Question:medium

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

Show Hint

Brain-like (cerebriform) tongue is the signature of pemphigus vegetans.
Updated On: Jun 25, 2026
  • Positive Nikolsky - Pemphigus vulgaris
  • Negative/absent Nikolsky - Bullous pemphigoid
  • Pseudo-Nikolsky - Stevens-Johnson syndrome
  • Cerebriform tongue - Pemphigus vegetans
Show Solution

The Correct Option is D

Solution and Explanation

Read this as a sign-to-disease mapping exercise built around epidermal cohesion. Where keratinocytes lose adhesion (acantholysis, as in pemphigus vulgaris), tangential pressure peels the skin and Nikolsky is positive. Where the split is below the epidermis (bullous pemphigoid, a hemidesmosomal/sub-epidermal disease), the overlying epidermis stays cohesive and Nikolsky is negative.

SJS/TEN produces full-thickness epidermal death; pressure over already inflamed skin shears it off, which is described as a pseudo-Nikolsky (Asboe-Hansen) phenomenon rather than the true acantholytic sign.

The single most disease-specific clue, however, is morphologic: pemphigus vegetans - an intertriginous, vegetating variant of pemphigus - produces a tongue with deep furrows and ridges resembling brain convolutions, i.e., the cerebriform tongue. That is the highlighted match.

\[\boxed{\text{Cerebriform tongue} \Rightarrow \text{Pemphigus vegetans}}\]
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