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Nikolskys Sign

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81. Staphylococcal Scalded Skin Syndrome (Treatment)

A, Naas T, Kerneis S, Fresco O, Giovangrandi Y, et al. Nosocomial outbreak of staphylococcal scalded skin syndrome in neonates: epidemiological investigation and control. J Hosp Infect . 2005 Oct. 61(2):130-8. . Brewer JD, Hundley MD, Meves A, Hargreaves J, McEvoy MT, Pittelkow MR. Staphylococcal scalded skin syndrome and toxic shock syndrome after tooth extraction. J Am Acad Dermatol . 2008 Aug. 59(2):342-6. . Moss C, Gupta E. The Nikolsky sign in staphylococcal scalded skin syndrome. Arch Dis Child (...) . 1998 Sep. 79(3):290. . Uzun S, Durdu M. The specificity and sensitivity of Nikolskiy sign in the diagnosis of pemphigus. J Am Acad Dermatol . 2006 Mar. 54(3):411-5. . Acland KM, Darvay A, Griffin C, Aali SA, Russell-Jones R. Staphylococcal scalded skin syndrome in an adult associated with methicillin-resistant Staphylococcus aureus. Br J Dermatol . 1999 Mar. 140(3):518-20. . Ito Y, Funabashi Yoh M, Toda K, Shimazaki M, Nakamura T, Morita E. Staphylococcal scalded-skin syndrome in an adult due

2014 eMedicine Emergency Medicine

82. Staphylococcal Scalded Skin Syndrome (Diagnosis)

. The Nikolsky sign in staphylococcal scalded skin syndrome. Arch Dis Child . 1998 Sep. 79(3):290. . Uzun S, Durdu M. The specificity and sensitivity of Nikolskiy sign in the diagnosis of pemphigus. J Am Acad Dermatol . 2006 Mar. 54(3):411-5. . Acland KM, Darvay A, Griffin C, Aali SA, Russell-Jones R. Staphylococcal scalded skin syndrome in an adult associated with methicillin-resistant Staphylococcus aureus. Br J Dermatol . 1999 Mar. 140(3):518-20. . Ito Y, Funabashi Yoh M, Toda K, Shimazaki M, Nakamura T

2014 eMedicine Emergency Medicine

83. Staphylococcal Scalded Skin Syndrome (Overview)

. The Nikolsky sign in staphylococcal scalded skin syndrome. Arch Dis Child . 1998 Sep. 79(3):290. . Uzun S, Durdu M. The specificity and sensitivity of Nikolskiy sign in the diagnosis of pemphigus. J Am Acad Dermatol . 2006 Mar. 54(3):411-5. . Acland KM, Darvay A, Griffin C, Aali SA, Russell-Jones R. Staphylococcal scalded skin syndrome in an adult associated with methicillin-resistant Staphylococcus aureus. Br J Dermatol . 1999 Mar. 140(3):518-20. . Ito Y, Funabashi Yoh M, Toda K, Shimazaki M, Nakamura T

2014 eMedicine Emergency Medicine

84. Staphylococcal Scalded Skin Syndrome (Follow-up)

, Meves A, Hargreaves J, McEvoy MT, Pittelkow MR. Staphylococcal scalded skin syndrome and toxic shock syndrome after tooth extraction. J Am Acad Dermatol . 2008 Aug. 59(2):342-6. . Moss C, Gupta E. The Nikolsky sign in staphylococcal scalded skin syndrome. Arch Dis Child . 1998 Sep. 79(3):290. . Uzun S, Durdu M. The specificity and sensitivity of Nikolskiy sign in the diagnosis of pemphigus. J Am Acad Dermatol . 2006 Mar. 54(3):411-5. . Acland KM, Darvay A, Griffin C, Aali SA, Russell-Jones R

2014 eMedicine Emergency Medicine

85. Linear IgA bullous dermatosis: comparison between drug-induced and spontaneous forms. (PubMed)

and 31 December 2010. Imputability, determined according to the French imputability method (modified Bégaud score) and Naranjo score, enabled classification into drug-induced and spontaneous LABD groups. Clinical and histological features were compared by blinded analysis of images and histological patterns.Sixteen patients had spontaneous LABD and 12 had drug-induced LABD. Nikolsky sign and large erosions were significantly more frequent in drug-induced than spontaneous LABD (P = 0.003 and P = 0.03 (...) , respectively), with no between-group differences for erythematous plaques, target or target-like lesions, string of pearls, location, mucosal involvement or histological features.Drug-induced LABD was more severe than the spontaneous form, with lesions mimicking toxic epidermal necrolysis. Because LABD may be polymorphic and sometimes life threatening, DIF assay is recommended for all patients with Nikolsky sign and large erosions.© 2013 British Association of Dermatologists.

2013 British Journal of Dermatology

86. Role of Proteasomes in a Dermatological Autoimmune Disease: Bullous Pemphigoid

, beta2, beta1i, beta5i and rpt5 subunits (weighted by beta-actin) presence/absence of oral lesions [ Time Frame: baseline ] For patients suffering from pemphigus Presence/absence of Nikolsky's sign [ Time Frame: baseline ] For patients with pemphigus only Pemphigus disease area index [ Time Frame: baseline ] For patients with Pemphigus only; score varying from 0 to 120. Anti-desmogleine 1 and 3 antibody concentrations [ Time Frame: baseline ] For patients with Pemphigus only; ELISA (U/ml CLASI score (...) must have given his/her informed and signed consent The patient must be insured or beneficiary of a health insurance plan The patient is not taking systemic treatment The patient has not been treated with topical steroids for more than 15 days. For the bullous pemphigoid group: clinical signs: erythematous-based lesions, especially on flexion areas of the arms and legs, not afflicting mucous membranes, and without atrophic scaring histology: without epidermal acantholysis For the pemphigus group

2012 Clinical Trials

87. Reduced Infant Response to a Routine Care Procedure After Glucose 25% Analgesia in Comparison to Materna RTF Stage 1

Days (Child) Sexes Eligible for Study: All Accepts Healthy Volunteers: Yes Criteria Inclusion Criteria: Full term above 37 weeks gestation. Normal birth-weight, healthy infants Males and Females Whose parents have signed the informed consent form Exclusion Criteria: Premature born below 37 weeks Chromosomal abnormalities or congenital malformation. Suffering neurological imbalance Inability of oral feeding Contacts and Locations Go to Information from the National Library of Medicine To learn more (...) : Shay Barak, MD 04-6652328 Sub-Investigator: Amir Kushnir, MD Principal Investigator: Shay Barak, MD Sub-Investigator: Elena Chulsky, MD Sub-Investigator: Tatiana Dolgunova, MD Sub-Investigator: Natali Nikolski, MD Sub-Investigator: Natali Shaykevich, MD Sub-Investigator: Orly Benor, RN,BSN.MsN Sub-Investigator: Gilat Yeganeh, LLB,LLM, RN Sub-Investigator: Maryanne Nabso, RN,MA Sub-Investigator: Sijal Hlehel, RN,MA Sponsors and Collaborators The Baruch Padeh Medical Center, Poriya Investigators

2012 Clinical Trials

88. Evaluating Sirolimus to Treat Autoimmune Blistering Dermatosis Pemphigus

of age or older. Subject must have an established diagnosis of pemphigus disorder via biopsy and/or serologic titer, as determined appropriate by the lead researcher. Subject must have active disease at the time of enrollment, as defined by a positive Nikolsky sign. Subject must not be taking any immunosuppressive medication or therapy other than corticosteroids. Subject must be able to understand and follow directions. If female, subject is not currently breast feeding and/or pregnant as confirmed

2011 Clinical Trials

89. Novel Approaches in Preventing and Limiting Events III Trial (NAPLES III): Bivalirudin in High-risk Bleeding Patients

of this drug. Bivalirudin (The Medicine's Co., Parsippany, NJ) is a synthetic direct thrombin inhibitor approved for patients with stable and unstable coronary syndromes undergoing PCI. Favourable properties of bivalirudin may minimize bleeding. Several clinical and procedural factors have been evaluated to identify patients exposed to a higher risk of hemorrhages. Nikolsky et al. have developed a risk score (validated on REPLACE-1 and REPLACE-2 data) based on clinical variable useful to predict (...) : All Accepts Healthy Volunteers: No Criteria Inclusion Criteria: • Male or female able to understand and sign a witnessed informed consent Age ≥ 18 ys Patients with stable (CCS 1-4) or unstable angina pectoris (but with the most recent anginal episode occurring >48 hours before the procedure) or documented silent ischemia Stable Hemodynamic conditions (systolic BP > 100 HR > 40 < 100). No clinical and ECG changes suggestive of ongoing acute or recent (<48 hours) myocardial infarction. Bleeding risk

2011 Clinical Trials

90. Purification of Exfoliatin Produced by Staphylococcus aureus of Bacteriophage Group 2 and Its Physicochemical Properties (Full text)

proteins which were all capable of causing the typical Nikolsky sign in neonatal mice were obtained and designated A, B, C, and D toxins. They had a molecular weight of about 24,000 and showed the same serological features in neutralization and precipitation tests, but were different from each other in showing a different single band with their respective mobilities in polyacrylamide disk electrophoresis. They were precipitated between pH 4.0 and 4.5 and lost their exfoliative capabilities

1973 Infection and immunity PubMed

91. New Type of Exfoliatin Obtained from Staphylococcal Strains, Belonging to Phage Groups Other than Group II, Isolated from Patients with Impetigo and Ritter's Disease (Full text)

of the epidermis with the so-called Nikolsky sign when subcutaneously inoculated into neonatal mice within 4 days after birth. The new toxin was serologically different from exfoliatin produced by the phage group II staphylococci previously reported (Kondo et al., 1973) and showed an electrophoretic pattern corresponding to that of the B-type toxin of the latter in acrylamide disc electrophoresis. It had the same molecular weight as that of the latter, which was estimated to be about 24,000

1974 Infection and immunity PubMed

92. Staphylococcal Scalded Skin Syndrome: Potentiation by Immunosuppression in Mice; Toxin-Mediated Exfoliation in a Healthy Adult (Full text)

exfoliative toxin was demonstrated to produce erythema, Nikolsky's sign, bullous formation, and flaking desquamation in a normal human adult. The results demonstrated the enhanced susceptibility of experimental animals receiving immunosuppressive therapy to the development of the staphylococcal scalded skin syndrome. They further showed that human adults are susceptible to the action of exfoliative toxin and suggested that, in the host with compromised defense mechanisms, toxin-producing strains may

1974 Infection and immunity PubMed

93. Description of Skin Lesions

pressure (eg, stroking or scratching the skin) in the distribution of the pressure. Up to 5% of normal patients may exhibit this sign, which is a form of physical urticaria. Darier sign refers to rapid swelling of a lesion when stroked. It occurs in patients with urticaria pigmentosa or . Nikolsky sign is epidermal shearing that occurs with gentle lateral pressure on seemingly uninvolved skin in patients with and some autoimmune . Auspitz sign is the appearance of pinpoint bleeding after scale (...) of drugs or metals in the skin, including minocycline , amiodarone , and silver (argyria). Ischemic skin appears purple to gray in color. Deep dermal nevi appear blue. Black skin lesions may be melanocytic, including nevi and . Black eschars are collections of dead skin that can arise from infarction, which may be caused by infection (eg, , angioinvasive fungi including Rhizopus, ), , arterial insufficiency, or . Other Clinical Signs Dermatographism is the appearance of an urticarial wheal after focal

2013 Merck Manual (19th Edition)

94. Stomatitis

for the location and nature of any lesions. The skin and other mucosal surfaces (including the genitals) are inspected for any lesions, rash, petechiae, or desquamation. Any bullous lesions are rubbed for the Nikolsky sign (upper layers of epidermis move laterally with slight pressure or rubbing of skin adjacent to a blister). Red flags The following findings are of particular concern: Fever Cutaneous bullae Ocular inflammation Immunocompromise Interpretation of findings Occasionally, causes are obvious (...) skin. The Nikolsky sign is usually positive in SJS and pemphigus vulgaris. Cutaneous vesicles are typical with chickenpox or herpes zoster (see ). Unilateral lesions in a band along a dermatome suggest herpes zoster. Diffuse, scattered vesicular and pustular lesions in different stages suggest chickenpox. usually has a macular rash, desquamation of hands and feet, and conjunctivitis; it occurs in children, usually those < 5 yr. Oral findings include erythema of the lips and oral mucosa. Other

2013 Merck Manual (19th Edition)

95. Bullous Pemphigoid

peripheral vesicles, can occur. Rarely, small blisters develop on the mucosa. Leukocytosis and eosinophilia are common, but fever is rare. The Nikolsky sign, where upper layers of epidermis move laterally with slight pressure or rubbing of skin adjacent to a blister, is negative. Diagnosis Skin biopsy and IgG titers If blisters develop, bullous pemphigoid needs to be differentiated from , a blistering disorder with a worse prognosis; differentiation is usually possible using clinical criteria (see Table (...) : ). Table Distinguishing Bullous Pemphigoid From Pemphigus Vulgaris Disorder Appearance of Lesion Oral Involvement Itching Nikolsky Sign Prognosis Bullous pemphigoid Tense bullae that developed on normal-appearing or erythematous skin or urticarial-appearing Rare, with small blisters Common Generally negative Usually good; occasionally fatal in the elderly Pemphigus vulgaris Flaccid bullae of various sizes Often shearing off of skin or mucosa, leaving painful erosions Typically starts in the mouth

2013 Merck Manual (19th Edition)

96. Staphylococcal Scalded Skin Syndrome

in areas of friction, such as intertriginous areas, buttocks, hands, and feet. Intact blisters extend laterally with gentle pressure (Nikolsky sign). The epidermis may peel easily, often in large sheets. Widespread desquamation occurs within 36 to 72 h, and patients become very ill with systemic manifestations (eg, malaise, chills, fever). Desquamated areas appear scalded. Loss of the protective skin barrier can lead to and to fluid and electrolyte imbalance. Diagnosis Biopsy Cultures from areas (...) (also called epidermolysin), a toxin that splits the upper part of the epidermis just beneath the granular cell layer by targeting desmoglein-1 (see also ). The primary infection often begins during the first few days of life in the umbilical stump or diaper area; in older children, the face is the typical site. Toxin produced in these areas enters the circulation and affects the entire skin. Symptoms and Signs Staphylococcal Scalded Skin Syndrome Image courtesy of Thomas Habif, MD. Staphylococcal

2013 Merck Manual (19th Edition)

97. Pemphigus Vulgaris

Pemphigus vulgaris should be suspected in patients with unexplained chronic mucosal ulceration, particularly if they have bullous skin lesions. This disorder must be differentiated from other disorders that cause chronic oral ulcers and from other bullous dermatoses (eg, , , , , , , , bullous ). Two clinical findings, both reflecting lack of epidermal cohesion, that are somewhat specific for pemphigus vulgaris are the following: Nikolsky sign: Upper layers of epidermis move laterally with slight (...) reference 1. : Rituximab used as a first-line single agent in the treatment of pemphigus vulgaris. J Am Acad Dermatol 65 (5):1064–1065, 2011. doi: 10.1016/j.jaad.2010.06.033. Key Points About half of patients with pemphigus vulgaris have only oral lesions. Use Nikolsky and Asboe-Hansen signs to help clinically differentiate pemphigus vulgaris from other bullous disorders. Confirm the diagnosis by immunofluorescence testing of skin samples. Treat with systemic corticosteroids, with or without other

2013 Merck Manual (19th Edition)

98. Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN)

of epithelium slide off the entire body at pressure points (Nikolsky sign), exposing weepy, painful, and erythematous skin. Painful oral crusts and erosions, keratoconjunctivitis, and genital problems (eg, urethritis, phimosis, vaginal synechiae) accompany skin sloughing in up to 90% of cases. Bronchial epithelium may also slough, causing cough, dyspnea, pneumonia, pulmonary edema, and hypoxemia. Glomerulonephritis and hepatitis may develop. Diagnosis Clinical evaluation Often skin biopsy Diagnosis is often (...) (showing necrotic epithelium) if clinical characteristics (eg, target lesions progressing to bullae, ocular and mucous membrane involvement, Nikolsky sign, desquamation in sheets) are inconclusive. Early treatment decreases the often high mortality rate. Except for mild cases, treat SJS/TEN in a burn unit and with intensive supportive care. Consult ophthalmology if the eyes are affected. Consider cyclosporine and possibly plasma exchange for severe cases. Last full review/revision May 2017 by Mercedes

2013 Merck Manual (19th Edition)

99. Rash in Infants and Young Children

erythema that develop large, flaccid blisters, which are easily ruptured, leaving large areas of desquamation Lateral extension of blisters with gentle pressure (positive Nikolsky sign) Spares the mucous membranes Usually in children < 5=""> Clinical evaluation Sometimes confirmed by biopsy and/or cultures Scaly, oval lesions with a slightly raised border and central clearing Mild itching Clinical evaluation Sometimes scrapings of lesions for KOH wet mount Viral infection (systemic) Maculopapular rash (...) in the mouth and lips but sometimes in the genital and anal regions Widespread areas of painful erythema that develop large, flaccid blisters, which are easily ruptured, leaving large areas of desquamation; possibly affecting the soles but usually not the scalp Lateral extension of blisters with gentle pressure (positive Nikolsky sign) Sometimes use of a causative drug (eg, sulfonamides, penicillins, anticonvulsants) Clinical evaluation Sometimes biopsy Well-circumscribed, pruritic, red, raised lesions

2013 Merck Manual (19th Edition)

100. Fatal toxic epidermal necrolysis associated with minoxidil. (PubMed)

for a cerebrovascular accident and uncontrolled hypertension. On hospital day 12, oral minoxidil was added to her drug regimen. On day 23, she developed a maculopapular rash on her face that gradually diffused to her chest and back. Vesicles and papular lesions extended to her extremities and mucosal membranes; results of a skin biopsy revealed SJS. A positive Nikolsky's sign (blisters spread on application of pressure) was detected. On days 27-31, diffuse bullae developed with rash exacerbation. Skin detachment

2009 Pharmacotherapy

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