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Nikolskys Sign

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81. Oral Manifestations of Autoimmune Blistering Diseases (Overview)

and immunopathologic findings usually are the same as that of human diseases and are not discussed here. Pemphigus group Pemphigus vulgaris is a very rare acantholytic skin disease. In most cases, oral involvement is severe, and the mouth sometimes can be the first site to exhibit lesions. Flaccid vesicles on the gums, tongue, and palate evolve rapidly into erosions and ulcerations with indistinct margins and peripheral sloughing of mucosal epithelium (Nikolsky sign). Pemphigus foliaceus, the most common form (...) Educate patients with autoimmune diseases about the nature of the disease and the possible adverse effects of long-term use of immunosuppressives. In addition, patients should know about the benefits of taking calcium and vitamin D supplements while using systemic corticosteroids. Finally, educate patients to monitor signs and symptoms of infection in order to report possible complications to physicians in a timely manner. Previous References Olivry T, Chan LS. Autoimmune blistering dermatoses

2014 eMedicine.com

82. Drug Eruptions (Overview)

after drug withdrawal and any reaction with readministration Physical examination should address clinical features that may indicate a severe, potentially life-threatening drug reaction, including the following: Mucous membrane erosions Blisters Nikolsky sign Confluent erythema Angioedema and tongue swelling Palpable purpura Skin necrosis Lymphadenopathy High fever, dyspnea, or hypotension It is important to appreciate the morphology and physical features of drug eruptions, as follows: Acneiform (...) and who suddenly develops a symmetric cutaneous eruption. Morbilliform eruption localized to striae has been described with clindamycin. [ ] Morbilliform drug eruption. Signs and symptoms The first steps in the history are as follows: Review the patient’s complete medication list, including prescription and over-the-counter drugs Document any history of previous adverse reactions to drugs or foods Consider alternative etiologies (eg, viral exanthems and bacterial infections) Note any concurrent

2014 eMedicine.com

83. Pemphigus Foliaceus (Follow-up)

with pemphigus that is relatively resistant to systemic steroid therapy. [ ] Toth and Jonkman also reported on successful therapy with intravenous immunoglobulin (low dose). [ ] References Nikolski PV. Materiali K.uchenigu o pemphigus foliaceus [doctoral thesis]. Kiev . 1896. Chorzelski T, Jablonska S, Blaszczyk M. Immunopathological investigations in the Senear-Usher syndrome (coexistence of pemphigus and lupus erythematosus). Br J Dermatol . 1968 Apr. 80(4):211-7. . Jablonska S, Chorzelski TP, Beutner EH (...) Research. N Engl J Med . 2000 Jul 6. 343(1):23-30. . Fariba G, Ayatollahi A, Hejazi S. Pemphigus foliaceus. Indian Pediatr . 2012 Mar 8. 49(3):240-1. . Metry DW, Hebert AA, Jordon RE. Nonendemic pemphigus foliaceus in children. J Am Acad Dermatol . 2002 Mar. 46(3):419-22. . Daoud YJ, Foster CS, Ahmed R. Eyelid skin involvement in pemphigus foliaceus. Ocul Immunol Inflamm . 2005 Sep-Oct. 13(5):389-94. . Uzun S, Durdu M. The specificity and sensitivity of Nikolskiy sign in the diagnosis of pemphigus. J

2014 eMedicine.com

84. Percutaneous Transluminal Coronary Angioplasty (Follow-up)

) guidelines on the management of NSTE-ACS (updated in 2014 [ ] ) recommend an early invasive strategy in most cases, with timing as follows: Immediate (within 2 hours) - Patients with refractory angina, recurrent angina after initial treatment, signs/symptoms of heart failure, new/worsening mitral regurgitation, hemodynamic instability, sustained ventricular tachycardia, or ventricular fibrillation Early (within 24 hours) - None of the immediate characteristics but new ST-segment depression, a GRACE risk (...) Foundation/AHA guidelines for management of unstable angina/NSTEMI recommend the use of an early invasive strategy or ischemia-guided strategy in patients with NSTE-ACS. An ischemia-guided approach is recommended for patients with a low-risk score (TIMI 0 or 1, GRACE < 109). Other patients will benefit from an early invasive strategy stratified by timing as follows: Immediate (within 2 hours) - Patients with refractory or recurrent angina with initial treatment, signs/symptoms of heart failure, new

2014 eMedicine.com

85. 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

86. Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis (Follow-up)

and bullae. Lesions, with the exception of central bullae, are typically flat. (Lesions of erythema multiforme are more likely to be palpable.) Less frequently, the initial eruption may be scarlatiniform. See the image below. Extensive blistering and sloughing on the back. Nondenuded areas have a wrinkled paper appearance. A Nikolsky sign is easily demonstrated by applying lateral pressure to a bulla. With regard to the arrangement of lesions, individual macules are found surrounding large areas (...) . In the study, the time from the onset of skin signs to arrest of disease progression and to complete reepithelialization was significantly shorter in the cyclosporine group. All patients in the cyclosporine group survived versus 50% surviving in the cyclophosphamide group. An open-label phase II trial of adults and a retrospective chart review of patients with Stevens-Johnson syndrome/toxic epidermal necrolysis treated with cyclosporine have also demonstrated a decrease in death and the progression

2014 eMedicine.com

87. Fogo Selvagem (Follow-up)

daily morning dose until blister formation ceases or the Nikolsky sign disappears. After initial control is achieved, the prednisone dose is reduced to about half the initial dose. This reduction is followed by slow tapering to the minimal effective maintenance dose over weeks to months. Adjuvant therapy includes the use of immunosuppressants such as azathioprine (1-2 mg/kg body weight until lesions clear; with slow tapering of dose), cyclophosphamide (100-200 mg qd, with a reduction (...) to therapy; however, this practice is not universal. Patients taking long-term steroids and/or immunosuppressants should be appropriately followed up and monitored. The lowest possible dose of steroids and immunosuppressants should be used to minimize the potential for systemic toxicities. Be aware of bacterial, viral, or fungal secondary infections and infestations. Disseminated strongyloidiasis is reported. Previous References Nikolsky PV. Materiali K. uchenigu o pemphigus foliaceus [doctoral thesis

2014 eMedicine.com

88. Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis (Diagnosis)

and bullae. Lesions, with the exception of central bullae, are typically flat. (Lesions of erythema multiforme are more likely to be palpable.) Less frequently, the initial eruption may be scarlatiniform. See the image below. Extensive blistering and sloughing on the back. Nondenuded areas have a wrinkled paper appearance. A Nikolsky sign is easily demonstrated by applying lateral pressure to a bulla. With regard to the arrangement of lesions, individual macules are found surrounding large areas (...) . In the study, the time from the onset of skin signs to arrest of disease progression and to complete reepithelialization was significantly shorter in the cyclosporine group. All patients in the cyclosporine group survived versus 50% surviving in the cyclophosphamide group. An open-label phase II trial of adults and a retrospective chart review of patients with Stevens-Johnson syndrome/toxic epidermal necrolysis treated with cyclosporine have also demonstrated a decrease in death and the progression

2014 eMedicine.com

89. Drug Eruptions (Diagnosis)

after drug withdrawal and any reaction with readministration Physical examination should address clinical features that may indicate a severe, potentially life-threatening drug reaction, including the following: Mucous membrane erosions Blisters Nikolsky sign Confluent erythema Angioedema and tongue swelling Palpable purpura Skin necrosis Lymphadenopathy High fever, dyspnea, or hypotension It is important to appreciate the morphology and physical features of drug eruptions, as follows: Acneiform (...) and who suddenly develops a symmetric cutaneous eruption. Morbilliform eruption localized to striae has been described with clindamycin. [ ] Morbilliform drug eruption. Signs and symptoms The first steps in the history are as follows: Review the patient’s complete medication list, including prescription and over-the-counter drugs Document any history of previous adverse reactions to drugs or foods Consider alternative etiologies (eg, viral exanthems and bacterial infections) Note any concurrent

2014 eMedicine.com

90. Staphylococcus Aureus Infection (Overview)

. Gentle shearing forces on intact skin cause the upper epidermis to slip at a plane of cleavage in the skin, which is known as the Nikolsky sign. How the exfoliative toxins produce epidermal splitting has not been fully elucidated. [ ] The most feared manifestation of S aureus toxin production is . Although first described in children, it was most frequently associated with women using tampons during menstruation. Since the early 1990s, at least half of the cases have not been associated (...) recently, vancomycin-resistant strains. An example of radiographic findings in S aureus infections is shown in the image below. Posteroanterior chest radiograph of a 15-year-old with staphylococcal endocarditis and multiple septic emboli, revealing borderline cardiomegaly, multiple nodular infiltrates, and bilateral pleural effusions. Signs and symptoms Types and presentation of S aureus infection include the following: Skin and soft tissue (impetigo): A small area of erythema that progresses

2014 eMedicine Pediatrics

91. Staphylococcus Aureus Infection (Diagnosis)

. Gentle shearing forces on intact skin cause the upper epidermis to slip at a plane of cleavage in the skin, which is known as the Nikolsky sign. How the exfoliative toxins produce epidermal splitting has not been fully elucidated. [ ] The most feared manifestation of S aureus toxin production is . Although first described in children, it was most frequently associated with women using tampons during menstruation. Since the early 1990s, at least half of the cases have not been associated (...) recently, vancomycin-resistant strains. An example of radiographic findings in S aureus infections is shown in the image below. Posteroanterior chest radiograph of a 15-year-old with staphylococcal endocarditis and multiple septic emboli, revealing borderline cardiomegaly, multiple nodular infiltrates, and bilateral pleural effusions. Signs and symptoms Types and presentation of S aureus infection include the following: Skin and soft tissue (impetigo): A small area of erythema that progresses

2014 eMedicine Pediatrics

92. 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

93. 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

94. 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

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

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

96. 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

97. 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

98. 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 available with Trip Pro

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

99. Staphylococcal Scalded Skin Syndrome: Potentiation by Immunosuppression in Mice; Toxin-Mediated Exfoliation in a Healthy Adult Full Text available with Trip Pro

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

100. Purification of Exfoliatin Produced by Staphylococcus aureus of Bacteriophage Group 2 and Its Physicochemical Properties Full Text available with Trip Pro

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

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