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Unusual scars in a young female patient

Q1: What other signs and symptoms would she present with?

• Skin—skin feels velvety to touch and is soft. Stretches and springs back easily. Atrophic "cigarette paper" scars.
  
• Musculoskeletal—pronounced joint hypermobility.
  
• Others—easy bruising and poor muscle tone.
  

Q2: What could be the cause of scars across her back?
Chickenpox scars when she was 10 years of age.

Q3: What is the diagnosis?
Ehlers-Danlos syndrome type 1.

Discussion
Ehlers-Danlos syndrome is a group of genodermatoses affecting connective tissues predominantly collagen fibres that are structurally abnormal.¹ Defects in elastin² and fibronectin³ metabolisms have been found in Ehlers-Danlos syndrome type IV and V respectively. Typically the dermal collagen is disorderly, sparse, and vortex-like. The mode of inheritance is variable and can be autosomal dominant, recessive, and X-linked recessive. Table 1 summarises the various types of Ehlers-Danlos syndrome.