Common Hair & Nail Disorders - MD

Question 1

What is the definition of nail clubbing, and what etiologies is it associated with?

Answer 1

-Nail angle > 180 degrees
-Etiologies:
Heart & Lung disease
Chronic Hypoxia (CF, cancer, CHF, COPD, asthma)

Question 2

What are Beau’s lines and what are they most often caused by?

Answer 2

• Transverse depressions in the central portion of nail plate
• Results from temporary interruption of proximal nail matrix (most often due to trauma)
• Involvement of multiple digits suggests systemic cause

Question 3

What is onychomadesis?

Answer 3

• proximal detachment of nail (often due to trauma_
• results in complete arrest of nail growth
• Multiple digits = systemic cause

Question 4

What are causes of nail pitting?

Answer 4

• psoriasis
• alopecia areata
• eczema

Question 5

What is leukonychia, and what are the three variations that are seen?

Answer 5

• White opaque discoloration
  1) Punctate: small, opaque white spots that move distally with nail growth
  2) Striate: transverse, parallel, opaque white lines that migrate distally with nail growth
  3) Diffuse (porcelain nails): completely opaque and white (rare)

Question 6

What can leukonychia be a sign of?

Answer 6

• repetitive trauma
• cirrhosis
• chemotherapy
• heavy metal poisoning

Question 7

What are Meurcke’s lines and what are they caused by?

Answer 7

• Transverse pale lines in the vascular nail beds (do not move)
• No nail grooves
• Due to ↓ protein synthesis (systemic Dz → metabolic stress)

Question 8

What is a subungual hematoma and how it is treated?

Answer 8

• Collection of blood under the nail

- Treated by releasing pressure (concept nail drill, 18 gauge needle, electrocautery) a.k.a nail trephination

Question 9

What is habit tic deformity?

Answer 9

• Traumatic nail dystrophy

- results from habitual picking of the proximal nail fold

Question 10

What is the hallmark finding of psoriatic nail changes?

Answer 10

• “pitting” (usually affecting several nails)

- remember to always inspect nail beds in patients with arthritis

Question 11

What effect does lichen planus have on nails?

Answer 11

-results in nail thinning, longitudinal ridging, fissuring,

fissuring with atrophy → angel’s wings

Question 12

What is onychomycosis and what does it usually start with?

Answer 12

• Chronic fungal infection of the nail bed
• Usually starts with tinea pedis
• Responds very poorly to topical antifungals

Question 13

What is the most common type of onychomycosis?

Answer 13

Distal Subungual onychomycosis (DSO)

• thickened nail, subungual debris, separation of nail plate from nail bed
• usually caused by dermatophyte → trichophyton rubrum

Question 14

How could one confirm the presence of a fungal nail infection?

Answer 14

• Fungal culture is preferred because ID of organism can help direct therapy
• KOH exam or nail biopsy also options

Question 15

What is the treatment plan for DSO?

Answer 15

• First-line: Terbinafine 250 mg q.d. x 12 weeks
• Do not begin Tx w/o confirmation of fungus on culture
• Second-line: Fluconazole or Itraconazole (may be helpful in DSO caused by non-dermatophyte molds or yeast)

Question 16

What is the treatment for in-grown toenails?

Answer 16

• Soaks, Abx,
• relieve pressure on ulcer
• surgical nail excision
• phenol ablation
• wedge resection
• education!

Question 17

What is paronychia? What organism usually causes it? How is it treated?

Answer 17

• Infection along lateral or proximal nail fold
• Usually S. aureus
• Tx: soaks, I&D, Abx (Keflex, Bactrim, Augmentin)

Question 18

What are periungal verrucae caused by? How are they treated?

Answer 18

• Usually caused by HPV

- Tx: salicylic acid, cryotherapy

Question 19

What is a pincer nail deformity?

Answer 19

transverse over-curvature of nail plate

Question 20

What are the three stages of hair growth?

Answer 20

1) Anagen: Active growth phase (2-6 years)
2) Catagen: Transition phase (1-2 weeks)
3) Telogen: Resting phase (5-6 weeks)

Question 21

What can cause scarring hair loss?

Answer 21

• Discoid lupus
• Infections (fungal/bacterial)
• Lichen Planus
• Pseudopelade
• Traction alopecia

Question 22

What causes traction alopecia?

Answer 22

caused by trauma to hair follicles from tight braids or ponytails, headbands, rubber bands, curlers, or rollers

Question 23

What organism is most likely the cause of a kerion?

Answer 23

• Trichophyton tonsurans
• Dx: woods light, culture
• Tx with oral antifungals (griseofulvin)

Question 24

What is the most common cause of hair loss?

Answer 24

Androgenic alpecia (pattern baldness)

Question 25

What is male-pattern baldness in females indicative of?

Answer 25

androgen excess

Question 26

What is telogen efflevium?

Answer 26

• Sudden loss of large amounts of hair

- Results from premature conversion of anagen to telogen

Question 27

What is alopecia areata and what is the hallmark finding?

Answer 27

• Autoimmune Dz associated with atrophy and nail changes (pitting)
• Rapid and complete loss of hair in round or oval patches on the scalp
• Hallmark: exclamation point hairs

Question 28

What is trichotillomania?

Answer 28

compulsive pulling, twisting, and breaking

Question 29

What is the cause of cheveux incoiffables?

Answer 29

hair shafts congenitally abnormal → causes hair to stand straight up

Question 30

What is considered a positive pull test for active shedding, indicating telogen effluvium?

Answer 30

the removal of 6 or more hairs is considered positive

Question 31

What percentage of telogen hairs would indicate telogen efflevium in a trichogram?

Answer 31

> 35% is highly suspicious of telogen efflevium

Question 32

What is the Tx for alopecia in men? women?

Answer 32

Men: Oral Finasteride (type II 5 alpha reductase inhibitor) → ↓ dihydrotestosterone

Women: antiandrogen (spironolactone)

Question 33

What is the Drug of Choice for tinea capitis?

Answer 33

-Griseofulvin x 6 weeks to months