REPORT OF A CASE
A 50-year-old man presented for evaluation of bilateral pretibial ulcers. Six months prior to presentation, the patient had noted a small erosion of the right pretibial area. Soon after this erosion was noted, a similar erosion appeared on the left pretibial shin. The patient related that he had a life-long history of bullae following minor trauma, although since adulthood he had noted that more trauma was required to produce a lesion. In addition, he had multiple dilatations for symptomatic esophageal stenosis beginning at the age of 40 years. Lastly, he had hypertension, which was well controlled with oral hydrochlorothiazide (50 mg/d) and propranolol hydrochloride (40 mg twice daily) therapy. Family history was negative for bullous diseases in the parents, but a brother had died with extensive blisters at the age of 3 months.The patient's initial physical examination demon