Hidradenitis suppurativa is a common inflammatory skin condition which causes recurrent abscesses, sinuses and scarring in the axillae, groin and inframammary areas. As well as causing significant physical distress due to pain and discharge, the condition impacts psychological well-being with markedly impaired quality of life. Patients suffer pain, embarrassment and psychological distress with impairment of their work and intimate relationships marking it as one of the most distressing dermatological conditions. Numerous studies have documented markers of psychological distress encompassing the physical effects such as pain and itch, affects on mood and impaired function.

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.

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Cosmetic tattooing involves the insertion of pigment into the dermis in order to create a permanent makeup and enhance one's appearance. Several adverse reactions have been described secondary to these procedures: allergic contact dermatitis, granulomatous inflammation, infection, and phototoxicity. 1-3 Red pigment is most commonly implicated in granulomatous reactions. 4 Inks usually contain diluents and preservatives, glycerin or ethanol, which facilitate the dyeing process of the skin. The most commonly reported reactions are tenderness and itching associated with allergic reactions and bumps secondary to granulomatous reactions.

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We report the case of a 53-year-old man who presented with multiple large areas of thickened, hyperkeratotic, papillomatous filiform fissuring plaques involving multiple fingers consistent with severe palmar warts (Fig. 1). The lesions had been present for 6 years, and were recalcitrant to previous topical treatments. The lesion had previously been smaller and managed with cryotherapy in primary care but this approach was no longer effective. The patient was otherwise generally well and was not immunosuppressed.We performed two 4-mm punch biopsy incisions in the central area of the plaques. Approximately 2 mL of 1% lidocaine with no epinephrine was used as local anaesthetic. The incisions were made to the depth of the dermis until a small amount of bleeding was elicited while the punch incision 'plug' was left in situ. The wound was covered with petroleum jelly and a self-adhesive absorbent dressing, which was kept in place for 48 h and then removed to allow for wound cleaning with cooled boiled water. A new dressing was replaced daily until the wound was dry and scabbed (7-10 days). The patient reported minimal pain during recovery and noted remission beginning from Week 2 with clearance of the large plaques by Week 6 after the procedure (Fig. 2a,b). There had been no recurrence of the large plaques at the 6-month follow-up.Verruca vulgaris (common wart) is a benign hyperkeratotic proliferation of the epidermis caused by the

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-

A woman in her 30s with severe BD presented with a new onset of painful and pruritic facial eruption during the early third trimester of her pregnancy. It progressively extended to her neck and upper arms.