Epidermolysis bullosa simplex of Weber–Cockayne type

Flaccid bullae and erosions on sides of feet.

Etiology: Genetic predisposition, autosomal dominantly inherited in which there is a defect in Keratins 5 and 14. Exacerbated by chronic rubbing or friction from an external source, warm weather, and/or sweating. This condition is probably not as rare as believed because patients often do not consider themselves to have a problem and thus do not seek medical attention.

Location: Primarily located at junctions between the sole of the foot and the sides of the toes or the main part of the foot . Involvement of the hands can be seen at points of chronic trauma. Can also be noted on knees of infants as they begin to crawl.

Hallmark of the Disease: Onset is generally early in childhood as the child begins to crawl or walk. Blisters arise where shoes rub against the feet. Thickening of the soles of the feet can be seen from chronic blistering. Often an erythematous halo can be seen around the blisters, which is typically lacking in other types of epidermolysis bullosa. Other areas of the body are rarely affected besides the hands and feet.

Treatment: Treatment is focused on wound management and infection control of the blisters. Puncturing the blister with a sterile needle can drain the blisters; however, the roof of the blister should not be peeled away. Soaking the blistered areas in a dilute potassium permanganate bath of 1:8000 can be a helpful bactericidal agent for the blisters. Also, efforts meant to decrease sweating will help, including Drysol^® and absorbent cotton socks and soft shoes.

Normal Course: Chronic with increasing blistering related to mechanical friction and extreme heat.

Patient Education: Encourage patient not to pick at blisters or sloughed off skin. Educating about proper footwear and wound dressings is also important. Genetic counseling should be discussed and offered since this is a genetic skin disorder.

Nursing Measures: Offer a variety of nonadherent dressings or samples of dressings for the patient to choose from for larger blisters. Mepitel^® over the blister secured with Coban^® wrap can be an effective dressing. Demonstrate a dressing application on an active blister