Case Number : Case 2861 - 24 June 2021 Posted By: Saleem Taibjee

Appears to be intraepidermal separation at level of the granular layer. Would consider a staphylococcal scalded skin syndrome. 

Subcorneal separation of cells, coagulative necrosis in the superior epidermis with dyskeratosis resembling pemphigus foliaceus, epidermal nuclear elongation and streaming, pyknotic tightly packed epidermal nuclei, dark staining of epidermal nuclei, homogenization of dermal collagen..thinking of some external traumatic agent, like burns...

superficial epidermal split. No inflammation. No epidermal necrosis and no dermmal inflamation

-staphylococcal scalded skin syndrome. 

Pemphigus Foliaceus

2 hours ago, Victor Delgado said:

Pemphigus Foliaceus

Histologically yes, but pemphigus is virtually unheard of in this age group.  I agree with SSSS.

SSSS.

Yes, well done. This was a recent case in which the suggested clinical diagnosis was Staphylococcal scalded skin syndrome. I haven't seen many examples of this histologically because it tends to be a clinical diagnosis and only rarely biopsied, and of course more common in children. In adults it is sometimes seen in the context of patients who are immunosuppressed or have renal impairment (which may impair clearance of the circulating toxin).

I have submitted this case to illustrate it as a nice example of the Floating (or absent) stratum corneum sign (see below). This is an important histological clue to a superficial (acantholytic) blistering process, and may be encountered in SSSS, bullous impetigo as well as pemphigus foliaceous.

BW

Saleem

SSSS, subcorneal separation and no significant eosinophilic or neutrophilic infiltrate, together with the history favor it 

Such a beautiful case!