“My old skin ain't what it used to be. It slides off whenever I bump or scratch it,” was the complaint of an eighty-year-old man. He had the problem for several months, particularly on his forehead where we saw a few small and large tense blisters. One long linear band of redness on the left side of the forehead was the site of a long scratch mark. He also reported isolated blisters on his back, forearms, and lower legs. The blisters appeared overnight or could be produced by scratching a spot. They did not itch and the eroded spots took as long as two weeks to heal. Redness in the area lasted even longer.

The patient was in good health. He had never had skin disease and was not even sensitive to poison ivy. We could rule out diabetes and kidney or liver disease, all known causes of blistering in the skin. He took no medications, so that drug allergy could not be the cause. Sunlight damage was minimal. Nor was it of viral origin typically presenting as blisters with depressed (umbilicated) centers. It was not the acute painful blistering of shingles. The blisters associated with cancer (paraneoplastic bullous disease) were also not likely, usually being much more dramatic in their presentation.

We could have called it “fragile old skin,” but it proved to be a polysyllabic tongue twister, epidermolysis bullosa acquisita.