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Why does my daughter get blisters on her hands and feet?

Q: My 11 months old daughter has been getting blisters on her hands and feet since she was 4 months old. She gets these whenever she crawls or walks. The dermatologist says that this is due to friction of the tender skin. He says that her upper layer of the skin is very sensitive, which leads to these boils. Is there a permanent cure for this?

A:Your child as well as wife are having epidermolysis bullosa simplex (EB simplex). It is a genetic inherited disorder. Diagnosis is made by histopathology, salt-split technique of immunofluorescence, electron microscopy, and immunoblotting technique. Blistering in hands and feet will improve with age but it never goes off completely. Fresh blisters should be drained after puncturing them with a sterile disposable needle as they extend if left alone. The blister roof should be left in situ. Ideally, the footwear should be made of very soft leather, with minimum number of internal seams. Towelling type of sport socks may be worn. It is sometimes useful for the patient to wear two pairs of socks as this helps to reduce friction. It is important that clothing does not have rough internal seams and that it fits loosely, especially at the neck, wrists and ankles. Avoidance of high environmental temperature is a helpful measure. Short courses of oral prednisolone to reduce blistering temporarily may be considered in any type of EB under the supervision of a doctor.

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