00:02
All right. So, for this next section,
we're going to review some of
the material we've talked about
by going through 3 questions.
00:07
After I ask the question, feel free to
pause the slides for a moment,
and then come back and we'll
go through the answers.
00:15
So question 1. Which of the
following would have
a negative Nikolsky sign?
Remember, the Nikolsky
sign is a very useful test
to help us to decide whether
or not the lesion is occurring
within the epidermis, that is, there
is an attack on the keratinocytes,
versus if the disease is at the
border between the epidermis
and the dermal layer underneath.
00:42
So, Stevens-Johnson syndrome.
This is an immune attack on
the epidermis, within the keratinocytes.
It should have
a positive Nikolsky sign. Pemphigus vulgaris,
same thing. It's the keratinocytes. It's an
antibody, the anti-desmoglein antibody within
the epidermis. Staphylococcal
scalded skin syndrome
also involves an attack on
the epidermis and
the keratinocytes. So the
only one on this list
that would lead to tense bullae
and a negative Nikolsky
is actually porphyria cutanea tarda.
01:12
Let's go on to our next question.
01:17
Which of the following is not
associated with pemphigus vulgaris?
Okay, so let's review. Pemphigus vulgaris.
01:32
Pruritic urticarial lesions?
Might see that. It's possible.
More likely, you'd see that with
bullous pemphigoid.
01:41
Extensive mucosal involvement?
Absolutely. That's a part of
pemphigus vulgaris. Typical age,
40-60 years old, definitely.
01:48
Anti-desmoglein immunoglobulin
antibodies, absolutely.
01:52
And flaccid bullae and hemorrhagic erosions?
Those are a characteristic feature
of pemphigus vulgaris.
01:58
So, it's really those pruritic
urticarial lesions,
which you're more likely to
see with bullous pemphigoid,
and that's the answer to this question.
02:05
Let's move on to our third question.
02:10
Which of the following is not associated
with staphylococcal scalded skin syndrome?
Okay. Going through each of
these answers, one at a time.
02:25
Extensive superficial skin sloughing?
That's a characteristic feature
of this syndrome.
02:30
Typical age, under 5 years old. As we
discussed, it's mostly a disease of babies.
02:35
It's caused by a systemically
absorbed exfoliative toxin.
02:39
That's correct. Comes from
Staphylococcus aureus.
02:42
Extensive mucosal involvement?
As we mentioned,
even though it can look a lot like something
like Stevens-Johnson syndrome
or even toxic epidermal necrolysis,
the big distinction is that there
is no mucosal involvement,
or very rarely would you find that. And,
of course, you do treat it with supportive
care and systemic antibiotics since
it is a self-resolving problem.
03:04
And with that, I think we're done.