News in brief: ‘Living guidelines’ for eczema therapies; ‘Covid toes’ are just work-from-home chilblains; Doctors win, nurses lose under Stage 3 tax changes

29 Mar 2022

‘Living guidelines’ for eczema therapies

‘Living guidelines’ for immuno-modulatory treatments for atopic dermatitis are in development by dermatologists in Canada and the UK.

They say a living network meta-analysis of systemic immuno-modulatory treatments is needed to keep pace with the ever widening range of choices, which now include cyclosporine, methotrexate, azathioprine, mycophenolate and dupilumab, with abrocitinib, baricitinib, tralokinumab and upadacitinib.

“In the last year alone, three oral and one injectable medication have come to market. However, the flip side to additional choice is that treatment decisions become more complex,” says Dr Aaron Drucker, dermatologist and scientist at Women’s College Hospital in Toronto, Canada.

Results from ongoing collaboration with Professor Carsten Flohr, Chair in Dermatology and Population Health Science at St John’s Institute of Dermatology at King’s College London are regularly updated and published online at EczemaTherapies.

“On the website patients and clinicians can compare both new and more established medications simultaneously, assessing how they stack up against common areas of concern like disease severity, side effect profiles and impact on quality of life,” the developers say.

Recent updates have shown that dupilumab and cyclosporine have greater efficacy than other conventional systemic therapies. The latest update found treatment with two Janus kinase inhibitors (abrocitinib 200mg daily and upadacitinib 30mg daily) was somewhat more effective in treating atopic dermatitis than dupilumab. The study also found the Janus kinase inhibitor baricitinib and the biologic tralokinumab were effective treatments for adults with moderate-to-severe atopic dermatitis.

‘Covid toes’ are just work-from-home chilblains

An increase in cases of paediatric perniosis during the COVID-19 pandemic is likely due to children working remotely at home rather than any unique covid-related skin condition, according to Sydney clinicians.

Doctors at the Sydney Children Hospital have described a series of cases of paediatric chilblain-like lesions referred to them during the winter season by GPs or families concerned about ‘covid toes’, but they concluded that they were actually ‘home-school toes’.

In a case series they reported the chilblains occurred mostly on the feet and none were associated with positive covid tests. All the cases occurred in children who were being home schooled, and many reported reduced levels of activity, not wearing shoes or socks at home and an association between their symptoms and cold exposure.

“Given the lack of laboratory-confirmed SARS-CoV-2 19 infection and the presence of social, environmental and behavioural risk factors, we propose that the increased presentations of paediatric perniosis over the winter months may represent ‘home-school toes’ resulting from lifestyle changes associated with lockdowns and homeschooling during the pandemic,” the report authors wrote in the Australasian Journal of Dermatology.

“Our data support no evidence of a causal relationship between COVID-19 and perniosis.”

Doctors win, nurses lose under Stage 3 tax changes

High income medical specialists such as surgeons will get a $9000 windfall from the government’s planned stage-three tax cuts, whereas other healthcare workers such as nurses will be worse off, a new analysis suggests.

The stage 3 tax cuts, worth $15.7 billion per year will come into effect in July 2024, and will increase the income at which the top tax bracket begins from $180,001 to $200,000.

According to the Australia Institute think tank, this will mean that medical practitioners such as surgeons and anaesthetists with average incomes over $200,000 will get the maximum tax cut worth $9,075 per year.

In contrast, healthcare occupations that currently qualify for the Low- and Middle-Income Tax Offset (LMITO), worth $7 billion per year, will be net losers when it is discontinued at the end of this year, the institute says.

It cites the example of a midwife with a salary of $78,784 who will gain $845 from the stage 3 tax cuts but lose $1,080 when the LMITO is removed.

Workers on incomes below $50,000 such as aged care staff, secretaries and receptionists will be worst off, receiving no tax cuts and losing up to $832 from the LMITO, the institute predicts.

Treasurer Josh Frydenberg confirmed in the 2022 Budget that the government has chosen to phase out the so-called Low and Middle Income Tax Offset (LMITO), but it will increase the payment for everyone, by $420, for its last year of operation.

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