
Lines or wrinkles on the face, typically radiating at right angles from the upper and lower lips or corners of the eyes, deeplines on the cheeks, or numerous shallow lines on the cheeks and lower jaw. A subtle gauntness of the facial features with prominence of the underlying bony contours. Fully developed this change gives the face and ‘atherosclerotic’ (sic. A bit like choked up blood vessels) look; lesser changes show as slight sinking of the cheeks. In some cases these changes are associated with a leathery, worn, or rugged look. An atrophic, somewhat pigmented grey look of the skin ,A plethoric, slightly orange, purple and red complexion different from the purply blue colour of cyanosis or the bloated appearance associated with the pseudo-Cushing’s changes of alcoholism"


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