Pretibial Epidermolysis Bullosa

History A 12-year-old boy presented with a history of blistering due to trauma on both shins since birth. They healed with scarring and milia formation. The lesions mainly affected the shins and some occasionally appeared on the waist. They were mildly pruritic and were worse in the summer as well as being precipitated by trauma. There was also toenail dystrophy but his hair and teeth were normal. He had been treated with a combination of topical steroid (clobetasol propionate) and antifungal cream (clotrimazole) leading to some improvement. There was no mucosal involvement. There was no significant medical history and he was not on any regular medication. His mother had similar nail changes but no skin lesions. His maternal uncle also had similar lesions on the shins but none of his immediate family was affected. Date: 10 January, 2001 Venue: Yaumatei Dermatology Clinic Organizer: Social Hygiene Service, DH; Clinico-pathological Seminar Physical examination On examination, there were isolated blisters on both shins with adjacent scarring, milia and lichenoid papules (Figure 1). There was nail dystrophy on both feet (Figure 2). His mucosa and dentition were normal. General examination was normal. The differential diagnosis included pretibial epidermolysis bullosa, bullous lichen planus, bullous lupus erythematosus and bullous pemphigoid.