Observation

Observation:

Skin colour:
Note - normal pink, cyanosis or pallor
Telangiectases  poor venous drainage
Haemosiderosis  poor venous drainage (due to back pressure from veins  leakage  brown deposits of iron complexes in skin)

The presence of blue/purple skin has been shown to only have a sensitivity of 17%, but a specificity of 89% for the diagnosis of an ABI <0.5 in those with diabetes .Gravitational eczema: Appears as scaly, lichenified, discoloured, pigmented skin with oedema, haemosiderosis. Can be itchy which leads to ulcers.Nail changes: Note - deformity, increased thickness, dystrophy Hypertrophy of nails may results from impaired circulation to nail matrix.Hair growth: Note - normal, reduced, absent Chronic reduction in blood flow  cessation of hair growth distallyAbsence of hair growth has been shown to only have a sensitivity of 48% and specificity of 71% for the diagnosis of an ABI <0.5 in those with diabetes .Nutritional changes: Loss of normal wrinkling over joint; ulcerationMorphology: Oedema  commonly associated with venous problems “Champagne legs”/”inverted bottle legs”  associated with chronic venous ulceration

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