Nikolsky sign
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Definition
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.
Images
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.