Dystrophic epidermolysis bullosa presenting as scarring skin eruptions and nail dystrophy

A 57-year-old Chinese gentleman presented with pruritic skin eruptions located mainly over the shins since childhood. Scratching resulted in skin blister and finally scarring. He also had nail dystrophy over the fingers and toes since childhood. Incisional skin biopsy for histology and electron microscopy was compatible with the diagnosis of dystrophic epidermolysis bullosa. His mother had "prurigo nodularis" and nail dystrophy, but she was not available for examination as she lived abroad. His siblings, children and father were free of skin diseases. He was given symptomatic treatment with topical steroid, eurax cream and oral antihistamine. Antibiotics and local antiseptic solution were used to control skin infections. His pruritic symptom was under control, although the skin scarring and nail dystrophy remained the same. 57