Bullous congenital ichthyosiform erythroderma masquerading as dystrophic epidermolysis bullosa

A black baby, born at full term of a normal healthy mother, showed multiple erosions and ulcers. No history of skin diseases was known in the family. A skin biopsy taken shortly after birth from an arm lesion showed subepidermal edema and cavity formation. Electron microscopy showed clumping of microfibrils and anchoring fibril-like fibers at the dermo-epidermal junction. In more severely affected areas, absence of anchoring fibrils and collagenolysis were found and the diagnosis of dystrophic epidermolysis bullosa was made. Two weeks later, the lesions healed without leaving scars and a second biopsy from the chest area revealed typical histopathology of epidermolytic hyperkeratosis.