A newborn presents with a skin lesion as shown. The infant is feeding normally, has no fever, hypotension, or… - INI-CET EXAM -2026

INI-CET EXAM -2026

Child Health Nursing (Pediatrics)

Hard

Appeared in: INI-CET EXAM -2026

Explanation

Neonatal pemphigus is caused by the transplacental passage of IgG autoantibodies from a mother with pemphigus vulgaris.
The target of these antibodies is desmoglein, a protein responsible for holding skin cells together. The antibody attack causes the cells to separate, leading to blisters.
A hallmark of this condition is a clinically well-appearing newborn despite extensive and dramatic skin blistering and erosions.
The condition is transient and resolves as the maternal antibodies are gradually cleared from the infant's circulation over several weeks to months.

Option A: Staphylococcal Scalded Skin Syndrome (SSSS) is an infectious disease caused by bacterial toxins. Infants with SSSS are typically systemically ill, presenting with fever, irritability, and significant skin tenderness, which contradicts the clinical picture of a well infant.
Option B: Bullous pemphigoid is an autoimmune blistering disease, but it involves autoantibodies against different proteins (hemidesmosomal proteins BP180 and BP230) at the dermal-epidermal junction, typically resulting in tense bullae. Neonatal pemphigus is the specific term for the condition caused by passively transferred anti-desmoglein antibodies.
Option C: Epidermolysis bullosa is a group of inherited genetic disorders that cause extreme skin fragility. Blisters and erosions appear at sites of minor friction or trauma. The generalized eruption in a well infant without a history of trauma makes this diagnosis less likely.

Clinical Relevance

Nursing practice connection: Prioritize focused assessment, early escalation, and real-time monitoring when managing Differential diagnosis of vesiculobullous (blistering) diseases in a newborn in acute care settings.
The primary nursing intervention is supportive care, including gentle handling to minimize trauma, meticulous wound care to prevent secondary infection, and pain management.
It is crucial to obtain a maternal history and examine the mother for any signs of blistering skin disease, as this can confirm the diagnosis of neonatal pemphigus.
Parents require significant reassurance and education about the transient nature of the condition and the excellent prognosis, as the skin lesions can be very alarming.

How to Approach the Question

First, analyze the patient's demographics and chief complaint: a newborn with skin lesions.
Next, carefully evaluate the clinical status provided in the stem. The statement 'feeding normally, has no fever, hypotension, or shock signs' is the most important piece of data.
Use the 'sick versus well' paradigm. A systemically ill patient often suggests an infectious or severe systemic process. A well-appearing patient with dramatic physical signs points towards other etiologies, such as congenital, genetic, or passively acquired conditions.
Evaluate the options in this context. SSSS is an infectious process that makes infants sick. Therefore, it is less likely.
Consider the remaining options. Neonatal pemphigus specifically describes a condition caused by passive antibody transfer from the mother, which perfectly explains why a newborn can have severe skin disease but be otherwise healthy.
Correlate the visual information (widespread bullae and erosions) with the most fitting diagnosis based on the clinical status.

Concept Tested & Keywords

Concept Tested: Differential diagnosis of vesiculobullous (blistering) diseases in a newborn.
Stem keywords: newborn, skin lesion, feeding normally, no fever, hypotension, shock signs
Lead-in keywords: most likely
Clinical cues: The description 'feeding normally, has no fever, hypotension, or shock signs' is the most critical clinical cue. It indicates the infant is systemically well, which strongly points away from infectious causes like SSSS.

Q0tNgnxW20BQjpaHYfbRPJ

E6 Nelson Textbook of Pediatrics(2024) — Volume 2 p. 1963-1965

E6 Ghai Essential Pediatrics(pp 26-904 of 913) p. 730-732

E6 Medicine Davidson Principles Practice 24e p. 1256-1258