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L’Imperio V, Ceola S, Cerbelli B, Barreca A, Pagni F. Systemic vasculitis involving the kidney: the nephropathologist's point of view. Pathologica 2024; 116:104-118. [PMID: 38767543 PMCID: PMC11138762 DOI: 10.32074/1591-951x-990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 03/01/2024] [Indexed: 05/22/2024] Open
Abstract
Kidneys are often targets of systemic vasculitis (SVs), being affected in many different forms and representing a possible sentinel of an underlying multi-organ condition. Renal biopsy still remains the gold standard for the identification, characterization and classification of these diseases, solving complex differential diagnosis thanks to the combined application of light microscopy (LM), immunofluorescence (IF) and electron microscopy (EM). Due to the progressively increasing complexity of renal vasculitis classification systems (e.g. pauci-immune vs immune complex related forms), a clinico-pathological approach is mandatory and adequate technical and interpretative expertise in nephropathology is required to ensure the best standard of care for our patients. In this complex background, the present review aims at summarising the current knowledge and challenges in the world of renal vasculitis, unveiling the potential role of the introduction of digital pathology in this setting, from the creation of hub-spoke networks to the future application of artificial intelligence (AI) tools to aid in the diagnostic and scoring/classification process.
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Affiliation(s)
- Vincenzo L’Imperio
- Department of Medicine and Surgery, Pathology, IRCCS Fondazione San Gerardo dei Tintori, University of Milano-Bicocca, Italy
| | - Stefano Ceola
- Department of Medicine and Surgery, Pathology, IRCCS Fondazione San Gerardo dei Tintori, University of Milano-Bicocca, Italy
| | - Bruna Cerbelli
- Department of Medical Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy
| | - Antonella Barreca
- Pathology Unit, Città della Salute e della Scienza di Torino University Hospital, Turin, Italy
| | - Fabio Pagni
- Department of Medicine and Surgery, Pathology, IRCCS Fondazione San Gerardo dei Tintori, University of Milano-Bicocca, Italy
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2
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Caproni M, Calabria VRD, Mariotti EB, Verdelli A, Aimo C, Corrà A, Quintarelli L, Volpi W, Alpsoy E, Sunderkötter C. The impact on the scientific community of the 2018 addendum to the CHCC. Front Med (Lausanne) 2022; 9:1081063. [DOI: 10.3389/fmed.2022.1081063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 11/02/2022] [Indexed: 12/02/2022] Open
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Marro J, Chetwynd AJ, Wright RD, Dliso S, Oni L. Urinary Protein Array Analysis to Identify Key Inflammatory Markers in Children with IgA Vasculitis Nephritis. CHILDREN 2022; 9:children9050622. [PMID: 35626799 PMCID: PMC9139281 DOI: 10.3390/children9050622] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 04/22/2022] [Accepted: 04/25/2022] [Indexed: 11/16/2022]
Abstract
Chronic kidney disease is a recognised complication of immunoglobulin A vasculitis, (IgAV; formerly Henoch–Schonlein purpura—HSP). The pathophysiology of IgAV and why some patients develop significant renal involvement remains largely unknown. Identifying urinary inflammatory markers could direct targets for earlier intervention. The aim of this cross-sectional exploratory study was to perform a large protein array analysis to identify urinary markers to provide insight into the mechanisms of kidney inflammation in children with established IgAV nephritis (IgAVN). Determination of the relative levels of 124 key proteins was performed using commercially available proteome profiler array kits. Twelve children were recruited: IgAVN, n = 4; IgAV without nephritis (IgAVwoN), n = 4; healthy controls (HCs), n = 4. The urinary concentrations of twenty proteins were significantly different in IgAVN compared to IgAVwoN. The largest fold changes were reported for B-cell activating factor (BAFF), Cripto-1, sex-hormone-binding globulin and angiotensinogen. The urinary levels of complement components C5/C5a and factor D were also significantly elevated in patients with IgAVN. A total of 69 urinary proteins significantly raised levels in comparisons made between IgAVN vs. HCs and nine proteins in IgAVwoN vs. HCs, respectively. This study identified key urinary proteins potentially involved in IgAVN providing new insight into the pathophysiology. Further longitudinal studies with larger cohorts are needed to quantitatively analyse these biomarkers.
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Affiliation(s)
- Julien Marro
- Department of Women’s and Children’s Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool L12 2AP, UK; (J.M.); (A.J.C.); (R.D.W.)
| | - Andrew J. Chetwynd
- Department of Women’s and Children’s Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool L12 2AP, UK; (J.M.); (A.J.C.); (R.D.W.)
| | - Rachael D. Wright
- Department of Women’s and Children’s Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool L12 2AP, UK; (J.M.); (A.J.C.); (R.D.W.)
| | - Silothabo Dliso
- NIHR Alder Hey Clinical Research Facility, Clinical Research Division, Alder Hey Children’s NHS Foundation Trust, Liverpool L14 5AB, UK;
| | - Louise Oni
- Department of Women’s and Children’s Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool L12 2AP, UK; (J.M.); (A.J.C.); (R.D.W.)
- Department of Paediatric Nephrology, Alder Hey Children’s NHS Foundation Trust Hospital, Liverpool L14 5AB, UK
- Correspondence: ; Tel.: +44-(0)151-252-5441
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Munera-Campos M, Bielsa I, Martínez-Morillo M, Aparicio G, Olivé A, Ferrándiz C. Manifestationen, Krankheitsverlauf und prognostische Parameter bei kutaner Polyarteriitis nodosa. J Dtsch Dermatol Ges 2020; 18:1250-1260. [PMID: 33251748 DOI: 10.1111/ddg.14271_g] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 05/21/2020] [Indexed: 01/14/2023]
Affiliation(s)
- Mónica Munera-Campos
- Department of Dermatology, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain
| | - Isabel Bielsa
- Department of Dermatology, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain
| | - Melania Martínez-Morillo
- Department of Rheumatology, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain
| | - Gloria Aparicio
- Department of Dermatology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Alejandro Olivé
- Department of Rheumatology, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain
| | - Carlos Ferrándiz
- Department of Dermatology, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain
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5
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Munera‐Campos M, Bielsa I, Martínez‐Morillo M, Aparicio G, Olivé A, Ferrándiz C. Manifestations, clinical course and prognostic markers in cutaneous polyarteritis nodosa. J Dtsch Dermatol Ges 2020; 18:1250-1259. [DOI: 10.1111/ddg.14271] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 05/21/2020] [Indexed: 12/29/2022]
Affiliation(s)
- Mónica Munera‐Campos
- Department of Dermatology Hospital Universitari Germans Trias i Pujol Universitat Autònoma de Barcelona Badalona Barcelona Spain
| | - Isabel Bielsa
- Department of Dermatology Hospital Universitari Germans Trias i Pujol Universitat Autònoma de Barcelona Badalona Barcelona Spain
| | - Melania Martínez‐Morillo
- Department of Rheumatology Hospital Universitari Germans Trias i Pujol Universitat Autònoma de Barcelona Badalona Barcelona Spain
| | - Gloria Aparicio
- Department of Dermatology Hospital Universitari Vall d’Hebron Universitat Autònoma de Barcelona Barcelona Spain
| | - Alejandro Olivé
- Department of Rheumatology Hospital Universitari Germans Trias i Pujol Universitat Autònoma de Barcelona Badalona Barcelona Spain
| | - Carlos Ferrándiz
- Department of Dermatology Hospital Universitari Germans Trias i Pujol Universitat Autònoma de Barcelona Badalona Barcelona Spain
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Ratzinger G, Zelger BG, Zelger BW. Bar Code Reader - an algorithmic approach to cutaneous occluding vasculopathies? part II medium vessel vasculopathies. J Dtsch Dermatol Ges 2020; 17:1115-1128. [PMID: 31765098 PMCID: PMC6899693 DOI: 10.1111/ddg.13973] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 03/27/2019] [Indexed: 12/13/2022]
Abstract
Aims Classifications of occluding vasculopathies (except vasculitis [1]) may exhibit some difficulties. Firstly, classifications may follow different principles, e.g. clinicopathologic findings, etiology or pathogenesis. Secondly, authors may not distinguish between vasculitis and occluding vasculopathies. Thirdly, occluding vasculopathies are systemic diseases. Organ‐specific variations make morphologic findings difficult to compare. Moreover, subtle changes are recognized in the skin, but may be invisible in other organs. Our aim was to use the skin and subcutis as a tool and clinicopathological correlation as the basic process for classification. Methods and results We first differentiate in the skin between small and medium vessel occluding vasculopathies. Here we focus on medium vessel‐occluding vasculopathies. In the second step we differentiate the vessel subtypes. In the final step, we differentiate according to the time point of the coagulation/reorganization process and the involved inflammatory cells/stromal features. By applying the same procedure to the various entities and visualizing the findings in the style of bar codes, the overlaps and differences in the clinical picture as well as the histopathology become more apparent. Conclusions Occluding vasculopathies are often not separate entities, but reaction patterns and epiphenomena. Distinguishing them from vasculitides is crucial because of the differences in pathogenesis, therapeutic approach and prognosis.
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Affiliation(s)
- Gudrun Ratzinger
- Department of Dermatology, Venereology and Allergology, Medical University Innsbruck, Innsbruck, Austria
| | - Bettina G Zelger
- Department of Pathology, Medical University Innsbruck, Innsbruck, Austria
| | - Bernhard W Zelger
- Department of Dermatology, Venereology and Allergology, Medical University Innsbruck, Innsbruck, Austria
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Buhl T, Beissert S, Gaffal E, Goebeler M, Hertl M, Mauch C, Reich K, Schmidt E, Schön MP, Sticherling M, Sunderkötter C, Traidl‐Hoffmann C, Werfel T, Wilsman‐Theis D, Worm M. COVID‐19 und Auswirkungen auf dermatologische und allergologische Erkrankungen. J Dtsch Dermatol Ges 2020; 18:815-825. [PMID: 32881343 PMCID: PMC7461475 DOI: 10.1111/ddg.14195_g] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Die durch das Coronavirus SARS‐CoV‐2 verursachte Krankheit COVID‐19 hat sich zu einer Pandemie entwickelt. Bei der Betrachtung von dermatologischen und allergologischen Krankheiten, die potenziell von COVID‐19 betroffen sind, stehen wir vor komplexen Herausforderungen, die Pathogenese und Beeinflussung verschiedener immunologischer Signalwege einschließen. Medizinische Behandlungen müssen daher im Zusammenhang mit dieser Infektion oft neu bewertet und in Frage gestellt werden. Dieser Übersichtsartikel fasst den aktuellen Wissensstand zu COVID‐19 hinsichtlich der wichtigsten dermatologischen und allergologischen Erkrankungen zusammen. Es werden aber auch die medizinischen Bereiche beschrieben, für die keine ausreichenden Daten vorliegen. Unter Zusammenfassung der publizierten Daten und grundsätzlicher pathophysiologischer Überlegungen werden hier Schlussfolgerungen für das Management unserer Patienten während der Pandemie gezogen. Wir konzentrieren uns auf häufige Hauterkrankungen mit komplexer immunologischer Pathogenese: Psoriasis, Ekzeme einschließlich atopischer Dermatitis, Typ‐I‐Allergien, blasenbildende Autoimmundermatosen, Kollagenosen, Vaskulitiden und Hautkrebserkrankung. Da viele weitere Hauterkrankungen verwandte oder vergleichbare immunologische Reaktionsmuster aufweisen, können pathophysiologisch ähnliche entzündliche Dermatosen möglicherweise auch mit ähnlichen therapeutischen Überlegungen und Schlussfolgerungen während der Pandemie behandelt werden. Daher soll diese Übersicht Behandlungsempfehlungen auf der Basis bisher publizierter Daten und Empfehlungen zu Therapieentscheidungen auch über die hier diskutierten, häufigsten Erkrankungen hinaus liefern.
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Affiliation(s)
- Timo Buhl
- Klinik für DermatologieVenerologie und AllergologieUniversitätsklinikum GöttingenDeutschland
- Niedersächsisches Institut für BerufsdermatologieUniversitätsklinikum GöttingenDeutschland
| | - Stefan Beissert
- Klinik für DermatologieUniversitätsklinikum Carl Gustav CarusTU DresdenDeutschland
| | - Evelyn Gaffal
- Klinik für DermatologieUniversitätsklinikum MagdeburgDeutschland
| | - Matthias Goebeler
- Klinik für DermatologieVenerologie und AllergologieUniversitätsklinik WürzburgDeutschland
| | - Michael Hertl
- Klinik für DermatologiePhilipps‐UniversitätMarburgDeutschland
| | - Cornelia Mauch
- Klinik für DermatologieUniversitätsklinik KölnDeutschland
| | - Kristian Reich
- Translational Research in Inflammatory Skin DiseasesIVDPUniversitätsklinikum Hamburg‐EppendorfDeutschland
| | - Enno Schmidt
- Klinik für DermatologieUniversität zu LübeckDeutschland
- Lübecker Institut für Experimentelle Dermatologie (LIED)Universität zu LübeckDeutschland
| | - Michael P. Schön
- Klinik für DermatologieVenerologie und AllergologieUniversitätsklinikum GöttingenDeutschland
- Niedersächsisches Institut für BerufsdermatologieUniversitätsklinikum GöttingenDeutschland
| | - Michael Sticherling
- Klinik für DermatologieFAU Erlangen‐Nürnberg und Universitätsklinikum ErlangenDeutsches Zentrum für Immuntherapie (DZI)ErlangenDeutschland
| | - Cord Sunderkötter
- Klinik für Dermatologie und VenerologieUniversitätsklinikum Halle‐WittenbergHalle (Saale)Deutschland
| | - Claudia Traidl‐Hoffmann
- Institut für UmweltmedizinUNIKA‐T AugsburgTechnische Universität München und Helmholtz Zentrum MünchenDeutsches Forschungszentrum für Gesundheit und UmweltDeutschland
- Ambulanz für UmweltmedizinUniversitätsklinikum AugsburgDeutschland
| | - Thomas Werfel
- Abteilung für Immundermatologie und AllergieforschungKlinik für Dermatologie und AllergologieMedizinische Hochschule HannoverDeutschland
| | - Dagmar Wilsman‐Theis
- Klinik für Dermatologie und AllergologieUniversitätsklinikumFriedrich‐Wilhelms‐UniversitätBonnDeutschland
| | - Margitta Worm
- Abteilung für Allergologie und ImmunologieKlinik für DermatologieVenerologie und AllergologieCharité ‐ Universitätsmedizin BerlinDeutschland
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8
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Buhl T, Beissert S, Gaffal E, Goebeler M, Hertl M, Mauch C, Reich K, Schmidt E, Schön MP, Sticherling M, Sunderkötter C, Traidl-Hoffmann C, Werfel T, Wilsman-Theis D, Worm M. COVID-19 and implications for dermatological and allergological diseases. J Dtsch Dermatol Ges 2020; 18:815-824. [PMID: 32717116 DOI: 10.1111/ddg.14195] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 06/30/2020] [Indexed: 12/15/2022]
Abstract
COVID-19, caused by the coronavirus SARS-CoV-2, has become pandemic. A further level of complexity opens up as soon as we look at diseases whose pathogenesis and therapy involve different immunological signaling pathways, which are potentially affected by COVID-19. Medical treatments must often be reassessed and questioned in connection with this infection. This article summarizes the current knowledge of COVID-19 in the light of major dermatological and allergological diseases. It identifies medical areas lacking sufficient data and draws conclusions for the management of our patients during the pandemic. We focus on common chronic inflammatory skin diseases with complex immunological pathogenesis: psoriasis, eczema including atopic dermatitis, type I allergies, autoimmune blistering and inflammatory connective tissue diseases, vasculitis, and skin cancers. Since several other inflammatory skin diseases display related or comparable immunological reactions, clustering of the various inflammatory dermatoses into different disease patterns may help with therapeutic decisions. Thus, following these patterns of skin inflammation, our review may supply treatment recommendations and thoughtful considerations for disease management even beyond the most frequent diseases discussed here.
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Affiliation(s)
- Timo Buhl
- Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Germany.,Lower Saxony Institute of Occupational Dermatology, University Medical Center Göttingen, Germany
| | - Stefan Beissert
- Department of Dermatology, University Hospital Carl Gustav Carus, TU Dresden, Germany
| | - Evelyn Gaffal
- Department of Dermatology, University Hospital Magdeburg, Germany
| | - Matthias Goebeler
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Germany
| | - Michael Hertl
- Department of Dermatology, Philipps University, Marburg, Germany
| | - Cornelia Mauch
- Department of Dermatology, University Hospital Cologne, Germany
| | - Kristian Reich
- Translational Research in Inflammatory Skin Diseases, IVDP, University Medical Center Hamburg-Eppendorf, Germany
| | - Enno Schmidt
- Department of Dermatology, University of Lübeck, Germany.,Lübeck Institute for Experimental Dermatology (LIED), University of Lübeck, Lübeck, Germany
| | - Michael P Schön
- Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Germany.,Lower Saxony Institute of Occupational Dermatology, University Medical Center Göttingen, Germany
| | - Michael Sticherling
- Department of Dermatology, FAU Erlangen-Nuremberg and University Hospital Erlangen, German Center Immunotherapy (DZI), Erlangen, Germany
| | - Cord Sunderkötter
- Department of Dermatology and Venereology, University Hospital Halle-Wittenberg, Halle (Saale), Germany
| | - Claudia Traidl-Hoffmann
- Institute of Environmental Medicine, UNIKA-T Augsburg, Technical University Munich and Helmholtz-Zentrum Munich, German Research Center for Environmental Health, Germany.,Outpatient Clinic for Environmental Medicine, University Hospital Augsburg, Germany
| | - Thomas Werfel
- Division of Immunodermatology and Allergy Research, Department of Dermatology and Allergy, Hannover Medical School, Germany
| | - Dagmar Wilsman-Theis
- Department of Dermatology and Allergology, University Medical Center, Friedrich Wilhelm University, Bonn, Germany
| | - Margitta Worm
- Division of Allergy and Immunology, Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, Germany
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Ratzinger G, Zelger BG, Zelger BW. Barcodeleser – ein algorithmischer Ansatz für okkludierende kutane Vaskulopathien? Teil 2: Vaskulopathien mittelgroßer Gefäße. J Dtsch Dermatol Ges 2019; 17:1115-1130. [PMID: 31765089 DOI: 10.1111/ddg.13973_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 03/27/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Gudrun Ratzinger
- Universitätsklinik für Dermatologie, Venerologie und Allergologie, Medizinische Universität Innsbruck, Innsbruck, Österreich
| | - Bettina G Zelger
- Institut für Pathologie, Medizinische Universität Innsbruck, Innsbruck, Österreich
| | - Bernhard W Zelger
- Universitätsklinik für Dermatologie, Venerologie und Allergologie, Medizinische Universität Innsbruck, Innsbruck, Österreich
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10
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Duschek N, Trautinger F. [Chronic leg ulcers in older patients]. Z Gerontol Geriatr 2019; 52:377-390. [PMID: 31187184 DOI: 10.1007/s00391-019-01567-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 05/20/2019] [Indexed: 01/13/2023]
Abstract
Chronic ulcers of the lower extremities are one of the most common medical problems encountered in western societies. The prevalence of leg ulcers is estimated to be 0.5-1.0% of the German population and is clearly associated with age. Therefore, in an aging society chronic leg ulcers are an important health issue with respect to increased morbidity and healthcare costs. The most frequent causes of leg ulcers are chronic venous insufficiency, peripheral arterial occlusive disease and diabetes mellitus. Efficient treatment necessitates an exact diagnosis and a close interdisciplinary collaboration. Affected patients often require instructions regarding self-help and support for competent nursing and prophylaxis. Therapeutic strategies, especially in the geriatric setting, aim to maintain the quality of life through preservation of patient mobility and autonomy.
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Affiliation(s)
- N Duschek
- Klinische Abteilung für Haut- und Geschlechtskrankheiten, Universitätsklinikum St. Pölten, Karl Landsteiner Privatuniversität für Gesundheitswissenschaften, Dunant-Platz 1, 3100, St. Pölten, Österreich.
| | - F Trautinger
- Klinische Abteilung für Haut- und Geschlechtskrankheiten, Universitätsklinikum St. Pölten, Karl Landsteiner Privatuniversität für Gesundheitswissenschaften, Dunant-Platz 1, 3100, St. Pölten, Österreich
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