Nikolsky's sign
Definition:
A condition in which the superficial layers of skin slip free from the lower layers with a slight rubbing pressure.
Considerations:
A positive Nikolsky's sign is present in the scalded skin syndrome and in a slightly different form in toxic epidermal necrolysis( not related to staph infection, but is thought to be a hypersensitivity reaction). In scalded skin syndrome, a toxin is release by the staphylococcal infection responsible for the illness. This toxin causes fluid to collect in the skin beneath the layer in which a blister would typically form. The skin is loosened and when rubbed slips free just as the skin on a blanched tomato or peach would do. The area beneath is pink and moist.
Areas around the joints where the skin flexes are where Nikolsky's sign is initially seen, but it rapidly effects other areas of the body. Scalded skin syndrome occurs mostly in infants and children under 5 years of age.
Common causes:
Note: There may be other causes of a positive Nikolsky's sign, but it is very specific for the two disorders listed above. Use the Symptom Analysis option to explore the possible explanations for a positive Nikolsky's sign, occurring alone or in combination with other problems.
Update Date: 02/09/00
Updated by: J. Gordon Lambert, MD, Associate Medical Director,
Utah Health Informatics and adam.com
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