An unusual case of bullae and scars


  • Tanvi P. Vaidya Department of Dermatology, Father Muller Medical College, Mangalore, Karnataka, India
  • Ramesh M. Bhat Department of Dermatology, Father Muller Medical College, Mangalore, Karnataka, India
  • Sukumar Dandekeri Department of Dermatology, Father Muller Medical College, Mangalore, Karnataka, India



EB, Basement membrane antigens, Immunofluorescence antigen mapping


The term epidermolysis bullosa (EB) encompasses a group of inherited mechano-bullous disorders, clinically characterized by blisters over skin and mucosae following minor frictional trauma. The diagnosis is predominantly clinical, but further classification is carried out by defining the histological level of the split. Histopathology tends to be ambiguous, as it was in this case. Our case is of a twelve-year-old male child who came with complaints of recurrent painful fluid filled lesions all over the body since 10 days of birth, aggravated by trauma, with exacerbations in the summer, and with a history of similar lesions in the mother and maternal uncle. On examination, there were multiple flaccid bullae, crusted erosions, scars and milia over trauma prone sites, such as the elbows, back, knees, shins and knuckles, with nail dystrophy and pitting of the teeth. The clinical impression as well as histopathology suggested a dominant dystrophic or a junctional EB, but immunofluorescence antigen mapping revealed it to be a case of EB simplex. We must thus bear in mind that histopathology is not definitive in EB, and immunofluorescence antigen mapping or transmission electron microscopy is imperative to correctly diagnose it.


Boeira V, Souza E, Bde RO, Oliveira PD, Oliveira Mde F, Rêgo VR, Follador I. Inherited epidermolysis bullosa: clinical and therapeutic aspects. An Bras Dermatol. 2013;88(2):185-98.

Shinkuma S, McMillan JR, Shimizu H. Ultrastructure and molecular pathogenesis of epidermolysis bullosa. Clin Dermatol. 2011;29(4):412–9.

Fine JD, Bruckner-Tuderman L, Eady RA, Bauer EA, Bauer JW, Has C, et al. Inherited epidermolysis bullosa: Updated recommendations on diagnosis and classification. J Am Acad Dermatol. 2014;70:1103-26.

Intong LRA, Murell DF. How to take skin biopsies for epidermolysis bullosa. Dermatol Clin. 2010;28:197-200.

Rao R, Mellerio J, Bhogal BS, Groves R. Immunofluorescence antigen mapping for hereditary epidermolysis bullosa. Indian J Dermatol Venereol Leprol. 2012;78:692-7.

Pohla-Gubo G, Cepeda-Valdes R, Hintner H. Immunofluorescence mapping for epidermolysis bullosa. Dermatol Clin. 2010;28:201-10.

Sarkar R, Bansal S, Garg VK. Epidermolysis bullosa: where do we stand?. Indian J Dermatol Venereol Leprol. 2011;77:431-8.

Has C, He Y. Research techniques made simple: immunofluorescence antigen mapping in epidermolysis bullosa. J Invest Dermatol. 2016;136:e65-71.