Heterozygosity for nonfunctional mutations in the FLG gene may contribute to the manifestation and maintenance of a particular CHE subtype that is characterized by the combination of allergic and irritant contact dermatitis.

Dietary change may play a role in the therapy of rosacea. Certain foods and beverages may act as “triggers” for rosacea exacerbations. These may be divided into heat-related, alcohol-related, capsaicin-related, and cinnamaldehyde-related. One potential pathogenic mechanism may be via the activation of transient receptor potential cation channels, which result in neurogenic vasodilatation. Further research is needed on the role of the gut skin connection in rosacea. Epidemiologic studies suggest that patients with rosacea have a higher prevalence of gastrointestinal disease, and one study reported improvement in rosacea following successful treatment of small intestinal bacterial overgrowth. While further research is required in this area, patients may be advised on measures to support a healthy gut microbiome, including the consumption of a fiber-rich (prebiotic) diet.

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Background Obstructive sleep‐disordered breathing (OSDB) is very common in children. Adenotonsillectomy is usually curative, but there is emerging evidence that topical nasal steroids can also be effective for some children and may avoid the need for surgery. The number of children referred for assessment of OSDB is increasing and in some departments, waiting times are long. We established a paediatrician‐led clinic for assessment and initial medical management of OSDB and in this study we report the proportion of children who avoided the need for surgery. Method Referral letters to the otolaryngology department were screened and those with suspected OSDB and no significant co‐morbidities were diverted to the paediatrician‐led clinic. We recorded data for a consecutive series of children seen in this clinic with suspected OSDB over a 3‐month period. Parents completed a 5‐item subset of questions from the OSA‐11 questionnaire before and after treatment with 6 weeks of topical nasal steroids. Results In the 3‐month study period, 103 children were seen, with a mean age of 6 (range 1‐16). Six (5.8%) had improved spontaneously before clinic attendance. Of the 97 children who were still symptomatic, 17 (17.5%) were referred directly for surgery on the basis of the severity of their symptoms, or because of other coexisting conditions that required surgical treatment (such as recurrent tonsillitis or otitis media). Three declined intranasal steroids. Seventy‐seven had a trial of intranasal steroids, of whom 34 (35%) reported enough improvement to avoid surgery, and 29 (28%) failed to improve and were referred for surgery. Fourteen (14%) failed to attend after the trial of steroids: of these, 5 (5%) were contactable by phone and confirmed improvement after topical steroids. OSA‐5 scores were significantly improved following intranasal steroids. Discussion A paediatrician‐led clinic can be an effective way to ease the workload of an over‐stretched otolaryngology service, and judicious use of topical nasal steroids can help around 40% of children with OSDB avoid surgery.