Background: Methotrexate, originally an anti‐neoplastic agent, is now extensively used at lower doses in dermatology and rheumatology for chronic inflammatory conditions. While its safety is supported by routine blood monitoring, there remains variability in recommended monitoring frequency, folic acid supplementation, liver function testing and the role of specific biomarkers like Type III Procollagen Peptide (PIIINP).Objectives: This study aimed to compare methotrexate prescribing and monitoring practices in Ireland with various national guidelines, including those from the European Medicines Agency (EMA), British Association of Dermatologists (BAD) and European Alliance of Associations for Rheumatology (EULAR). The goal was to document current practices among dermatologists and rheumatologists in Ireland to identify any discrepancies in methotrexate prescribing and monitoring.Methods: An online survey was distributed to members of the Irish Association of Dermatologists (IAD) and the Irish Society of Rheumatology (ISR) in July 2024. The questionnaire covered pretreatment screening, blood monitoring practices, folic acid supplementation and adverse events. Data was finalised and analysed in September 2024.Results: Of the 52 respondents, all conducted baseline full blood count (FBC), renal profile (RP) and liver function tests (LFTs). Dermatologists were significantly more likely to perform infectious disease screenings compared to rheumatologists (p < 0.05). When initiating methotrexate, only 17 practitioners (32.7%) employed a test dose of 2.5–5 mg weekly, with a statistically significant difference (p < 0.05) observed in the starting doses of methotrexate. All respondents prescribed folic acid supplementation, with a statistically significant (p < 0.05) noted in supplementation practices between the two specialties. Abnormal LFTs/PIIINP prompted hepatology referrals for 48%. Seven (13%) reported irreversible liver damage cases, and one (2%) death from pneumonia was noted.Conclusions: This study highlights significant discrepancies in methotrexate prescribing and monitoring practices among Irish clinicians, similar to the various international guidelines. These variations underscore the need for updated, unified guidelines to ensure consistent and safe methotrexate use across the specialties.

Hidradenitis suppurativa (HS) is a chronic inflammatory condition associated with multimorbidity. Frailty is a syndrome of decreased reserve, the prevalence of which increases with multimorbidity and is associated with increased mortality as well as health resource utilization and costs. This case–control study is the first to quantify frailty in HS, and we report statistically worse frailty scores and higher body mass index in patients with HS compared with non-HS controls.

Introduction: Climate change represents a devastating threat to health. Peripheral dermatology clinics have proven to be effective in enhancing patient access to healthcare. We studied the environmental health benefits of peripheral clinics in the Republic of Ireland by calculating the reduction in carbon dioxide emissions. Methods: A national cross-sectional study of patients attending peripheral clinics and central dermatology departments over 2023 was conducted. The round-trip distances between the peripheral clinics and central dermatology departments were calculated, with results used to estimate the reduction in carbon emissions. Results: A total of 21,786 patients attended the peripheral clinics. The average round-trip distance was 109.7 km. A total distance of 1,986,369 km was avoided by using this model, which would have otherwise resulted in additional 331 tonnes of carbon emissions. Conclusion: With global warming accelerating at an alarming rate, healthcare professionals have a duty to adopt greener practices to reduce carbon footprints. Specialised peripheral clinics not only enhanced patient access to healthcare but also significantly reduced the carbon footprint associated with patient travel.

Mycosis fungoides is a misnomer that means ‘mushroom‐like fungal disease’, but it is, in fact, the most common form of cutaneous T‐cell lymphoma. The diagnosis of mycosis fungoides is often delayed due to non‐specific symptoms and cutaneous signs that mimic other common benign inflammatory dermatoses. We report a case series to emphasize the importance of considering fungal skin infections in patients with mycosis fungoides, especially when the rash is atypical.

Itch, or pruritus, is a common and unpleasant sensation transmitted by both the peripheral and central nervous systems, sharing pathways with pain sensation. The itch pathway is complex, and itch is a perplexing symptom. We report a patient whose presentation following a spinal stroke highlights the potential mechanism of neuropathic itch, the challenges in managing chronic neuropathic itch and dysaesthesia and the importance of a holistic approach in treating patients who have these symptoms.

A 29-year-old gentleman of African descent presented to the emergency department with a three month history of a rash affecting the trunk, upper limbs, and thighs. The patient was unsure of any triggers and denied any preceding illness, new medications, illicit drug use, or recent vaccinations. On examination, there was a widespread papulosquamous eruption characterised by scaly, hyperpigmented papules and plaques involving the trunk, upper arms, and upper thighs. A definitive diagnosis was established through a diagnostic skin biopsy of a fresh lesion.