Nikolsky's sign

Considerations:
A positive Nikolsky's sign is present in the scalded skin syndrome and in a slightly different form in toxic epidermal necrolysis . In scalded skin syndrome, a toxin is release by the staphylococcal infection responsible for the illness. This toxin causes fluid to collect in the skin beneath the layer in which a blister would typically form. The skin is loosened and when rubbed slips free just as the skin on a blanched tomato or peach would do. The area beneath is pink and moist.

Common Causes:

Note: There may be other causes of a positive Nikolsky's sign, but it is very specific for the two disorders listed above. Use the Symptom Analysis option to explore the possible explanations for a positive Nikolsky's sign, occurring alone or in combination with other problems.

Home Care:
There is no home care for the conditions associated with a positive Nikolsky's sign; affected people are hospitalized.

Call Your Healthcare Provider If:

  • you or your child develop the Nikolsky sign or redness and blistering of the skin without an obvious cause.

(Note: This finding is usually discovered by the health care provider.)

What to Expect:
The affected person will be hospitalized, as the conditions associated with Nikolsky's sign are serious. The medical history will be obtained and a physical examination performed. Intravenous fluid resuscitation is often needed, and intravenous antibiotics may also be needed.

Medical history questions documenting Nikolsky's sign in detail may include:

  • When did you first notice that the skin was red or blistered?
  • What other symptoms occur at the same time?

After seeing your health care provider:
You may want to add a diagnosis related to a positive Nikolsky's sign to your personal medical record.


Staphylococcal scalded skin syndrome is a serious illness that develops as a result of toxin-producing staphylococci. It is characterized by bright red, painful skin. The outer (superficial) layers loosen and can be slipped loose like the skin on a ripe peach (Nikolsky's sign), as is seen in this photograph. The condition is life-threatening if not promptly treated.



Staphylococcal scalded skin syndrome is a serious illness that develops as a result of toxin-producing staphylococci. It is characterized by bright red, painful skin. The outer (superficial) skin layers loosen and can be slipped loose like the skin on a ripe peach (Nikolsky's sign). This child in this photograph has lost a significant amount of superficial skin. The condition is life-threatening if not promptly treated.