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JOHN S. HUNT, M.D.; ANN S. MINOT, Ph.D.

Arch Derm Syphilol. 1949;59(1):114-115.

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In many patients with pemphigus the epidermis, even in those areas of skin where bullae have not appeared, may be easily displaced from the underlying dermis by gentle friction (Nikolsky's sign). The reason for this manifestation would appear to be a general defect in the cement substance of the skin. The highly viscous mucopolysaccharide hyaluronic acid has been shown to be a constituent of the cement substance of normal skin. Furthermore, it is known that hyaluronic acid is readily hydrolyzed by the enzyme hyaluronidase. MacCardle and associates¹ suggested that bullae might be formed in localities where hyaluronic acid had been destroyed by enzymatic hydrolysis. Although no direct studies of this enzyme system were undertaken by these authors, data compatible with their hypothesis were furnished by observations on the comparative rates of spread of hemoglobin injected into the skin of normal subjects and of patients with pemphigus.

In the present . . . [Full Text PDF of this Article]

Author Affiliations
NASHVILLE, TENN.

From the Departments of Medicine and Biochemistry, Vanderbilt University School of Medicine.

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