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</div><div><span>Nikolsky sign</span></div></div>
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<article><div id="d-article"><div class="page-info"><div class="page-title"><a name="start" id="start">
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</a><h1 class="with-also" itemprop="name">Nikolsky sign</h1>
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</noscript></div><div class="main"><div id="ency_summary"><p>Nikolsky sign is a skin finding in which the top layers of the skin slip away from the lower layers when rubbed.</p></div><section><div class="section"><div class="section-header"><div class="section-title"><h2>Considerations</h2></div><div class="section-button"><button type="submit" aria-controls="section-1" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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</div></div><div class="section-body" id="section-1"><p>The sign is more common in newborn babies and in young children under 5 years of age. It often begins in the mouth and on neck, shoulder, arm pit, and genital area. A child may be lethargic, irritable, and feverish. They may develop red painful blisters on the skin, which break easily.</p><p>Adults with disturbed kidney functions or with a weak immune system may have this sign. Your health care provider may use a pencil eraser or finger to test for Nikolsky sign. The skin is pulled to the side with a shearing pressure on the surface, or by rotating the eraser back and forth.</p><p>If the test result is positive, the very thin top layer of skin will shear off, leaving skin pink and moist, and usually very tender.</p><p>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.</p></div></div></section><section><div class="section"><div class="section-header"><div class="section-title"><h2>Causes</h2></div><div class="section-button"><button type="submit" aria-controls="section-2" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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</div></div><div class="section-body" id="section-2"><p>The Nikolsky sign can be often found in people with:</p><ul><li>Autoimmune blistering conditions such as <a test="test" href="./000882.htm">pemphigus vulgaris</a></li><li>Bacterial infections such as <a test="test" href="./001352.htm">scalded skin syndrome</a></li><li>Drug reactions such as <a test="test" href="./000851.htm">erythema multiforme</a></li></ul></div></div></section><section><div class="section"><div class="section-header"><div class="section-title"><h2>When to Contact a Medical Professional</h2></div><div class="section-button"><button type="submit" aria-controls="section-3" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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</div></div><div class="section-body" id="section-3"><p>Contact 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).</p></div></div></section><section><div class="section"><div class="section-header"><div class="section-title"><h2>What to Expect at Your Office Visit</h2></div><div class="section-button"><button type="submit" aria-controls="section-4" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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</div></div><div class="section-body" id="section-4"><p>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 <a test="test" href="./002274.htm">physical examination</a>.</p><p>Treatment will depend on the cause of the condition.</p><p>You may be given:</p><ul><li>Fluid and antibiotics through a vein (<a test="test" href="./002383.htm">intravenously</a>)</li><li>Petroleum jelly to decrease pain</li><li>Local wound care</li></ul><p>Healing of the skin blisters occurs in about 1 to 2 weeks with no scarring.</p></div></div></section><section><div class="section sec-mb"><div class="section-header"><div class="section-title"><h2>Images</h2></div><div class="section-button"><button type="submit" aria-controls="section-tnails" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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<li><img src="//medlineplus.gov/ency/images/ency/tnails/17280t.jpg" alt="Nikolsky sign" title="Nikolsky sign" class="side-img"/><a href="../imagepages/17280.htm">Nikolsky sign</a></li>
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</ul></div></div></section><section><div class="section"><div class="section-header"><div class="section-title"><h2>References</h2></div><div class="section-button"><button type="submit" aria-controls="section-Ref" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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</div></div><div class="section-body" id="section-Ref"><p>Fitzpatrick JE, High WA, Kyle WL. Blisters and vesicles. In: Fitzpatrick JE, High WA, Kyle WL, eds. <em>Urgent Care Dermatology: Symptom-Based Diagnosis</em>. Philadelphia, PA: Elsevier; 2018:chap 11.</p><p>Grayson W, Calonje E. Infectious diseases of the skin. In: Calonje E, Brenn T, Lazar AJ, Billings SD, eds. <em>McKee's Pathology of the Skin</em>. 5th ed. Philadelphia, PA: Elsevier; 2020:chap 18.</p><p>Levin LE, Garzon MC, Lauren CT, Morel KD. Dermatology. In: Polin RA, Ditmar MF, eds. <em>Pediatric Secrets</em>. 7th ed. Philadelphia, PA: Elsevier; 2021:chap 4.</p><p>Marco CA. Dermatologic presentations. In: Walls RM, ed. <em>Rosen's Emergency Medicine: Concepts and Clinical Practice</em>. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 107.</p></div></div></section>
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<section><div class="section"><div class="section-header"><div class="section-title"><h2>Review Date 2/15/2024</h2></div><div class="section-button"><button type="submit" aria-controls="section-version" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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<div id="section-version" class="section-body"><p>Updated by: Elika Hoss, MD, Assistant Professor of Dermatology, Mayo Clinic, Scottsdale, AZ. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team. </p>
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