Risk factors for severe disease:
(1) alcoholism or drug addiction
(2) psychiatric patient
(3) extreme poverty, especially in urban ghettos
(4) improper care of lesions
(5) immobility from partial or total paralysis
Clinical features:
(1) extensive disease (>= 50 lesions)
(2) deep tissue fissures, ulcerations or areas of extensive tissue necrosis
(3) exposure of underlying bone
(4) severe deformation or auto-amputation of digits
Disability and functional impairment:
(1) inability to walk resulting in immobility
(2) inability to grip with hands
(3) inability to work
(4) sleep impairment consequent to severe itching or pain
Infectious complications:
(1) superinfection with cellulitis, osteomyelitis, gangrene or sepsis
(2) tetanus
