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Drug reaction with eosinophilia and systemic symptoms (DRESS) is a potentially life-threatening adverse drug reaction with a mortality rate of 10%. Interstitial nephritis, pneumonitis, myocarditis, meningitis, thyroiditis and pancreatitis are major causes of morbidity and mortality in this syndrome. Cessation of offending medication is paramount. There is paucity in high quality prospective studies guiding the treatment of DRESS, and there are no published therapeutic clinical trials in the treatment of corticosteroid refractory hypersensitivity myocarditis. The authors present a unique case of ciprofloxacin-induced DRESS with concurrent thyroiditis and refractory eosinophilic myocarditis that required mepolizumab and multiple immunosuppressants for successful treatment.

Background: Merkel cell carcinoma (MCC) is a rare primary cutaneous neuroendocrine tumour. While dermally invasive MCC is known to have a five-year survival of only 30-40%, the prognosis and management of MCC in situ (MCCis) is not widely reported.Objective: We present a systematic review to elucidate the prognosis and management of MCCis. Methods:We performed a systematic review, searching three databases to 01 June 2021. Case reports, cohort studies, clinical trials and literature reviews were considered for inclusion. Results:We identified 26 cases of MCCis published in the literature with a median age of 74 years and involving 19 males and 7 females. Most cases were on the face and neck (n = 17), followed by upper limb (n = 8) and lower limb (n = 1). Sentinel lymph node biopsy was performed in three patients, and all were negative. One subject underwent adjuvant radiotherapy. No MCCis-associated deaths were reported. Conclusion:This review suggests that MCCis has an excellent prognosis with minimal, if any, risk of mortality and a very low risk of dermal invasion and recurrence when treated with wide local excision alone. Sentinel lymph node biopsy is unlikely to be useful for MCCis.

Background Dermatology consultation has been shown to have a significant beneficial impact on admitted hospital patients with concurrent or newly diagnosed skin conditions. This study aimed to determine the change in diagnosis and management after dermatology consultation in a tertiary Australian referral hospital. Methods A retrospective analysis of dermatology consultations for hospital inpatients from June 1, 2018, through November 11, 2019, was performed. Demographic and clinical data were extracted from electronic medical records, and a chi‐squared test was used to analyze categorical variables. Results There were 306 consultations during the period of interest. The male to female ratio was 1:1 with a median age of 63. Consultations were most often requested by medical teams (69%), and the majority of patients seen in the emergency department were discharged home (86%). In 44% of cases, the requesting team did not provide a diagnosis; in the cases where it did provide a diagnosis, it was changed 57.9% of the time. The most commonly misdiagnosed conditions were dermatitis and skin infections. Dermatologists established or changed management in 82% of cases, and a total of 676 suggestions were made for management. Conclusion The results of this review reinforce the value of dermatology input in the diagnosis and management of hospital in patients. Ensuring maintained presence of hospital‐based dermatologists has the potential to improve diagnosis and management of cutaneous issues early on; by extension, this can minimize unnecessary investigations, improve the quality of healthcare, reduce hospital burden, and facilitate outpatient follow‐up.

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Background Clinical trial participants receiving investigational new drugs, which subsequently become approved by a medicines regulatory authority for its trialled indication, effectively gain free early access to efficacious treatment. Participants may also benefit from receiving approved, but unsubsidised medicines. These financial benefits of clinical trial participation have not previously been defined or quantified. Additionally, there are limited Australian pharmaceutical cost avoidance studies quantifying government savings through sponsored clinical trials. Aims To calculate pharmaceutical financial benefits and cost avoidance of clinical trial participation at a single Clinical Research Unit. Methods Recruiting clinical trials between 1 January 2006 and 31 December 2017 conducted at the Haematology Clinical Research Unit, Concord Repatriation General Hospital, Sydney were reviewed. Dispensing records were used to quantitate the pharmaceuticals dispensed to every participant. Financial calculations were based on Pharmaceutical Benefits Scheme (PBS) pricing, or from UpToDate for non‐PBS listed agents. Results Thirty‐six eligible clinical trials involving 245 participants accrued AU$3 971 357 in financial benefit from early access to subsequently approved investigational new drugs, AU$12 209 538 in financial benefit from accessing approved medications not PBS listed, and AU$6 728 576 in government cost avoidance. These findings totalled AU$22 909 471, 89% of which was derived in the past 5 years. Conclusion Pharmaceutical financial benefit is a previously unquantified aspect of clinical trial participation, its assigned value reflecting a measure of the quality and quantity of life delivered to patients. These data, albeit from a single discipline and institution, suggest that financial benefit represents a greater value than cost avoidance, and that its inclusion in cost‐analyses may better reflect the monetary benefits of accessing efficacious pharmaceutical agents through clinical trials.

Anticoagulant‐induced skin necrosis is a rare and potentially life‐threatening complication of anticoagulant therapy. The majority of cases of anticoagulant‐induced skin necrosis have been attributed to warfarin, known as warfarin‐induced skin necrosis (WISN). The use of anticoagulation reversal agents such as Prothrombinex‐VF in the development of WISN is not a commonly documented phenomenon. The authors present a case of WISN post‐recommencement of warfarin and the use of Prothrombinex‐VF.

COMMON WARTS (Verruca vulgaris), plantar warts (Verruca plantaris) and flat/plane warts (Verruca plana), collectively known as cutaneous warts, are benign growths of the skin caused by the human papillomavirus (HPV). In Australia, up to 24% of children and 5% of adults are affected. 1 A break in the epidermal barrier of the skin allows entry of HPV and subsequent infection of basal epithelial cells. HPV replicates alongside the natural lifecycle of epithelial cells, and is eventually released from desquamated keratinocytes on the surface of warts, potentially infecting other sites via direct contact or through fomites. 2 Cutaneous warts generally self-resolve. Up to two-thirds of immunocompetent children experience spontaneous clearance of their cutaneous warts by two years of age. 3 Adults tend to take longer. Patients might request treatment for their warts when they cause discomfort, functional impairment, social ostracism, are numerous, grow large or raise concerns regarding transmission. 4 Treatment for cutaneous warts can be painful, scar, cause pigmentary disturbances and might not be effective. 5 Therefore, clinicians should be wary of the evidence behind the efficacy of cutaneous wart treatment. This review summarises high-quality studies investigating the efficacy of chemical and physical destructive wart therapies. MethodsWe performed a literature review (up to June 2021) of published articles for wart management from the MEDLINE and Embase databases. No language restrictions were applied. We considered systematic reviews, randomised controlled trials (RCTs), cohort studies and case series. Case reports were excluded. For MEDLINE, we used the Boolean operation to combine MeSH terms 'warts' AND 'therapeutics'. For Embase, we used the Boolean operation to combine MeSH terms 'Verruca vulgaris' AND 'therapy'. We included studies that investigated chemical or physical destructive therapies.