The autosomal recessive, dystrophic form of epidermolysis bullosa is a multisystem disease that is characterized by chronic and recurrent subepidermal blistering. The disorder often leads to severe disability, interfering with the normal processes of growth and development. Blister formation usually begins at or shortly after birth, and intraoral involvement may lead to early feeding difficulties. Normal handling of the infant with this disease results in the formation of tense bullae which quickly evolve into ulcerations. The typical blisters, crusts, and erosions of dystrophic epidermolysis bullosa are seen in Fig. 14-23. The most serious sequelae of this disorder are due to the fact that the blisters heal with scarring. The recurrent episodes of bulla formation and healing on the hands and feet may result in an acquired syndactyly, as illustrated in Fig. 14-24. In the esophagus, the same process eventuates in mechanical obstruction. The strictures that form lead to nutritional difficulties and even perforation or squamous cell carcinoma of the esophagus. Eye involvement, with ulcers, keratitis, and opacities, is an additional problem.