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Nikolsky sign

 

Nikolsky sign is a skin finding in which the top layers of the skin slip away from the lower layers when slightly rubbed.

Considerations

Your health care provider may use a pencil eraser to test for Nikolsky sign. The eraser is placed on your skin and gently twirled back and forth.

If the test result is positive, a blister will form in the area, usually within minutes.

A positive result is usually a sign of a blistering skin condition. People with a positive sign have loose skin that slips free from the underlying layers when rubbed. The area beneath is pink and moist, and usually very tender.

Causes

 

The Nikolsky sign can be often found in people with:

  • Autoimmune blistering conditions such as pemphigus vulgaris
  • Bacterial infections such as scalded skin syndrome
  • Drug reactions such as erythema multiforme

 

When to Contact a Medical Professional

 

Call your provider if you or your child develops painful loosening, redness, and blistering of the skin, which you do not know the cause of (for example, a skin burn).

 

What to Expect at Your Office Visit

 

The conditions associated with Nikolsky sign can be serious. Some people need to be admitted to the hospital. You will be asked about your medical history and given a physical examination. You may be given fluid and antibiotics through a vein (intravenously).

Treatment will depend on the cause of the condition.

 

 

References

Garber B, Cydulka RK. Dermatologic presentations. In: Marx JA, Hockberger RS, Walls RM, et al, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 8th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 120.

Habif TP. Vesicular and bullous diseases. In: Habif TP, ed. Clinical Dermatology: A Color Guide to Diagnosis and Therapy. 6th ed. Philadelphia, PA: Elsevier; 2016:chap 16.

 
  • Nikolsky sign

    Nikolsky sign - illustration

    Nikolsky sign is a condition caused by a staphylococcal infection in which the superficial layers of skin slip free from the lower layers with a slight rubbing pressure. Large areas of the skin will blister and peel away leaving wet, red and painful areas.

    Nikolsky sign

    illustration

  • Skin layers

    Skin layers - illustration

    The skin is the largest organ of the body. The skin and its derivatives (hair, nails, sweat and oil glands) make up the integumentary system. One of the main functions of the skin is protection. It protects the body from external factors such as bacteria, chemicals, and temperature. The skin contains secretions that can kill bacteria and the pigment melanin provides a chemical pigment defense against ultraviolet light that can damage skin cells. Another important function of the skin is body temperature regulation. When the skin is exposed to a cold temperature, the blood vessels in the dermis constrict. This allows the blood which is warm, to bypass the skin. The skin then becomes the temperature of the cold it is exposed to. Body heat is conserved since the blood vessels are not diverting heat to the skin anymore. Among its many functions the skin is an incredible organ always protecting the body from external agents.

    Skin layers

    illustration

    • Nikolsky sign

      Nikolsky sign - illustration

      Nikolsky sign is a condition caused by a staphylococcal infection in which the superficial layers of skin slip free from the lower layers with a slight rubbing pressure. Large areas of the skin will blister and peel away leaving wet, red and painful areas.

      Nikolsky sign

      illustration

    • Skin layers

      Skin layers - illustration

      The skin is the largest organ of the body. The skin and its derivatives (hair, nails, sweat and oil glands) make up the integumentary system. One of the main functions of the skin is protection. It protects the body from external factors such as bacteria, chemicals, and temperature. The skin contains secretions that can kill bacteria and the pigment melanin provides a chemical pigment defense against ultraviolet light that can damage skin cells. Another important function of the skin is body temperature regulation. When the skin is exposed to a cold temperature, the blood vessels in the dermis constrict. This allows the blood which is warm, to bypass the skin. The skin then becomes the temperature of the cold it is exposed to. Body heat is conserved since the blood vessels are not diverting heat to the skin anymore. Among its many functions the skin is an incredible organ always protecting the body from external agents.

      Skin layers

      illustration

    Talking to your MD

     

      Self Care

       

        Tests for Nikolsky sign

         

           

          Review Date: 1/31/2016

          Reviewed By: Kevin Berman, MD, PhD, Atlanta Center for Dermatologic Disease, Atlanta, GA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

          The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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