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Figure 1. A six-year-old boy was hospitalized with a rash and fever. He had been well until two days before admission, when general pruritus developed. That evening, small water blisters developed at the base of his nose and face. During the next two days, the lesions spread despite treatment with cephalexin, which had been initiated one day before admission. The child's temperature was 38.3°C on admission. He appeared extremely uncomfortable but not acutely ill. He had numerous flaccid bullae on his face, neck, axilla, perianal region, upper back, and thighs. Nikolsky's sign was present (ready separation of the outer layer of epidermis from the basal layer), and a biopsy of a skin specimen revealed that the level of cleavage was at the granular layer. The boy was treated with intravenous nafcillin, and his condition improved over the next few days. He was discharged after seven days, with almost complete resolution of his rash.
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