DERMATOLOGY
DIFFERENTIAL
■ Secondary syphilis
■ Pityriasis rosea–like drug reaction (captopril, barbituates)
TREATMENT
■ Supportive, topical steroids
PEMPHIGUS VULGARISSYMPTOMS/EXAM
■ Symptoms include bullous lesions in the mouth and lips that erode and
leave painful ulcers (see Figure 17.5).
■ Subsequently, small, flaccid bullae form anywhere on the body. They
erode easily, forming widespread, confluent erosionsthat are often secon-
darily infected.
■ Nikolsky sign is positive. New blisters may be formed by tangential pres-
sure on intact dermis.
ETIOLOGY
■ The disease affects both sexes equally, and is most common in 40- to 60-year-
olds. The cause is unknown, but use of penicillamine and captopril have
been associated with its development.
FIGURE 17.5. Pemphigus vulgaris. Typically the blisters are eroded, leaving painful
erythematous lesions.
(Courtesy of James J. Nordlund, MD as printed in Knoop KJ, Stack LB, Storrow AB.Atlas of
Emergency Medicine, 2nd ed. New York: McGraw-Hill, 2002:424.)
Nikolsky sign is positive in
blistering disease with a very
superficial blister, in particular
toxic epidermal necrolysis,
staphylococcal scalded skin
syndrome, and pemphigus
vulgaris.