Health Library

Nikolsky sign

Nikolsky sign is a skin finding in which the top layers of the skin slip away from the lower layers when rubbed. A positive result is usually a sign of a blistering skin condition.

Images

I Would Like to Learn About:

Considerations

This sign is more common in newborn babies and in children under 5 years of age. It often begins in the mouth and on the neck, shoulder, arm pit, and genital areas. A child may be lethargic, irritable, and feverish. They may develop red painful blisters on the skin, which break easily.

Adults with disturbed kidney functions or with a weak immune system may have this sign. Your health care provider may use a pencil eraser or finger to test for Nikolsky sign. The skin is pulled to the side with a shearing pressure on the surface, or by rotating the eraser back and forth.

If the test result is positive, the very thin top layer of skin will shear off, leaving skin that is pink and moist, and usually very tender.

Causes

The Nikolsky sign can be often found in people with:

• Autoimmune blistering conditions such as pemphigus vulgaris
• Bacterial infections such as scalded skin syndrome
• Drug reactions such as erythema multiforme

When to Contact a Medical Professional

Contact your provider if you or your child develops painful loosening, redness, and blistering of the skin, for which you do not know the cause (for example, a skin burn).

What to Expect at Your Office Visit

The conditions associated with Nikolsky sign can be serious. Some people need to be admitted to the hospital. You will be asked about your medical history and given a physical exam.

The treatment will depend on the cause of the condition.

You may be given:

• Fluids and antibiotics through a vein (intravenously)
• Petroleum jelly to decrease pain
• Local wound care

Healing of the skin blisters occurs in about 1 to 2 weeks with no scarring.

Related Information

References

James WD. Bacterial infections. In: James WD, ed. Andrews' Diseases of the Skin: Clinical Dermatology. 14th ed. Philadelphia, PA: Elsevier; 2026:chap 12.

James WD. Chronic blistering dermatoses. In: James WD, ed. Andrews' Diseases of the Skin: Clinical Dermatology. 14th ed. Philadelphia, PA: Elsevier; 2026:chap 16.

Joyce JC. Vesiculobullous disorders. In: Kliegman RM, St. Geme JW, Blum NJ, et al, eds. Nelson Textbook of Pediatrics. 22nd ed. Philadelphia, PA: Elsevier; 2025:chap 695.

Marco CA. Dermatologic presentations. In: Walls RM, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 107.

Review Date: 1/28/2026  

Reviewed By: Ramin Fathi, MD, FAAD, Director, Phoenix Surgical Dermatology Group, Phoenix, AZ. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

A.D.A.M., Inc. is accredited by URAC, for Health Content Provider (www.urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics. This site complies with the HONcode standard for trustworthy health information: verify here.

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. No warranty of any kind, either expressed or implied, is made as to the accuracy, reliability, timeliness, or correctness of any translations made by a third-party service of the information provided herein into any other language.

© 1997- 2026 A.D.A.M., a business unit of Ebix, Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

All content on this site including text, images, graphics, audio, video, data, metadata, and compilations is protected by copyright and other intellectual property laws. You may view the content for personal, noncommercial use. Any other use requires prior written consent from Ebix. You may not copy, reproduce, distribute, transmit, display, publish, reverse-engineer, adapt, modify, store beyond ordinary browser caching, index, mine, scrape, or create derivative works from this content. You may not use automated tools to access or extract content, including to create embeddings, vectors, datasets, or indexes for retrieval systems. Use of any content for training, fine-tuning, calibrating, testing, evaluating, or improving AI systems of any kind is prohibited without express written consent. This includes large language models, machine learning models, neural networks, generative systems, retrieval-augmented systems, and any software that ingests content to produce outputs. Any unauthorized use of the content including AI-related use is a violation of our rights and may result in legal action, damages, and statutory penalties to the fullest extent permitted by law. Ebix reserves the right to enforce its rights through legal, technological, and contractual measures.