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There seem to be a group of diseases whose pathogenesis appears to be related to the unique circulatory environment of the lower extremities that occurs as a result of hydrostatic forces that are present at the bottom of a column of fluid that is furthest from the heart. Treatment of all of these diseases includes compression, which seems to correct the chronic defect (though the clinical symptom may be an acute on chronic process) or as Peter Heald says, “to make the legs more like the arms, where none of these clinical signs occur”. The spectrum of changes includes:
| • | elephantiasis nostra verrucosa |
| • | livedo vasculitis / atrophie blanche |
| • | don’t use if ankle/brachial index is <0.7 (normal = >1.2) , because indicates arterial insufficiency and risk of gangrene with compression |
| • | write prescription: “gradient compression hosiery (below knee) 30mmHg at ankle” |
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rare - eccrine syringofibroadenoma occurs in the setting of (vs. as a result of ) stasis
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