Infections: bacterial, viral, fungal, parasitic: bullous scabies mimicking pemphigoid: practice question

A Dermatology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Dermatology · Infections: bacterial, viral, fungal, parasitic: bullous scabies mimicking pemphigoid

Sample item

An 80-year-old man has tense blisters on the arms and thighs with severe nocturnal itch. His wife is also itchy, and small burrows are seen in the finger webs. What is the most appropriate management?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Topical permethrin for him and his household contacts

Bullous scabies can closely mimic bullous pemphigoid in the elderly. Burrows, nocturnal itch and itching in a close contact point to scabies, which is treated with a scabicide for the patient and all household contacts. Immunosuppression for a presumed autoimmune disease would worsen the infestation.

Option by option

  • A. Oral prednisolone at high dose for pemphigoid

    High-dose steroid assumes an autoimmune blistering disease and would aggravate infestation.

  • B. Topical clobetasol propionate alone

    Topical steroid alone suppresses inflammation but leaves the mites untreated and the contacts infested.

  • C. Topical permethrin for him and his household contacts (correct)

    Correct. Scabicide treatment of the patient and contacts treats the cause, and the blisters resolve with it.

  • D. Oral dapsone alone for dermatitis herpetiformis

    Dapsone targets dermatitis herpetiformis, which is not suggested by burrows and a household itch.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

More Dermatology questions

Questions about this Dermatology question

What is the answer to this Dermatology question?

The best answer is C, Topical permethrin for him and his household contacts. Bullous scabies can closely mimic bullous pemphigoid in the elderly.

Why is "Oral prednisolone at high dose for pemphigoid" not the answer?

High-dose steroid assumes an autoimmune blistering disease and would aggravate infestation.

Why is "Topical clobetasol propionate alone" not the answer?

Topical steroid alone suppresses inflammation but leaves the mites untreated and the contacts infested.

Why is "Oral dapsone alone for dermatitis herpetiformis" not the answer?

Dapsone targets dermatitis herpetiformis, which is not suggested by burrows and a household itch.

What concept does this question test?

It tests Infections: bacterial, viral, fungal, parasitic: bullous scabies mimicking pemphigoid in Dermatology. Burrows, nocturnal itch and itching in a close contact point to scabies, which is treated with a scabicide for the patient and all household contacts. Immunosuppression for a presumed autoimmune disease would worsen the infestation.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Infections: bacterial, viral, fungal, parasitic: bullous scabies mimicking pemphigoid?

Learn each condition by its primary lesion, site and signature sign. Then use the flashcards and the other Dermatology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.