A 5-year-old boy presents with widespread tender erythema, superficial flaccid bullae, and peeling of skin over the face, neck, and axillary folds. Mucous membranes are completely spared. Nikolsky sign is positive. Histology would show the cleavage plane at which level?

• A Within the upper dermis around vessels
• B At the dermoepidermal junction
• C Within the granular layer of the epidermis ✓
• D Between the basal layer and basement membrane

Explanation

Staphylococcal scalded skin syndrome results from hematogenous spread of exfoliatin toxin from a distant focus; the toxin cleaves desmoglein 1 within the granular layer, causing superficial splitting. This explains the intact mucous membranes, since oral epithelium expresses other desmogleins. Toxic epidermal necrolysis splits at the dermoepidermal junction and involves mucosae, which kills that distractor.

Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.