Non-dermatomal cutaneous herpes zoster infection in a solid-organ transplant patient.

Diagnosis of atypical generalized forms of herpes zoster can be a challenge and may lead to a delay in treatment. Herpes zoster can present with atypical clinical manifestations, some with higher risk of complications that are potentially life-threatening. We describe a patient that presented with several ulcerated papules and plaques in a non-dermatomal distribution in whom disseminated cutaneous herpes zoster was proven by molecular amplification testing. Patients with disseminated herpes zoster should be treated initially with intravenous antiviral therapy, followed by oral acyclovir, valacyclovir, or famciclovir in most adults, with close follow-up. Earlier treatment may reduce the risk of developing complications and progression of visceral involvement. This case adds to the evolving literature related to herpes zoster, especially regarding patients with immunosuppressed status.

Combination Therapy of Apremilast and Biologic Agent as a Safe Option of Psoriatic Arthritis and Psoriasis.

INTRODUCTION: Psoriasis is a chronic immune-medicated inflammatory condition that affects 2-3% of the population, which can lead to psoriatic arthritis. There are multiple regimens for the treatment of psoriasis including disease- modifying anti rheumatic drugs (DMARDS) and biologic agent, phototherapy and apremilast. While monotherapy with biologic agents is effective for many patients with psoriasis some patients are not satisfied by the outcome and require combination therapy. No data exist on the safety of apremilast as a component of combination therapy with biological therapies. OBJECTIVE: The aim of the study was to determine the safety of apremilast in combination of biologic therapies in the treatment of plaque psoriasis and psoriatic arthritis. METHODS: This was retrospective study, open label study carried out at a single community Rheumatology center. Twenty-two patients diagnosed with plaque psoriasis and psoriatic arthritis according to American college of Rheumatology criteria-participated. Apremilast was added to their current biologic agent. Patients were permitted to their current biologic treatment. RESULTS: Out of 22 patients, six patients developed side effects, none of which caused discontinuation of therapy. Out of the six patients who developed side effects, two patients developed nausea and two patients developed diarrhea. One patient developed weight loss and one patient developed abdominal pain. CONCLUSION: Apremilast can be safely combined with all biologic agents in patients with plaque psoriasis or psoriatic arthritis not responding adequately to biologics alone.

Incidence of wound complications in cesarean deliveries following closure with absorbable subcuticular staples versus conventional skin closure techniques.

OBJECTIVE: To determine if there is a significant difference in composite wound complications among traditional closure techniques versus absorbable subcuticular staple closure. STUDY DESIGN: This study is a retrospective cohort study of cesarean sections performed from January through September of 2014. Composite wound complications included surgical site infection, separation, and fluid collection. Medical records were reviewed and data including the patient demographics, comorbidities, closure type and wound complications were recorded. Patients with incomplete data were excluded. Data were analyzed with ANOVA or Fisher exact test, according to data type. RESULTS: Of the 186 patients identified, 176 patients were included in the data analysis (n=83 suture, n=49 traditional staple, n=44 the absorbable subcuticular staple). The groups were similar in all demographic categories; labor prior to delivery, estimated blood loss, and medical and pregnancy related comorbidities. The overall incidence of wound complications at our institution during this study was 5.7%. The incidence of complications among the suture and subcuticular staple closure was not significantly different (3.6% versus 0%, p=0.3), however there were significantly less complications in the suture and subcuticular staple closure groups when compared to traditional staple closure (14.3%) (p=0.03 and p=0.01, respectively). CONCLUSION: Herein, we report a decreased incidence of composite wound complications with subcuticular staple closure versus traditional staple closure in patients undergoing cesarean section. Absorbable subcuticular staple closure represents a convenient, safe and cost-effective closure technique.