A 1-year-old girl presented with numerous pruritic bullae all over the body. There were complaints of recurrent episodes of diarrhea and vomiting. Development was normal. She started developing episodes of intense itching at 8 months of age, followed by appearance of erythematous macules, plaques, and tense bullae at the sites of itching as well as other sites (scalp, trunk and upper extremities) (Fig. 1 and 2). Bullae were present on a non-urticated base containing clear fluid. Few of the urticarial plaques showed peau-d-orange appearance. Darier’s sign was positive. The palms, soles and mucosae were free. Routine investigations and urine analysis were normal. Skin biopsy showed sub-epidermal bulla and an upper dermal inflammatory infiltrate comprising lymphocytes and many mast cells. Toluidine blue staining showed metachromatic granules and a diagnosis of bullous mastocytosis was made. The patient was treated with antihistamines for itching and topical as well as systemic antibiotics for preventing secondary infection. Parents were counseled regarding the prognosis and course of disease and the importance of avoiding certain medications that may provoke mast cell degranulation.

Fig. 1 Multiple tense bullae and erosions over the trunk.	Fig.2 Bullae, plaques and erosions on face and trunk.