Common Hair & Nail Disorders - MD Flashcards
What is the definition of nail clubbing, and what etiologies is it associated with?
-Nail angle > 180 degrees
-Etiologies:
Heart & Lung disease
Chronic Hypoxia (CF, cancer, CHF, COPD, asthma)
What are Beau’s lines and what are they most often caused by?
- 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
What is onychomadesis?
- proximal detachment of nail (often due to trauma_
- results in complete arrest of nail growth
- Multiple digits = systemic cause
What are causes of nail pitting?
- psoriasis
- alopecia areata
- eczema
What is leukonychia, and what are the three variations that are seen?
- 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)
What can leukonychia be a sign of?
- repetitive trauma
- cirrhosis
- chemotherapy
- heavy metal poisoning
What are Meurcke’s lines and what are they caused by?
- Transverse pale lines in the vascular nail beds (do not move)
- No nail grooves
- Due to ↓ protein synthesis (systemic Dz → metabolic stress)
What is a subungual hematoma and how it is treated?
- Collection of blood under the nail
- Treated by releasing pressure (concept nail drill, 18 gauge needle, electrocautery) a.k.a nail trephination
What is habit tic deformity?
- Traumatic nail dystrophy
- results from habitual picking of the proximal nail fold
What is the hallmark finding of psoriatic nail changes?
- “pitting” (usually affecting several nails)
- remember to always inspect nail beds in patients with arthritis
What effect does lichen planus have on nails?
-results in nail thinning, longitudinal ridging, fissuring,
fissuring with atrophy → angel’s wings
What is onychomycosis and what does it usually start with?
- Chronic fungal infection of the nail bed
- Usually starts with tinea pedis
- Responds very poorly to topical antifungals
What is the most common type of onychomycosis?
Distal Subungual onychomycosis (DSO)
- thickened nail, subungual debris, separation of nail plate from nail bed
- usually caused by dermatophyte → trichophyton rubrum
How could one confirm the presence of a fungal nail infection?
- Fungal culture is preferred because ID of organism can help direct therapy
- KOH exam or nail biopsy also options
What is the treatment plan for DSO?
- 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)
What is the treatment for in-grown toenails?
- Soaks, Abx,
- relieve pressure on ulcer
- surgical nail excision
- phenol ablation
- wedge resection
- education!
What is paronychia? What organism usually causes it? How is it treated?
- Infection along lateral or proximal nail fold
- Usually S. aureus
- Tx: soaks, I&D, Abx (Keflex, Bactrim, Augmentin)
What are periungal verrucae caused by? How are they treated?
- Usually caused by HPV
- Tx: salicylic acid, cryotherapy
What is a pincer nail deformity?
transverse over-curvature of nail plate
What are the three stages of hair growth?
1) Anagen: Active growth phase (2-6 years)
2) Catagen: Transition phase (1-2 weeks)
3) Telogen: Resting phase (5-6 weeks)
What can cause scarring hair loss?
- Discoid lupus
- Infections (fungal/bacterial)
- Lichen Planus
- Pseudopelade
- Traction alopecia
What causes traction alopecia?
caused by trauma to hair follicles from tight braids or ponytails, headbands, rubber bands, curlers, or rollers
What organism is most likely the cause of a kerion?
- Trichophyton tonsurans
- Dx: woods light, culture
- Tx with oral antifungals (griseofulvin)
What is the most common cause of hair loss?
Androgenic alpecia (pattern baldness)
What is male-pattern baldness in females indicative of?
androgen excess
What is telogen efflevium?
- Sudden loss of large amounts of hair
- Results from premature conversion of anagen to telogen
What is alopecia areata and what is the hallmark finding?
- 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
What is trichotillomania?
compulsive pulling, twisting, and breaking
What is the cause of cheveux incoiffables?
hair shafts congenitally abnormal → causes hair to stand straight up
What is considered a positive pull test for active shedding, indicating telogen effluvium?
the removal of 6 or more hairs is considered positive
What percentage of telogen hairs would indicate telogen efflevium in a trichogram?
> 35% is highly suspicious of telogen efflevium
What is the Tx for alopecia in men? women?
Men: Oral Finasteride (type II 5 alpha reductase inhibitor) → ↓ dihydrotestosterone
Women: antiandrogen (spironolactone)
What is the Drug of Choice for tinea capitis?
-Griseofulvin x 6 weeks to months
