1: J Clin Rheumatol. 2009 Mar;15(2):101.

Herpes zoster infection followed by henoch-schönlein purpura in a girl receiving 
infliximab for ulcerative colitis.

Nobile S, Catassi C, Felici L.

Department of Pediatrics; Università Politecnica delle Marche; Ancona, Italy
(Nobile, Catassi) Department of Pediatrics; Ospedale San Salvatore; Pesaro, Italy
(Felici).

PMID: 19265360 [PubMed - in process]

2: Auris Nasus Larynx. 2009 Mar 3. [Epub ahead of print]

Herpes zoster laryngitis with intractable hiccups.

Morinaka S.

Department of Otorhinolaryngology, Kobe Japanpost Hospital, 6-2-43
Kamitsutsui-dori, Chuo-ku, 651-8798 Kobe, Japan.

A 73-year-old man presented to our hospital with a sore throat (left-sided) and
hiccups. The patient had mucosal swelling and erosions affecting the left
posterior pillar, base of tongue, epiglottis, arytenoid, and aryepiglottic fold. 
As the laryngeal mucosal edema became worse, herpetic vesicles and erosions
developed on the left cavum conchae, external auditory canal, and palate. The
patient was treated with acyclovir and a steroid. His hiccups were treated with
metoclopramide, but it had little effect, and hiccups only subsided gradually
after the disappearance of erosions. His hiccups relapsed transiently with
vomiting, and then resolved completely. Elevation of the CF titer after 2 weeks
confirmed the diagnosis of herpes zoster. This condition should be considered in 
patients with unilateral sore throat and intractable hiccups, and treatment with 
acyclovir should be provided.

PMID: 19264432 [PubMed - as supplied by publisher]

3: J Clin Microbiol. 2009 Mar 4. [Epub ahead of print]

Multiplex PCR testing detected higher than expected rates of cervical
Mycoplasmas, Ureaplasmas, Trichomonas and viral agents in sexually active
Australian women.

McIver CJ, Rismanto N, Smith C, Naing ZW, Rayner B, Lusk J, Konecny P, White PA, 
Rawlinson WD.

Virology Division, Microbiology Department (SEALS), The Prince of Wales Hospital,
School of Medical Sciences, School of Biotechnology and Biomolecular Sciences,
The University of New South Wales, RPA Sexual Health, Royal Prince Alfred
Hospital, Department of Immunology and Infectious Diseases, St George Hospital,
Sydney, Australia.

Knowing the prevalence of potential aetiologic agents of non-gonococcal and
non-chlamydial cervicitis is important for improving efficacy of empirical
treatments for this commonly encountered condition. We describe four multiplex
PCRs (mPCRs) designated VDL05, VDL06, VDL07 and VDL09, which facilitate the
detection of a wide range of agents either known to be or putatively associated
with cervicitis including: Cytomegalovirus (CMV), Enterovirus (EV), Epstein Barr 
Virus (EBV), Varicella Zoster virus (VZV), Herpes simplex virus -1 (HSV-1) and
Herpes simplex -2 (HSV-2) (VDL05); Ureaplasma parvum, Ureaplasma urealyticum,
Mycoplasma genitalium, Mycoplasma hominis (VDL06); Chlamydia trachomatis,
Trichomonas vaginalis, Treponema pallidum, and group B streptococci (VDL07); and 
adenovirus species A-E (VDL09). The mPCRs were used to test 233 cervical swabs
from 175 women attending a sexual health clinic in Sydney Australia, during
2006-2007. The agents detected alone or in combination in all cervical swabs
(percentage total swabs) include: CMV (6.0), EV (2.1), EBV (2.6), VZV (4.7), HSV 
-1 (2.6), HSV -2 (0.8), HSV-2 and VZV (0.4), U. parvum (57.0), U. urealyticum
(6.1), M. genitalium (1.3), M. hominis (13.7), C. trachomatis (0.4), T. vaginalis
(3.4), and Group B streptococci (0.4). Adenovirus species A-E and T. pallidum
were not detected. These assays are adaptable for routine diagnostic laboratories
and provide an opportunity to measure the true prevalence of micro-organisms
potentially associated with cervicitis and other genital infections.

PMID: 19261782 [PubMed - as supplied by publisher]

4: Clin Vaccine Immunol. 2009 Mar 4. [Epub ahead of print]

A Comparison of the Immunogenicity and Safety of ZOSTAVAX(R) in Adults 50 to 59
Years Old and Adults >=60 Years Old.

Sutradhar SC, Wang WW, Schlienger K, Stek JE, Xu J, Chan IS, Silber JL.

Merck Research Laboratories, Upper Gwynedd, PA.

Background: ZOSTAVAX(R) has been shown to be efficacious in the prevention of
herpes zoster (HZ), and generally well tolerated in clinical trials among
subjects >/=60 years old. This prespecified combined analysis from 2 studies
compares immunogenicity and safety of ZOSTAVAX(R) in subjects 50 to 59 years old 
versus those >/=60 years old. Methods: VZV Ab titers were measured by
glycoprotein enzyme-linked immunosorbent assay (gpELISA) at baseline and 4 weeks 
postvaccination. Noninferiority was evaluated by estimated geometric mean fold
rise (GMFR) ratio [50 to 59 years old/>/=60 years old] and 2-sided 95% confidence
interval (CI). Success was defined by lower bound (LB) of 95% CI of GMFR ratio
>0.67. Acceptability of postvaccination VZV Ab was defined by LB of 95% CI of
GMFR >1.4. Safety data was recorded for 28 days postvaccination by standardized
Vaccination Report Card. Results: Estimated GMFR from baseline to 4 weeks
postvaccination was 2.6 (95% CI: 2.4, 2.9) in subjects 50 to 59 years old and 2.3
(95% CI: 2.1, 2.4) in subjects >/=60 years old. The estimated GMFR ratio [50 to
59 years old/>/=60 years old] was 1.13 (95% CI: 1.02, 1.25). No
ZOSTAVAX(R)-related serious AEs were reported. Conclusions: After a dose of
ZOSTAVAX(R), GMFR of VZV Ab response in subjects 50 to 59 years old was
noninferior to that in subjects >/=60 years old. VZV Ab response was acceptable
in both age groups. ZOSTAVAX(R) was generally well tolerated in both age groups.

PMID: 19261769 [PubMed - as supplied by publisher]

5: Cleve Clin J Med. 2009 Mar;76(3):152; author reply 152.

Comment on:
    Cleve Clin J Med. 2009 Jan;76(1):45-8.

Shingles vaccine ((JANUARY 2009).

Hirsch R.

Publication Types: 
    Comment
    Letter

PMID: 19258459 [PubMed - in process]

6: Eur J Dermatol. 2009 Mar 2. [Epub ahead of print]

Herpes zoster occurring as a solitary vesicular in malignant lymphoma.

Ishida N, Watanabe D, Kuhara T, Takama H, Tamada Y, Matsumoto Y.

PMID: 19258238 [PubMed - as supplied by publisher]

7: Mayo Clin Proc. 2009 Mar;84(3):274-80.

Herpes zoster (shingles) and postherpetic neuralgia.

Sampathkumar P, Drage LA, Martin DP.

Division of Infectious Diseases, Mayo Clinic, 200 First St SW, Rochester, MN
55905, USA. sampathkumar.priya@mayo.edu

Herpes zoster (HZ), commonly called shingles, is a distinctive syndrome caused by
reactivation of varicella zoster virus (VZV). This reactivation occurs when
immunity to VZV declines because of aging or immunosuppression. Herpes zoster can
occur at any age but most commonly affects the elderly population. Postherpetic
neuralgia (PHN), defined as pain persisting more than 3 months after the rash has
healed, is a debilitating and difficult to manage consequence of HZ. The
diagnosis of HZ is usually made clinically on the basis of the characteristic
appearance of the rash. Early recognition and treatment can reduce acute symptoms
and may also reduce PHN. A live, attenuated vaccine aimed at boosting immunity to
VZV and reducing the risk of HZ is now available and is recommended for adults
older than 60 years. The vaccine has been shown to reduce significantly the
incidence of both HZ and PHN. The vaccine is well tolerated, with minor local
injection site reactions being the most common adverse event. This review focuses
on the clinical manifestations and treatment of HZ and PHN, as well as the
appropriate use of the HZ vaccine.

PMID: 19252116 [PubMed - in process]

8: JAAPA. 2009 Jan;22(1):45-7.

Hypertension; herpes zoster.

Olsen ME, Klingler AM.

Nephrology & Hypertension Associates, Middlebury, Connecticut, USA.

PMID: 19248361 [PubMed - in process]

9: World J Gastroenterol. 2009 Feb 28;15(8):1004-6.

Severe autoimmune hepatitis triggered by varicella zoster infection.

Al-Hamoudi WK.

Gastroenterology and Hepatology Unit (59), Department of Medicine, King Saud
University, PO Box 2925, Riyadh 11461, Saudi Arabia. walhamoudi@gmail.com.

Autoimmune hepatitis (AIH) is a chronic disease of unknown etiology that is
characterized by the presence of circulatory autoantibodies and inflammatory
histological changes in the liver. Although the pathogenesis of AIH is not known,
it is thought that, in a genetically predisposed individual, environmental
factors such as viruses can trigger the autoimmune process. Herpes simplex virus,
Epstein-Barr virus, measles virus, and hepatitis viruses are thought to play a
role in the etiology of AIH. Proteins belonging to these viruses may be similar
to the amino acid chains of different autoantigens in the liver, this causes
immune cross reactions and liver tissue damage. We report a case of severe AIH
following varicella zoster infection in a 23-year-old man, and speculate that,
based on the molecular mimicry hypothesis, the liver damage was caused by an
immune cross reaction to the viral proteins. Varicella-zoster-induced AIH has not
been reported previously.

PMID: 19248202 [PubMed - in process]

10: Indian J Ophthalmol. 2009 Mar-Apr;57(2):163-4.

Herpes zoster ophthalmicus or Herpes zoster maxillaris?

Chandravanshi SL, Rathore MK.

Department of Ophthalmology, S. S. Medical College and Gandhi Memorial Hospital
Rewa, M.P - 486 001, India. dr_scl@rediffmail.com.

Publication Types: 
    Letter

PMID: 19237800 [PubMed - in process]

11: Zhongguo Shi Yan Xue Ye Xue Za Zhi. 2009 Feb;17(1):214-7.

[Bortezomib combined with other drugs for treating 60 cases of multiple myeloma.]

[Article in Chinese]

Zhong YP, Chen SL, Li X, Hu Y, Zhang JJ.

Department of Hematology and Oncology, Beijing Chaoyuang Hospital, Capital
Medical University, Beijing 100043, China. E-mail: zhongyp3352@126.com.

The aim of this study was to investigate the efficacy and safety of
bortezomib-combined with dexamethasone, methylprednisolone and other drugs in the
treatment of patients with multiple myeloma (MM). 60 MM patients including 19 de 
novo patients, out of them 14 patients received the treatment using regimen of
bortezomib in combination with thalidomide (BT), 5 patients received
bortezomib-methylprednisolone regimen (BMP). Out of 41 patients with refractory
or relapsed myeloma 26 cases of MM received the treatment using regimen of
bortezovnib combirned with methylpreamsolone (BMP), 6 cases received the
treatment using regimen of bortezomib combined with cyclophosphamide, predisone
and thalidomide (BCPT), 5 cases received the treatment using regimen of
bortezomib combined with cis-diaminodichloroplatimm, etoposide, cydophosphomide
and dexame thecson (BDECD), 4 cases received the treatment using regimen of
bortesomib combined with dexamethason (BD). Each patient received treatment of
2-8 courses at least. Response was assessed according to the criteria of the
Bladè. Adverse events were graded according to the commom Toxicity Criteria,
version 3.0 (NCI CTCAE, USA). The median follow-up from the start of bortezomib
treatment was 9 months. The results showed that out of 19 newly aiagnosed
patients, 6 cares acheieved CR, 6 cases acheived nearly CR, 5 cases acheived PR, 
1 case acheived MR, resulting in an ORR of 94.7%. Out of 41 refractory or
relapsed patients, 5 cases acheieved CR, 10 cases got nearly CR, 14 cases were PR
and 5 cases were MR, resuling in an ORR of 82.92%. The main toxicities were
fatigue, gastrointestinal disorders, peripheral neuropathy, thrombocytopenia,
herpes zoster, skinrash. All adverse events were diminished by using routine
ways. In couclusion, bortezomib combined with orthe drugs is a very effective
regimen, its side effects are predictable and manageable.

Publication Types: 
    English Abstract

PMID: 19236782 [PubMed - in process]

12: Mol Pharmacol. 2009 Feb 20. [Epub ahead of print]

Human Mitochondrial Thymidine Kinase (TK-2) is Selectively Inhibited by
3'-Thiourea Derivatives of {beta}-Thymidine. Identification of residues crucial
for both inhibition and catalytic activity.

Balzarini J, Van Daele I, Negri A, Solaroli N, Karlsson A, Liekens S, Gago F, Van
Calenbergh S.

Rega Institute for Medical Research.

Substituted 3'-thiourea derivatives of beta-thymidine (dThd) and 5'-thiourea
derivatives of alpha-dThd have been evaluated for their inhibitory activity
against recombinant human cytosolic dThd kinase-1 (TK-1), human mitochondrial
TK-2, herpes simplex virus type 1 (HSV-1) TK and varicella-zoster virus (VZV) TK.
Several substituted 3'-thiourea derivatives of beta-dThd proved highly inhibitory
to and selective for TK-2 (IC50: 0.15-3.1 microM). The 3'-C-branched
p-methylphenyl (1) and 3-CF3-4-Cl-phenyl (7) thiourea derivatives of beta-dThd
showed competitive inhibition of TK-2 when dThd was used as the variable
substrate (Ki: 0.40 microM and 0.05 microM, respectively) but uncompetitive
inhibition in the presence of variable concentrations of ATP (Ki: 15 microM and
2.0 microM, respectively). These kinetic properties of 1 and 7 against TK-2 could
be accounted for by molecular modeling showing that two hydrogen bonds can be
formed between the thiourea nitrogens of 7 and the oxygens of the gamma-phosphate
of ATP. The importance of several active-site residues was assessed by
site-directed mutagenesis experiments on TK-2 and the related HSV-1 TK. The low
Ki/Km ratios for 1 and 7 (0.38 and 0.039 against dThd, and 0.75 and 0.12 against 
ATP, respectively) indicate that these compounds are amongst the most potent
inhibitors of TK-2 described so far. In addition, a striking close correlation
was found between the inhibitory activities of the test compounds against TK-2
and Mycobacterium tuberculosis thymidylate kinase that is strongly indicative of 
close structural and/or functional similarities between both enzymes in relation 
to their mode of interaction with these nucleoside analogue inhibitors.

PMID: 19233899 [PubMed - as supplied by publisher]

13: J Clin Virol. 2009 Feb 20. [Epub ahead of print]

Detection of herpes viruses in children with acute appendicitis.

Katzoli P, Sakellaris G, Ergazaki M, Charissis G, Spandidos DA, Sourvinos G.

Laboratory of Virology, Faculty of Medicine, University of Crete, Heraklion
71003, Crete, Greece.

OBJECTIVE: This study aimed to investigate the incidence of herpes simplex virus 
(HSV) types-1 and -2, varicella-zoster virus (VZV), cytomegalovirus (CMV),
Epstein-Barr virus (EBV), human herpes virus 6 (HHV-6) and human herpes virus 7
(HHV-7) in childhood acute appendicitis. STUDY DESIGN: Polymerase chain reaction 
(PCR) assays were applied to detect herpes virus DNA in 38 children [11 girls and
27 boys, mean age 9 years (STD+/-2.59), range 6-14 years], who underwent an
appendectomy within a 2.5-year period. Appendix, omentum and peripheral blood
mononuclear cells (PBMCs) were available from each case. Of the 38 children with 
acute appendicitis, 20 (52.6%) had advanced (phlegmonous) acute appendicitis and 
18 (47.4%) had perforated appendicitis and local peritonitis. Forty-one blood
specimens from age-matched healthy children (25 female and 16 male), with
clinical manifestations unrelated to viral infections served as negative
controls. RESULTS: CMV was the most frequently detected virus (8/38, 21%),
followed by HHV-6 (3/38, 7.9%). EBV and HSV-1 were detected, though not in all
three different types of tissue specimens tested. None of the samples examined
were HSV-2-, VZV- or HHV-7-positive. Of all the specimens, the omentum was the
most commonly infected tissue (63.0%) while the appendix and peripheral blood
specimens were found to be positive for viral infection in 60.5% and 50% of
cases, respectively. The CMV IgG+ antibodies were positive in 54% of the control 
cases while 86% of the same group presented HHV-6 IgG+ antibodies. CONCLUSION: To
the best of our knowledge, this is the first study documenting the presence of
herpes virus DNA in children with acute appendicitis, suggesting that possible
viral infection or reactivation is associated with childhood appendicitis.

PMID: 19233720 [PubMed - as supplied by publisher]

14: Pain. 2009 Feb 20. [Epub ahead of print]

Controlled release oxycodone - An evidence-based treatment for pain in acute
herpes zoster.

Haanpää M.

Rehabilitation Centre ORTON, Tenholantie 10, FIN-00280 Helsinki, Finland;
Department of Neurosurgery, Helsinki University Central Hospital, Helsinki,
Finland.

Publication Types: 
    EDITORIAL

PMID: 19233562 [PubMed - as supplied by publisher]

15: Eye. 2009 Feb 20. [Epub ahead of print]

Herpes zoster ophthalmicus complicated by incomplete ophthalmoplegia and a
neurotrophic ulcer.

Chan EW, Sanjay S.

[1] 1Department of Ophthalmology and Visual Sciences, Alexandra Hospital,
Singapore, Singapore [2] 2Eye Clinic, Jurong Medical Centre, Singapore,
Singapore.

PMID: 19229277 [PubMed - as supplied by publisher]

16: Masui. 2009 Feb;58(2):153-9.

[The effects of early nerve blocks for prevention of postherpetic neuralgia and
analysis of prognostic factors]

[Article in Japanese]

Tajima K, Iseki M, Inada E, Miyazaki T.

Department of Anesthesiology and Pain Medicine, Juntendo University of Medicine, 
Tokyo 113-0033.

BACKGROUND: Herpes zoster causes acute pain and sometimes leads to postherpetic
neuralgia (PHN). The previously reported risk factors of PHN such as old age,
allodynia, paresthesia and so on are not based on evidence. Although nerve block 
is useful to relieve acute pain and recommended for prevention of PHN, evidence
is scanty. METHODS: The patients with herpes zoster within 3 months after the
onset were studied. The patient underwent nerve blocks and proper medical
treatment, and were followed for up to one year. The risk factors of PHN were
assessed. We evaluated whether nerve block prevented PHN. RESULTS: A total of 144
consecutive patients were studied. Twenty seven % of patients suffered PHN. Old
age (> 65 y. o) and hypesthesia were confirmed to be the risk factors of PHN,
whereas the intensity of acute pain was not. Patients who underwent nerve block
within 1 month after the onset were less likely to suffer from PHN compared with 
patients of delayed nerve blocks. CONCLUSIONS: Old age, hypesthesia and delayed
nerve blocks were the risk factors of PHN. Nerve blocks in the early phase of
herpes zoster may be useful to prevent PHN, particularly in the younger patients.

Publication Types: 
    English Abstract

PMID: 19227166 [PubMed - in process]

17: JAMA. 2009 Feb 18;301(7):774-5.

Comment on:
    JAMA. 2009 Feb 18;301(7):737-44.

Herpes zoster in the age of focused immunosuppressive therapy.

Whitley RJ, Gnann JW Jr.

Publication Types: 
    Comment
    Editorial
    Research Support, N.I.H., Extramural

PMID: 19224757 [PubMed - indexed for MEDLINE]

18: JAMA. 2009 Feb 18;301(7):737-44.

Comment in:
    JAMA. 2009 Feb 18;301(7):774-5.

Risk of herpes zoster in patients with rheumatoid arthritis treated with
anti-TNF-alpha agents.

Strangfeld A, Listing J, Herzer P, Liebhaber A, Rockwitz K, Richter C, Zink A.

Epidemiology Unit, German Rheumatism Research Center, Chariteplatz 1, 10117
Berlin, Germany. strangfeld@drfz.de

CONTEXT: The risk of bacterial infection is increased in patients treated with
drugs that inhibit tumor necrosis factor alpha (TNF-alpha). Little is known about
the reactivation of latent viral infections during treatment with TNF-alpha
inhibitors. OBJECTIVE: To investigate whether TNF-alpha inhibitors together as a 
class, or separately as either monoclonal anti-TNF-alpha antibodies (adalimumab, 
infliximab) or a fusion protein (etanercept), are related to higher rates of
herpes zoster in patients with rheumatoid arthritis. DESIGN, SETTING, AND
PATIENTS: Patients were enrolled in the German biologics register RABBIT, a
prospective cohort, between May 2001 and December 2006 at the initiation of
treatment with infliximab, etanercept, adalimumab, or anakinra, or when they
changed conventional disease-modifying antirheumatic drug (DMARD). Treatment,
clinical status, and adverse events were assessed by rheumatologists at fixed
points during follow-up. MAIN OUTCOME MEASURES: Hazard ratio (HR) of herpes
zoster episodes following anti-TNF-alpha treatment. Study aims were to detect a
clinically significant difference (HR, 2.0) between TNF-alpha inhibitors as a
class compared with DMARDs and to detect an HR of at least 2.5 for each of 2
types of TNF-alpha inhibitors, the monoclonal antibodies or the fusion protein,
compared with conventional DMARDs. RESULTS: Among 5040 patients receiving
TNF-alpha inhibitors or conventional DMARDs, 86 episodes of herpes zoster
occurred in 82 patients. Thirty-nine occurrences could be attributed to treatment
with anti-TNF-alpha antibodies, 23 to etanercept, and 24 to conventional DMARDs. 
The crude incidence rate per 1000 patient-years was 11.1 (95% confidence interval
[CI], 7.9-15.1) for the monoclonal antibodies, 8.9 (95% CI, 5.6-13.3) for
etanercept, and 5.6 (95% CI, 3.6-8.3) for conventional DMARDs. Adjusted for age, 
rheumatoid arthritis severity, and glucocorticoid use, a significantly increased 
risk was observed for treatment with the monoclonal antibodies (HR, 1.82 [95% CI,
1.05-3.15]), although this risk was lower than the threshold for clinical
significance. No significant associations were found for etanercept use (HR, 1.36
[95% CI, 0.73-2.55]) or for anti-TNF-alpha treatment (HR, 1.63 [95% CI,
0.97-2.74]) as a class. CONCLUSION: Treatment with monoclonal anti-TNF-alpha
antibodies may be associated with increased risk of herpes zoster, but this
requires further study.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 19224750 [PubMed - indexed for MEDLINE]

19: Am J Clin Dermatol. 2009;10(2):73-86. doi: 10.2165/00128071-200910020-00001.

Clinical implications of aging skin: cutaneous disorders in the elderly.

Farage MA, Miller KW, Berardesca E, Maibach HI.

The Procter & Gamble Company, Winton Hill Business Center, Cincinnati, Ohio, USA.

Aging skin undergoes progressive degenerative change. Structural and physiologic 
changes that occur as a natural consequence of intrinsic aging combined with the 
effects of a lifetime of ongoing cumulative extrinsic damage and environment
insult (e.g. overexposure to solar radiation) can produce a marked susceptibility
to dermatologic disorders in the elderly. As skin ages, the vasculature
progressively atrophies. The supporting dermis also deteriorates, with collagen
and elastin fibers becoming sparse and increasingly disordered. These changes
leave the elderly increasingly susceptible to both vascular disorders such as
stasis dermatitis and skin injuries such as pressure ulcers and skin tears, with 
a steadily decreasing ability to effect skin repair. A parallel erosion of normal
immune function produces higher levels of autoimmune skin disorders such as
bullous pemphigoid, benign mucous membrane pemphigoid, paraneoplastic pemphigoid,
and pemphigus vulgaris. Lichen sclerosus, an autoimmune disorder often occurring 
in the genital area in older women, is not common but is an important development
because of the potential for substantial discomfort as well as serious
complications. The prevalence of polypharmacy in this population increases the
risk for autoimmune drug reactions, and diagnosis should be undertaken with an
awareness that polypharmacy in this population creates a greatly increased
susceptibility to drug eruptions that can mimic other cutaneous disorders.
Immunologic senescence in the elderly also sets the stage for potential
reactivation of the Varicella zoster virus, in which initial dermatologic
involvement expands into the major sensory ganglia. Known as shingles, this
disorder can be excruciatingly painful with the potential to cause blindness if
the optic nerve becomes involved. Dermatoses such as xerosis, pruritus, and
eczema are also widespread in the elderly, create substantial suffering in those 
afflicted, and often prove recalcitrant to treatment. Individual susceptibility
to specific types of contact dermatitis changes over the lifetime, and seborrheic
dermatitis is substantially more prevalent in the elderly. It is not uncommon for
older patients to have multiple impairments, with the potential for cognitive
dysfunction as well as impaired vision, hearing, or mobility. In addition, they
may not have adequate housing or nutrition, or the financial resources necessary 
for adequate compliance. Physicians must take into consideration the patient's
physical ability to comply with the recommended therapy as well as socioeconomic 
factors that may impact on compliance. Simple topical regimens are preferable
wherever possible in order to maximize compliance and, therefore, efficacy. Extra
effort may be necessary to ensure that instructions are accurately followed and
that ongoing compliance with the regimen prescribed is actually achieved.
Management of dermatologic disorders in the elderly is often less than optimal,
due to the fact that the special needs and limitations of this population are not
adequately considered. Treatments should consider the intrinsic differences
between younger and older patients that may impact on diagnosis and therapy
choice. The aged patient is often afflicted with numerous co-morbidities that can
influence the choice of therapy. Skin integrity in the elderly is compromised,
and safety concerns are increased with the long-term use of any medication
prescribed. In addition, the prevalence of polypharmacy in the aged population
substantially increases the risk of cutaneous drug reactions, which can
profoundly complicate accurate diagnosis of dermatologic disorders. The aged
population also needs to be more closely monitored because of increased fragility
of the skin and the physical limitations that may hinder compliance with
prescribed regimens.

PMID: 19222248 [PubMed - in process]

20: Neurology. 2009 Feb 17;72(7):670-1.

Brown-Séquard syndrome after herpes zoster.

Young-Barbee C, Hall DA, LoPresti JJ, Schmid DS, Gilden DH.

Department of Neurology, Mail Stop B182, University of Colorado Denver School of 
Medicine, 4200 E. 9th Ave., Denver, CO 80262, USA.

Publication Types: 
    Research Support, N.I.H., Extramural

PMID: 19221302 [PubMed - in process]