12 A practical guide to the Istanbul Protocol – for medical doctors Figure 3. A scar shaped like a boat, placed across the calf with an atrophic centre and a narrow, regular zone of hyperpigmentation in the periphery (Danielsen, 1995). Published with kind permission from Sår. Figure 4. Venous insufficiency with indistinctly limited hyperpigmentation distally on the lower leg (Danielsen, 1995). Published with kind permission from Sår.