QuestionSBA
QuestionChoice
Although pemphigus vulgaris also presents with blisters, desquamation and a positive Nikolsky sign, it is not the most likely diagnosis as the fact that the oral mucosa is not affected in this patient. Furthermore, pemphigus vulgaris tends to present in adults and would not present with a fever as it is not an infectious disease.
10001368
b
Pemphigus Vulgaris
QuestionChoice
Bullous pemphigoid is not Nikolsky sign positive and presents with tense, rather than superficial, blisters
10001369
c
Bullous pemphigoid
QuestionChoice
This is the most likely diagnosis based on the sparing of the oral mucosa, the positive Nikolsky sign and the patient's age. Staphylococcal scalded skin syndrome normally occurs in young children.
10001367
a
Staphylococcal scalded skin syndrome
QuestionChoice
Eczema herpeticum presents with a widespread painful vesicular rash, rather than blisters. Also, eczema herpeticum is caused by the herpes simplex virus whereas pemphigus vulgaris is an autoimmune disease.
10001370
d
Eczema herpeticum
QuestionChoice
TEN presents similarly to pemphigus vulgaris with widespread erythema, desquamation and a positive Nikolsky sign. However, TEN is more likely to present with involvement of the oral mucosa and usually occurs as a reaction to a newly initiated drug.
10001371
e
Toxic epidermal necrolysis (TEN)
Concept
Chapter
2693
3917
staphylococcal scalded skin syndrome
Topic
144
Dermatology
12820
A 4-year-old girl presents to A&E with a 24-hour history of widespread large superficial blisters. On examination, there is widespread erythema and patches of desquamation. The oral mucosa is unaffected and Nikolsky sign is positive. Vital signs are normal apart from a temperature of 38 degrees. The patient has no significant past medical history.

What is the most likely diagnosis?
a