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Editorial |

Clinical Approach to Atypical Wounds With a New Model for Understanding Hypertensive Ulcers

Michael L. Shelling, MD; Daniel G. Federman, MD; Robert S. Kirsner, MD, PhD
Arch Dermatol. 2010;146(9):1026-1029. doi:10.1001/archdermatol.2010.213.
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In 2004, the American Academy of Dermatology, in concert with the Society of Investigative Dermatology, reported on the burden of skin disease in the United States.1 Examining both direct and indirect costs, they found wounds to be the most financially costly of all skin disease. In fact, recent estimates suggest that nearly 6.5 million patients in the United States are affected with chronic wounds, with an annual expenditure of nearly $25 billion for treatment alone.2 More importantly, the burden of disease appears to be on the rise owing, at least in part, to the increasing prevalence of diabetes, obesity, and an aging population. These numbers do not include the numerous skin diseases ranging from a primary syphilitic chancre to pemphigus vulgaris, with resultant wounds as one of their manifestations. In addition, dermatologists create more surgical wounds than any other specialty.3 Collectively, wounds are responsible for significant personal distress and discomfort, economic burden, morbidity, and even mortality.

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Figure.

Approach to the diagnosis of typical and atypical wounds. *Diagnostic classification as suggested by Hafner et al.9 ABI indicates ankle-brachial index; HE, hematoxylin-eosin; HYTILU, hypertensive ischemic leg ulcer; IBD, inflammatory bowel disease; and RA, rheumatoid arthritis.

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