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Physical examination revealed extensive, nearly confluent, pink-red plaques associated with tense and flaccid bullae, as well as erosions resulting from ruptured bullae (Figure 1). Linear deposition of IgG and C3 at the dermal-epidermal junction can be shown on direct immunofluorescence, which is the best method for diagnosis of bullous pemphigoid with a sensitivity of 90.8%.2 Detection of circulating autoantibodies against collagen XVII and dystonin-e by enzyme-linked immunosorbent assay may aid in the diagnosis. The Nikolsky sign is usually present.3 SUMMARY TABLE Condition Clinical characteristics Mucosal involvement Nikolsky sign Bullosis diabeticorum Tense bullae on normal-appearing, noninflamed acral sites in patients with diabetes mellitus; asymptomatic lesions Not present Not present Bullous pemphigoid Tense, serous, or hemorrhagic bullae on the trunk and extremities; often associated with pruritic urticarial plaques Not commonly present Not present (positive Asboe-Hansen sign) Pemphigus vulgaris Painful, flaccid bullae with erosions and hemorrhagic crust formation; usually on the face, scalp, trunk, and intertriginous areas Present Present Stevens-Johnson syndrome Pink-red morbilliform rash on the face, trunk, and extremities that progresses to purpuric macules and patches with painful epidermal detachment Present Present