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Clin Med III: Dermatology > Hair and Digit Tip Disorders > Flashcards

Hair and Digit Tip Disorders Flashcards

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1
Q

phases of hair growth cycle

A
  • Anagen - growth stage, phase of normal active growth
  • Catagen - degenerative stage, brief transition in which hair growth stops
  • Telogen - resting phase
  • Exogen - hair shedding phase

Phases of growth are followed by periods of inactivity and then expulsion

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2
Q

Duration and rate of growth of anagen phase determines what?

A

ultimate length of hair in that area

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3
Q

Duration and rate of growth of scalp?
legs?
arms?
eyelashes?

A
  • Scalp: 2-8 y
  • Legs: 5–7 m
  • Arms: 1.5–3 m
  • Eyelashes: 4-6 w
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4
Q

soft, fine hair that covers much of the fetus; usually sheds before birth

A

Lanugo hair

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5
Q

fine, non-pigmented hair that covers the body of children and adults; not affected by hormones - aka “peach fuzz”

A

Vellus hair

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6
Q

characteristics of vellus and terminal hairs (occur on scalp)

A

Intermediate hair

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7
Q

thick, pigmented hair found on the scalp, beard, axilla, pubic area; eyelash and eyebrow hair in which growth is influenced by hormones

A

Terminal hairs

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8
Q

w/u for hair loss

A
  1. hair pull
  2. scalp bx - scraping or shave
  3. Trichogram
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9
Q

nml and abnml finding for hair pull

A
  • Normal: 3 - 5 hairs are dislodged
  • Abnormal: > 5 hair suggest pathology
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10
Q

goal of Trichogram ?

A

determine the anagen to telogen ratio

hair loss

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11
Q

trichogram shows growing hairs with a long encircling hair sheath

what type of hair?

A

Anagen hairs

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12
Q

Trichogram reveals resting hairs with an inner root sheath and roots usually largest at the base.

what type of hair?

A

Telogen hairs

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13
Q

normal findings of Trichogram

A

80-90% of hairs are anagen

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14
Q

MC form of alopecia

A

androgenic - Male and female pattern baldness

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15
Q

classifications for androgenic alopecia?

A
  • women: Ludwig-savin classification
  • men: norwood hamilton
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16
Q

Androgenic Alopecia MC in who and when?

A
  • Men > Women - white > black > Asian men
  • Men - after puberty (early as 20’s) - Typically fully expressed by 40
  • Women - MC after 50
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17
Q

what hormone causes terminal follicles to transform into vellus like hair follicles
- atrophy

A

DHT

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18
Q

During successive follicular cycles - hairs produced are _____ lengths and of _____ diameter

A
  • shorter
  • decreased
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19
Q

w/u for androgen alopecia?
findings?

A
  1. Bx - telogen phase follicles & atrophic follicles
  2. Trichogram - ^ telogen hairs
  3. Hormones - Testosterone total and free, DHEAS, Prolactin
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20
Q

3 treatable conditions that could be causing androgen alopecia

A
  1. Thyroid
  2. Anemia
  3. Autoimmune
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21
Q

tx for androgenic alopecia

A
  1. Minoxidil /Rogaine 2 or 5% solution BID; Warn about hair loss
  2. Finasteride - MEN ONLY
  3. Spironolactone - Females
  4. hair transplant, wigs
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22
Q

MOA of Finasteride

A
  • Inhibits testo to DHT
  • Slows hair loss in 3 months, regrowth in 6 months
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23
Q
  • localized loss of hair in round or oval areas with no apparent inflammation of the skin
  • T cell mediated autoimmune disorder - Non scarring; +/- nails
A

Alopecia Areata

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24
Q

MC for of hair loss in children
< 25 yo MC

A

Alopecia Areata

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25
Q

pathology of Alopecia Areata

A
  1. damage to hair follicle in anagen stage
  2. rapid transformation to catagen and telogen = dystrophic
  3. Active = cannot progress beyond anagen
  4. No scarring
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26
Q

s/s of Alopecia Areata
MC areas

A
  • Patchy hair loss
  • Weeks to months
  • Oval/round
  • Defined borders
  • Bald patches
  • Skin seems normal = no scarring

MC areas: Scalp, Beard, Eyebrows, Extremities

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27
Q
  1. “Black dots”
  2. Dermoscopy - breaks before surface
  3. Exclamation hairs
    - Blunt distal end and taper proximally
    - Appear when broken hair are pushed out of the follicle
A

Alopecia Areata

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28
Q

subtypes of Alopecia Areata

A
  • Alopecia areata (AA) - Solitary or multiple areas of hair loss
  • AA totalis (AAT) - Total loss of terminal scalp hair
  • AA universalis (AAU) - Total loss of all terminal body and scalp hair
  • Ophiasis - Bandlike pattern of hair loss over periphery of scalp.
  • Nails - Fine pitting (“hammered brass”) of dorsal nail plate.
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29
Q

w/u for alopecia areata

A
  • Biopsy
  • RPR – syphilis
  • KOH – fungal
  • ANA – autoimmune
  • Thyroid Panel – endocrine
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30
Q

mgmt and prognosis for Alopecia Areata

A
  • Spontaneous Remission: Onset – after puberty = 80%; Recurrence happens
  • Psych consult
  • Noninvasive - Wigs, Hair piece
  • Topical CS: Class 1 & 2 w/ Minoxidil; ILK
  • Systemic: Short term; Pred 20-40 mg daily; Taper by 5mg daily with a few weeks
  • Minoxidil 5% - best with CS
  • Anthralin - Safe in kids, avoid face
  • Poor prognosis: Childhood onset, Body hair involvement, Nail, Atopy, Family hx
31
Q
  • A common condition resulting from hyperkeratinization of the skin and keratotic follicular plugging
  • Affects nearly 50-80% of all adolescents and approximately 40% of adults
  • Genetic predisposition with 30-50% having a positive family history
  • Worsen in winter and improves in summer
A

Keratosis Pilaris

32
Q

pathophys of Keratosis Pilaris

A

An excess formation and/or buildup of keratin leads to the abrasive goose-bump texture of the skin

33
Q

associated conditions with Keratosis Pilaris

A

ichthyosis vulgaris, xerosis, and, less commonly, atopic dermatitis, asthma and allergies

34
Q

presentation of Keratosis Pilaris during early childhood

A
  • Affects the face and arms
  • Gradual improvement in later childhood or adolescence
35
Q

presentation of keratosis pilaris during adolescence

A
  • Affects the extensor arms and legs
  • Improves by the mid-20s
36
Q
  1. chicken/goose bumps or chicken/goose skin
  2. asx with occasional pruritus
  3. Small 1-2 mm rough papules scattered over affected area
    - MC Upper outer arm and thighs
  4. (+/-) Erythema if associated inflammation
A

Keratosis Pilaris

37
Q

w/u for Keratosis Pilaris

A
  1. Bx can be utilized if presentation is atypical
    - histology - follicular orifice distended by a keratin plug
38
Q

tx for keratosis pilaris

A
  1. Mild soaps
  2. unscented lotions 2-3 x/d
    - OTC - Cetaphil, Lubriderm
    - Rx - Lac-Hydrin
  3. Steroid cream 1-2x/d x 7-10 d
  4. Keratolysis - SA, topical urea, topical retinoids
39
Q

Nail grows into one side or both of the paronychium or nail bed
MC in males
MC in 20’s
MC on great toe

A

Onychocryptosis

40
Q

pathophys of Onychocryptosis

A
  • impingement of the nail into the dermal tissue distally or into the distolateral nail groove
  • Nail = FB inflammation - Erythema, Edema, Purulence, Granulation tissue
41
Q

RF Onychocryptosis

A
  1. Shoes
  2. Sweating
  3. Genetics
  4. Dystrophy
  5. Fungus
  6. Improper cutting
  7. Neuropathy/diabetes
42
Q

complications of onychocryptosis

A
  1. Paronychia
  2. Cellulitis
  3. Osteomyelitis
  4. Bacteremia
  5. Sepsis
43
Q

mgmt for onychocryptosis

A
  1. Warm soaks
  2. mupirocin BID until healed
  3. Trimming of nail (properly)
  4. Training (cotton)
  5. Surgical - Complete or partial nail; Matrixectomy
44
Q

after procedure mgmt for Onychocryptosis

A
  1. Keep clean with normal soap and water
  2. Antibacterial
  3. Mupirocin
  4. Resume activity after 48-72 hours
45
Q

Aka tinea unguium
Fungus of the nail
MC on toes
Fungus invades the nail via the hyponychium

A

Onychomycosis

46
Q

cause of Onychomycosis

A

trichophyton rubrum

47
Q

s/s Onychomycosis

A
  • Asymptomatic
  • Discoloration MC complaint
  • Thickening
  • Lifting of the nail from the bed
48
Q

RF Onychomycosis

A
  1. Family History
  2. Old age
  3. Poor health
  4. Trauma
  5. Climate
  6. Fitness
  7. Immunosuppression
  8. Communal bathing
  9. Footwear
49
Q

what needs to be r/o with ANY discoloration of the toenail

A

MELANOMA
needs to be ruled out clinically off history or biopsy

50
Q

w/u for Onychomycosis

A

Nail clipping or scraping

  1. Clip toenail - bx
  2. Scrap from under the nail - KOH
    - No Antifungals for 2 wks prior to sample
51
Q

mgmt for Onychomycosis

A
  1. Ciclopirox (Penlac)
  2. Efinaconazole (Jublia) Daily x 48 weeks
  3. Home: 50/50 apple cider vinegar + water x 10 mins/d soaks
  4. Terbinafine - 6 wks for fingers; 12 wks for toes
52
Q

labs for Terbinafine

A

CBC and LFT’s @ baseline and then monthly
Risks: hepatotoxicity, pancytopenia, agranulocytosis

53
Q

onychomycosis may take how long to be resolved?

A

a year for nail to completely grow out therefore discoloration may still be present

54
Q

Detachment form the nail bed

A

Onycholysis

55
Q

causes of Onycholysis

A
  1. primary: idiopathic, mechanical/chemical damage
  2. trauma
  3. secondary: vesiculobullous dz, nail bed hyperkeratosis, nail bed tumors
56
Q
  • Whitish or opaque discoloration
  • NO inflammation
  • Smooth nails
A

Onycholysis

57
Q

gray/black Onycholysis indicates ?
green?

A
  1. Gray/black = air
  2. Green = bacteria
58
Q
  • Inflammation of the proximal or lateral nail fold
  • Begins as cellulitis and progresses to abscess
  • MCC Trauma - Secondary bacterial infection
A

Paronychia

59
Q

RF Paronychia

A
  1. Nail biting
  2. Sucking
  3. Trauma
  4. Chemical irritants
  5. Nail glue
  6. Sculpted nails
  7. Frequent hand washing
60
Q

MC pathogen of Acute Paronychia

A

staph
Green = pseudomonas

61
Q

w/u for Acute Paronychia

A
  • Gram stain
  • C&S
  • KOH
  • Tzanck = HW
  • Xray
62
Q

tx for Acute Paronychia

A
  1. Warm soaks 3-4x daily
  2. Fluctuant = I&D
  3. Oral abx when cellulitis (DM, PVD, Immunocomp)
    - Augmentin 500mg/125mg BID x 10 d
    - Clindamycin
    - Cephalexin
63
Q

when to consult hand surgeon for Acute Paronychia

A
  1. Significant cellulitis or lymphangitis
  2. Tenosynovitis
  3. Deep space infection
  4. Osteomyelitis
64
Q

s/s of chronic paronychia

A
  • Fungal/mechanical/chemical - From repeat exposure
  • Inflammation waxes and wanes
  • Pain
  • Swelling - Usually x 6 weeks
  • Swelling, Erythema, Tenderness, +/- thickening or discoloration (Possible fungal infection also)
65
Q

mgmt for Chronic Paronychia

A
  1. Avoid RF’s
  2. Keep dry
  3. Avoid manipulation
  4. Warm antiseptic soaks – then dry
  5. Topical antifungals if necessary; Severe – PO antifungals
66
Q

Herpetic Whitlow MC what viruses?

A
  1. MC HSV -1 or gingivostomatitis children
    - RF: sucking thumb or finger
  2. MC HSV -2 adults
    - RF: Healthcare worker

2-14 day incubation

67
Q

s/s of herpetic whitlow

A

Before lesions begins..

  1. Burning
  2. Pruritus - Vesicular, Tender, Swelling, Induration
68
Q

w/u for herpetic whitlow

A
  1. clinical
  2. Tzanck
69
Q

mgmt for herpetic whitlow

A
  1. Do not I&D
  2. Self limiting x 3 wks
  3. Contagious
  4. OTC pain meds
  5. Acyclovir, Valacyclovir
70
Q
  • Soft tissue infection of pulp space of distal phalanx
  • Caused by infection (created by fibrous septa passing between the skin and periosteum)
  • Hx: penetrating injury, splint, and paronychia
A

Felon

71
Q

distribution of Felon?

A
  • Thumb
  • Index finger
72
Q

complications of felon

A
  1. Osteitis
  2. Osteomyelitis
  3. Septic joint
  4. Tenosynovitis
73
Q

w/u and mgmt for felon

A
  • Gram stain with C&S; Tzanck if Herpetic Whitlow suspected; X ray
  • Augmentin BID x 10 d; Surgical decompression

Clin Med III: Dermatology (13 decks)

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