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Nikolsky sign
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Nikolsky sign

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Nikolsky sign is a skin finding in which the top layers of the skin slip away from the lower layers when slightly rubbed.

Your doctor or nurse 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.

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  • Considerations

    Your doctor or nurse 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

    • Autoimmune condition (pemphigus vulgaris)
    • Bacterial infection ( scalded skin syndrome)
    • Drug reaction (toxic epidermal necrolysis)
  • When to Contact a Medical Professional

    Call your health care provider if you or your child develop 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 are 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.

Related Information

  Scalded skin syndr...Erythema multiform...Pemphigus vulgaris...    

References

Pasternack MS, Swartz MN. Cellulitis, necrotizing fasciitis, and subcutaneous tissue infections. In: Mandell GL, Bennett JE, Dolin R, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2009:chap 90.

Schumann-Gable N. Dermatology. In: Custer JW, Rau RE, eds. The Harriet Lane Handbook. 18th ed. Philadelphia, Pa: Elsevier Mosby; 2009:chap 8.

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Review Date: 2/25/2014  

Reviewed By: Richard J. Moskowitz, MD, Dermatologist in Private Practice, Mineola, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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