Nikolsky’s sign (Toxic epidermal necrolysis) Nikolsky's sign: The sign is present when slight rubbing of the skin at the boarder of a blister results in exfoliation of the outermost layer Here you can see the epidermis sloughing off of the dermis in sheets. There is widespread mucous membrane involvement in this patient as well, with sloughing of the buccal mucosa. Nikolsky's sign is positive in this patient. This is characteristic of TEN which is an extremely serious condition. This condition is a result of a drug reaction to antibiotics or seizure drugs. Treatment is supportive and these patients must be transferred to burn units and have a 30-40% mortality rate (with proper treatment).