Enlarged hair follicles in patients with Ehlers-Danlos syndrome.

Sir,Ehlers-Danlos syndrome (EDS) is a rare connectivetissue disease manifested clinically as joint hypermobi-lity, skin hyperextensibility, poor wound healing withabnormal scarring and bruising due to blood vesselfragility (1). The diagnosis of EDS is based on a scoringsystem that requires a time-consuming examination(2, 3). Recently attempts have been made to findadditional minor criteria that may contribute to thediagnosis of EDS (3, 4).We have observed that the hair follicles of the skin inpatients with EDS are macroscopically more prominentthan those of healthy subjects (Fig. 1A, B). To verifythis finding the size of the hair follicles in patientswith EDS was measured by skin ultrasonography.Ultrasonography is an established method for non-invasive investigation of the skin, and the imagesclearly show the epidermal entrance echo, the dermisand the hair follicles (5, 6).PATIENTS AND METHODS