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 distally
Absence 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; ulceration
Morphology:
Oedema commonly associated with venous problems
“Champagne legs”/”inverted bottle legs” associated with chronic venous ulceration
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