|Ahead of print publication
A simple and succinct simulation of Nikolsky phenomenon and sign
Keshavmurthy A Adya1, Arun C Inamadar1, Aparna Palit2
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 Web Publication||24-Jan-2020|
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
Source of Support: None, Conflict of Interest: None
|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 [Epub ahead of print] [cited 2020 Feb 19]. Available from: http://www.idoj.in/preprintarticle.asp?id=276565
| Clinical Challenge|| |
Nikolsky sign 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.
| Solution|| |
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].
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Conflicts of interest
| References|| |
Shakeri A. Pyotr Vasilyevich Nikolsky – The man behind the sign. JAMA Dermatol 2018;154:181.
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. [Full text]