Nikolsky's sign is a clinical dermatological sign, named after Pyotr Nikolsky (1858–1940), a Russian physician who trained and worked in the Russian Empire. The sign is present when slight rubbing of the skin results in exfoliation of the outermost layer.[1][2][3][4] A typical example would be to place the eraser of a pencil on the roof of a lesion and spin the pencil in a rolling motion between the thumb and forefinger. If the lesion is opened (i.e., skin sloughed off), then the Nikolsky's sign is present/positive.
Nikolsky's sign is almost always present in Stevens-Johnson Syndrome/toxic epidermal necrolysis[5] and Staphylococcal scalded skin syndrome, caused by the exfoliative toxin of Staphylococcus aureus.[1] It is also associated with pemphigus vulgaris and pemphigus foliaceus.[6][7] It is useful in differentiating between the diagnosis of pemphigus vulgaris or mucous membrane pemphigoid (where the sign is present) and bullous pemphigoid (where it is absent).
The Nikolsky sign is dislodgement of intact superficial epidermis by a shearing force, indicating a plane of cleavage in the skin at the dermal-epidermal junction. The histological picture involves thinner, weaker attachments of the skin lesion itself to the normal skin - resulting in easier dislodgement.
The formation of new blisters upon slight pressure (direct Nikolsky) and shearing of the skin due to rubbing (indirect Nikolsky) is a sign of pemphigus vulgaris, albeit not a 100% reliable diagnosis.[8] In addition, another physical exam, the Asboe-Hansen signs, must be used to determine the absence of intracellular connections holding epidermal cells together.[9]
See also
Chronic blistering skin diseases
Asboe-Hansen sign
List of cutaneous conditions
References
^ abMoss C, Gupta E (September 1998). "The Nikolsky sign in staphylococcal scalded skin syndrome". Arch. Dis. Child. 79 (3): 290. doi:10.1136/adc.79.3.290. PMC 1717681. PMID 9875032.
^"eMedicine - Pemphigus Foliaceus : Article by Robert A Schwartz". 2018-04-03.
^Asz J, Asz D, Moushey R, Seigel J, Mallory SB, Foglia RP (December 2006). "Treatment of toxic epidermal necrolysis in a pediatric patient with a nanocrystalline silver dressing". J. Pediatr. Surg. 41 (12): e9–12. doi:10.1016/j.jpedsurg.2006.08.043. PMID 17161178.
^Ma, O. Emergency Medicine Manual. McGraw Hill. 2004.
^Beigi, Pooya Khan Mohammad (2018). "Background". A Clinician's Guide to Pemphigus Vulgaris. Springer, Cham. pp. 3–10. doi:10.1007/978-3-319-67759-0_1. ISBN 9783319677583.
^Venugopal, Supriya S.; Murrell, Dédée F. (July 2011). "Diagnosis and clinical features of pemphigus vulgaris". Dermatologic Clinics. 29 (3): 373–380, vii. doi:10.1016/j.det.2011.03.004. ISSN 1558-0520. PMID 21605802.
…clinical scenario, a positive Nikolsky sign may be observed at the edge of an existing lesion, in an area of normal-appearing skin, or in both locations . The Nikolsky sign is often cited as a feature of …
…concurrent cutaneous, conjunctival, or internal staphylococcal infection Positive Nikolsky sign; The Nikolsky sign describes blistering or sloughing of skin in response to gentle mechanical pressure …
…absent. Although any cutaneous site may be affected, the palms and soles are usually spared. The Nikolsky sign (induction of blistering via mechanical pressure at the edge of a blister or on normal skin) often …
…the disease progresses, vesicles and bullae form, and within days the skin begins to slough. Nikolsky sign (ie, the ability to extend the area of superficial sloughing by applying gentle lateral pressure …
…presenting with bullae, applying shearing forces to the skin can show skin detachment, as in the Nikolsky sign in pemphigus. Stroking or rubbing with a tongue blade can demonstrate dermographism or urtication…
English Journal
Distinguishing Stevens-Johnson syndrome/toxic epidermal necrolysis from clinical mimickers during inpatient dermatologic consultation - a retrospective chart review.
Weinkle A, Pettit C, Jani A, Keller J, Lu Y, Malachowski S, Trinidad JC, Kaffenberger BH, Ergen EN, Hughey LC, Smith D, Seminario-Vidal L.
Journal of the American Academy of Dermatology. 2019 May;().
Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are life-threatening conditions that may present with similar findings to other severe dermatological diseases. The primary objective of this exploratory study was to explore factors associated with SJS/TEN and develop a model that
Review of Autoimmune Blistering Diseases: the Pemphigoid diseases.
Daniel BS, Murrell DF.
Journal of the European Academy of Dermatology and Venereology : JEADV. 2019 May;().
Autoimmune Blistering Diseases of the Pemphigoid type is characterised by sub-epidermal blisters (SEB) with circulating autoantibodies against components of the basement membrane zone (BMZ). The main disorders to date include bullous pemphigoid (BP), pemphigoid gestationis, mucous membrane pemphigoi
Lisinopril-associated bullous pemphigoid in an elderly woman: a case report of a rare adverse drug reaction.
Ballout RA, Musharrafieh U, Khattar J.
British journal of clinical pharmacology. 2018 Nov;84(11)2678-2682.
An 87-year-old woman with a long-standing history of hypertension, hypothyroidism and diabetes presented to us with scaly and pruritic vesicles of an erythematous base and crusted surface of 2-month duration. They first appeared on her abdomen and gradually spread to her lower back, thighs, before s
Your health care provider may use a pencil eraser or finger to test for Nikolsky sign. The skin is pulled to the side with a shearing pressure on the surface, or by rotating the eraser back and forth. If the test result is ...
Nikolsky's sign: The sign is present when slight rubbing of the skin at the boarder of a blister results in exfoliation of the outermost layer Here you can s...