Pathology · patient case question
The blistering produced by gentle lateral pressure on clinically normal mucosa is termed:
Patient case: Vesiculobullous Disease
demo: 55-year-old female
chief: “Spicy food burns terribly and my gums peel.”
history: Six-month history of oral ulceration preceding any skin involvement. No fever.
meds: None
findings: Diffuse buccal mucosal erythema with ragged erosions, desquamative gingivitis, and flaccid bullae that rupture readily. Gentle lateral pressure on adjacent normal-appearing mucosa produces a new blister.
Show answer and explanation
Correct answer: B. A positive Nikolsky sign
- A. Wickham striae are the fine white lacy lines of lichen planus.
- B. Correct. Nikolsky sign reflects intraepithelial acantholysis — desmosomal adhesion has failed, so the epithelium slides apart under shear.
- C. Koplik spots are the blue-white buccal macules of measles.
- D. The Tzanck test is a cytologic smear looking for acantholytic cells, not a clinical sign.