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Picture of the Month Quiz

A 3-year-old adopted girl was referred for evaluation of a history of skin fragility and blister formation since adoption 2 years earlier. Although the lesions appeared widespread, they were mainly located in sites of trauma. They rapidly evolved to crusts, leaving some pigmentary changes.

She was a native of the tribe of Ngöbe-Buglé. The adoptive parents were unaware of the medical history of the patient or her family.

Skin examination revealed erosions and crusts over the face and fingers. There was dyspigmentation with hyperpigmented and hypopigmented macules in both sun-exposed and non–sun-exposed areas. The skin was thin and atrophic, with cigarette paper–like wrinkling, especially over the dorsa of the hands and feet (Figure 1). Proximal webbing was present between the middle and ring fingers (Figure 2). There were no scars and no milia. Nails, gingiva, and mucous membranes were normal.

Image of thin, atrophic skin

Figure 1.

Image of proximal webbing

Figure 2.

What is your diagnosis?

For a complete discussion of this month's case, read next month's Picture of the Month—Quiz Case. For a complete discussion of last month's case, read this month's Picture of the Month—Quiz Case.