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Our Dermatol Online.  2013; 4(4): 579-581
DOI:.  10.7241/ourd.20134.146
Date of submission:  14.06.2013 / acceptance: 16.07.2013
Conflicts of interest: None


Khalid Al Aboud1, Ahmad Al Aboud2

1Department of Public Health, King Faisal Hospital, Makkah, Saudi Arabiaa
2Dermatology Department, King Abdullah Medical City, Makkah, Saudi Arabia

Corresponding author:  Dr. Khalid Al Aboud    e-mail: amoa65@hotmail.com


The word “sign” refers to important physical finding or observation made by the physician when examining the patient. Dermatologic diagnosis relies on the careful observation and documentation of signs, which can be highly pathognomonic for a certain conditions. Most of the signs appear either de novo or have to be elicited by the physician [1]. There are important publications which gathered the signs seen in dermatology practice. In addition, Dr Piotr Brzeziński, the Editor – in-Chief of this journal along with other authors had published alphabetical series entitled ‚’DERMATOLOGY EPONYMS – SIGN – LEXICON’’, where they elaborated on the signs seen in dermatology. In this communication, we aimed to highlight on selected eponyms linked to "signs’’ in the dermatology literature, shown in Table I [1-11].
Eponyms linked to „signs’’ in the
dermatology literature
Albright’s dimple sign [1-5]
This is seen in Albright’s hereditary osteodystrophy in which there is presence of a dimple over the knuckle of the typically affected fourth metacarpal and can be enhanced by clenching of the fist.It is named for Fuller Albright (1900-1969), (Fig. 1), who was an American endocrinologist who made numerous contributions to his field, especially to the area of calcium metabolism.
Figure 1. Fuller Albright (1900-1969).
Asboe-Hansen sign (Blister spread
sign) [6]
The Asboe-Hansen sign (also known as „indirect Nikolsky sign” refers to the extension of a blister to adjacent unblistered skin when pressure is put on the top of the bulla. This sign is named for Gustav Asboe-Hansen (1917–1989), (Fig. 2), who was a Professor and Head of the Department of Dermatology and Venereology at the University Hospital in Copenhagen, Denmark. His article was published in 1960. Asboe-Hansen noticed the differences between the blister-spread patterns in pemphigus and those in bullous pemphigoid. Whereas in pemphigus vulgaris, the blister extension had a sharp angle, in bullous pemphigoid, the advanced border was rounded as in a pressure bulla.
Figure 2. Gustav Asboe-Hansen
Auspitz sign [1-3]
It is seen in psoriasis, 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.
Auspitz sign is named for, Heinrich Auspitz (1835-1886), (Fig. 3), who was an Austrian dermatologist.
Figure 3. Heinrich Auspitz
Cullen sign [1-3]

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. Thomas Stephen Cullen (1868-1953), (Fig. 4), was a Canadian gynecologist associated with Johns Hopkins Hospital.

Figure 4. Thomas Stephen Cullen (1868-1953).
Darier sign [1-3]

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. Darier sign is named after the French dermatologist Ferdinand-Jean Darier (1856-1938), (Fig. 5), who first described it.

Figure 5. Ferdinand-Jean Darier
Forscheimer sign [1-3]

Also known as Forchheimer spots. It is 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. Can also be seen in infectious mononucleosis. It is named for Frederick Forchheimer (1853–1913), (Fig. 6), who was an American pediatrician.

Figure 6. Frederick Forchheimer (1853–1913).
Gorlin sign [1-3]

It is the ability of patients of Ehlers-Danlos syndrome to touch the tip of the nose with the tip of their tongue Named for Robert James Gorlin (1923-2006), (Fig. 7), who was a professor and researcher at the University of Minnesota known for pioneering research into craniofacial disorders, genetic defects, syndromes, and oral and maxillofacial pathology.

Figure 7. Robert James Gorlin
Higoumenaki sign [1-3]

It refers enlargement of the sternal end of the (right) clavicle, frequently observed in patients with late congenital syphilis .It is named for, George Higoumenakis (1895-1983), (Fig. 8), who was a Greek dermatologist.

Figure 8. George Higoumenakis

Nikolsky sign [7-9]

The sign is encountered in blistering disorders, and it is present when slight rubbing of the skin results in exfoliation of the outermost layer of the skin. Named for, Russian dermatologist Pyotr Vasiliyevich Nikolskiy (1858-1940), (Fig. 9).

Figure 9. Piotr Vasiliyevich
Nikolskiy (1858-1940).
Winterbottom sign [1,10,11]

It is seen in early stages of African trypanosomiasis caused by Trypanosoma brucei rhodensiense and Trypanosoma brucei gambiense known Sleeping sickness. Winterbottom’s sign is enlargement of lymph nodes in the posterior cervical chain. It is named for Thomas Masterman Winterbottom (1766-1859), (Fig. 10), who was an English physician. Winterbottom noted that slave traders used the sign of neck swelling as an indicator of sleepiness, and would avoid those slaves. He had no children, so his considerable estate was left to a number of charities which he had supported during his life. The bulk of this bequest was to found the South Shields Marine College, which he had established in 1837.

Figure 10. Thomas Masterman
Winterbottom (1766-1859).
A courtesy of The Bridgeman Art Library Ltd.

                  Table I. Selected Eponyms linked to „signs’’ in the dermatology literature

1. Madke B, Nayak C: Eponymous signs in dermatology. Indian Dermatol Online J. 2012;3:159-65.
2. Al Aboud K, Al Hawsawi K, Ramesh V, Al Aboud D, Al Githami A: Cutaneous signs. Skinmed. 2003;2:104-7.
3. Freiman A, Kalia S, O’Brien EA: Dermatologic signs. J Cutan Med Surg. 2006;10:175–82.
4. Manring MM, Calhoun JH: Biographical sketch: Fuller Albright, MD 1900-1969. Clin Orthop Relat Res. 2011;469:2092-5.
5. Loriaux L: Foundations of pediatrics: Fuller Albright, MD (1900- 1969). Adv Pediatr. 2010;57:1-6.
6. Al Aboud K, Al Aboud D: Eponyms in the dermatology literature linked to Denmark. Our Dermatol Online. 2013;3(Suppl.2):420-1.
7. Channual J, Wu JJ: The Nikolskiy sign. Arch Dermatol. 2008;144:1140.
8. Grando SA, Grando AA, Glukhenky BT, Doguzov V, Nguyen VT, Holubar K: History and clinical significance of mechanical symptoms in blistering dermatoses: a reappraisal. J Am Acad Dermatol. 2003;48:86-92.
9. Al Aboud K, Al Aboud A: Eponyms in the dermatology literature linked to Russia. Our Dermatol Online. 2013;4(Suppl.1):414-5.
10. Stephan C, Just-Nuebling G, Fichtlscherer S, Kriener S, Brodt HR: Winterbottom’s sign and hypertrophic cardiomyopathy. Scand J Infect Dis. 2002;34:544–5.
11. Ormerod WE: Hypothesis: the significance of Winterbottom’s sign. J Trop Med Hyg. 1991;94:338-40.



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