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Pathology · patient case question

What can NOT be in the differential diagnosis for this case?

Patient case: Desquamative gingivitis with positive Nikolsky sign

Scenario: Buccal mucosa PEELS on slight manipulation and the patient has a burning mouth after eating spicy food. There is GENERALISED DESQUAMATIVE GINGIVITIS on the facial gingiva (photo showed swollen, reddish gingiva). The description is effectively a POSITIVE NIKOLSKY SIGN.

  1. Mucous membrane pemphigoid
  2. Aphthous ulceration
  3. Erosive lichen planus
  4. Pemphigus vulgaris
Show answer and explanation

Correct answer: B. Aphthous ulceration

  • A. Mucous membrane (cicatricial) pemphigoid is the single most common cause of desquamative gingivitis and is Nikolsky-positive (subepithelial split).
  • B. Correct. Recurrent aphthous ulceration produces discrete, punched-out ulcers with an erythematous halo on NON-KERATINISED, NON-ATTACHED mucosa. It does not cause desquamative gingivitis and is Nikolsky-NEGATIVE, so it cannot explain this presentation.
  • C. Erosive lichen planus is the third member of the classic desquamative gingivitis triad and can also give a positive Nikolsky sign.
  • D. Pemphigus vulgaris is a classic cause of desquamative gingivitis with a positive Nikolsky sign (intraepithelial split, suprabasilar acantholysis).

Note: The desquamative gingivitis triad worth memorising: MUCOUS MEMBRANE PEMPHIGOID, PEMPHIGUS VULGARIS, and EROSIVE LICHEN PLANUS.

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