Nikolsky Sign
Pronunciation: nih-KOL-skee syn
A clinical examination finding in which lateral pressure or rubbing of apparently normal perilesional mucosa causes it to slough or separate, indicating intraepithelial or subepithelial acantholysis.
Full Definition
The Nikolsky sign is elicited by applying lateral mechanical pressure with a finger or instrument to clinically normal-appearing mucosa adjacent to an existing lesion; a positive result produces erosion or blistering, suggesting fragility of the epithelial attachment. It is classically associated with vesiculobullous disorders such as pemphigus vulgaris (where it is strongly positive) and is variably present in mucous membrane pemphigoid and other blistering conditions. In oral medicine reports and case records, the finding must be documented as positive or negative and should always be coupled with the anatomical location tested. The eponym 'Nikolsky' is named after Pyotr Nikolsky and should always be capitalised and followed by 'sign' (not 'test'). Editors must be alert to misspellings including 'Nikolski' and 'Nickolsky'.
Usage
Usage note: Always capitalise 'Nikolsky' as an eponym. Preferred form is 'Nikolsky sign' (without possessive apostrophe) in modern clinical usage, though 'Nikolsky's sign' remains acceptable. Flag misspellings: 'Nikolski', 'Nickolsky'.
In Context
- "A positive Nikolsky sign on the buccal mucosa supported the clinical diagnosis of pemphigus vulgaris prior to biopsy." — Oral medicine consultation letter
- "The examiner documented a negative Nikolsky sign, making a diagnosis of pemphigus less likely in this presentation." — Oral medicine clinical examination record