diagnosing skin conditions and one‐third (33.9%) were ‘not confident’ o...

Conflict of interest: the authors declare that they have no conflicts of interest. Dear Editor, Lichen sclerosus (LS) is a chronic inflammatory dermatosis that predominantly affects the anogenital region. The diagnosis of LS is a clinical one, and a confirmatory biopsy is not always required if typical clinical features are present. A biopsy is rec...

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease characterized by the formation of nodules, abscesses, and fistula at intertriginous sites. The skin-gut axis is an area of emerging research in inflammatory skin disease and is a potential contributory factor to the pathogenesis of HS. 59 patients with HS provided fecal samples, n...

This study highlights a significant reduction in carbon emissions secondary to the wholesale adoption of teledermatology during the period of national lockdown. It also shows the considerable time saving afforded to patients by implementing teledermatology. We believe our data is representative of the environmental benefits that teledermatology cou...

The beneficial effects of isotretinoin in treating acne vulgaris are mediated through reduced sebum production. Excessive xerosis at other sites can manifest as dermatitis, cheilitis, rhinitis sicca, and blepharitis. The presence of cyanoacrylates in adhesives may cause diagnostic confusion in patients who develop blepharitis following application...

Our findings call into question the current mechanism of providing Sunscreen funding for OTR in Ireland. There is poor awareness of the scheme amongst Community Pharmacists (49%), as well as low levels of uptake, with only 29% having applied to the scheme on behalf of a patient. Considerable frustration is felt by Pharmacists, with issues involvin...

COVID‐19 has transformed healthcare delivery globally. The main benefits of teledermatology are reported to be patient convenience and resource efficiency. 1 The environmental benefits of teledermatology have rarely been considered. Our group has previously highlighted the environmental benefit of dermatology outreach clinics. 2 We performed a cros...

Misinformation is one of the greatest threats to global health. Atopic dermatitis (AD) is a common skin disorder with a complex multifactorial aetiology, rendering it susceptible to misinformation. Little is known about the content of misinformation regarding AD online. We performed a review of misinformation related to AD available online, via Pub...

Dear Editor, Misinformation has been a major global challenge in the COVID‐19 pandemic. Several therapies relevant to dermatology have been falsely touted as beneficial, including hydroxychloroquine

Full skin examination (FSE) may improve the detection of malignant melanoma (MM). The objective of this study was to assess the safety of targeted lesion examination (TLE) compared to FSE in our pigmented lesion clinic (PLC). Patients attending PLC were randomised in a 2:1 ratio to FSE (intervention) or TLE (standard care). Demographic details and...

Lan et al recently highlighted the under‐representation of older adults in clinical trials of systemic therapies for atopic dermatitis (AD). Late‐onset AD is increasingly recognised in older adults. Spontaneous remission is uncommon with this phenotype. Existing drug treatments such as corticosteroids, methotrexate, ciclosporin, and azathioprine ar...

Genito‐urinary medicine (GUM) is a high‐volume, outpatient‐based specialty, predominantly involving healthy young people. Our GUM clinic is the largest in south‐west Ireland, with a broad catchment area. We outline the changes made to optimise safety and enhance efficiency during the COVID‐19 pandemic.

Organ transplant recipients (OTR) have an increased risk of keratinocyte cancers (KC), with a standardised incidence ratio of 6.3 for squamous cell carcinoma and 3.2 for basal carcinoma observed among an Irish cohort. ¹ Sunscreen use reduces the rate of KC among OTR by reducing exposure to solar ultraviolet radiation. 2, 3, 4 High SPF sunscreen is...

Dermatological issues are uniquely represented among certain visually‐driven social media platforms, presumably owing to the impact of skin‐health on the self‐esteem and outward appearance.¹ From a dermatology health‐promotion perspective, familiar platforms (SnapchatTM, InstagramTM)2,3 have been evaluated; TikTokTM is yet to be explored.

“All’s changed, changed utterly” – WB Yeats The COVID‐19 pandemic has had a monumental impact on healthcare delivery. Dermatology is a high‐volume, outpatient‐based, visual specialty, with complex patients and therapies. We summarise the adaptations in a dermatology department in Cork, Ireland, to enhance safety and streamline practice (Figure 1).

Lichen sclerosus (LS) is a chronic inflammatory dermatosis that predominantly affects the anogenital region. Potential complications of vulvar LS include scarring, loss of architecture and vulvar squamous cell carcinoma (SCC). It has been suggested that individualised treatment regimens with long‐term topical corticosteroid (TCS) may modify the cou...

The arrival of Covid-19 in early 2020 posed a unique challenge for Dermatology, a largely outpatient based and highly visual specialty. We, a large Dermatology Department based in the south of Ireland, recognised that a dramatic reduction in face-to-face interaction must be delivered on a tight timeline to ensure patient and staff safety. The resp...

The arrival of Covid-19 in early 2020 posed a unique challenge for Dermatology, a largely outpatient based and highly visual specialty. We, a large Dermatology Department based in the south of Ireland, recognised that a dramatic reduction in face-to-face interaction must be delivered on a tight timeline to ensure patient and staff safety. The resp...

The Haemangioma Investigator Group has published guidance on management of infantile haemangiomas (IH) during the COVID19 pandemic, advising tele-triage or virtual visits to stratify risk. Our centre in Ireland has co-ordinated a national electronic photo-triage system since November 2016 to facilitate rapid assessment and urgent treatment of infan...

Alden et al assert isotretinoin and alitretinoin are contraindicated in nut allergic patients unless tested using the proposed protocol. We feel this is an unsupported step, limiting treatment options for adolescents with two very common conditions: nut allergy and acne. The index case’s eye and lip swelling occurring very late (12 hours) after iso...

Covid‐19 has resulted in unprecedented global disruption. As this global pandemic persists with no end in sight, we must not ignore its impact on undergraduate medical education. Dermatology undergraduate exposure is variable, limited and often suboptimal. It has been shown that medical students and qualified doctors are not adequately confident in...

Lichen sclerosus (LS) is a chronic inflammatory dermatosis that predominantly affects the anogenital region. First line treatment is with topical clobetasol propionate 0.05%. Vulval LS is associated with a risk of progression to vulval squamous neoplasia, which is estimated to occur in approximately 1-5% of patients.1 It has been shown that individ...