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Nikolskys Sign

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1. Nikolsky's Sign

Nikolsky's Sign Nikolskys Sign Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Nikolsky's Sign Nikolsky's Sign Aka: Nikolsky's Sign (...) , Nikolsky Sign II. Indication Evaluation of ( ) III. Technique Lateral pressure applied to edge of bulla Positive test if bulla extends laterally with pressure Suggests detaches from skin IV. Causes: Positive test conditions (e.g. ) V. References Images: Related links to external sites (from Bing) These images are a random sampling from a Bing search on the term "Nikolskys Sign." Click on the image (or right click) to open the source website in a new browser window. Related Studies (from Trip Database

2018 FP Notebook

2. Nikolsky's Sign

Nikolsky's Sign Nikolskys Sign Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Nikolsky's Sign Nikolsky's Sign Aka: Nikolsky's Sign (...) , Nikolsky Sign II. Indication Evaluation of ( ) III. Technique Lateral pressure applied to edge of bulla Positive test if bulla extends laterally with pressure Suggests detaches from skin IV. Causes: Positive test conditions (e.g. ) V. References Images: Related links to external sites (from Bing) These images are a random sampling from a Bing search on the term "Nikolskys Sign." Click on the image (or right click) to open the source website in a new browser window. Related Studies (from Trip Database

2015 FP Notebook

3. Pemphigus

the keratinocytes of the skin and mucosa together. History and exam presence of risk factors chronic erosive blistering of the skin, mucosa, or both chronic mouth erosions (PV, PNP) Nikolsky's sign (PV, PF) painful lips (PNP) shortness of breath (PNP) pruritic scalp (PV, PF) bloody nose (PV, PNP) painful skin (PV, PF, PNP) dysphagia (PV) pruritic skin (PV, PF) conjunctivitis (PV, PNP) HLA DR4 (PV) HLA DQ1 (PV) HLA DRB1 (PNP) underlying malignancy (PNP) D-penicillamine captopril enalapril penicillin thiopronine

2019 BMJ Best Practice

4. Pemphigus

the keratinocytes of the skin and mucosa together. History and exam presence of risk factors chronic erosive blistering of the skin, mucosa, or both chronic mouth erosions (PV, PNP) Nikolsky's sign (PV, PF) painful lips (PNP) shortness of breath (PNP) pruritic scalp (PV, PF) bloody nose (PV, PNP) painful skin (PV, PF, PNP) dysphagia (PV) pruritic skin (PV, PF) conjunctivitis (PV, PNP) HLA DR4 (PV) HLA DQ1 (PV) HLA DRB1 (PNP) underlying malignancy (PNP) D-penicillamine captopril enalapril penicillin thiopronine

2018 BMJ Best Practice

5. Stevens-Johnson syndrome and toxic epidermal necrolysis

commonly anticonvulsants, antibiotics, and non-steroidal anti-inflammatory drugs. Other associated factors include infections. The patient may present with Nikolsky's sign, where the epidermal layer easily sloughs off when pressure is applied to the blistered or erythematous area. Diagnosis is made by clinical presentation and confirmed with skin biopsy. On diagnosis the offending medicine should be stopped. Management is then supportive. Patients do best if they are sent to a burn centre for wound (...) . 2013;69:187. http://www.ncbi.nlm.nih.gov/pubmed/23866879?tool=bestpractice.com History and exam presence of risk factors rash mucosal involvement Nikolsky's sign blisters anticonvulsant medicines recent infection recent antibiotic use other medicines SLE AIDS radiotherapy bone marrow transplantation HLA and genetic predisposition smallpox vaccination Diagnostic investigations skin biopsy blood cultures FBC urea LFTs arterial blood gases and saturation of oxygen serum electrolytes serum creatinine

2018 BMJ Best Practice

6. Assessment of vesicular-bullous rash

(e.g., intraoral blisters typically present as erosions due to oral trauma, irrespective of localisation, within or below the epidermis). Harper J, Oranje A, Prose N. Textbook of pediatric dermatology, Volume 1. Blackwell Science; 2000. Friction blisters occur subcorneally, but present as tense bullae due to the thick stratum corneum of acral skin. Bullae located intraepidermally are flaccid and rupture easily. They may demonstrate the Nikolsky's sign (pressure on unblistered skin in a bullous (...) eruption with resultant shearing off of the epithelium) or the Asboe-Hansen sign (extension of blister into unblistered skin when pressure is applied to the top of the blister). Berger TG, James WD, Elston DM. Andrew's diseases of the skin, clinical dermatology, 10th edition. WB Saunders; 2008. These signs serve to demonstrate that in some diseases (e.g., pemphigus vulgaris and severe bullous drug eruptions) the extent of blistering is greater than observed by simple inspection. Bullae located

2018 BMJ Best Practice

8. British Association of Dermatologists guidelines for the management of Stevens-Johnson syndrome/toxic epidermal necrolysis in children and young people

of this symptom should alert the physician to incipient epidermal necrolysis. Large areas of confluent erythema develop in severe cases. Lesional skin is tender to touch; minimal shearing forces will cause the epidermis to peel back (Nikolsky sign). Blistering ensues, in which necrotic epidermis separates from the underlying dermis, producing flaccid bullae. Extensive necrolysis results in the detachment of sheets of epidermis, leaving areas of exposed dermis. Denuded dermis exudes serum, becomes secondarily (...) hypersecretion, haemoptysis Symptoms indicating bowel involvement, i.e. diarrhoea, abdominal distension Date when the patient developed the first symptom or sign of the disorder, e.g. sore throat, rash, skin pain, sore eyes/mouth Previous or ongoing medical problems; specifically, history of previous drug reactions, recurrent herpes simplex virus (HSV) infections, chest infections, diagnosis and treatment for malignancy and/or stem cell transplant. Diagnosis and causality R2 (↑↑) Exclude* the differential

2019 British Association of Dermatologists

10. Management of Immune-Related Adverse Events in Patients Treated With Immune Checkpoint Inhibitor Therapy

). Assess for lymphadenopathy, facial or distal extremity swelling (may be signs of drug-induced hypersensitivity syndrome [DIHS]/drug reaction with eosinophilia and systemic symptoms [DRESS]). Assess for pustules or blisters or erosions in addition to areas of “dusky erythema,” which may feel painful to palpation. To assess for a positive Nikolsky sign, place a gloved finger tangentially over erythematous skin and apply friction parallel to the skin surface. Nikolsky sign is positive if this results (...) of DIHS/DRESS). Assess for pustules or blisters or erosions in addition to areas of dusky erythema, which may feel painful to palpation. To assess for a positive Nikolsky sign, place a gloved finger tangentially over erythematous skin and apply friction parallel to the skin surface. Nikolsky sign is positive if this results in detached or sloughing epidermis, demonstrating poor attachment of the epidermis to the dermis, which is the case in some autoimmune disorders (eg, pemphigus) and SJS/TEN

2018 American Society of Clinical Oncology Guidelines

12. Out-of-Hospital Cardiac Arrest Resuscitation Systems of Care: A Scientific Statement From the American Heart Association

of cardiac resuscitation systems and evidence of their effectiveness, as well as recent progress in dissemination and implementation throughout the United States. Emphasis is placed on evidence published since the original recommendations (ie, including and since 2010). Cardiac arrest is loss of mechanical activity of the heart confirmed by the absence of signs of circulation. Approximately 356 461 people are treated for out-of-hospital cardiac arrest (OHCA) annually in the United States. One third (...) resuscitated. Recognizing the absence of accurate symptoms or signs to assess neurological prognosis in the emergency department, , AHA guidelines have argued that case selection for emergent angiography after resuscitation should be independent of neurological assessment. This conflicts with hospital and physician concerns about reportable outcomes data related to postprocedure, specifically mortality, and the public perception of publicly reported numbers. As a consequence, the proportion of patients who

2018 American Heart Association

13. AATS/ACC/SCAI/STS Expert Consensus Systems of Care Document: Operator and Institutional Recommendations and Requirements for Transcatheter Aortic Valve Replacement

/STS staff. A public comment period was held to obtain further feedback. Following reconciliation of all comments and sign-off by the writing committee and oversight task force, this document was approved for publication by the approval bodies of the partnering societies. Bavaria JE, et al. TAVR Recommendations and Requirements 19 3. Structural Program Requirements The structural measures of quality include the requirement that operators and institutions have the skills, experience, foundational

2018 Society for Cardiovascular Angiography and Interventions

14. British Association of Dermatologists guidelines for the management of pemphigus vulgaris

levels did not correlate with clinical activity. 43 Some of these problems re?ect saturation of the ELISAs at higher values, which could be overcome by increasing the serum dilution. 46 The use of sequential salivary antidesmoglein 3 IgG titres as a biomarker of disease activity is an emerging area of interest, and titres have recently been shown to re?ect oral disease activity. 26 In general, falling or persistently low and negative IIF or ELISA titres are a good sign, such that immunosuppression (...) ; two courses in one case) resulted in increased complete remission rates (44% vs. 0%) and lower mean maintenance oral corticosteroid doses in nine patients with recalcitrant PV compared with six con- trols. 86 In terms of the rapidity of disease control, a retrospec- tive case series reported signs of improvement within a week of pulsed methylprednisolone in all 12 patients, 87 but similar responses have been reported with oral corticosteroids. Summary There is no evidence that pulsed

2017 British Association of Dermatologists

15. CRACKCast E120 – Dermatologic presentations

by the abrupt development of a macular rash that may appear as target lesions . The extremities are com- monly involved, although any area may be affected. The exanthem becomes confluent, and dermal-epidermal dissociation ensues; Nikolsky ’ s sign ( denudation with shear stress ) is present , and the skin is commonly painful to the touch . Mucous membrane involvement may occur with erythema, blistering, sloughing, or necrosis Similar initial presentation to SJS but with RAPID systemic involvement The main (...) herpetiformis …cause is very dependent on location of the vesicles! [20] List 4 lesions with a positive Nikolsky’s sign This sign is positive if with gentle rubbing the skin sloughs off (the top layer of the epidermis). SJS TENS Pemphigus Vulgaris staphylococcal scalded skin syndrome ……and a subset of patients with bullous pemphigoid [21] List 4 complications of HSV infection “HSV-1 primarily affects nongenital sites, whereas lesions caused by HSV-2 are found predominantly in the genital area

2017 CandiEM

16. Clinical practice guidelines for the care of girls and women with Turner syndrome: proceedings from the 2016 Cincinnati International Turner Syndrome Meeting

to consider testing for Turner syndrome (TS) in a female with typical signs ( ) (⨁⨁⨁⨁). R 1.5. We recommend gonadectomy in all female individuals with Y chromosome material identified on standard karyotyping (⨁⨁◯◯). 2. Growth and puberty R 2.1. We recommend initiating growth hormone (GH) treatment early (around 4–6 years of age, and preferably before 12–13 years) in the following circumstances: the child already has evidence of growth failure (e.g., below 50th percentile height velocity (HV) observed over (...) a more evidence-based analysis of the genotype–phenotype associations. 1.1.3. Indications for testing R 1.4. We recommend to consider testing for TS in a female with typical signs ( ) (⨁⨁⨁⨁). Table 2 Detailed list of more common abnormalities associated with Turner syndrome and their approximate prevalence (see also ). Feature Frequency (%) Growth failure and reduced adult height 95–100 Failure to thrive during first year of life 50 Endocrinopathies Glucose intolerance 15–50 Type 2 diabetes 10 Type 1

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2016 European Society of Human Reproduction and Embryology

17. European Society of Endocrinology Clinical practice guidelines for the care of girls and women with Turner syndrome

for Turner syndrome (TS) in a female with typical signs ( ) (⨁⨁⨁⨁). R 1.5. We recommend gonadectomy in all female individuals with Y chromosome material identified on standard karyotyping (⨁⨁◯◯). 2. Growth and puberty R 2.1. We recommend initiating growth hormone (GH) treatment early (around 4–6 years of age, and preferably before 12–13 years) in the following circumstances: the child already has evidence of growth failure (e.g., below 50th percentile height velocity (HV) observed over 6 months (...) a more evidence-based analysis of the genotype–phenotype associations. 1.1.3. Indications for testing R 1.4. We recommend to consider testing for TS in a female with typical signs ( ) (⨁⨁⨁⨁). Table 2 Detailed list of more common abnormalities associated with Turner syndrome and their approximate prevalence (see also ). Feature Frequency (%) Growth failure and reduced adult height 95–100 Failure to thrive during first year of life 50 Endocrinopathies Glucose intolerance 15–50 Type 2 diabetes 10 Type 1

2017 European Society of Endocrinology

18. SCAI Expert Consensus Statement: 2016 Best Practices in the Cardiac Catheterization Laboratory

into the electronic health record. All of these items must be documented in the medical record prior to the proce- dure or as part of the checklist mentioned above. Non- invasive hemodynamic and oximetric monitoring of patient vital signs should be routine. Defibrillation pads should be attached to all STEMI patients. Access related risks should be considered with the goal of choosing the optimal access site to reduce complica- tions. CCL staff should ensure that at least one work- ing IV is in place prior (...) must be recorded in a procedure log or electronic re- cord and signed by the attending physician, and such records should be easily accessible, particularly when the patient leaves the CCL. Infection Control in the Catheterization Laboratory Infectious complications resulting from cardiac cathe- terization are exceedingly rare; however, best practices for sterile technique are essential. Electric clippers should be used to prepare the femoral access site. A variety of antimicrobial agents

2016 Society for Cardiovascular Angiography and Interventions

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