News in brief: Novel combination biologics for recalcitrant psoriasis; Hand sanitisers may contain contact allergens; Specialty training colleges’ ‘dirty secret’

30 Nov 2021

Novel combination biologics for recalcitrant psoriasis

Dual biologic therapy may be an effective option for patients with recalcitrant psoriasis that is not controlled by biologic monotherapy or other agents, Sydney dermatologists say.

A novel combination of an IL-23 inhibitor (risankizumab) with a TNF-inhibitor (golimumab) was successful in the treatment of a 49-year old man with severe chronic plaque psoriasis and severe psoriatic arthritis that had not improved after almost two years of secukinumab followed by golimumab, according to their case report published in the Australasian Journal of Dermatology.

After six months of adding risankizumab the man showed significant improvement in both his cutaneous disease and his psoriatic and was able to resume his activities of daily living without adverse effects to date, the authors said. However they cautioned that little is known about the long-term efficacy and safety of combination biologics with dual targets, and it is essential to obtain informed consent from the patient and employ multidisciplinary care.

Hand sanitisers may contain contact allergens

Contact allergens are present in many commercial hand sanitiser products that are marketed as ‘natural’ or ‘hypoallergenic’ a US study has found.

With the widespread promotion of hand hygiene during the Covid pandemic it is cause for concern that more than 70% were found to contain allergens, according to dermatologists who tested 160 commercial hand sanitisers

The most common allergens were tocopherol, fragrance, propylene glycol, and phenoxyethanol. Nevertheless, 39% of products labelled  “fragrance free” contained fragrance or cross-reactors, and 70% of “hypoallergenic” sanitisers had ingredients in the NACDG contact allergen series. Overall, 20% of the hand sanitiser claims were misleading, they found, noting that the consumer-driven demand for “natural products” had resulted in the marketing of sanitisers containing highly sensitizing fragrances/botanical extracts and more allergenic preservatives such as phenoxyethanol as replacements for parabens “due to popularised and, in some cases, dubious evidence of potential endocrine-disruption and carcinogenic effects.”

Specialty training colleges’ ‘dirty secret’

Training colleges, consultants, and hospital executives have been blamed for enabling ongoing abuse and overwork of registrars, in an article about speciality training written by an anonymous junior doctor deploring what they describe as medicine’s ‘dirty secret’.

Published in mainstream newspapers this week, the article entitled ‘Distressed doctors don’t bend, so they break’ describes a training regime that encourages mental distress and suicide among registrars who are given a heavy workload and responsibilities but no support from senior doctors or management.

“They are the first to arrive at the hospital and the last to leave. You are told not to make waves, to keep your head down, to get through it. You are often working unsupervised with vast responsibilities and unsupportive distant supervisors. The less you complain, the more you’re willing to endure, the more attractive and hireable you become. Troublemakers do not get hired,” it says.

The article says the current approach by training colleges is flawed because “the focus has been on coping with abuse rather than ending abuse.’

“The medical fraternity needs to host a meaningful discussion about how to fix our training system to provide more support for doctors and improve their wellbeing. Workload is an issue but the crux of the problem is the lack of support from those in authority,” it concludes.

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