Mutations in the type VII collagen gene (COL7A1) have recently been established as the molecular basis of the inherited blistering skin disorder, dystrophic epidermolysis bullosa. We report a novel combination of COL7A1 mutations in a Japanese patient with an autosomal recessive form of dystrophic epidermolysis bullosa. Clinically, the patient had suffered from generalized trauma-induced blistering since the first week of life loss of most finger- and toenails, esophageal stenosis and partial fusion of the fingers and toes. Immunofluorescence microscopy of the dermal-epidermal junction in the patient's skin revealed reduced intensity of staining with an anti-type VII collagen antibody. Transmission electron microscopy showed only a few thin, poorly formed anchoring fibrils. The patient was a compound heterozygote for a nonsense mutation on one COL7A1 allele and a donor splice site mutation on the other allele. The mutations were identified by PCR amplification of genomic DNA, heteroduplex analysis, and nucleotide sequencing, and verified by restriction endonuclease digestion. Reverse transcriptase-PCR and sequencing of cDNA from the patient's cultured keratinocyte mRNA showed evidence of aberrant splicing resulting from the donor splice site mutation, due to activation of a cryptic intronic splice site that leads to a frameshift and a downstream premature termination codon. Knowledge of the genetic lesions in this patient is helpful in elucidating the molecular consequences of COL7A1 mutations in dystrophic epidermolysis bullosa and in providing information about the fundamental mechanisms involved in maintaining adhesion between the epidermis and the dermis.