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In 1927, Nikolsky wrote that if lateral pressure is applied to the normal skin between blisters of pemphigus foliaceus, the upper epidermis will peel off. There have been many reinterpretations of this description. This author asks: Is the skin base dry, or wet? The paper uses six case summaries of patients with blistering disease for illustration, and reviews the history and interesting debates surrounding the Nikolsky sign.
When the Nikolsky sign was elicited in the staphylococcal scalded skin syndrome (two cases) or pemphigus erythematosus (one case), the skin under the removed epidermal sheet was dry (non exudative). The skin base was wet in one patient with bullous impetigo and one with toxic epidermal necrolysis. In one patient with pe…