A newborn develops multiple tense bullae on the extremities and around the mouth within the first week of life. The blisters are present at sites of mechanical pressure. Nikolsky sign is negative. Electron microscopy shows cleavage at the dermo-epidermal junction. What is the diagnosis?

• A Staphylococcal scalded skin syndrome
• B Herpes simplex infection
• C Bullous impetigo
• D Epidermolysis bullosa ✓

Explanation

Epidermolysis bullosa presents with blisters at sites of trauma, negative Nikolsky sign, and cleavage at the dermo-epidermal junction on electron microscopy. Staphylococcal scalded skin syndrome shows positive Nikolsky sign with cleavage in the superficial epidermis (granular layer). Bullous impetigo is caused by Staphylococcus aureus exfoliative toxins and shows superficial blisters. Herpes simplex shows multinucleated giant cells on Tzanck smear.

Reference: Nelson Textbook of Pediatrics, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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