Uzun Soner, Durdu Murat
Faculty of Medicine, Department of Dermatology, Cukurova University, Adana, Turkey.
J Am Acad Dermatol. 2006 Mar;54(3):411-5. doi: 10.1016/j.jaad.2005.10.019. Epub 2005 Dec 27.
The Nikolskiy sign is a well-known mechanical symptom that can be helpful in the diagnosis of pemphigus. The reports about associations with other than pemphigus cause confusion concerning the diagnostic importance of the Nikolskiy sign in pemphigus.
Our purpose was to examine the significance and usefulness of the Nikolskiy sign on the clinical diagnosis of pemphigus by determination of its sensitivity and specificity.
Presence of the Nikolskiy sign with the modifications of "direct" and "marginal" on 123 consecutive patients with various cutaneous diseases presenting as intact blisters and/or erosions was sought.
A positive Nikolskiy sign was demonstrated in 24 (19.5%) of the 123 patients. Of the positive 24 patients, 18 had pemphigus, 4 had bullous pemphigoid, 1 had linear IgA dermatosis, and 1 had staphylococcal scalded skin syndrome. The sensitivity of "direct" Nikolskiy sign (38%) was less than that of the "marginal" form (69%), but the specificity of "direct" Nikolskiy sign (100%) was higher than that of the "marginal" form (94%) in the diagnosis of pemphigus.
This study was primarily concerned with the diagnostic importance of the Nikolskiy sign in pemphigus. We did not focus on its prognostic value in pemphigus. The small size of the group of patients with pemphigus, which is related to low annual incidence of pemphigus in our region, is another limitation of this study.
The Nikolskiy sign offers a moderately sensitive but highly specific tool for the diagnosis of pemphigus.
尼氏征是一种众所周知的体征，对天疱疮的诊断有帮助。关于其与天疱疮以外疾病的关联的报道，使得尼氏征在天疱疮诊断中的重要性存在混淆。
我们的目的是通过测定尼氏征的敏感性和特异性，来检验其在天疱疮临床诊断中的意义和实用性。
在123例表现为完整水疱和/或糜烂的各种皮肤病患者中，寻找“直接”和“边缘”改良型尼氏征。
123例患者中有24例（19.5%）尼氏征阳性。在这24例阳性患者中，18例患有天疱疮，4例患有大疱性类天疱疮，1例患有线状IgA大疱性皮病，1例患有葡萄球菌性烫伤样皮肤综合征。在天疱疮诊断中，“直接”尼氏征的敏感性（38%）低于“边缘”型（69%），但“直接”尼氏征的特异性（100%）高于“边缘”型（94%）。
本研究主要关注尼氏征在天疱疮诊断中的重要性。我们没有关注其在天疱疮中的预后价值。天疱疮患者组规模较小，这与我们地区天疱疮的低年发病率有关，这是本研究的另一个局限性。
尼氏征为天疱疮的诊断提供了一种中度敏感但高度特异的工具。
