• Pemphigus vulgaris is vulgar in that the blisters rupture and it's gross. + Nikolsky sign. (Its also more vulgar to use your mouth which is why only vulgaris has oral blisters.) Desmosomes are shot.

• bullous pemphigus is therefore not vulgar and doesn't pop = - Nikolsky sign. Hemidesmosomes are shot.

• lets rule everything else out for completeness

• Collagen type VII (i know wtf) = basement membrane btwn epidermis & dermis. NBME language synonyms = Basal Lamina, Reticular Lamina, Extracellular Matrix. Hemidesmosomes, which are made of integrin, fibronectin/laminin, bind to this collagen so it is close to correct but still wrong.

• cytokeratin is that intracellular intermediate filament in epithelial cells used in stains to distinguish cancers.

• Desmoplakin is apparently a part of desmosomes, which makes etymological sense. They are going for paraneoplastic pemphigus here. Sucks for them cuz we never learned that one haha. Gottem.

• Aside here--FA 2020 just mentions desmosomes are made from desmoglein I and III. Antibodies against desmoglein I and III are seen in pemphigus vulgaris and against I is seen in scalded skin syndrome from Staph aureus via exfoliative toxin AKA exfolitoxin. That is why both diseases are + Nikolsky. Good old nikolsky

• plakoglobin? nobody cares.

https://en.wikipedia.org/wiki/Nikolsky%27s_sign https://en.wikipedia.org/wiki/Desmoplakin https://en.wikipedia.org/wiki/Exfoliatin https://en.wikipedia.org/wiki/Plakoglobin

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