Nail changes in Dermatology !!

Darier’s disease – Red streak lines

Pitting of nail , longitudinal ridging & oil drop sign – Psoriasis

Cris cross black lines on nail plate known as Hutchinson nail – Malignant melanoma

Mees line -Chronic Arsenic poisoning

Lichen planus -Pterygium

Half and half nail-Chronic renal failure

Muehrcke lines – Severe Hypoalbuminemia



Continued from PART 1

*****Nikolskiy’s sign
Refers to easy peeling of skin on applying tangential pressure over a bony prominence and classically seen in pemphigus, toxic epidermal necrolysis, and staphylococcal scalded skin syndrome. Nikolskiy’s sign can also be elicited in the oral cavity with the help of cotton-tipped applicator.

****Osler’s sign
Blue black pigmentation in the sclera near insertion of rectus muscle in patients whohave Alkaptonuria.

*****Russell’s sign
Crusted callosity on the knuckles of dominant hand due to repeated self-induced vomiting in patients of bulimia.

****Sandwich sign
In dermatophytosis, fungi are present in the horny layer between two zones of cornified cells, the upper being orthokeratotic and lower consisting partially parakeratoticcellular.

****Shawl sign
Confluent macular violaceous erythema on the posterior neck and shoulders in patientsof dermatomyositis is called Shawl sign.
****Samitz’s sign
Dystrophic and ragged cuticle seen in dermatomyositis is called as Samitz sign.

****Thumb sign (Steinberg sign)
In patients of Marfan syndrome, the thumbs protrude from the clenched fist beyond theulnar border of hand.

****Wartenberg’s sign
In ulnar nerve paralysis due to leprosy, the little finger assumes the position of constant abduction secondary to paralysis of adductor digiti minimi.

****Wimberger’s sign
Wimberger’s sign is the presence of bilateral, symmetrical, and well-defined metaphyseal defects on the medial surface of upper tibia, can result in pseudoparalysis, and is considered pathognomonic of congenital syphilis.


To be continued ………..:)


****Asboe-Hansen sign (Blister spread sign)

Enlargement of bulla by applying finger pressure to small, intact, and tense bulla in patients with pemphigus and
bullous pemphigoid

In the traditional bulla spread sign, pressure is applied to the blister from one side, whereas in eliciting Asboe-Hansen sign     pressure is applied at the center of the blister and perpendicular to the surface due to smaller size of the lesion.

****Antenna sign
It is seen in keratosis pilaris in which individual follicles show a long strand of keratin glinting when examined in tangentially incident light.

*****Auspitz sign
where there is pinpoint bleeding on removal of scales from the lesions of psoriasis. The test by which Auspitz sign is elicited is called as Grattage test. Other dermatoses where Auspitz sign can be positive is Darier’s disease and actinic keratosis.

*****Branham’s sign (Nicoladoni sign)
It is to be elicited in cases of arterio-venous fistula where there is slowing of the heart rate in response to (manual) compression.

*****Buschke-Ollendorff sign
This is a sign to be elicited in case of secondary syphilis and cutaneous vasculitis,where there is deep dermal tenderness on pressing the lesion (e.g., papular lesions of syphilis) with a pinhead.

*****Carpet tack sign (Tin tack sign, Cat tongue sign)
When the adherent scale is removed from the lesions of discoid lupus erythematosus, the undersurface of the scale shows horny plugs that have occupied patulous hair follicles. This sign is also seen in seborrheic dermatitis.

*****Crowe’s sign
Axillary freckling seen in type I neurofibromatosis is known as Crowe’s sign.

*****Cullen’s sign
Periumbilical ecchymosis in cases of acute hemorrhagic pancreatitis and ruptured ectopic pregnancy is termed Cullen’s sign. Similar changes in the flank is called as Grey-Turner sign.

*****Darier’s sign
Rubbing a lesion of mastocytoma causes urtication, flare, swelling and sometimes blister formation due to release of histamine. In contrast, pseudo-Darer’s sign is seen in smooth muscle hamartoma where there is increase in induration and piloerection after firm stroking. Other conditions where one could find positive Darier’s sign are leukemia cutis, juvenile xanthogranuloma, and Langerhans cell histiocytosis.

*****Dimple sign (Fitzpatrick sign)
Squeezing the skin adjacent to a dermatofibroma causes a dimpled appearance on its surface, also termed a positive “pinch sign” or “dimple sign,”

*****Flag sign

The presence of sharply demarcated alternating bands of normally pigmented and hypopigmented zone of hair indicating episodes of normal nutrition and intermittent malnutrition respectively, seen in kwashiorkor- or marasmus-type malnutrition.

*****Forscheimer’s sign
Seen in 20% of rubella patients, where there is an enanthem of dull-red macules or petechiae confined to the soft palate during the prodromal period or on the first day of the rash.

*****Gottron’s sign
It is a characteristic finding in dermatomyositis typified by scaly erythematous eruption seen on the dorsa of hands, metacarpophalangeal joints, and proximal interphalangeal joints.

*****Leser-Trelat sign
Characterized by sudden eruption of numerous seborrhoeic keratosis, usually associated with pruritus and is considered as a marker of internal malignancy.


More of these coming soon ………………………… 🙂


Regarding qs based upon DIF(DIRECT IMMUNOFLORESCENCE ) in skin :

1. Phemphigus vulgaris : IgG and/or C3 deposits are present in intercellular spaces forming FISH NET PATTERN [imp repeat q].

2. Bullous phemphigoid : Linear deposits of IgG and C3 along basement membrane zone [imp repeat q].

3. Herpes gestationalis : Only linear C3 deposit along basement membrane.

4. Dermatitis herpetiformis : Granular IgA deposits in basement membrane zone + in papillary dermis = PICKET FENCE PATTERN [ repeat imp q]

Some more +++ points 🙂 🙂 🙂

[1] In paraneoplastic phemphigus in addition to intercelluar pattern as seen in phemphigus vulgaris granular C3 deposits are seen in dermoepidermal junction.

[2] SLE : “Band like IgG deposit” along basement membrane of skin and in nucleus of epiermal cells.

Q1] A 3O year old male has severly itchy papulo-vesicular lesions on extremities, knees, elbow and buttocks for one year. DIF shows IgA deposition at dermoepidermal junction. The most probable diagonois is ..

[a] Phemphigus vulgaris

[b] Bullous phemphigoid

[c] Dermatitis herpetiformis

[d] SLE


NOTE : [1]There is well documented association between dermatitis herpetiformis and celiac disease.

[2] Pathognomonic histopathological finding of DH is = small clusters of neutrophills in papillary dermis = PAPILLARY DERMAL MICROABSCESSES

Q2] A 40 years old male developed persistent oral ulcers followed by multiple flaccid bullae on trunk and extremities . DIF  on skin biopsy showed intercellular IgG deposits in epidermis …

[1] Phemphigus vulgaris

[2] Bullous phemphigoid

[3] SLE

[4] Epidermolysis bullosa acquistia

ANS = [A] Phemphigus vulgaris

NOTE : ” Row of tombstone ” appearance on HPE is seen in Phemphigus vulgaris.

Q3] A 50 years male has multiple blisters over the trunk and extremities. DIF showed linear deposits of IgG along the basement membrane. Which of following is most likely diagonosis ..

[a] Phemphigus vulgaris

[b] Bullous phemphigoid

[c] Dermatitis herpetiformis

[d] SLE

ANS = [B] Bullous phemphigoid