Nikolsky Sign

Goodman, Herman

doi:10.1001/archderm.1953.01540090096013

Cited by 29 publications

(9 citation statements)

References 1 publication

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“…Pemphigus is a chronic autoimmune blistering disease characterized by loss of cohesion between adjacent keratinocytes 1 . This phenomenon forms the basis of Nikolsky's sign 2 which was originally described by Pierre W. Nikolsky 3 in 1896 in pemphigus foliaceus. The original description states that the sign can be elicited by two methods: (i) ‘by pulling the ruptured wall of the blister it is possible to take off the horny layer for a long distance on a seemingly healthy skin’ and (ii) ‘the rubbing off of the epidermis between the bullae by slight friction without breaking the surface of the skin and leaving moist surface of the granular layer.’ We refer to the original Nikolsky's sign as clinical Nikolsky's sign in this article in order to distinguish it from the microscopic Nikolsky's sign that we will describe.…”

Section: Introductionmentioning

confidence: 99%

Microscopic Nikolsky's sign

Hameed

Khan

1999

Clinical and Experimental Dermatology

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Nikolsky's sign is a useful clinical sign in patients with active pemphigus. It does not however, indicate the level of split in the skin, and is seldom present in partially-treated patients. The purpose of this study was two fold: (i) to document the microscopic or subclinical counterpart of clinical Nikolsky's sign; and (ii) to improve the diagnostic yield of routine histopathology in pemphigus patients in whom the lesions are infected/old and are therefore not useful for histopathology, and when intact blisters are not present; this is particularly useful for institutions in which immunofluorescence facilities are not available. Pemphigus patients were allocated to one of two groups. Group A patients (n = 23) were subjected to manual tangential pressure over the perilesional skin before a biopsy specimen was taken from that site; group B patients (n = 14) were subjected to a biopsy without the tangential pressure technique. Group C consisted of 37 healthy volunteers who were subjected to the tangential pressure technique before a biopsy. Histopathological changes of pemphigus vulgaris or foliaceus were present in 73.9% patients in group A, 28.6% in group B and none in the control group C. Tangential pressure as described below can produce microscopic changes in the epidermis which are diagnostic of pemphigus. These changes are produced at the suprabasal level in pemphigus vulgaris and intraepidermally in pemphigus foliaceus. This technique is of value in those parts of the world where immunofluorescence facilities are not readily available.

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Section: Introductionmentioning

confidence: 99%

Microscopic Nikolsky's sign

Hameed

Khan

1999

Clinical and Experimental Dermatology

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“…Usually, the lesions rapidly exhibit the Nikolsky's sign (epidermal separation induced by gentle lateral pressure of the skin surface) which facilitates the diagnosis [5]. Besides affecting the mucosal and ocular surface, the lesions can become extremely extensive until a complete loss of epidermis within 24 h. Thus, TEN is associated with significant morbidity, including thermoregulatory disturbance and dehydration, and leads to lung, renal, liver and heart failure in severe cases [6].…”

Section: Discussionmentioning

confidence: 99%

A Rare Case of Toxic Epidermal Necrolysis with Unexpected Fever Resulting from Dengue Virus

Grieb¹,

Alazemi²,

Das³

et al. 2010

Case Rep Dermatol

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Toxic epidermal necrolysis (TEN), also known as Lyell’s syndrome, is a life-threatening disease with common development of large wounds. Thus, affected patients are usually treated in specialized centers. Herein, we present a case of TEN in a patient infected with human immunodeficiency virus with the additional, unexpected diagnosis of dengue fever. In this context, we discuss cause, diagnosis, pathology, and treatment of TEN and highlight the role of rare and unexpected findings, as in this case an additional tropical virus infection. We underpin the importance of an interdisciplinary approach involving dermatologists, ophthalmologists, intensive care physicians, burn specialists and various other departments and emphasize the challenge of TEN treatment, especially if rare pathological findings occur.

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“…blisters, excoriations) on seemingly unaffected skin. [ 15 ] Nikolsky's observations were later confirmed by Lyell in 1956, who described a Nikolsky's sign in patients with toxic epidermal necrolysis. [ 14 ]…”

Section: Introductionmentioning

confidence: 93%

Diagnostic procedures for autoimmune vesiculobullous diseases: A review

Rastogi¹,

Sharma

Misra

et al. 2014

J Oral Maxillofac Pathol

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Oral soft tissues are affected by numerous pathologic conditions of variable etiology and hence their appropriate management relies on their accurate diagnosis. Clinical identification of intact vesicle and bulla in the oral cavity is really a challenge due to the regular irritation and the friable nature of oral mucosa. Rupture of these lesions leads to erosions or ulcerations on the surface, hence making the diagnosis of vesiculobullous (VB) lesions is even more difficult due to the fact that the differential diagnosis along with VB lesions will also include ulcerative, immunological-mediated diseases, and neoplasms and systemic diseases. Hence, knowledge of the clinical presentation of these disorders and the relevant diagnostic procedures is important not just for dermatologists, but also for general practitioners and dentists. In this article, the various procedures have been explained that can be used for the diagnostic purpose of VB lesions.

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Nikolsky Sign

Cited by 29 publications

References 1 publication

Microscopic Nikolsky's sign

Microscopic Nikolsky's sign

A Rare Case of Toxic Epidermal Necrolysis with Unexpected Fever Resulting from Dengue Virus

Diagnostic procedures for autoimmune vesiculobullous diseases: A review

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