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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:
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Autoimmune blistering conditions such as
pemphigus vulgaris
Pemphigus vulgaris
Pemphigus vulgaris (PV) is an autoimmune disorder of the skin. It involves blistering and sores (erosions) of the skin and mucous membranes....
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Bacterial infections such as
scalded skin syndrome
Scalded skin syndrome
Scalded skin syndrome is a skin infection caused by bacteria in which the skin becomes damaged and sheds.
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Drug reactions such as
erythema multiforme
Erythema multiforme
Erythema multiforme (EM) is a skin reaction that comes from an infection or another trigger.
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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 ).
Physical examination
During a physical examination, a health care provider studies your body to determine if you do or do not have a physical problem. A physical examinat...
Intravenously
Intravenous means "within a vein. " Most often it refers to giving medicines or fluids through a needle or tube inserted into a vein. This allows th...
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.
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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
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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 - 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 - 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
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.
