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Appelman, Charlton (141) showed that skeletal muscle structure is associated with a lower exercise capacity in LC patients, and local and systemic metabolic disturbances, severe exercise-induced myopathy, and tissue infiltration of amyloid-containing deposits in skeletal muscles of patients with LC worsen after induction of post-exertional malaise (141)

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In this chapter, a systematic approach to the physical examination and subsequent decision-making will be discussed as means by which to distinguish non-melanocytic from melanocytic causes of nail pigmentation