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To the Editor:
—An answer in the Questions and Answers section of The Journal (185:153 [July 13] 1963) needs further elucidation. This 60-year-old patient with "no evidence of systemic disease, or peripheral vascular disease of the lower extremity" had a painful ulcer, measuring 2.5 cm, on the lateral aspect of the lower third of one leg. This was felt by your consultant to be a hypertensive ischemic ulcer. While the blood pressure, as your consultant stated, was not noted the inquirer states that there was no evidence of systemic disease. In the absence of systemic disease and hypertension, true ischemic ulceration does not, to all intents and purposes, occur. One should seriously consider the diagnosis of atrophie blanche en plaque (Arch Derm (Chicago)72:242 [Sept] 1955). While atrophie blanche has many of the characteristics of hypertensive ischemic ulceration, it is a different entity and should be separated from
Lawrence M. Nelson. Atrophie Blanche en Plaque. JAMA. 1963;186(10):958. doi:10.1001/jama.1963.03710100096026