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Nikolsky Sign

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Nikolsky Sign

(a) Eliciting Nikolsky's sign on perilesional skin. Note the tangential pressure, (b) Eliciting Nikolsky's sign, peeling of skin revealing moist erosion[1]
Positive Nikolsky's sign
  • Nikolsky's Sign
  • Nikolsky Phenomenon
  • Nikolsky Test

Purpose

  • Used to assess epidermal fragility and loss of cohesion between epidermal cells
  • Most commonly utilized in the evaluation of autoimmune blistering diseases, severe exfoliative skin disorders

Description

  • Examiner applies gentle tangential or lateral pressure to normal-appearing skin adjacent to a lesion or blister
  • Positive test occurs
    • Superficial epidermis shears away from the underlying skin
    • Resulting in erosion or extension of an existing blister

Pathology

  • Pemphigus Vulgaris
  • Pemphigus Foliaceus
  • Staphylococcal Scalded Skin Syndrome
  • Toxic Epidermal Necrolysis
  • Stevens-Johnson Syndrome

Evidence

Any Pemphigus

  • Uzon et al[2]
    • Sensitivity: 38-69%
    • Specificity: 94-100%

See Also

References

  1. ↑ Seshadri, Divya, M. Sendhil Kumaran, and Amrinder J. Kanwar. "Acantholysis revisited: back to basics." Indian journal of dermatology, venereology and leprology 79 (2013): 120.
  2. ↑ Uzun, Soner, and Murat Durdu. "The specificity and sensitivity of Nikolskiy sign in the diagnosis of pemphigus." Journal of the American Academy of Dermatology 54.3 (2006): 411-415.
Created by:
John Kiel on 2 June 2026 16:42:20
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Last edited:
4 June 2026 01:29:10
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