UMEM Educational Pearls

Category: Dermatology

Title: Nikolsky's sign

Keywords: Nikolsky's sign, Dermatology (PubMed Search)

Posted: 12/26/2009 by Michael Bond, MD (Updated: 3/28/2024)
Click here to contact Michael Bond, MD

Nikolsky's sign is positive when slight rubbing of the skin results in exfoliation of the skin's outermost layer.  The more technical term is acantholysis which is the loss of the normal adhesion of the epithelial skin cells which allows for this sloughing.

Seen in:

  • Toxic Epidermal Necrolysis
  • Pemphigus vulgaris
  • Scalled Skin Syndrome
  • Bullous impetigo
  • Epidermolysis bullosa

Often helpful to differentiate pemphigus vulgaris from bullous pemphigoid. The sign is usually absent in bullous pemphigoid.  Just be careful with how much testing you are doing as this can be very painful to the patient.