A patient with widespread lichen planus develops tense blisters arising within pre-existing violaceous papules. Histology confirms subepidermal clefting. The immediate cause of blister formation in this setting is:

• A Autoantibodies against BP180 collagen XVII
• B Necrosis of the suprapapillary plate over dilated capillaries
• C Subcorneal accumulation of neutrophils
• D Confluent basal layer degeneration creating dermoepidermal clefts called Max-Joseph spaces ✓

Explanation

In bullous lichen planus, intense liquefactive degeneration of the basal layer becomes confluent, separating the epidermis from the dermis and forming Max-Joseph spaces that rupture into blisters confined to existing lesions. Antibodies against BP180 define bullous pemphigoid, where blisters arise on normal or urticarial skin. Subcorneal neutrophil collections occur in pustular psoriasis and suprapapillary thinning belongs to psoriasis histology.

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.