Nikolsky’s Sign: A Commentary on its Clinical Significance


  • Abdul Rehman Arshad CMH LMC & IOD
  • Aleeza Jawed Ziauddin Medical University



Nikolsky's Sign, Microscopic Nikolsky’s sign, Pemphigus Vulgaris, Toxic epidermal necrolysis


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.


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30-07-2022 — Updated on 01-03-2023


How to Cite

Abdul Rehman Arshad, & Aleeza Jawed. (2023). Nikolsky’s Sign: A Commentary on its Clinical Significance. MedERA - Journal of CMH LMC and IOD, 4(1). (Original work published July 30, 2022)