Enlarged hair follicles in patients with Ehlers-Danlos syndrome.

Sir, Ehlers-Danlos syndrome (EDS) is a rare connective tissue disease manifested clinically as joint hypermobility, skin hyperextensibility, poor wound healing with abnormal scarring and bruising due to blood vessel fragility (1). The diagnosis of EDS is based on a scoring system that requires a time-consuming examination (2, 3). Recently attempts have been made to find additional minor criteria that may contribute to the diagnosis of EDS (3, 4). We have observed that the hair follicles of the skin in patients with EDS are macroscopically more prominent than those of healthy subjects (Fig. 1A, B). To verify this finding the size of the hair follicles in patients with EDS was measured by skin ultrasonography. Ultrasonography is an established method for noninvasive investigation of the skin, and the images clearly show the epidermal entrance echo, the dermis and the hair follicles (5, 6).