Database : MEDLINE
Search on : Leg and Dermatoses [Words]
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[PMID]: 29033819
[Au] Autor:Didan A; Donnelly A; Chua H
[Ad] Address:Department of Dermatology, Fiona Stanley Hospital, Murdoch, Washington, Australia.
[Ti] Title:An Unusual Presentation of Pyoderma Gangrenosum Leading to Systemic Inflammatory Response Syndrome.
[So] Source:Case Rep Dermatol;9(3):146-150, 2017 Sep-Dec.
[Is] ISSN:1662-6567
[Cp] Country of publication:Switzerland
[La] Language:eng
[Ab] Abstract:This is a report of an atypical presentation of pyoderma gangrenosum (PG) in a 26-year-old male who had a negative septic screen. The patient had a life-threatening presentation requiring an intensive care unit (ICU) admission for vasopressor support. It was thought that the likely cause of circulatory collapse was an overwhelming cytokine reaction or systemic inflammatory response syndrome (SIRS) secondary to extensive PG lesions rather than septic shock. The patient presented with multiple large ulcers, the largest being 4 cm in diameter on the central chest. He developed fevers and circulatory shock preceding his ICU admission. Microbiological specimens, including blood cultures and wound swabs, were negative for any growth (bacterial, fungal, and tuberculosis). No infective foci could be identified as a cause of hemodynamic instability. During admission, the patient's condition was complicated by multi-organ dysfunction. Wound debridement extending to the deep fascia on the anterior chest, back, bilateral shoulders, and right upper thigh was deemed necessary and performed by the plastic surgery team. Histopathology showed abundant neutrophils but could not confirm an infective process. Overall, the patient made an impressive recovery with almost complete healing of all lesions following oral prednisolone alone. Based on the history and clinical and laboratory findings, a diagnosis of PG complicated by a SIRS was favored. Very few cases of neutrophilic dermatoses have been described in this way. A similar presentation has been described in a 76-year-old female with lower-leg ulcers who developed circulatory shock and required an amputation. Lesions continued to appear despite antibiotics and surgical treatment. Septic screen was negative. She was subsequently diagnosed with PG and recovered rapidly after steroid therapy.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1710
[Cu] Class update date: 171018
[Lr] Last revision date:171018
[St] Status:PubMed-not-MEDLINE
[do] DOI:10.1159/000479923

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[PMID]: 28794554
[Au] Autor:Ghosh SK; Bandyopadhyay D; Biswas SK; Darung I
[Ad] Address:Department of Dermatology, Venereology, and Leprosy, R. G. Kar Medical College, Kolkata, West Bengal, India.
[Ti] Title:Mucocutaneous Manifestations in Patients with Rheumatoid Arthritis: A Cross-sectional Study from Eastern India.
[So] Source:Indian J Dermatol;62(4):411-417, 2017 Jul-Aug.
[Is] ISSN:1998-3611
[Cp] Country of publication:India
[La] Language:eng
[Ab] Abstract:BACKGROUND: Cutaneous manifestations are fairly common in rheumatoid arthritis (RA) and they can help in early diagnosis, prompt treatment, and hence reduced morbidity from the disease. AIMS: The objective of the present study was to find out the different patterns of dermatoses in a group of patients with RA from Eastern India. METHODOLOGY: Consecutive patients fulfilling the American Rheumatism Association 1987 revised criteria for the classification of RA and who had different dermatoses were included in this cross-sectional study done over a period of 8 years in a tertiary care hospital in Eastern India. Thorough clinical examination and appropriate laboratory investigations were performed as needed. Data were recorded in a predesigned schedule, and appropriate statistical analysis was done. RESULTS: We studied 111 evaluable patients with an age range of 19-71 years and a female to male ratio of 7:1. The mean disease duration of RA was 6.5 years. Cutaneous infections as a group was the most common mucocutaneous manifestation (34.2%) followed by xerosis including ichthyotic skin changes (27%), pigmented purpuric dermatoses (14.4%), leg ulcer (9.9%), periungual telangiectasia (9.9%), rheumatoid nodules (RNs) (8.1%), purpura and ecchymoses (7.2%), small vessel vasculitis in (7.2%), corn and callosities (6.3%), palmar erythema (4.5%), and neutrophilic dermatosis (4.5%). Raynaud's phenomenon was found in 3.6% patients and panniculitis in (3.6%) patients. Rheumatoid factor (RF) and anti-cyclic citrullinated peptides antibody were positive in 74.8% and 88.3% patients, respectively. No statistically significant difference of incidence of leg ulcer, small vessel vasculitis, RN, or Raynaud's phenomenon could be noted between RF positive and negative groups. LIMITATIONS: Being an institution-based study, the study findings may not reflect the true situation in the community which remained a limitation of this study. CONCLUSION: While some of the features of this study were analogous to Western data, other features showed discordance which may be due to ethnic variations among the patients with RA.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1708
[Cu] Class update date: 170813
[Lr] Last revision date:170813
[St] Status:In-Data-Review
[do] DOI:10.4103/ijd.IJD_260_17

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[PMID]: 28677489
[Au] Autor:Birner B; Glauser T; Balmer F; Escher R; Klein M
[Ad] Address:1 Medizinische Klinik, Regionalspital Emmental Standort Burgdorf, Burgdorf.
[Ti] Title:Wie lautet Ihre Diagnose?
[So] Source:Praxis (Bern 1994);106(14):755-756, 2017 Jul.
[Is] ISSN:1661-8157
[Cp] Country of publication:Switzerland
[La] Language:ger
[Mh] MeSH terms primary: Erythema/etiology
Leg Dermatoses/etiology
Leg/blood supply
Purpura/diagnosis
Purpura/etiology
Vasculitis/diagnosis
Vasculitis/etiology
[Mh] MeSH terms secundary: Aged
Diagnosis, Differential
Female
Humans
Physical Exertion
[Pt] Publication type:CASE REPORTS; JOURNAL ARTICLE
[Em] Entry month:1708
[Cu] Class update date: 170828
[Lr] Last revision date:170828
[Js] Journal subset:IM
[Da] Date of entry for processing:170706
[St] Status:MEDLINE
[do] DOI:10.1024/1661-8157/a002724

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[PMID]: 28670256
[Au] Autor:Kot M; Bogaczewicz J; Krecisz B; Wozniacka A
[Ad] Address:Department of Dermatology and Venereology, Medical University of Lodz, Lodz, Poland.
[Ti] Title:Contact allergy in the population of patients with chronic inflammatory dermatoses and contact hypersensitivity to corticosteroids.
[So] Source:Postepy Dermatol Alergol;34(3):253-259, 2017 Jun.
[Is] ISSN:1642-395X
[Cp] Country of publication:Poland
[La] Language:eng
[Ab] Abstract:INTRODUCTION: Clinical studies indicate that contact allergy to glucocorticosteroids (GCS) is not rare and has been increasingly reported over the past decade. Among the risk factors for developing contact hypersensitivity to topical corticosteroids, chronic inflammatory skin diseases and polyvalent contact allergy seem to be most important. AIM: To present the structure of contact allergy in the population of patients with chronic inflammatory dermatoses (CID) and contact hypersensitivity to corticosteroids. MATERIAL AND METHODS: Twenty-seven patients with contact allergy to GCS and chronic inflammatory dermatoses were patch tested with 28 European Baseline Series allergens and 8 corticosteroid allergens. This study group consisted of 5 patients with atopic dermatitis (AD), 15 patients with contact eczema (CE) and 7 with chronic leg eczema (CLE). Nineteen (70.4%) patients were females and 8 (29.6%) were males. RESULTS: In the study group, the most sensitizing non-steroidal allergens were nickel sulfate (51.8%), cobalt chloride (33.3%) and balsam of Peru (29.6%). The most sensitizing corticosteroid allergens were budesonide (77.8%), betamethasone valerate and clobetasol propionate (55.5% each). A total of 77.8% of patients allergic to GCS also showed sensitivity to at least one non-steroidal allergen from the European Baseline Series. CONCLUSIONS: The most important risk factors for developing contact allergy to corticosteroids appear to be chronic inflammatory dermatoses, long disease duration, extended on-and-off topical corticosteroid use, patients presenting two or more positive patch test results and polyvalent contact allergy to metal salts and to other non-steroidal haptens.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1707
[Cu] Class update date: 170816
[Lr] Last revision date:170816
[St] Status:PubMed-not-MEDLINE
[do] DOI:10.5114/ada.2017.67848

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[PMID]: 28631307
[Au] Autor:Dalal A; Eskin-Schwartz M; Mimouni D; Ray S; Days W; Hodak E; Leibovici L; Paul M
[Ad] Address:Department of Dermatology, Beilinson Hospital, Rabin Medical Center, 39 Jabotinski Street, Petah Tikva, Israel, 49100.
[Ti] Title:Interventions for the prevention of recurrent erysipelas and cellulitis.
[So] Source:Cochrane Database Syst Rev;6:CD009758, 2017 06 20.
[Is] ISSN:1469-493X
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:BACKGROUND: Erysipelas and cellulitis (hereafter referred to as 'cellulitis') are common bacterial skin infections usually affecting the lower extremities. Despite their burden of morbidity, the evidence for different prevention strategies is unclear. OBJECTIVES: To assess the beneficial and adverse effects of antibiotic prophylaxis or other prophylactic interventions for the prevention of recurrent episodes of cellulitis in adults aged over 16. SEARCH METHODS: We searched the following databases up to June 2016: the Cochrane Skin Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and LILACS. We also searched five trials registry databases, and checked reference lists of included studies and reviews for further references to relevant randomised controlled trials (RCTs). We searched two sets of dermatology conference proceedings, and BIOSIS Previews. SELECTION CRITERIA: Randomised controlled trials evaluating any therapy for the prevention of recurrent cellulitis. DATA COLLECTION AND ANALYSIS: Two authors independently carried out study selection, data extraction, assessment of risks of bias, and analyses. Our primary prespecified outcome was recurrence of cellulitis when on treatment and after treatment. Our secondary outcomes included incidence rate, time to next episode, hospitalisation, quality of life, development of resistance to antibiotics, adverse reactions and mortality. MAIN RESULTS: We included six trials, with a total of 573 evaluable participants, who were aged on average between 50 and 70. There were few previous episodes of cellulitis in those recruited to the trials, ranging between one and four episodes per study.Five of the six included trials assessed prevention with antibiotics in participants with cellulitis of the legs, and one assessed selenium in participants with cellulitis of the arms. Among the studies assessing antibiotics, one study evaluated oral erythromycin (n = 32) and four studies assessed penicillin (n = 481). Treatment duration varied from six to 18 months, and two studies continued to follow up participants after discontinuation of prophylaxis, with a follow-up period of up to one and a half to two years. Four studies were single-centre, and two were multicentre; they were conducted in five countries: the UK, Sweden, Tunisia, Israel, and Austria.Based on five trials, antibiotic prophylaxis (at the end of the treatment phase ('on prophylaxis')) decreased the risk of cellulitis recurrence by 69%, compared to no treatment or placebo (risk ratio (RR) 0.31, 95% confidence interval (CI) 0.13 to 0.72; n = 513; P = 0.007), number needed to treat for an additional beneficial outcome (NNTB) six, (95% CI 5 to 15), and we rated the certainty of evidence for this outcome as moderate.Under prophylactic treatment and compared to no treatment or placebo, antibiotic prophylaxis reduced the incidence rate of cellulitis by 56% (RR 0.44, 95% CI 0.22 to 0.89; four studies; n = 473; P value = 0.02; moderate-certainty evidence) and significantly decreased the rate until the next episode of cellulitis (hazard ratio (HR) 0.51, 95% CI 0.34 to 0.78; three studies; n = 437; P = 0.002; moderate-certainty evidence).The protective effects of antibiotic did not last after prophylaxis had been stopped ('post-prophylaxis') for risk of cellulitis recurrence (RR 0.88, 95% CI 0.59 to 1.31; two studies; n = 287; P = 0.52), incidence rate of cellulitis (RR 0.94, 95% CI 0.65 to 1.36; two studies; n = 287; P = 0.74), and rate until next episode of cellulitis (HR 0.78, 95% CI 0.39 to 1.56; two studies; n = 287). Evidence was of low certainty.Effects are relevant mainly for people after at least two episodes of leg cellulitis occurring within a period up to three years.We found no significant differences in adverse effects or hospitalisation between antibiotic and no treatment or placebo; for adverse effects: RR 0.87, 95% CI 0.58 to 1.30; four studies; n = 469; P = 0.48; for hospitalisation: RR 0.77, 95% CI 0.37 to 1.57; three studies; n = 429; P = 0.47, with certainty of evidence rated low for these outcomes. The existing data did not allow us to fully explore its impact on length of hospital stay.The common adverse reactions were gastrointestinal symptoms, mainly nausea and diarrhoea; rash (severe cutaneous adverse reactions were not reported); and thrush. Three studies reported adverse effects that led to discontinuation of the assigned therapy. In one study (erythromycin), three participants reported abdominal pain and nausea, so their treatment was changed to penicillin. In another study, two participants treated with penicillin withdrew from treatment due to diarrhoea or nausea. In one study, around 10% of participants stopped treatment due to pain at the injection site (the active treatment group was given intramuscular injections of benzathine penicillin).None of the included studies assessed the development of antimicrobial resistance or quality-of-life measures.With regard to the risks of bias, two included studies were at low risk of bias and we judged three others as being at high risk of bias, mainly due to lack of blinding. AUTHORS' CONCLUSIONS: In terms of recurrence, incidence, and time to next episode, antibiotic is probably an effective preventive treatment for recurrent cellulitis of the lower limbs in those under prophylactic treatment, compared with placebo or no treatment (moderate-certainty evidence). However, these preventive effects of antibiotics appear to diminish after they are discontinued (low-certainty evidence). Treatment with antibiotic does not trigger any serious adverse events, and those associated are minor, such as nausea and rash (low-certainty evidence). The evidence is limited to people with at least two past episodes of leg cellulitis within a time frame of up to three years, and none of the studies investigated other common interventions such as lymphoedema reduction methods or proper skin care. Larger, high-quality studies are warranted, including long-term follow-up and other prophylactic measures.
[Mh] MeSH terms primary: Anti-Bacterial Agents/therapeutic use
Antibiotic Prophylaxis
Cellulitis/prevention & control
Erysipelas/prevention & control
Secondary Prevention/methods
Selenium/therapeutic use
[Mh] MeSH terms secundary: Aged
Anti-Bacterial Agents/adverse effects
Antibiotic Prophylaxis/adverse effects
Arm
Erythromycin/adverse effects
Erythromycin/therapeutic use
Hospitalization/statistics & numerical data
Humans
Leg Dermatoses/prevention & control
Middle Aged
Penicillin G Benzathine/adverse effects
Penicillin G Benzathine/therapeutic use
Penicillin V/adverse effects
Penicillin V/therapeutic use
Randomized Controlled Trials as Topic
Recurrence
[Pt] Publication type:JOURNAL ARTICLE; META-ANALYSIS; RESEARCH SUPPORT, NON-U.S. GOV'T; REVIEW
[Nm] Name of substance:0 (Anti-Bacterial Agents); 63937KV33D (Erythromycin); H6241UJ22B (Selenium); RIT82F58GK (Penicillin G Benzathine); Z61I075U2W (Penicillin V)
[Em] Entry month:1709
[Cu] Class update date: 170901
[Lr] Last revision date:170901
[Js] Journal subset:IM
[Da] Date of entry for processing:170621
[St] Status:MEDLINE
[do] DOI:10.1002/14651858.CD009758.pub2

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[PMID]: 28609516
[Au] Autor:Chalhoub NE; Kaw D; Nagaraja V
[Ad] Address:Division of Immunology, Allergy and Rheumatology, Department of Internal Medicine, University of Cincinnati Medical Center, Cincinnati, Ohio.
[Ti] Title:A Man With a Nonblanchable Purpuric Rash.
[So] Source:JAMA;317(22):2329-2330, 2017 Jun 13.
[Is] ISSN:1538-3598
[Cp] Country of publication:United States
[La] Language:eng
[Mh] MeSH terms primary: Immunoglobulin A
Purpura, Schoenlein-Henoch/diagnosis
[Mh] MeSH terms secundary: Aged
Exanthema/pathology
Humans
Leg Dermatoses/pathology
Male
Purpura/pathology
Purpura, Schoenlein-Henoch/immunology
Purpura, Schoenlein-Henoch/pathology
Recurrence
Torso
[Pt] Publication type:CASE REPORTS
[Nm] Name of substance:0 (Immunoglobulin A)
[Em] Entry month:1707
[Cu] Class update date: 170707
[Lr] Last revision date:170707
[Js] Journal subset:AIM; IM
[Da] Date of entry for processing:170614
[St] Status:MEDLINE
[do] DOI:10.1001/jama.2017.4954

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[PMID]: 28538889
[Au] Autor:Cavalcante MLLL; Masuda PY; Brito FF; Pinto ACVD; Itimura G; Nunes AJF
[Ad] Address:Department of Dermatology of the Instituto Lauro de Souza Lima (ILSL) - Bauru (SP), Brazil.
[Ti] Title:Schamberg's disease: case report with therapeutic success by using colchicine.
[So] Source:An Bras Dermatol;92(2):246-248, 2017 Mar-Apr.
[Is] ISSN:1806-4841
[Cp] Country of publication:Brazil
[La] Language:eng
[Ab] Abstract:Pigmented purpuric dermatoses (PPD) include a spectrum of diseases with different clinical aspects, but with similar histopathological features. Specific clinical findings allow the division of PPD in variants. Schamberg's disease is the most common. Treatment is sometimes ineffective and recurrences are common. There are reports of patients who responded well to the use of colchicine. We report the case of a 32-year-old woman, previously healthy, with a history of onset of asymptomatic lesions in legs. She presented purpuric skin eruptions and brownish stains diffusely distributed in the lower limbs. Biopsy was compatible with PPD. We decided for the introduction of colchicine, with good clinical response. The patient has been followed on outpatient basis for ten months without recurrence.
[Mh] MeSH terms primary: Colchicine/therapeutic use
Leg Dermatoses/drug therapy
Pigmentation Disorders/drug therapy
Purpura/drug therapy
[Mh] MeSH terms secundary: Adult
Biopsy
Female
Humans
Leg Dermatoses/pathology
Pigmentation Disorders/pathology
Purpura/pathology
Recurrence
[Pt] Publication type:CASE REPORTS
[Nm] Name of substance:SML2Y3J35T (Colchicine)
[Em] Entry month:1710
[Cu] Class update date: 171006
[Lr] Last revision date:171006
[Js] Journal subset:IM
[Da] Date of entry for processing:170525
[St] Status:MEDLINE

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[PMID]: 28355140
[Au] Autor:Herskovitz I; Hughes O; MacQuhae F; Kirsner RS
[Ad] Address:Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL.
[Ti] Title:Pretibial Myxedema Masquerading as a Venous Leg Ulcer.
[So] Source:Wounds;29(3):77-79, 2017 Mar.
[Is] ISSN:1943-2704
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:The authors report a case of pretibial myxedema (PTM) masquerading as a venous leg ulcer to alert wound care clinicians to this diagnostic possibility. Pretibial myxedema is a localized form of mucin cutaneous deposition characterized by indurated plaques most commonly on anterior legs. It is more likely to present in patients with Graves' disease, but it can be found in euthyroid patients as well. The physiopathology of PTM is complex, and there is an accumulation of highly hydrophilic glycosaminoglycans in the dermis. Minimal morbidity is associated with PTM, but the pruritus related to mucin deposition can be intense. The skin around venous leg ulcers and the skin changes related to PTM can have a similar clinical presentation, which may be a reason PTM is under-recognized.
[Mh] MeSH terms primary: Glucocorticoids/therapeutic use
Graves Disease/pathology
Leg Dermatoses/pathology
Myxedema/pathology
Triamcinolone Acetonide/therapeutic use
Varicose Ulcer/pathology
[Mh] MeSH terms secundary: Aged, 80 and over
Diagnosis, Differential
Female
Graves Disease/complications
Graves Disease/therapy
Humans
Leg Dermatoses/etiology
Leg Dermatoses/therapy
Mucins/analysis
Myxedema/etiology
Myxedema/therapy
Treatment Outcome
Wound Healing
[Pt] Publication type:CASE REPORTS; JOURNAL ARTICLE
[Nm] Name of substance:0 (Glucocorticoids); 0 (Mucins); F446C597KA (Triamcinolone Acetonide)
[Em] Entry month:1710
[Cu] Class update date: 171020
[Lr] Last revision date:171020
[Js] Journal subset:IM
[Da] Date of entry for processing:170330
[St] Status:MEDLINE

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[PMID]: 28302629
[Au] Autor:Mitchell LV; Wilson MR; Holmes S
[Ad] Address:Walton Building, Glasgow Royal Infirmary, Glasgow, UK.
[Ti] Title:A historic disease still prevalent today.
[So] Source:BMJ;356:j1013, 2017 03 16.
[Is] ISSN:1756-1833
[Cp] Country of publication:England
[La] Language:eng
[Mh] MeSH terms primary: Scurvy/diagnosis
[Mh] MeSH terms secundary: Aged
Ascorbic Acid/therapeutic use
Ecchymosis/etiology
Humans
Leg Dermatoses/etiology
Male
Scurvy/complications
Scurvy/drug therapy
[Pt] Publication type:CASE REPORTS; JOURNAL ARTICLE
[Nm] Name of substance:PQ6CK8PD0R (Ascorbic Acid)
[Em] Entry month:1711
[Cu] Class update date: 171113
[Lr] Last revision date:171113
[Js] Journal subset:AIM; IM
[Da] Date of entry for processing:170318
[St] Status:MEDLINE
[do] DOI:10.1136/bmj.j1013

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[PMID]: 28221208
[Au] Autor:Fernandez-Flores A
[Ad] Address:Consultant Histopathologist, Department of Cellular Pathology, Hospital El Bierzo, Ponferrada, Spain.
[Ti] Title:Study on Mucin in Normal-Appearing Leg Skin.
[So] Source:Am J Dermatopathol;39(3):163-170, 2017 Mar.
[Is] ISSN:1533-0311
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:Dermal deposits of mucin in the legs have been described associated with venous insufficiency. However, some degree of stasis dermatitis is generally common in aged individuals. Therefore, some amount of mucin is expected a priori in the reticular dermis of aged patients, even in the absence of clinical lesions. To test this hypothesis, the authors investigated the mucin in the legs of aged individuals without any dermatologic disease. Cutaneous samples were taken from the legs of 15 autopsy cases. A sample of the skin of the legs (either from the left or the right leg without any distinction being made) was randomly taken (without selecting any specific area or attending to macroscopical features). The skin samples were fixed in formaldehyde, and sections obtained from all samples were stained with hematoxylin and eosin, iron, and Alcian blue. Iron deposits were graded as 0/4 in 7 cases, as 1/4 in 4 cases, as 2/4 in 2 cases, and as 4/4 in 2 cases. Cases with greater deposits of iron also had other signs of stasis, such as neovascularization. All the samples scored 0 for dermal mucin deposits in the reticular dermis. The authors conclude that mucin deposits in the legs are not inherent to aging. Therefore, any mucin deposit in the reticular dermis, as well as expansion of the periadnexal dermis by mucin deposits, should be considered abnormal.
[Mh] MeSH terms primary: Mucins/analysis
Skin/pathology
[Mh] MeSH terms secundary: Adult
Aged
Aged, 80 and over
Aging/pathology
Autopsy
Female
Humans
Leg
Leg Dermatoses/pathology
Male
Middle Aged
[Pt] Publication type:JOURNAL ARTICLE
[Nm] Name of substance:0 (Mucins)
[Em] Entry month:1703
[Cu] Class update date: 170314
[Lr] Last revision date:170314
[Js] Journal subset:IM
[Da] Date of entry for processing:170222
[St] Status:MEDLINE
[do] DOI:10.1097/DAD.0000000000000588


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