Treatment of epidermolysis bullosa pruriginosa using systemic and topical agents

To the Editor: A 46-year-old Hispanic woman presented to our dermatology clinic with a 6-year history of an intermittent pruritic vesicobullous eruption on her lower legs and, to a lesser extent, on her forearms (Fig 1, A). She had failed to respond to prior treatments, including topical and intralesional corticosteroids, mycophenolate mofetil, and phototherapy. There was no family history of a similar condition. Histologic findings showed subepidermal clefts with minimal inflammation. Direct immunofluorescence on perilesional skin was negative.