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Nikolsky's sign

Skin layers

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•	Scalded skin syndrome
•	Erythema multiforme
•	Pemphigus vulgaris

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Nikolsky’s sign

Definition

Nikolsky's sign involves the superficial layers of skin slipping free from the lower layers with slight pressure.

Considerations

A positive Nikolsky's sign is present in the scalded skin syndrome (caused by staphylococcal infection) and in a slightly different form in toxic epidermal necrolysis (a severe drug reaction). It may also be seen in pemphigus vulgaris (a disease which causes blisters to form on the skin).

In each of these diseases, the skin is loosened and when rubbed, slips free just as the skin on a blanched tomato or peach would. The area beneath is pink and moist and may be very tender.

Causes

• Scalded skin syndrome (also called Ritter disease)
• Toxic epidermal necrolysis
• Pemphigus vulgaris

Home Care

There is no home care for the majority of conditions associated with a positive Nikolsky's sign -- most affected people are hospitalized. Pemphigus is a chronic disease and is treated both at home and in the hospital.

When to Contact a Medical Professional

• you or your child develop loosening, redness, and blistering of the skin without an obvious cause.

Note: This finding is usually discovered by the health care provider.

What to Expect at Your Office Visit

The affected person will be hospitalized, as the conditions associated with Nikolsky's sign are serious. Medical history is obtained and a physical examination performed. Intravenous fluid and intravenous antibiotics may be used.

Medical history questions documenting Nikolsky's sign in detail may include:

• When did you first notice that the skin was red or blistered?
• What other symptoms occur at the same time?

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