Target PG - TNPG 2002 Derm - Nikolsky Sign

Target PG - TNPG 2001 to
2004 Book

2002 DERMATOLOGY

Author:
Dr.J.Mariano Anto Bruno Mascarenhas

Question Stem

163. Nikolsky Sign is seen in all except

Choices given

A)
Staphylococcal Scalded Skin
Syndrome

B)
Pemphigus Vulgaris

C)
Bullous Pemphigoid

D)
Steven Johnson’s Syndrome

Answer

C) Bullous Pemphigoid

Reference

Harrison 15^th Edition Chapter 58

Question Analysis

Based on	Question Category	Question Grade	Question Type	Books	Target PG Opinion
Concept	Subtle Point	PG Entrance	Straight forward	Given in most books	Needs Memory

Facts

Ä
In the exfoliative stage,
manual light lateral pressure pressure to the skin of patients may elicit the
separation of the epidermis (Nikolsky's sign) to form bullae. This
finding, while characteristic of PV, is not specific to this disorder and is
also seen in toxic epidermal necrolysis, Stevens-Johnson syndrome, and a few
other skin diseases

Interpretation

Self Explanatory. This Nikolsky’s sign is
characteristically absent in Bullous Pemphigoid

Remarks

Ä
Nikolsky’s sign is epidermal
cell separation induced by firm sliding pressure of the finger on apparently
normal or perilesional skin of patients with PEMPHIGUS especially pemphigus
foliaceus, and, on the erythematous skin of patients with toxic epidermal
necrolysis or SSSS. And this is not to be confused with lateral extension of
a pre-existing bulla by pressure on it, common to many bullous diseases.

Tit Bits

Ä

Differentiation between the two blistering diseases

Features	Pemphigus	Pemphigoid
Age	40-60	60-80
HPE-Row of Tombstones	Present	Absent
Nikolsky’s Sign	Present	Absent
Bulla Location	Intraepidermal	Sub Epidermal
Bulla Features	Flacced	Tense
Mucosa (eg Oral )	Involved	Not involved
Acantholysis	Present	Absent

Ä

About the Blisters

§

PemphiguS
has Superficial
(Intra epidermal) blisters

§

PemphigoiD
has Deep
(Sub Epidermal) blisters

Ä

And among Pemphigus

§

P.Erythematosus
and P.Foliaceous
show intraepidermal Acantholytic Split in Stratum
Granulosum
(Pnemonic EFG)and

§

P.Vulgaris and P.Vegetans show Intraepidermal Acantholytic split in between the
Basal layer and the Prickle cell layer