Apr12 M2-Hair and Nails

Question 1

nail anatomy

Answer 1

proximal nail fold = base
lateral nail fold = skin on both sides
nail plate = nail part near lateral fold
onychodermal band = nail part near finger tip
lunula = whiter part near base
cuticle = tissue on base
matrix = most important part under the lunula. produces the nail

Question 2

most important part of the nail and location

Answer 2

nail matrix. white tissue (see that it’s white if remove nail) under the lunula.

Question 3

nail bed def

Answer 3

bed on which the nail rests, extending from lunula to hyponychium (which is the skin under the nail on the finger tip)

Question 4

3 year old with sudden onset of shedding of nails and separation of nail plate from bed: different possible causes

Answer 4

• trauma (manicure, onychotillomania)
• eczema, erythroderma
• severe systemic conditions
• high fever
• viral illness

Question 5

3 year old with sudden onset of shedding of nails and separation of nail plate from bed: name of the condition and important related cause

Answer 5

onychomadesis

-hand foot and mouth disease caused by enteroviruses

Question 6

tx of onychomadesis

Answer 6

nail will grow back

Question 7

nail pitting (holes in the nail) means what

Answer 7

can be associated with

• psoriasis
• eczema
• alopecia areata
• trauma

Question 8

swelling and redness around nail + painful erythmatous and purulent swelling of nail folds dx

Answer 8

acute paronychia

Question 9

cause of acute paronychia

Answer 9

staph aureus

Question 10

chronic paronychia looks like what

Answer 10

• rednes and swelling around thumb, inflammed folds, dystrophic plate, not purulent
• candida and irritation caused by saliva

Question 11

group of pustules (pustular vesicular lesions) on fingernail and finger tip: name of that

Answer 11

herpetic whitlow

• HSV1 or 2 infection of fingertip and perionychium
• pain edema and erythema (and the pustular grouped vesicles**)

Question 12

(imp?) brown line on the nail is what

Answer 12

melanonychia

• think of melanoma refer to dermatology
• nail matrix nevus or lentigo
• subungal melanoma

Question 13

racial melanonychia is what

Answer 13

• melanonychia involving several nails

- benign

Question 14

thick yellow toenails + debris under the nails: name of this SYMPTOM

Answer 14

subungal hyperkeratosis

nail plate separated from nail bed

Question 15

disease where you see subungal hyperkeratosis and cause

Answer 15

onychomycosis

caused by fungal infections

Question 16

most common type of onychomycosis

Answer 16

distal subungual onychomycosis

Question 17

(imp?) distal subungual onychomycosis charact

Answer 17

• onycholysis (bed-plate separation)
• subungual hyperkeratosis
• invasion of inferior plate
• yellow brown discoloration

Question 18

white superficial onychomychosis charact

Answer 18

• superficial infection of nail plate

- well demarcated opaque friable plaque on dorsal plate (outer)

Question 19

dx of onychomycosis

Answer 19

• KOH coloration and smear
• fungal culture
• PAS stain (periodic acid Schiff)

Question 20

tx of onychomycosis

Answer 20

oral antifungal for 4 months

Question 21

diff parts of the hair

Answer 21

• hair shaft = above scalp
• hair root= in scalp
• hair follicle = hole of the root
• hair bulb = matrix cells making bottom of hair root
• sebaceous glands to make sebum and keep hair and skin waterproof

Question 22

3 phases of hair growth

Answer 22

• anagen
• catagen
• telogen

Question 23

anagen phase charact

Answer 23

• lasts 1000 days

- matrix cells geown and become keratinized

Question 24

catagen phase charact

Answer 24

matrix cells suddenly stop proliferating

Question 25

telogen phase charact

Answer 25

100 days | -hair shedding phase, goes out of the follicle

Question 26

alopecia def and 2 things to check

Answer 26

means hair loss - localized vs diffuse - cicatricial or non cicatricial (scarring)

Question 27

cicatricial vs non cicatricial hair loss

Answer 27

cicatricial = lack of follicular ostia (holes) + shiny atrophic skin non cicatricial = see hair follicles

Question 28

(important) alopecia areata def

Answer 28

autoimmune disease of patchy, non itchy, non scarring, non edematous hair loss

Question 29

tinea capitis def

Answer 29

circular patches of hair loss, itchy and scaly. broken hair

Question 30

cause of tinea capitis

Answer 30

dermatophyte fungi

Question 31

tinea capitis kerion def

Answer 31

- inflammatory mass surrounded by follicular pustules - fever and local lymphadenopathy - severe and reactive infection. form of tinea capitis

Question 32

cause of tenia capitis kerion

Answer 32

fungal infection

Question 33

specific fungus that often causes tinea capitis

Answer 33

T. tonsurans

Question 34

dx of tinea capitis

Answer 34

- scraping - KOH - culture

Question 35

(IMPORTANT) tx of tinea capitis

Answer 35

ORAL anti fungal | topical therapy is just to reduce infectivity

Question 36

trichotillomania def

Answer 36

- habitual compulsive plucking of hair - broken hairs - frontotemporal or parietotemporal regions

Question 37

3 important things in trichotillomania

Answer 37

- have access to this area of hair - pattern of hair loss - hair of different length

Question 38

tx of trichotillomania

Answer 38

- stop habbit | - psychiatric evaluation

Question 39

androgenetic alopecia charact

Answer 39

-genetically determined sensitivity of scalp hair follicles to adult levels of androgens -

Question 40

androgenetic alopecia in men vs women

Answer 40

``` men = vertex (top of scalp) then bitemporal then both join women = diffuse central thinning of the crown with preservation of the frontal hair line ```

Question 41

androgenetic alopecia cause

Answer 41

- testosterone is transformed to DHT by 5 alpha reductase (enzyme in hair follicles) - have more levels of 5a reductase = have more androgen receptors - DHT leads to thinning and miniaturization of hair

Question 42

AGA (androgenetic alopecia) how androgen levels are diff from other people

Answer 42

NORMAL ANDROGEN LEVELS | just more 5a reductase and more androgen Rs

Question 43

DHT exact effect

Answer 43

-shortens growth phase from 3-6 years to a few weeks or months

Question 44

telogen effluvium charact

Answer 44

-premature shift of hair follicle to the telogen phase caused by some triggers (surgery, bad disease, fever, etc.)

Question 45

(imp?) triggers of telogen effluvium

Answer 45

SEND Stress (psychosocial, surgery, systemic disease) Endocrine (hypo, hyperthyroidism) Nutritional (iron deficiency, etc.) Drug (acitretin, anticoagulant, allopurinol)

Question 46

telogen effluvium evolution

Answer 46

- shedding for 3-4 months after initiating cause | - 6-12 months for hair density to go back to normal