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Nikolsky sign

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

  • Considerations
    • Your health care provider 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
  • When to Contact a Medical Professional
    • Call your provider if you or your child develops 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 can be 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.

  • References
    • Garber B, Cydulka RK. Dermatologic presentations. In: Marx JA, Hockberger RS, Walls RM, et al, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 8th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 120.

      Habif TP. Vesicular and bullous diseases. In: Habif TP, ed. Clinical Dermatology: A Color Guide to Diagnosis and Therapy. 6th ed. Philadelphia, PA: Elsevier; 2016:chap 16.