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June 1991

Protein C and Protein S Plasma Levels in Patients With Lipodermatosclerosis and Venous Ulceration

Author Affiliations

USA Dermatology Service Tripler Army Medical Center Honolulu, HI 96859

Arch Dermatol. 1991;127(6):908-909. doi:10.1001/archderm.1991.01680050154023

To the Editor.—  I read with interest the article by Falanga et al1 on the potential association of protein S and protein C with venous ulceration and lipodermatosclerosis. Although I applaud the effort, I wish to caution interpretation of hypercoagulable evaluations analyzing isolated defects. Clot formation and dissolution is a very dynamic and complex process, and studies attempting to show a cause-and-effect relationship must exclude other potential factors. The authors state "One proposed hypothesis suggests that the sustained elevation of venous pressure (venous hypertension), resulting from inadequate functioning of the "calf muscle pump," lends to dermal pericapillary deposition of fibrin, which alters the interactions between vasculature and dermis." They further state: "Thus, an increased propensity for deep vein thrombosis, as could occur in the setting of protein C or protein S deficiency, and perhaps in combination with a faulty fibrinolytic system, may lead to the development of venous

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