Nikolsky’s sign

Nikolsky’s sign is present in all of the following cases EXCEPT –

A. Stevens–Johnson syndrome

B. Staphylococcal scalded skin syndrome

C. Pemphigus vulgaris

D. Bullous pemphigoid

Which of the following pathophysiology is associated with Nikolsky’s sign?

A. Desmoplasia

B. Acantholysis

C. Acanthosis

D. Keratosis

False Nikolsky’s sign is also known as –

A. Cornell’s sign

B. Sheklakov’s sign

C. Louvel’s sign

D. Wellens’ sign


What is Nikolsky’s sign?

Sign is present when slight rubbing of the skin results in exfoliation of the outermost layer.

Nikolsky’s sign – useful in differentiating between the diagnosis of –

  1. Pemphigus vulgaris or mucous membrane pemphigoid – Nikolsky’s sign is present
  2. Bullous pemphigoid – Nikolsky’s sign is absent
  3. Positive sign seen in diseases with intraepidermal acantholysis.
  4. Negative in diseases with dermo‑epidermal separation,
  5. This helps to distinguish pemphigus from bullous pemphigoid

What is Acantholysis?

  1. Acantholysis- loss of coherence between epidermal cells due to the breakdown of their intercellular bridges.
  2. In acantholysis the cells remain intact but are no longer attached to each other

What are the conditions show positive Nikolsky’s sign?

Nikolsky’ s sign

Positive Nikolsky’s sign is the hallmark of pemphigus

Moderately sensitive but highly specific tool for the diagnosis of pemphigus.

Other blistering conditions, which are known to exhibit Nikolsky’s sign

  1. pemphigus foliaceous,
  2. paraneoplastic pemphigus,
  3. Stevens‑Johnson syndrome,
  4. staphylococcal scalded skin
    syndrome (SSSS),
  5. toxic epidermal necrolysis (TEN),
  6. oral lichen planus,
  7. benign mucous membrane pemphigoid,
    epidermolysis bullosa

“Marginal Nikolsky’s sign”

Described as the extension of the erosion on the surrounding normal‑appearing skin
by rubbing the skin surrounding existing lesions.

“Direct Nikolsky’s sign”

“Direct Nikolsky’s sign” is the induction of an erosion on normal‑appearing skin, distant from the lesions.

Positive direct Nikolsky’s sign indicates severe activity of the disease in pemphigus.

It is the first sign to disappear as the disease responds to therapy; the marginal Nikolsky’s sign may persist
for sometime.

Nikolsky’s phenomenon

The term “Nikolsky’s phenomenon” is applied when the superficial layer of the epidermis is felt to move over the deeper layer

Mauserung phenomenon

The Nikolsky’ssign may also be elicitable in the rare ichthyosis bullosa of Siemens, where it is termed the “Mauserung phenomenon”

“Pseudo Nikolsky’s sign”

Pseudo Nikolsky’s sign -is positive for Stevens–Johnson Syndrome, some burn cases, toxic epidermal necrolysis, and bullous ichthyyosiform erythroderma.

Here, the underlying pathophysiology is necrosis and not acantholysis, which is seen in the “true Nikolsky’s sign”

    Subscribe Medicine Question BankWhatsApp Channel

    FREE Updates, MCQs & Questions For Doctors & Medical Students

      Medicine Question Bank
      Enable Notifications OK No thanks