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A laboratory micro‑CT technique is useful to visualize and characterize dermal skin components in a 3D manner

  • Authors:
    • Katarina Lundqvist
    • Hanna Tufvesson
    • Lars B. Dahlin
    • Marius Reichardt
    • Bodil Ohlsson
  • View Affiliations / Copyright

    Affiliations: Division of Dermatology and Venereology, Skåne University Hospital, Lund, Scania S‑221 85, Sweden, Department of Gastroenterology, Skåne University Hospital, Malmö, Scania S‑205 02, Sweden, Department of Hand Surgery, Skane University Hospital, Malmö, Scania S‑205 02, Sweden, Histomography® GmbH, Göttingen, Lower Saxony D-37075, Germany, Department of Clinical Sciences, Lund University, Malmö, Scania S‑205 02, Sweden
    Copyright: © Lundqvist et al. This is an open access article distributed under the terms of Creative Commons Attribution License.
  • Article Number: 120
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    Published online on: February 27, 2026
       https://doi.org/10.3892/etm.2026.13116
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Abstract

Bowel and skin biopsies from patients with gastrointestinal disorders have revealed neuropathic changes and altered connective tissue. Patients with postural orthostatic tachycardia syndrome (POTS) often suffer from gastrointestinal symptoms and concomitant hypermobility spectrum disorders, such as hypermobile Ehlers‑Danlos syndrome (hEDS). Since the skin is more accessible than the bowel, the aim of the present study was to evaluate skin biopsies in a 3D manner using micro‑CT in patients with POTS and controls and relate the findings to symptoms presented. Healthy controls (n=13) and patients with POTS with (n=11) or without hEDS/EDS (n=26) were evaluated. Skin biopsies were taken proximally to the lateral malleolus using a 3 mm needle, fixed in formaldehyde and embedded in paraffin. The samples were harvested using a 1.5 mm punch (length, 2‑5 mm) and scanned using a laboratory X‑ray phase‑contrast micro‑CT. Scans were evaluated in a blinded manner and the regularity, thickness and tightness of collagen fiber bundles were assessed. All dermal structures were visible without staining. Intraepidermal nerves were not visible and a number of cell types could not be separated. The percentage of disorganized collagen bundles differed between groups, due to the majority being disorganized in hEDS/EDS (P=0.030). The proportion of any disorganized and parallel bundles throughout the biopsy differed within both patient groups (P<0.001) but not within the control group (P=0.175). There were no differences in symptoms between participants with disorganized bundles and participants without disorganized bundles. In conclusion, X‑ray phase‑contrast micro‑CT was suitable to visualize and characterize dermal skin components in 3D. Patients with POTS and hEDS/EDS exhibited more disorganized collagen bundles; however, the technique cannot currently be used for diagnostic purposes until more patients are examined.
View Figures

Figure 1

Skin tissue punch biopsy from patients
with POTS, with and without hEDS, and 1 control, showing a scanned
vertical overview. (A) Overview of skin biopsies. (B) The same
scans with higher magnification illustrating the disorganized
collagen fiber bundles throughout the biopsy in the patients with
and without hEDS and more organized parallel fiber bundles
throughout the biopsy in the control. (C) A transversal
cross-section of the data set. Scale bars, 250 µm. a, stratum
corneum; b, stratified granulosum; c, stratum spinosum; d, dermo
epidermal junction; e, hair follicle with hair shaft; f, follicle
bulb; g, arrector pili; h, sebaceous gland; k, collagen fiber
bundles. hEDS, hypermobile Ehler-Danlos syndrome; POTS, postural
orthostatic tachycardia syndrome.

Figure 2

Skin biopsy from a healthy control
participant. A control with organized collagen bundles throughout
the skin biopsy. Vertical overview and transversal views at three
different depths (marked in green, red and blue). k, organized
collagen fiber bundles. Scale bars, 250 μm.

Figure 3

Skin biopsy from a patient with POTS.
A patient with disorganized collagen bundles throughout the skin
biopsy. Vertical overview and transversal views at three different
depths (marked in green, red and blue). k, disorganized collagen
fiber bundles. Scale bars, 250 μm. POTS, postural
orthostatic tachycardia syndrome.

Figure 4

Skin biopsy from a patient with POTS
and hEDS. Vertical overview and transversal views at three
different depths (marked in green, red and blue). k, disorganized
collagen fiber bundles. Scale bars, 250 μm. hEDS,
hypermobile Ehler-Danlos syndrome; POTS, postural orthostatic
tachycardia syndrome.

Figure 5

Immunohistochemistry of skin biopsy.
Representative image from (A) healthy participant, (B) patient with
POTS and (C) patient with POTS and hEDS. Skin with small
intraepidermal nerves (arrows) in a 5 μm skin section shown
through protein gene product 9.5 staining. Magnification, x50.
hEDS, hypermobile Ehler-Danlos syndrome; POTS, postural orthostatic
tachycardia syndrome.
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Copy and paste a formatted citation
Spandidos Publications style
Lundqvist K, Tufvesson H, Dahlin LB, Reichardt M and Ohlsson B: A laboratory micro‑CT technique is useful to visualize and characterize dermal skin components in a 3D manner. Exp Ther Med 31: 120, 2026.
APA
Lundqvist, K., Tufvesson, H., Dahlin, L.B., Reichardt, M., & Ohlsson, B. (2026). A laboratory micro‑CT technique is useful to visualize and characterize dermal skin components in a 3D manner. Experimental and Therapeutic Medicine, 31, 120. https://doi.org/10.3892/etm.2026.13116
MLA
Lundqvist, K., Tufvesson, H., Dahlin, L. B., Reichardt, M., Ohlsson, B."A laboratory micro‑CT technique is useful to visualize and characterize dermal skin components in a 3D manner". Experimental and Therapeutic Medicine 31.5 (2026): 120.
Chicago
Lundqvist, K., Tufvesson, H., Dahlin, L. B., Reichardt, M., Ohlsson, B."A laboratory micro‑CT technique is useful to visualize and characterize dermal skin components in a 3D manner". Experimental and Therapeutic Medicine 31, no. 5 (2026): 120. https://doi.org/10.3892/etm.2026.13116
Copy and paste a formatted citation
x
Spandidos Publications style
Lundqvist K, Tufvesson H, Dahlin LB, Reichardt M and Ohlsson B: A laboratory micro‑CT technique is useful to visualize and characterize dermal skin components in a 3D manner. Exp Ther Med 31: 120, 2026.
APA
Lundqvist, K., Tufvesson, H., Dahlin, L.B., Reichardt, M., & Ohlsson, B. (2026). A laboratory micro‑CT technique is useful to visualize and characterize dermal skin components in a 3D manner. Experimental and Therapeutic Medicine, 31, 120. https://doi.org/10.3892/etm.2026.13116
MLA
Lundqvist, K., Tufvesson, H., Dahlin, L. B., Reichardt, M., Ohlsson, B."A laboratory micro‑CT technique is useful to visualize and characterize dermal skin components in a 3D manner". Experimental and Therapeutic Medicine 31.5 (2026): 120.
Chicago
Lundqvist, K., Tufvesson, H., Dahlin, L. B., Reichardt, M., Ohlsson, B."A laboratory micro‑CT technique is useful to visualize and characterize dermal skin components in a 3D manner". Experimental and Therapeutic Medicine 31, no. 5 (2026): 120. https://doi.org/10.3892/etm.2026.13116
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