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Diagnosing Skin Disease
Published in Ayşe Serap Karadağ, Lawrence Charles Parish, Jordan V. Wang, Roxburgh's Common Skin Diseases, 2022
The unique accessibility of the skin allows for the utilization of a variety of tests that can be readily carried out in the clinical setting. Manipulation of the skin by a clinician is one such test that can yield useful diagnostic information. In the case of Darier’s sign, vigorous rubbing of the patient’s skin can support the diagnosis of mastocytosis when it results in significant swelling, itch, and erythema. The presence of Auspitz’s sign, which is the appearance of punctate bleeding after the scraping of scaly lesions, can be indicative of psoriasis. Additionally, the shearing of skin with rubbing, known as the Nikolsky sign, can be a clinically useful diagnostic finding in the evaluation of blistering skin disorders, such as pemphigus and toxic epidermal necrolysis.
Dermatology
Published in Kaji Sritharan, Jonathan Rohrer, Alexandra C Rankin, Sachi Sivananthan, Essential Notes for Medical and Surgical Finals, 2021
Kaji Sritharan, Jonathan Rohrer, Alexandra C Rankin, Sachi Sivananthan
Superficial (epidermal) bullae which break easily causing erosions – lesions can be anywhere but commonly occur around the mouth. Positive Nikolsky sign (superficial skin layers slide off when pressure applied to ‘normal’ epidermis). Lesions can become secondarily infected. Treatment: high dose oral steroids followed by steroid-sparing agents.
Diagnostic Approach to Rash and Fever in the Critical Care Unit
Published in Cheston B. Cunha, Burke A. Cunha, Infectious Diseases and Antimicrobial Stewardship in Critical Care Medicine, 2020
Lee S. Engel, Charles V. Sanders, Fred A. Lopez
The generalized form of SSSS is termed pemphigus neonatorum or Ritter’s disease. Risk factors for development in adults include renal dysfunction, lymphoma, and immunosuppression [166,167]. Patients with pemphigus neonatorum present with fever, erythema, malaise, and irritability. Patients then develop large superficial blisters that rupture easily due to friction [160]. A positive Nikolsky sign refers to dislodgement of the superficial epidermis when gently rubbing the skin [168]. If untreated, the epidermis will slough off, leaving extensive areas of denuded skin that are painful and susceptible to infection. Mucous membranes are not affected in SSSS.
Drug-induced Stevens-Johnson syndrome: a disproportionality analysis from the pharmacovigilance database of the World Health Organization
Published in Expert Opinion on Drug Safety, 2022
Yi Zheng, Wenli Zhou, Xiaojing Guo, Lijie Chi, Chenxin Chen, Zhijian Guo, Jizhou Liang, Lianhui Wei, Xiao Chen, Xiaofei Ye, Jia He
Stevens-Johnson syndrome (SJS) is a rare skin condition that has been categorized as one of the most serious disorders of the skin. The initial clinical manifestations of SJS include fever, uncomfortable swallowing, eye irritation, and other systemic nonspecific symptoms [], followed by damage to various skin tissues and mucus membranes[1]. Mucosal damage is severe and extensive and can involve the mucosa of the mouth, eyes, vulva, respiratory tract, and digestive tract. Damage to the eyes, mouth, and vulva are the most common [2]. It is worth noting that long term ocular complications would affect 20–75% of survivors of SJS [3]. Damage to the mucosa of the digestive tract and respiratory tract is more serious, and can lead to serious complications such as gastrointestinal bleeding and respiratory failure. Skin damage includes papules, erythema, bullae, or other forms of skin disturbances, including a positive Nikolsky sign [4]. Skin lesions are distributed on any part of the body, except for the palms, plantars, backs of hands, and extensible sides of limbs, and often involve the trunk and face. In severe cases of SJS, 10% of the body’s skin surface area may be detached [5]. The incidence of severe exfoliative skin reactions is estimated to be 1 to 7 cases per million person-years [6]. Severe cases may be accompanied by liver damage, renal failure, respiratory failure, and other serious complications, with a mortality rate of 1–5% [7]. However, the mortality rates of the elderly and children with severe SJS are much higher.
Stevens Johnson syndrome: A review of a vision and life-threatening mucocutaneous disease including histopathology with updates on pathogenesis and genetic risk factors
Published in Seminars in Ophthalmology, 2021
Vamsee K. Neerukonda, Anna M. Stagner
The initial cutaneous manifestations of SJS are erythematous, purpuric macules of variable sizes and shapes. Early in the disease, epidermal detachment is not apparent. One can clinically evaluate the integrity of the dermal-epidermal junction (DEJ) by assessing the Nikolsky sign.107 As epidermal involvement progresses to full thickness, the red, dusky macular lesions adopt a characteristic grayish hue due to epidermal necrosis.26 Eventually, the necrotic epidermis detaches and fluid occupies the new cavity created by separation at the DEJ, clinically apparent as a flaccid bullae or blister. The blister can be mobilized laterally with slight digital pressure allowing for additional necrotic epidermis to be displaced laterally (Asboe-Hansen sign).108109 Once the skin is detached and pulled away, raw bleeding dermis is often revealed and is described as having a scalded appearance. More rigid or tense blisters may survive longer on the thicker and more trauma-resistant acral surfaces.107
Cushings syndrome complicating pemphigoid gestationis
Published in Cogent Medicine, 2018
O.Y. Olisova, N.P. Tepljuk, A.R. Hubail, R.K. Belkharoeva, O.V. Grabovskaya, V.B. Pinegin
At admission there were features of the iatrogenic Cushing syndrome: turgor and elasticity of the skin drastically reduced; dysplastic adiposis was present on the face, neck, abdomen, chest and back with symptoms of muscle atrophy of the hands and feet. The face was moon shaped, skin purplish-red in color, with pronounced hypertrichosis mainly on the chin area, which also had many small follicular pustules and yellowish crusts. On the skin of the trunk, especially the abdomen, hyperemia showed abundant striae (see Figure 4). On the skin of the head, trunk, and the right hand, the rash showed single tense blisters with tight covering and serous component, with a diameter from 0.5 to 2 cm, located on the background of erythema. There are restricted erosions at the place of opened vesicles, with no tendency for peripheral growth, the surface is bright pink, with fragments of epidermis peripherally. The Nikolsky sign was negative. The nails and mucous membranes were not affected. The hair did not present any changes. Lymph-nodes were not enlarged. Subjectively, she said that minimal movement caused unbearable pain in the back (steroid osteoporosis and multiple fractures of the spine); and that she had general weakness, weakness while moving (steroid myopathy).