8 A practical guide to the Istanbul Protocol – for medical doctors tively indistinct periphery (Kjærsgård & Ge-​ nefke, 1977). damage caused by material running down the body (Rasmussen, 1990). ≠≠ Dermatological conditions, e.g. sequels to pustules, might be a differential diagnosis. A scar following alleged torture from burning with a glowing metal rod placed across the broad area of the calf was primarily suggested to represent changes induced by venous insufficiency. The scar was shaped like a boat, and was placed across the broad part of the calf; it had an atrophic centre and a regular, narrow zone of hyperpigmentation in the periphery (Fig. 3) (Danielsen, 1995). The shape of the scar thus corresponds to a lesion induced by a rod pressed against the soft calf, and the appearance of the scar to a third degree burn because of its atrophic centre and the narrow hyperpigmented zone in its periphery. Burning via the transfer of larger amounts of energy to the skin than that transferred when stubbing a cigarette on the skin often produces markedly atrophic scars. They present a narrow, regular, hyperpigmented or hypertrophic periphery, originating from the inflammatory zone, which surrounds the necrotic tissue in the acute phase (Danielsen, 1982). While their shape reflects the shape of the instrument used, their size relates to the amount of energy transferred to the skin. Following alleged torture from burning on several areas of the skin with a heated, circular metal rod, the size of a cigarette, mostly circular scars with an atrophic centre and a regular, narrow, hyperpigmented or hypertrophic zone in the periphery were observed. Their diameter varied from below 1 cm to around 2 cm, and the patient had 35 scars distributed on several areas of the skin (Danielsen & Berger, 1981). ≠≠ A differential diagnosis could be sequels to abscesses, but such scars usually do not show the typical, narrow zone in the periphery (Petersen & Rasmussen, 1992). Burning material from a rubber tyre, placed above the head of a woman, running down on her head and body, left keloid changes on the central area of her chest (the medial areas of her breasts not included). The periphery of the scar was irregular and demarcated via a narrow, well-defined zone of hyperpigmentation, and its shape corresponded to ≠≠ In contrast, venous insufficiency leaves indistinctly limited hyperpigmentation and scars from ulcers located distally on the lower leg (Fig. 4) (Danielsen, 1995). Afterwards, the patient was granted refugee status. When the nail matrix is burnt, subsequent growth produces striped, thin, deformed nails, sometimes broken up in longitudinal segments. If the nail is also pulled off, an overgrowth of tissue may occur from the proximal nail fold (Danielsen, 1992). ≠≠ Changes caused by lichen planus may be a relevant differential diagnosis, while fungus infection is characterised by thickened, yellowish, crumbling nails, different from those mentioned above. 5. CORROSIVE INJURIES Corrosive injuries, caused by acid thrown against a victim, caused linear scars, a few cm wide, with a depigmented centre and a regular, narrow, hyperpigmented zone in the periphery, located on the thighs and buttocks (Gordon & Mant, 1984). They were