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Block F -- Defense > Finger and Toenails, Scalp and Hair > Flashcards

Finger and Toenails, Scalp and Hair Flashcards

1
Q

Define nail plate

A

Keratinized structure which continues growing throughout life

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2
Q

Define lateral nail folds

A

Cutaneous folds providing lateral borders to the nail

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3
Q

Define proximal nail fold

A

Cutaneous fold providing the visible proximal border of the nail

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4
Q

Define cuticle (eponychium)

A

Extends from the proximal nail fold and adhering to nail plate

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5
Q

Define nail matrix (nail root)

A

Nail factory, beneath the proximal nail fold

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6
Q

Define lunula (half moon)

A

Convex margin of the matrix seen through the nail

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7
Q

Define nail bed

A

Vascular bed upon which the nail rests, extending from the lunula to the hyponychium

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8
Q

Define hyponychium

A

Cutaneous margin underlying free nail

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9
Q

Define onychomadesis

A
  • Complete separation of the nail plate from the bed

* Full but temporary arrest of growth of nail matrix

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10
Q

5 causes of oncyhomadesis

A
  • Trauma (i.e. manicure, onychotillomania)
  • Dermatologic diseases (i.e. eczema, erythroderma)
  • Systemic conditions
  • High fever
  • Viral illness
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11
Q

Management of onychomadesis

A

Reassurance (nail will grow back)

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12
Q

Define trachyonychia

A

Nail roughness and opacity due to excessive longitudinal ridging

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13
Q

5 causes of trachyonychia

A
  • Idiopathic
  • Alopecia areata
  • Psoriasis
  • Dermatitis
  • Lichen planus

NOTE: May occur before apparition of other signs of related disease, so should observe them to exclude these and THEN label as idiopathic

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14
Q

4 points of management for trachyonychia

A
  • Spontaneous improvement if possible
  • Keep nails short with frequent filing
  • Can use potent topical corticosteroid
  • Oral biotin
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15
Q

Define nail pitting

A

Common disorder where punctate depressions appear on nail plate

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16
Q

4 associated conditions to nail pitting

A
  • Psoriasis
  • Eczema
  • Alopecia areata
  • Trauma
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17
Q

4 points of management for nail pitting

A
  • Look for symptoms and signs of possible associated disease
  • If nothing, follow up to see if later development
  • Observation
  • Potent topical corticosteroid
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18
Q

Define acute paronychia

A

Painful, erythematous indurated swelling of nail folds with purulent draining developing over a few hours

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19
Q

Usual cause of acute paronychia

A

Staphylococcus aureus

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20
Q

Management of acute paronychia

A
  • Oral antibiotics with gram-positive coverage against S. aureus
  • If progression to abscess –> drain promptly
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21
Q

Define chronic paronychia

A

Non-purulent, glistening erythema with nail dystrophy

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22
Q

Cause of chronic paronychia

A

Candida and irritation caused by saliva (not uncommon in thumb suckers)

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23
Q

Define herpetic whitlow

A

HSV 1 or 2 infection of the fingertip and perionychium presenting with pain, edema and erythema

NOTE: may be confused with acute bacterial paronychia

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24
Q

3 points of managements for herpetic whitlow

A
  • Warm compress
  • Topical antibiotic to prevent secondary bacterial infection
  • Oral acyclovir can shorten duration???
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25
Q

Define melanonychia

A

Tan, brown or black pigmented band along the length of nail

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26
Q

Conditions associated with melanonychia

A

Nail matrix nevus or lentigo

Early subungual melanoma rare but reported

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27
Q

5 alerting signs in the event of melanonychia

A
  • In adults
  • Non-uniform color
  • Change in color or width
  • WHen the edge becomes blurred
  • Familial history of melanoma
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28
Q

Define racial melanonychia

A

WHen the pigmented band involves several nails; more common in darker skin phototypes

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29
Q

Prevalence of racial melanonychia

A

77% of young African-American adults and almost 100% of those older than 50 years of age

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30
Q

Define drug-induced melanonychia

A

When there are multiple pigmented bands on several nails, usually in the situations of chemotherapy, antiretroviral and antimalaria treatments

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31
Q

4 consequences of periungual warts

A
  • Embarrassment
  • Pain
  • Nail deformity
  • Keratolysis
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32
Q

Management of periungual warts

A

Cryotherapy

Avoid nail biting and cuticle picking

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33
Q

Define onychomycosis

A

Fungal infection of nail unit

NOTE: Look for tinea pedia in patients and the family

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34
Q

Define distal subungual onychomycosis

A

Fungal invasion of nail bed and inferior portion of nail plate

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35
Q

3 symptoms of distal subungual onychomychosis

A
  • Onycholysis
  • Subungual hyperkeratosis
  • Yellow brown discoloration
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36
Q

Define white superficial onychomycosis

A

Superficial infection of nail plate

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37
Q

Describe the manifestation of white superficial onychomycosis

A

Well demarcated whitish, opaque, friable plaques on dorsal nail plate

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38
Q

How to culture the fungus from white superficial onychomycosis

A

1) Scrape the debris under the nail
2) Send it off in a sterile container to the lab
3) Is usually branched septate fungal hyphae

39
Q

4 points of diagnosis for onychomycosis

A
  • KOH discoloration
  • Periodic acid-Schiff (PAS) stain
  • Recommended to do diagnostic tests
  • Consider alternative causes of nail changes
40
Q

3 treatments for onychomycosis

A 
• Oral lamisil (60% success)
  - 12 weeks for toes
  - 6 weeks for fingers
• CBC and LFT base (every month)
• Penlac (Ciclopirox) = 20% success
  - 48 weeks
41
Q

5 ways to reduce relapse rate in the event of onychomycosis

A
  • Don’t share shoes
  • No poorly fitted shoes
  • Use antifungal sprays or powders in shoes and socks
  • Avoid going barefoot at all
  • Discard old shoes
42
Q

Define hair follicle

A

A tube-like depression, or pocket in the skin or scalp that encases the hair root

43
Q

Define hair bulb

A

A thickened, club-shaped structure that forms the lower part of the hair root

44
Q

Give a brief description of how the hair shaft is made

A

Matrix cells in hair bulb proliferate and differentiate to make the hair shaft during the anagen

45
Q

Time length of anagen

A

1000 days

46
Q

Define anagen

A

Matrix cells grow, divide and become keratinized to form the growing hair

47
Q

Define catagen

A

Matrix proliferating cells abruptly cease proliferating so that hair bulb involutes and regresses

48
Q

Define telogen

A

Club-shaped proximal end shed from the hair follicle

49
Q

Time length of telogen

A

100 days

50
Q

2 categorizations of alopecia

A

Localized vs. diffuse

Cicatricial vs. non-cicatricial

51
Q

Define cicatricial alopecia

A
  • Lack of follicular ostia

* Shiny atrophic skin

52
Q

Define alopecia areata

A
  • Recurrent non-scarring, non-scaly type of hair loss

* One or more alopetic plaque

53
Q

Define exclamation point hairs

A
  • Short broken hairs

* Narrower proximal end compared to distal end

54
Q

6 poor prognostic factors in the event of alopecia

A
  • Young age
  • Atopy
  • Extensive involvement
  • Pitting
  • Ophiasis
  • Recurrence
55
Q

Define alopecia totalis

A

100% hair loss on the scalp

56
Q

Prevalence of pitting in alopecia patients

A

6.8 to 49.4% of patients

57
Q

Define ophiasis

A

Pattern of hair loss that is localized to the sides and lower back of the scalp

58
Q

Define tinea capitis

A

Infection of the scalp with a dermatophyte fungi

59
Q

Demographics of tinea capitis

A

Pre-school and school aged children

Black children

60
Q

Define the seborrheic type of tinea capitis

A

Scaling of scalp, often without noticeable hair loss

61
Q

Define tinea capitis with black dot

A

Small black dots (stubs of broken hairs) within areas of alopecia

62
Q

Define tinea capitis kerion

A

A boggy inflammatory mass surrounded by follicular pustules due to a hypersensitivity reaction to the fungal infection

63
Q

2 potential accompanying symptoms of tinea capitis kerion

A

Fever

Local lymphadenopathy

64
Q

3 potential misdiagnoses in the event of tinea capitis kerion

A

Impetigo
Cellulitis
Abscess

65
Q

Define grey patch tinea capitis

A

Circular patches of alopecia with marked scaling with broken hair close to the surface

66
Q

2 causes of tinea capitis

A

T. tonsurans

M. canis

67
Q

How is T. tonsurans spread?

A

From one person to another (anthropophilic)

Remains viable on combs, hairbrushes and other fomites for long periods of time

68
Q

How is M. canis spread?

A

Zoophilic (grows naturally on an animal) so spreads to human by contact with an infected kitten or rarely an older cat or dog

69
Q

How to diagnose tinea capitis

A

Scraping –> KOH and culture

70
Q

3 treatment points for tinea capitis

A
  • Oral lamisil for 4 - 6 weeks
  • Loprox lotion BID during the Tx period
  • Topical therapy reduce infectivity
71
Q

4 preventive measures to prevent the spread of tinea capitis

A
  • Treat the close contacts if affected
  • Clean brushes and combs in bleach solution
  • No sharing of hair brushes, combs and hats
  • Using the Nizoral shampoo for all the family to prevent reinfection
72
Q

Define scalp psoriasis

A

Discrete erythematous plaques covered by a silver-gray scale. Affects hair margins; pruritis possible.

NOTE: No alopecia

73
Q

Define trichotillomania

A

Habitual, compulsive plucking of hair

74
Q

Consequence of trichotillomania

A

A well-defined area of hair loss with shortened, broken-off hairs of different lengths (frontotemporal or parietotemporal)

An obsessive compulsive disorder

75
Q

Treatment for trichotillomania

A

Habit should be stopped –> psychiatric evaluation

76
Q

What should be ruled out if localized non-cicatricial alopecia presents as scaly

A

Tinea capitis

77
Q

What is the diagnosis if the patient presents with localized non cicatricial alopecia that is not scaly and with exclamation mark hair

A

Alopecia areata

78
Q

What is the diagnosis if the patients presents with non-cicatricial alopecia that is not scaly and with shortened, broken-off hairs of different lengths

A

Trichotillomania

79
Q

Define androgenetic alopecia

A

Genetically determined sensitivity of scalp hair follicles to adult levels of androgens –> loss of hair in frontotemporal and vertex area

80
Q

Prevalence of androgenetic alopecia

A

Common disorder affecting roughly 50% of men and women older than 40 years

81
Q

Describe the progression of androgenetic alopecia in men

A

1) Bitemporal recession of the frontal hairline
2) Diffuse thinning over the vertex of scalp
3) Bald patch progressively enlarges –> eventually joins receding frontal hairline
4) Just marginal parietal and occipital hair left

82
Q

Describe the progression of androgenetic alopecia in women

A

Diffuse central thinning of the crown with preservation of the frontal hair line

83
Q

Metabolite with a dominant role in androgenetic alopecia

A

DHT (testosterone metabolite)

84
Q

What regulates DHT production

A

5-alpha reductase (found in hair follicles!)

85
Q

Describe the levels of 5-alpha reductase in androgenetic alopecia

A

Higher levels of 5-alpha reductase –> more androgen receptors

86
Q

Effect of DHT on hair

A

Shorten the growth phase of the hair from a usual duration of 3 - 6 years to just weeks or months –> miniaturisation of the follicles and lower production and finer anagen hairs

87
Q

2 drugs to treat androgenetic alopecia

A

Minoxidil

Finasteride

88
Q

Describe the supposed effects of minoxidil

A

Lengthen duration of anagen phase
May increase blood supply to follicle
At least 4 months to have effect

89
Q

Consequence of discontinuing minoxidil

A

Rapid reversion to the pretreatment balding pattern

90
Q

Define finasteride

A

5-alpha reductage type 2 inhibitor

91
Q

Effect of finasteride

A

Diminish the progression of androgenetic alopecia and may stimulate new regrowth

92
Q

Define telogen effluvium

A

Generalized and diffuse hair loss (not normally permanent)

Increased percentage of hair follicles are in a resting phase than would normally be expected

93
Q

6 causes of telogen effluvium

A
  • Hypo- or hyperthyroidism
  • Postpartum
  • Dietary insufficiency
  • Medication
  • Surgery
  • Systemic illness
94
Q

Timeline of telogen effluvium

A
  • Loss within 3 - 5 weeks of inciting signal
  • Shedding continues for about 3 - 4 months after removal of cause
  • Hair density may take 6 - 12 months to return to baseline

Block F -- Defense (4 decks)

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