Mask exemptions not warranted for facial skin diseases?

Written mask exemptions for patients with dermatological issues should almost always be given an expiry date as few skin problems are severe enough to warrant them permanently, researchers say.

While mask mandates have been scaled back over recent months in Australia, clinicians are still receiving requests for exemptions to rules requiring face coverings in healthcare and other settings.

But despite most jurisdictions allowing exemptions for serious facial skin conditions, guidance remains limited, according to researchers from the Occupational Dermatology Research and Education Centre, Skin Health Institute in Melbourne.

In a letter to the MJA this week, they stressed there were cases that may warrant exemption including severe dermatitis with crusting or weeping and severe infections such as impetigo or eczema herpeticum.

Treatments for actinic damage such as 5- fluorouracil, imiquimod or photodynamic therapy may cause severe inflammation, they wrote.

But they added: “We suggest if exemptions are warranted, duration should be minimised, which may be before resolution of the dermatoses (eg, 2 weeks followed by a review).”

“This is essential given masks have been key in reducing SARS-CoV-2 transmission.”

Education regarding skin care was also vital during with the aim of eventually ending mask exemptions, the researchers said.

They called for an assessment pathway to be developed for facial dermatoses impeding mask use which would guide prompt treatment and a return to masking where appropriate.

Infliximab switching appears safe in psoriasis patients

Switching to an infliximab biosimilar brand appears to be safe with no increase in incidence of infusion reactions, experience from Queensland suggests.

In 2020 many patients in the state were switched to Renflexis after Queensland Health removed the infliximab originator from the state formulary. A review of medical records for 119 patients who were switched found that the rate of infusion reactions was no different (1.7% vs 2.6%) when compared to reactions to doses prior to the switch. There were no infusion reactions reported among 17 treatment-naive patients initiated on Renflexis, according to University of Queensland researchers.

The most common indications for infliximab were Crohn’s disease and ulcerative colitis (56%), ankylosing spondylitis (14.4%), rheumatoid arthritis (5%), psoriatic arthritis (5%) and psoriasis (5%).

Their findings are published in Journal of Pharmacy Practice and Research.

Rethink your imaging requests to cut carbon footprint

Clinicians are being urged to reduce the healthcare carbon footprint by adopting a three-pronged strategy to make more efficient use of diagnostic imaging.

Diagnostic imaging and pathology testing account for almost 10% of the hospital carbon footprint, with MRI and CT scans accounting for a high proportion of it, a Melbourne University study has shown.

The carbon emissions from an MRI were equivalent to driving a car for 145 km, while a CT scan carbon emission was equal to driving 76 km, the findings in Lancet Regional Health showed.

Much of the large carbon footprint was due to electricity use by scanners, and in particular, their standby power use, said the researchers, who recommended that clinicians and administrators make efforts to reduce unnecessary imaging and/or switch imaging to a lower carbon modality such as X-rays.

Other carbon footprint reduction tips include turning scanners off when they are not required rather than leaving them on standby and ensuring existing scanners have high utilisation rates, the researchers suggested.