Natural history of SARS-CoV-2 infection in healthcare workers in Northern Italy.

At present, the time-frame used for the quarantine of individuals with coronavirus disease 2019 (COVID-19) is the entire duration of symptoms plus 14 days after symptom recovery; however, no data have been reported specifically for healthcare workers (HCWs). In the study population of 142 HCWs with COVID-19, the mean time for viral clearance was 31.8 days. Asymptomatic subjects cleared the virus more quickly than symptomatic subjects (22 vs 34.2 days; P<0.0001). The presence of fever at the time of diagnosis was associated with a longer time to viral clearance (relative risk 11.45, 95% confidence interval 8.66-14.25; P<0.0001). These findings may have a significant impact on healthcare strategies for the future management of the COVID-19 pandemic.

Surgical management of leg ulcers.

Before an ulcer is treated, a systemic work-up should be pursued to find the etiology. Treatment should be instituted to prevent more ulcers from occurring. However, once an ulcer has formed, good medical management is usually sufficient to heal an ulcer and prevent others from occurring. If the ulcer persists despite adequate medical treatment, then pinch grafting or split-thickness grafting are relatively simple techniques with good success rates.

Livedo reticularis.

A middle-aged woman was admitted to the hospital with livedo reticularis of the extremities in addition to nonspecific symptoms and signs of hypothyroidism. The livedo reticularis disappeared with treatment of the hypothyroidism. Although livedo reticularis has been reported previously to be associated with thyroid disease, this association is rare. We review the literature and present the conditions associated with livedo reticularis.

Cutis marmorata telangiectatica congenita: report of 22 cases.

Twenty-two cases of cutis marmorata telangiectatica congenita were evaluated during an 8-year period. All but two patients were examined in the first year of life; 14 of the 22 (64%) were female infants. Four patients had focal cutaneous atrophy associated with the reticulated vascular pattern, and eight had ulcerations of involved skin. Six (27%) had additional anomalies. Of these, three patients had a nevus flammeus, and one had congenital generalized fibromatosis and hemiatrophy. Two of the infants had glaucoma; one also had a facial nevus flammeus and the other had cutis marmorata telangiectatica congenita of the face. A congenital pigmented nevus and a localized venous malformation constituted the remaining associated defects. This disease is an uncommon cutaneous vascular anomaly that is most often solitary but occasionally may be associated with other developmental defects.

Actinic cheilitis: a review of the etiology, differential diagnosis, and treatment.

With today's increase in sun worshippers, the number of sun-induced skin lesions is increasing. Actinic cheilitis is the counterpart of actinic keratosis of the skin and can also develop into squamous cell carcinoma. In this article we review the etiology, clinical spectrum, histology, differential diagnosis, and treatment of actinic cheilitis. Actinic cheilitis needs to be differentiated from many other lip conditions, and the dermatologist must be attune to its possibility whenever assessing scaly lips. Because of its potential to develop into squamous cell carcinoma, treatment should be instituted as soon as possible.

Cutaneous squamous cell carcinoma and hypercalcemia.

An elderly man was admitted to the hospital with a large squamous cell carcinoma involving the right side of the chest wall. The patient was severely confused, and evaluation revealed pronounced hypercalcemia. With total surgical removal of the tumor, the serum calcium level fell to normal and his confusion cleared. Although hypercalcemia has been reported in association with a number of malignant tumors, including metastatic squamous cell carcinoma, this finding has been encountered only rarely with squamous cell carcinoma localized to the skin. The secretion of transforming growth factor or of another humoral substance has been postulated as the possible cause of hypercalcemia in this patient.

Treatment of resistant severe psoriasis with systemic cyclosporine.

Four patients with severe psoriasis have been treated with oral cyclosporine for 6 months. Two had generalized erythroderma and two had extensive plaque-type psoriasis; all had either become unresponsive to or were unable to use other accepted treatments. All four patients responded rapidly and were completely clear of psoriasis within 3 weeks of beginning therapy. Initial doses ranged from 7.5 to 8.5 mg/kg/day. Mild reversible nephrotoxicity occurred in the one patient whose cyclosporine trough level briefly exceeded 200 ng/ml. Cyclosporine may offer an alternative therapeutic modality in the management of erythrodermic or severe resistant plaque-type psoriasis. The effectiveness of cyclosporine in psoriasis underscores the putative role of cell-mediated immune factors in the pathogenesis of psoriasis.

Antinuclear antibodies during psoralens plus ultraviolet A (PUVA) therapy--are they worthwhile?

From 1979 to 1985, 497 patients with psoriasis were started on psoralens plus ultraviolet A (PUVA) therapy at Northwestern University. Two hundred sixty-nine of these received therapy for greater than 3 months and had at least two antinuclear antibody (ANA) determinations. We have found that the difference between the number of significantly positive ANAs pre-PUVA therapy (4 of 269) compared to post-PUVA therapy (16 of 269) was not statistically significant. Furthermore, of the patients who did develop a significantly positive ANA, not one was found to have any symptoms, signs, or laboratory evidence of systemic lupus erythematosus. We therefore suggest obtaining ANAs prior to initiating PUVA therapy and obtaining follow-up ANAs only if the initial ANA is significantly positive. Patients with pre-PUVA--positive ANAs can be started on PUVA therapy if there is no evidence of lupus erythematosus.