Nikolsky's sign on the gingival mucosa: a clinical tool for oral health practitioners.
BACKGROUND
Nikolsky's sign is a clinical sign which is elicited by a horizontal, tangential pressure to the mucosa and/or skin resulting in blisters extending and separating or peeling away. Few data are currently available in the literature about its usefulness, specificity, and sensitivity in the diagnosis of either oropharyngeal or cutaneous bullous diseases. The purpose of this study was to determine the sensitivity and specificity of the gingival Nikolsky's sign in the identification of an autoimmune blistering disease.


METHODS
Over a period of 13 years, we recruited 566 patients with autoimmune oral bullous and non-bullous diseases who possessed either maxillary or mandibular gingival mucosal lesions. All patients were subjected to a test causing a gingival Nikolsky's sign at their first visit during the diagnostic algorithm and in the active disease phase before commencing treatment.


RESULTS
A total of 566 patients (184 with and 382 without bullous lesions) had at least gingival involvement. A positive gingival Nikolsky's sign resulted in 100 (17.7%) of 566 patients: 86 patients with bullous lesions (53 with pemphigus vulgaris, eight with mucous membrane pemphigoid, 22 with bullous/mixed lichenoid lesions, and three with erythema multiforme) and 14 with non-bullous lesions (12 with non-bullous lichenoid lesions and two with systemic lupus erythematous/mixed connective tissue disease). Thus, the specificity of Nikolsky's sign was higher (96.3%) than the sensitivity (46.7%).


CONCLUSIONS
The results of this study support the use of Nikolsky's sign of the gingival mucosa as a viable test to establish the presence of oral bullous diseases.
Mignogna
Michele D
MD
Oral Medicine Unit, Department of Odontostomatological and Maxillofacial Sciences, School of Medicine and Surgery, "Federico II" University of Naples, Naples, Italy. mignogna@unina.it
Fortuna
Giulio
G
Leuci
Stefania
S
Ruoppo
Elvira
E
Marasca
Flavio
F
Matarasso
Sergio
S
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000974:Antibodies, Antinuclear / Q000032:analysis; D001324:Autoantigens / Q000032:analysis; D001327:Autoimmune Diseases / Q000175:diagnosis*; D002352:Carrier Proteins / Q000032:analysis; D015331:Cohort Studies; D003598:Cytoskeletal Proteins / Q000032:analysis; D051183:Desmoglein 1 / Q000032:analysis; D051184:Desmoglein 3 / Q000032:analysis; D003937:Diagnosis, Differential; D000071821:Dystonin; D004892:Erythema Multiforme / Q000175:diagnosis; D005260:Female; D005882:Gingival Diseases / Q000175:diagnosis*; D006801:Humans; D017512:Lichenoid Eruptions / Q000175:diagnosis; D008137:Longitudinal Studies; D008180:Lupus Erythematosus, Systemic / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D008947:Mixed Connective Tissue Disease / Q000175:diagnosis; D009419:Nerve Tissue Proteins / Q000032:analysis; D024041:Non-Fibrillar Collagens / Q000032:analysis; D010390:Pemphigoid, Benign Mucous Membrane / Q000175:diagnosis; D010392:Pemphigus / Q000175:diagnosis; D012680:Sensitivity and Specificity; D012872:Skin Diseases, Vesiculobullous / Q000175:diagnosis*; D055815:Young Adult; D000097805:Collagen Type XVII
D000974:Antibodies, Antinuclear; D001324:Autoantigens; D002352:Carrier Proteins; D003598:Cytoskeletal Proteins; D051183:Desmoglein 1; D051184:Desmoglein 3; D000071821:Dystonin; D009419:Nerve Tissue Proteins; D024041:Non-Fibrillar Collagens; D000097805:Collagen Type XVII; C071894:DSG3 protein, human; C486268:DST protein, human