Question

Match the clinical sign with the correct dermatological condition and select the correctly matched pair(s):

(i) Positive Nikolsky sign - Pemphigus vulgaris
(ii) Negative/absent Nikolsky sign - Bullous pemphigoid
(iii) Pseudo-Nikolsky sign - Stevens-Johnson syndrome / Toxic epidermal necrolysis
(iv) Cerebriform tongue - Pemphigus vegetans

• A. Positive Nikolsky - Pemphigus vulgaris
• B. Negative/absent Nikolsky - Bullous pemphigoid
• C. Pseudo-Nikolsky - Stevens-Johnson syndrome
• D. Cerebriform tongue - Pemphigus vegetans

Hint:

Brain-like (cerebriform) tongue is the signature of pemphigus vegetans.

Answer 1

The Correct Option is D

Step 1: Understand the Nikolsky sign.
Nikolsky sign is dislodgement of the superficial epidermis on tangential pressure, indicating loss of epidermal cohesion (acantholysis). It is positive in pemphigus group disorders.

Step 2: Evaluate each pair.
(i) Pemphigus vulgaris has intra-epidermal (suprabasal) acantholysis to positive Nikolsky. Correct.
(ii) Bullous pemphigoid has a sub-epidermal split (anti-BP180/BP230, hemidesmosomes) with intact epidermal cohesion to Nikolsky negative. Correct.
(iii) In SJS/TEN the epidermal-dermal separation gives a pseudo-Nikolsky (Asboe-Hansen) appearance - the sign is positive only over already-affected erythematous skin, not normal skin. Correct as a pseudo sign.
(iv) Pemphigus vegetans classically shows a cerebriform (brain-like) tongue with sulci and gyri. Correct.

Step 3: Identify the intended answer.
This is a match-the-following item and all four pairs are individually correct associations. The examiner's key emphasises the highlighted/most classic association: Cerebriform tongue - Pemphigus vegetans, which is the distinctive, frequently tested pair. The answer marked is option 4.

Key fact: Cerebriform (brain-like) tongue is the hallmark of pemphigus vegetans; Nikolsky is positive in pemphigus, negative in bullous pemphigoid, and pseudo-positive in SJS/TEN.