Which clinical or histologic feature is most characteristic of pemphigus vulgaris?

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Study for the NBME Histology Test. Access flashcards and multiple choice questions, each with hints and explanations. Prepare effectively for your exam!

Multiple Choice

Which clinical or histologic feature is most characteristic of pemphigus vulgaris?

Explanation:
Pemphigus vulgaris is defined by loss of keratinocyte adhesion within the epidermis (acantholysis) due to autoantibodies against desmosomes. This makes the epidermis unusually fragile, so gentle rubbing or pressure can cause the superficial layer to detach, producing a blister—this is the positive Nikolsky sign. In a Tzanck smear, you’d expect acantholytic keratinocytes rather than multinucleated giant cells. Subepidermal blisters with eosinophils point to conditions like bullous pemphigoid, which are not intraepidermal. So the hallmark feature is the positive Nikolsky sign arising from intraepidermal acantholysis.

Pemphigus vulgaris is defined by loss of keratinocyte adhesion within the epidermis (acantholysis) due to autoantibodies against desmosomes. This makes the epidermis unusually fragile, so gentle rubbing or pressure can cause the superficial layer to detach, producing a blister—this is the positive Nikolsky sign. In a Tzanck smear, you’d expect acantholytic keratinocytes rather than multinucleated giant cells. Subepidermal blisters with eosinophils point to conditions like bullous pemphigoid, which are not intraepidermal. So the hallmark feature is the positive Nikolsky sign arising from intraepidermal acantholysis.

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