Considerations:

A positive Nikolsky’s sign is present in the scalded skin syndrome (caused by staphlococcal infection) 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:

• scalded skin syndrome (also called Ritter disease)
• toxic epidermal necrolysis
• pemphigus vulgaris

Home Care:

There is no home care for the majority of conditions associated with a positive Nikolsky’s sign; most affected people are hospitalized. Pemphigus is a chronic disease and is treated both at home and in the hospital.

Call If:

• you or your child develop the Nikolsky sign or redness and blistering of the skin without an obvious cause.

Note: This finding is usually discovered by the health care provider.

What To Expect:

The affected person will be hospitalized, as the conditions associated with Nikolsky’s sign are serious. The medical history will be obtained and a physical examination performed. Intravenous fluid and intravenous antibiotics are used to treat the patient.

Medical history questions documenting Nikolsky’s sign in detail may include:

• When did you first notice that the skin was red or blistered?
• What other symptoms occur at the same time?