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Nikolsky sign is a clinical dermatological examination maneuver that assesses the integrity of the epidermis in response to a shearing force. It is particularly relevant in the evaluation of blistering skin disorders. The presence or absence of Nikolsky sign can help in differentiating certain
skin conditions.
1. Nikolsky Sign Interpretation:
-Positive Nikolsky Sign: When gentle pressure on apparently normal-appearing skin causes it to separate and blister, it is considered positive. This indicates a loss of cohesion between the layers of the skin, typically due to some underlying pathology affecting the integrity of the epidermis.
-Negative Nikolsky Sign: If there is no blistering or separation of the skin with pressure, it is considered negative.
2. Conditions Associated with Positive Nikolsky Sign:
-Pemphigus Vulgaris: This autoimmune blistering disorder involves the formation of blisters within the epidermis and mucous membranes. It is a potentially serious condition.
-Toxic Epidermal Necrolysis (TEN): A severe and life-threatening reaction to certain medications, characterized by widespread epidermal necrosis and blistering.
-Staphylococcal Scalded Skin Syndrome (SSSS): Caused by exfoliative toxin-producing Staphylococcus aureus, leading to widespread blistering and desquamation of the skin.
*Clinical Application:
-Nikolsky sign is elicited by applying lateral pressure to the skin using a finger or a cotton swab.
-It is important to perform this test carefully to avoid causing trauma to the skin.
*Note:*
-Nikolsky sign is a clinical observation and may not be present in all cases of the mentioned conditions. Its absence does not exclude these conditions, and other diagnostic methods may be necessary for confirmation.
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