Ch. 20&21 - Hair & Nail Disorders Flashcards
an idiopathic hair disorder characterized by ell circumscribed, round or oval patches of NON-SCARRING hair loss
Alopecia areata
What are important elements of the history that should be included in the evaluation of a patient with hair loss?
- time of onset
- meds taken
- recent emotional or phys. stress
- diet
- grooming techniques,
- family hx of baldness or hair disorders
Which phase of the hair cycle is abruptly terminated in the affected area in alopecia areata?
anagen
What areas of the body des alopecia areata effect?
scalp, beard, eyebrows, eyelashes
5% of patients with Alopecia Areata may develop which disorder?
Alopecia Totalis
hair disorder where the patient loses all body hair
Alopecia universalis
What is the treatment for Alopecia Areata?
- Steroids
- topical (clobetasol)
- intralesional (injection)
- spontaneous remission
term used to describe excessive shedding of normal telogen club hairs
Telogen Effluvium
When does Telogen Effluvium appear?
approximately 2-4 mths after the inciting event
What are the two forms of Androgenetic Alopecia?
Male & Female Pattern Hair Loss
Who does Androgenetic alopecia most often occur in?
genetically predisposed men and women
What causes hair follicle miniaturization in male androgenetic alopecia?
DHT (dihydrotestosterone)
What regions of the scalp does Androgenetic alopecia involve?
vertex and frontotemporal regions
What is the treatment options for men with MPHL?
- Minoxidil (Rogaine) topically BID
- Finasteride (Propecia)
- hair tranplants
What is the treatment for FPHL?
- minoxidil BID
- spironolactone
- Hair transplant/wig
T/F: Common baldness is androgen-dependent in females.
FALSE; in MALES
When does Telogen effulvium most often occur?
postpartum
T/F: the normal hair cycle is disturbed in telogen effluvium.
true
A superficial fungal infection of the scalp.
Tinea Capitis
What are the most common dermatophytes that cause Tinea Capitis?
- Trichophyton tonsurans
2. Microsporum canis
Who is more commonly affected by Tinea Capitis?
More common in children (equal in male & female) & African Americans
Tinea Capitis causes…
- Seborrheic-like dermatitis
- “Black dot” ringworm
- Kerion
What is needed to be done to confirm the diagnosis of tinea capitis?
A KOH preparation or fungal culture
What is the therapy for Tinea capitis?
- oral antifungals (for 4-8 wks)
- griseofulvin (Grispeg)
- Terbinafine (Lamasil)
- Selenium Sulfide shampoo to dec. shedding of spores
a traumatic, self-induced alopecia resulting from compulsive plucking, twisting, and rubbing, which cause broken or epilated hair shafts.
Tichotillomania
Which areas of the body are affected by Trichotillomania?
- scalp (most often)
- eyebrows
- eyelashes
What are the characteristics that aid in diagnosis of Trichotillomania?
- bizarre patterns of non-scarring alopecia
2. coarse-feeling, broken hairs
What is the treatment for Trichotillomania?
psychiatric help
What hair disorder represents as patchy “moth-eaten” alopecia or generalized thinning?
Syphilis
Which hair disorder is an autoimmune disorder that often affects the scalp and cause patchy, scarring alopecia?
Discoid Lupus Erythematosus (DLE)
What is the goal of treatment in DLE?
to prevent the follicular destruction that results in permanent alopecia.
What are the treatments for DLE?
- Sun protection
- Steroids
- topical (clobetasol)
- intralesional
- antimalarials
Which hair disorder is inflammatory in nature and presents as perifollicular erythema, violaceous scalp, and scarring?
Lichen Planopilaris
Which hair disorder is a slowly progressive, scarring alopecia that begins in the crown and then spreads outward?
Central Centrifugal Cicatricial Alopecia (aka Triple C)
What is thought to cause Central Centrifugal Cicatricial Alopecia?
- heat
- chemicals
- traction
Who does CCC Alopecia most common in?
African American women
What are the growth rates of fingernails and toenails?
Fingernails = 3mm/mth Toenail = 1mm/mth
T/F: Appearance alone is usually not enough to make the diagnosis of a nail disorder.
TRUE
T/F: Therapy is often difficult or unsuccessful for nail disorders.
TRUE
T/F: The physical appearance of the nail can be used reliably to make a diagnosis.
FALSE: CANNOT be used
Nail disorder involving an inflammatory process of the nail fold.
Paronychia
inflammatory nail disorder that is most often the result of a bacterial infection (Staph or Strep)
acute paronychia
How does Acute Paronychia present upon physical examination?
painful, red, and swollen, and may be accompanied by pus
What is the appropriate therapy for acute paronychia?
- it should first be incised and drained
- then treated with antibiotics
An inflammatory nail disorder that is most often the result of a yeast infection.
Chronic paronychia
Who is chronic paronychia common in?
people who constantly have wet hands
How does chronic paronychia present upon physical examination?
loss of cuticle, slight tenderness, swelling, erythema, and sometimes separation of the nail fold from the plate.
T/F: Trauma and exposure to water must be stopped to cure chronic paronychia.
TRUE
nail disorder that is caused by a viral infection and only presents usually on one digit.
Herpetic Whitlow
What is the treatment for Herpetic Whitlow?
oral antivirals (Valacyclovir)
term used to describe fungal infections of the nail?
onychomycosis
What are the most common dermatophytes that cause onychomycosis?
- Trichophytn rubrum
2. T. mentagrophytes
What is onychomycosis usually associated with?
Tinea pedis
What is the most common site of onychomycosis?
toenails (uncommon for all 10 to be involved)
How does the nail present during physical examination with onychomycosis?
white, thick, and crumbly nail plate
What is needed to be done to determine onychomycosis?
A KOH prep. or fungal culture
What is the treatment for onychomycosis?
-oral antifungals (terbinafine or itraconazole)
a neoplastic nail disorder which presents as a papule at the proximal nail fold and causes longitudinal groove in the nail
digital myxoid cyst
neoplastic nail disorder which presents as a wide band of longitudinal pigmentation in variegated color usually on the 1st or 2nd digit.
melanoma
What is a key determining factor that a patient has melanoma of the nail?
Hutchinson’s sign (pigment on the nail folds as well as nail)
what nail manifestation is described as punctate depressions of the nail plate and transient disturbance of the nail matrix?
pitting
What conditions is pitting associated with?
- psoriasis
- alopecia areata
- eczema
Which nail manifestation is the result of abnormal keratinization of the nail matrix and bed?
nail psoriasis
Which disorder can nail psoriasis mimic?
onychomycosis
How does nail psoriasis present upon physical examination?
pitting and thickened nail plate, brown, discolored nail with distal separation, hyperkeratosis of the epidermis
How does the nail manifestions of lichen planus present clinically?
thinning, splitting, scarring, and pterygium of the nail
nail sign of systemic disease that presents as transverse & longitudinal curvature of the nails
clubbing
Which systemic diseases is clubbing most commonly caused by?
pulmonary & cardiovascular disorders
nail sign of systemic disease that presents as spooning of nails
koilonychia
What is koilonychia associated with?
iron deficiency (most common) & thyroid disease
Nail sign of system disease that presents as transverse grooves or white lines in the nail plate.
Beau’s Lines
What is Beau’s lines caused by?
disruption in nail growth (due to an illness or chemo)
What nail sign of systemic disease presents as 90/10 in coloration of nails? (90% white/10% pink)
Terry’s Nails
Which systemic diseases is Terry’s nails associated with?
cirrhosis, CHF, DM
