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Related Experiment Videos

Microscopic Nikolsky's sign.

A Hameed1, A A Khan

  • 1Departmment of Dermatology, Military Hospital Rawalpindi, Pakistan.

Clinical and Experimental Dermatology
|August 24, 1999
PubMed
Summary

Applying tangential pressure before skin biopsy can reveal microscopic pemphigus changes, aiding diagnosis when blisters are absent. This method improves histopathology yield for pemphigus vulgaris and foliaceus.

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Area of Science:

  • Dermatology
  • Histopathology
  • Immunopathology

Background:

  • Nikolsky's sign is a clinical indicator in active pemphigus but lacks specificity regarding skin cleavage level.
  • Its presence is diminished in partially treated patients, complicating diagnosis.
  • Routine histopathology may be insufficient for diagnosing pemphigus when lesions are old, infected, or blisters are absent.

Purpose of the Study:

  • To identify the microscopic or subclinical correlate of the clinical Nikolsky's sign.
  • To enhance the diagnostic accuracy of histopathology for pemphigus, especially in challenging cases.
  • To provide a diagnostic alternative for institutions lacking immunofluorescence facilities.

Main Methods:

  • Pemphigus patients were divided into two groups: Group A (n=23) underwent biopsy after tangential pressure on perilesional skin, and Group B (n=14) underwent biopsy without pressure.
  • A control group (Group C, n=37) of healthy volunteers received tangential pressure before biopsy.
  • Histopathological examination was performed on all biopsy specimens.

Main Results:

  • Histopathological changes diagnostic of pemphigus vulgaris or foliaceus were observed in 73.9% of Group A patients, compared to 28.6% in Group B.
  • No pemphigus-related changes were detected in the control Group C.
  • Tangential pressure induced microscopic epidermal changes at the suprabasal level (pemphigus vulgaris) or intraepidermally (pemphigus foliaceus).

Conclusions:

  • Manual tangential pressure applied to perilesional skin can induce diagnostic microscopic epidermal changes in pemphigus.
  • This technique improves the diagnostic yield of routine histopathology for pemphigus, particularly when intact blisters are unavailable.
  • The method is valuable for diagnosing pemphigus in resource-limited settings without immunofluorescence capabilities.

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