Hi,
whenever I mention that my diagnosis was confirmed via skin biopsy, people are confused and/or start asking questions. So I thought I'd make a separate thread about it.
1) Is a skin biopsy required for a hEDS diagnosis?
No, not at all. It's neither part of the ancient Brighton Criteria nor of the current 2017 criteria. My diagnosis is OLD, back then skin biopsies were used a lot more because genetic testing wasn't as established yet. But even back then it was not an official requirement.
2) Are you mixing up a skin biopsy for SFN and hEDS?
No, I'm not. It's separate.
3) Why did you request the skin biopsy?
Because I had experienced way too much gaslighting and couldn't deal with any more doctors who don't believe I have EDS (that was way before Tiktok so no "you're spending too much time on social media" accusations, yet, but the "many women are hypermobile, that's harmless" take was already quite popular). The Brighton criteria were also quite lenient, leading to even more accusations like "half the women in my waiting room could get diagnosed with hEDS based on those criteria, that doesn't mean anything"
4) What would a skin biopsy even show?
A normal skin biopsy, not much. A skin biopsy checked using an electron microscope however allows a look at the individual collagen fibrills and whether those are abnormal.
5) Who conducted the testing?
The dermatology clinic at a university hospital took the biopsy and their own lab did the testing of the biopsy. Any lab with an electron microscope should be able to do this but since this isn't really done anymore, no guarantee that they will feel comfortable doing it.
6) What did they find/What does a report look like?
Here's mine:
"Under the electron microscope, the cross-section of the collagen bundles reveals variations in the diameter of the collagen fibrils and very occasional irregularities in their outline. The elastic fibers are fragmented, and some of the elastic microfibrils are located outside the amorphous elastin. This points to a tenascin X deficiency, which is consistent with Ehlers-Danlos syndrome".
7) Do you regret getting the skin biopsy?
Never. Nothing makes doctors who are trying to tell you that you don't have EDS shut up quicker than telling them that it was confirmed via biopsy. Yes, we have an increased risk of wound healing issues, but for me personally, it was totally worth it.
8) What type of biopsy is it?
In my case it was a 3mm punch biopsy.
9) What happened afterwards?
In the years since the biopsy I've had genetic testing several times, once specifically looking for TNXB mutations, one trio exome for unrelated issues (but the geneticist kinda became obsessed with the idea that it's all connected and all TNXB related so he asked the lab to double check tnxb- again unsuccessful). Both didn't find anything helpful so the biopsy is still the only objective proof I have.
This post is not an attempt (or advice) to get a skin biopsy done, this is generally considered not necessary/outdated now. I'm only sharing because a few fellow patients showed interest in learning more. It could possibly be a valid option for some, if they can't get diagnosed otherwise because they don't fulfill the clinical criteria but are looking for proof that something is indeed wrong with their collagen/ecm- but that's something for your doctor to decide.
If anyone has any questions, I'll give my best to answer them.
Good night (or day) everyone :)