Clinical Challenge
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
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.
Video available on www.idoj.in
References
- 1.Shakeri A. Pyotr Vasilyevich Nikolsky – The man behind the sign. JAMA Dermatol. 2018;154:181. doi: 10.1001/jamadermatol.2017.5164. [DOI] [PubMed] [Google Scholar]
- 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. [Google Scholar]
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