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Hyperpigmented with leakage of red blood changes also may include thickening of the ankle with nonpitting edema (woody fibrosis) that does not resolve with the recumbent position. The clinician should ask about previous topical well as home remedies (including alterna-tive medicines).
Nourishment is provided to these layers via diffusion from the dermis, since the epidermis is without direct blood supply. The epidermis contains four cell types: keratinocytes, melanocytes, Langerhans cells, and Merkel cells.
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