The Nikolsky sign describes the observation that a shearing force, such as when using a finger to laterally pull on the skin surrounding a lesion, will result in the separation of the epidermis and creation of an erosion. It is a sign consistent with blistering pathologic abnormalities of superficial skin, as seen in patients with staphylococcal scalded skin syndrome. Furthermore, and as dutifully learned by medical trainees, the presence of this sign is one of the main differentiating factors between pemphigus vulgaris, where the sign is present, and bullous pemphigoid, in which the Nikolsky sign is absent because the plane of epidermal separation is deeper and hence the blisters are less fragile. In addition, Nikolsky sign is absent in bullous lupus erythematosus and erythema multiforme-toxic epidermal necrolysis syndromes.1
Shakeri A. Pyotr Vasilyevich Nikolsky—The Man Behind the Sign. JAMA Dermatol. 2018;154(2):181. doi:10.1001/jamadermatol.2017.5164
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