Nikolsky’s Sign: A Commentary on its Clinical Significance

Abstract

Nikolsky’s sign is a clinical dermatological maneuver that dates back more than 2 centuries ago and is named after Pyotr Nikolsky (1858-1940). It has served as a very important diagnostic tool, being pathognomonic for diseases such as pemphigus vulgaris, toxic epidermal necrolysis, and staphylococcal scalded skin syndrome. Nikolsky’s sign, however, suffers from a lack of standardization, especially with regards to the method used to elicit the sign. This reduces its standard to be more qualitative than quantitative. Although Nikolsky’s sign has a high specificity, it has only a moderate sensitivity of 38% for the diagnosis of Pemphigus Vulgaris. The role of Microscopic Nikolsky’s sign has also been discussed as being a better metric than Nikolsky’s sign in the diagnosis of PV. In this paper, we discuss the clinical significance of Nikolsky’s sign, and the requirement for alternative techniques and manoeuvres.