findings such as anonychia or dystrophic nails, and certain subtypes are associated with other systemic complications such as muscular dystrophy, pyloric atresia, or photosensitivity Over time, severe subtypes may mitigate, and milder subtypes can become more severe Mode of transmission varies depending on the subtype, therefore family history may be useful in making the diagnosis The differential diagnosis of EB in the newborn period includes infections such as herpes simplex virus (HSV), varicella (VZV) and bullous impetigo, and cultures should be obtained to rule out an infectious etiology Epidermolytic ichthyosis, also known as bullous congenital ichthyosiform erythroderma, is a rare, autosomal dominant ichthyosis caused by mutations in keratins and 10 found in the epidermis and presents with widespread superficial blistering and erythroderma in the neonatal period that can be confused with EB The flexures, palms, and soles are most commonly involved, and mucosal surfaces are spared With time, the skin develops thick, corrugated-like scale likely as compensation for the blistering, which helps to clinically differentiate it from EB Diagnosis is made by skin biopsy using immunofluorescence antigen mapping (IFM) and/or transmission electron microscopy (TEM) on newly induced blisters to detect the location of blistering and which cellular attachments are disrupted However, genetic testing via mutation analysis is becoming first line as inducing new blisters can be challenging, especially in the newborn period Additionally, mutation analysis allows for specific subclassification, which is important for prognosis and genetic counseling In the emergency setting, the most important part of managing patients with possible or known EB is handling the patients with care This includes limiting palpation only to areas of concern and avoiding adhesives as much as possible (this includes adhesives for intravenous lines, nasogastric tubes, electrocardiogram leads, etc.) Due to the numerous open areas of skin, EB patients are at high risk for skin infection and frequently become infected (as well as colonized) with Staphylococcus aureus and Pseudomonas aeruginosa Areas concerning for infection should be cultured and treated If the patient is acutely ill, they should be managed as needed in the acute setting with attention to skin as secondary Once stable, dermatology consultation is warranted, and further wound care recommendations may be provided For more information about EB, visit www.debra.org