10-05-2007, 12:03 PM
The correct answer is D. Bullous diseases of the skin are subdivided on the basis of the level at which
the
cleavage for blister formation occurs. In general, the lower in the epidermis/dermis that the cleavage
plane
occurs, the more dangerous and widespread the blistering. This is because blistering at lower levels,
particularly those that damage or remove the basal cell layer, permits loss of substantial amounts of
fluid and
heals slowly (often with significant scarring). Scalded-skin syndrome (toxic epidermal necrolysis), as
seen in this
patient, may follow staphylococcal (often phage group II) skin infection. This disorder fortunately
involves the
very superficial squamous cells just beneath the granular layer. Consequently, the disease (which
typically
produces bright red skin sloughing, predominately in intertriginous regions) usually resolves without
sequelae
after antibiotic therapy. "Scalded-skin" may also be observed in association with drug-induced
erythema
multiforme. Major inciting agents include phenylbutazones, sulfonamides, and barbiturates. This form
usually
affects the mucosa (eyes, mouth) first, and is much more dangerous because the blistering is
subepidermal,
and the entire overlying epidermis becomes necrotic.
the
cleavage for blister formation occurs. In general, the lower in the epidermis/dermis that the cleavage
plane
occurs, the more dangerous and widespread the blistering. This is because blistering at lower levels,
particularly those that damage or remove the basal cell layer, permits loss of substantial amounts of
fluid and
heals slowly (often with significant scarring). Scalded-skin syndrome (toxic epidermal necrolysis), as
seen in this
patient, may follow staphylococcal (often phage group II) skin infection. This disorder fortunately
involves the
very superficial squamous cells just beneath the granular layer. Consequently, the disease (which
typically
produces bright red skin sloughing, predominately in intertriginous regions) usually resolves without
sequelae
after antibiotic therapy. "Scalded-skin" may also be observed in association with drug-induced
erythema
multiforme. Major inciting agents include phenylbutazones, sulfonamides, and barbiturates. This form
usually
affects the mucosa (eyes, mouth) first, and is much more dangerous because the blistering is
subepidermal,
and the entire overlying epidermis becomes necrotic.