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DERMATOLOGY PEARLS
Year : 2020  |  Volume : 11  |  Issue : 3  |  Page : 465  

A simple and succinct simulation of Nikolsky phenomenon and sign


1 Department of Dermatology, Venereology and Leprosy, SBMP Medical College, Hospital and Research Center, BLDE (Deemed to be University), Vijayapur, Karnataka, India
2 Department of Dermatology and Venereology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India

Date of Submission21-May-2019
Date of Decision02-Jun-2019
Date of Acceptance10-Jun-2019
Date of Web Publication10-May-2020

Correspondence Address:
Arun C Inamadar
Department of Dermatology, Venereology and Leprosy, Shri B M Patil Medical College, Hospital and Research Center, BLDE (Deemed to be University), Vijayapur - 586 103, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/idoj.IDOJ_247_19

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How to cite this article:
Adya KA, Inamadar AC, Palit A. A simple and succinct simulation of Nikolsky phenomenon and sign. Indian Dermatol Online J 2020;11:465

How to cite this URL:
Adya KA, Inamadar AC, Palit A. A simple and succinct simulation of Nikolsky phenomenon and sign. Indian Dermatol Online J [serial online] 2020 [cited 2020 May 27];11:465. Available from: http://www.idoj.in/text.asp?2020/11/3/465/276565




   Clinical Challenge Top


Nikolsky sign[1] is classically seen in pemphigus vulgaris wherein the epidermis is separated from the underlying dermis due to acantholysis. On palpation, one can feel the movement of the detached epidermis over the underlying dermis (Nikolsky phenomenon [Video 1]). Application of a tangential shearing force detaches the separated epidermis exposing the dermis (Nikolsky sign). It is also seen in other conditions like toxic epidermal necrolysis and staphylococcal scalded skin syndrome. The presence of Nikolsky phenomenon and/or sign indicates disease activity and is absent in inactive disease and hence, may not be elicited in all cases for clinical demonstration to the students.[2]


   Solution Top


We provide this simple and lucid simulation of epidermal separation from the underlying dermis using a soaked almond for demonstration and explanation of Nikolsky phenomenon and sign. The separated skin of the almond can be easily moved over it akin to the movement of the detached epidermis over the dermis in Nikolsky phenomenon. Further shearing force peels off the skin exposing the almond similar to the peeling of the detached epidermis exposing the underlying dermis in Nikolsky sign [Video 2].

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Shakeri A. Pyotr Vasilyevich Nikolsky – The man behind the sign. JAMA Dermatol 2018;154:181.  Back to cited text no. 1
    
2.
Soni AG. Nikolsky's sign - A clinical method to evaluate damage at epidermal-dermal junction. J Indian Acad Oral Med Radiol 2018;30:68-72.  Back to cited text no. 2
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