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February 1980

A Modified Technique for Eliciting Nikolsky's Sign

Arch Dermatol. 1980;116(2):160. doi:10.1001/archderm.1980.01640260036008

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To the Editor.—  A patient with a history suggestive of urticaria was tested for dermatographism by the firm stroking of the skin with a paper clip. This procedure elicited Nikolsky's sign. The patient also suffered from a severe form of familial benign chronic pemphigus (Hailey and Hailey disease).Nikolsky's sign was similarly elicited in other patients who suffered from pemphigus vulgaris, pemphigus erythematosus, and epidermolysis bullosa dystrophica. In two patients with clinically and immunologically inactive pemphigus vulgaris, the test results were negative.The accepted procedure for eliciting Nikolsky's sign, first described by Nikolsky in 1895, is to exert firm sliding pressure with the thumb on the patient's skin. The resulting dislodgment of some or all of the epidermis may occur over a large area and is always painful, disturbing, and unaesthetic. As an alternative, we suggest the use of a round-ended, medium-sized, paper clip. It should be held at an angle

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