Generalized erosions, blisters, scarring, and milia in a 65-year-old woman: a diagnostic challenge

Epidermolysis bullosa acquisita (EBA) is a chronic autoimmune subepidermal blistering disease of the skin and mucous membranes. EBA is caused by antibodies targeting type VII collagen, the major component of anchoring fibrils that connects the basement membrane to dermal structures. The classic presentation is characterized by blisters, mild mucosal involvement, and healing with dense scars primarily at trauma-prone areas. Herein, we present a case of EBA. Our case of a 65-year-old female patient distinctively demonstrated generalized multiple erosions, flaccid bullae, dystrophic nail changes, scarring, painful erosions, and milia. We emphasize the importance of differentiating EBA from bullous systemic lupus erythematosus because both cases have different responses to steroids.