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Many patients have blisters only on the feet Symptoms usually become apparent during early childhood , although mild cases may go undiagnosed until early adult life Hyperhidrosis of the feet is common The blisters usually heal without significant scarring or milia Refer to the related chapter Epidermolysis bullosa Dominant dystrophic epidermolysis bullosa A mild form of this condition can cause dystrophy of both fingernails and toenails, with very few other cutaneous features Refer to the related chapter Epidermolysis bullosa Epidermolysis bullosa acquisita - mechanobullous type (figure 42) Tense vesicles and bullae (serous or haemorrhagic) primarily on areas of trauma such as the extensor surfaces of hands, elbows, knees, ankles and feet Lesions heal with significant scarring, milia and hyperpigmentation Refer to the related chapter Epidermolysis bullosa acquisita Pachyonychia congenita (figure 43) Is a rare, autosomal dominant condition that primarily affects the nails and skin The signs and symptoms of this condition usually become apparent within the first few months of life , although a rare form of the condition known as pachyonychia congenita tarda appears in adolescence or early adulthood Almost everyone with pachyonychia congenita has hypertrophic nail dystrophy , which causes the fingernails and toenails to become thickened and abnormally shaped