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Dermatology > Hair and Digit Tip Disorders > Flashcards

Hair and Digit Tip Disorders Flashcards

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Dermatology Board Prep flashcards
1
Q

Phases of hair growth

A

Intermittent activity followed by inactivity and expulsion

Anagen
Catagen
Telogen
Exogen

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2
Q

What is anagen?

A

Growth stage, phase of normal active growth

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3
Q

What is catagen?

A

Degenerative stage, brief transition in which hair growth stops
hair follicle detaches from nourishment of blood supply

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4
Q

What is telogen?

A

Resting phase
No nourishment from blood supply, hair dies and falls out

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5
Q

What is exogen?

A

hair shedding phase

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6
Q

What is the duration of the anagen phase for scalp? Legs? Arms? Eyelashes?

A

Scalp: 2-8 years
Legs: 5-7 months
Arms: 1.5-3 m
Eyelashes: 4-6 weeks

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7
Q

What is lanugo?

A

soft, fine hair
covers fetus
usually shed before birth

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8
Q

What is intermediate hair?

A

Has characteristics of vellus and terminal hairs (on scalp)

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8
Q

What is vellus hair?

A

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

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9
Q

What is terminal hair?

A

Thick, pigmented hair found on scalp, beard, axilla, pubic area
Eyelash and eyebrow hair
Growth influenced by hormones

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10
Q

What is a hair pull test?

A

Scalp gently pulled
Normal: 3-5 hairs are dislodged
Abnormal: >5 hairs dislodged

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11
Q

When would scalp biopsy be helpful?

A

Scraping or shave biopsy shows insight into pathogenesis

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12
Q

What is the goal of a trichogram? How does anagen vs telogen appear?

A

Determine anagen to telogen ratio by plucking 50 hairs from the scalp
Anagen: growing hairs with long encircling hair sheath
Telogen: resting hairs with inner root sheath and roots largest at base

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13
Q

What is alopecia?

A

Hair loss in a variety of patterns and causes
Most common = androgenic alopecia

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14
Q

What is androgenic alopecia?

A

Male and female pattern baldness
Gradual converstion of terminal hairs into indeterminate vs vellus hairs

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15
Q

Risk factors for androgenic alopecia?

A

Genetic predisposition to androgen effecting hair follicles
Male
White men>black and asian

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16
Q

Classification of androgenic alopecia?

A

Ludwig-Savin classification for females
Norwood Hamilton Classification for males

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17
Q

How does female hair loss tend to present? Male?

A

Widened hair line
Male: top of scalp

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18
Q

What age is androgenic alopecia most common?

A

Men: after puberty and fully expressed by 40
Women: MC after 50

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19
Q

What causes androgenic alopecia?

A

Atrophy of hair follicle due to DHT causing terminal follicles to transform into vellus like hair follicles
During successive follicular cycles hairs are shorter lengths and of decreased diameter

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20
Q

H&P of androgenic alopecia

A

Gradual thinning noted
Typically otherwise normal
Women: increased androgen such as acne, hirsutism, irregular menses

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21
Q

Diagnosis of androgenic alopecia

A

Typically clinical
Can do biopsy: telogen phase follicles and atrophic follicles
Trichogram: increased telogen hairs
Hormone studies: testosterone total and free, DHEAS, prolactin

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22
Q

What are treatable causes of androgenic alopecia?

A

Thyroid
Anemia
Autoimmune

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23
Q

Treatment of androgenic alopecia

A

Topical minoxidil/rogaine 2% or 5% BID
5% typically for males
Warn about hair loss
Oral finasteride 1 mg PO daily for men only

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24
Q

What is the mechanism of action of finasteride?

A

inhibits testosterone to DHT to slow hair loss in 3 months, regrowth in 6 months

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25
Q

What medication for androgenic alopecia can be used in females?

A

Spironolactone 50-100 mg QD, blocks action of DHT

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26
Q

What additional non medication treatments can be given for androgenic alopecia?

A

Hair transplant (expensive $10-20,000)
Hair piece/wig

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27
Q

What is alopecia areata?

A

Localized loss of hair in round or oval areas with no apparent inflammation of the skin due to T cell autoimmune disorder
Non-scarring
+/- nails

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28
Q

What is the epidemiology of alopecia areata?

A

MC for hair loss in children
<25 yo MC
Usually family history
Maybe increased stress?

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29
Q

What is the pathology of alopecia areata?

A

Damage to hair follicles in anagen stage
Leads to rapid transformation to catagen and telogen –» dystrophic
Active = cannot progress beyond anagen
No scarring

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30
Q

Presentation of alopecia areata

A

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

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31
Q

MC areas affected by alopecia areata

A

Scalp
Beard
Eyebrows
Extremities

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32
Q

What is the presence of alopecia areata on dermoscopy?

A

Black dots
Exclamation hairs: blunt distal end and taper proximally, appear when broken hair are pushed out of follicles

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33
Q

Subtypes of alopecia areata

A

Alopecia areata: solitary or multiple areas of hair loss
AA totalis: total loss of terminal scalp hair
AA universalis: total loss of all terminal body and scalp hair

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34
Q

Patterns of alopecia areata

A

Ophiasis: bandlike pattern of hair loss over periphery of scalp
Nails: fine pitting of dorsal nail plate

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35
Q

DDx of alopecia areata

A

Tinea capitis: scaly itchy
Trichotillomania: psych
Early scarring alopecia: shiny taut area
Androgenic alopecia
Secondary syphilis

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36
Q

Diagnosis of alopecia areata

A

Generally clinical
Biopsy if not responding
RPR: syphilis
KOH: r/o fungal
ANA: autoimmune
Thyroid panel: endocrine

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37
Q

Course of alopecia areata

A

Majority have spontaneous remission with onset after puberty (80%)
Recurrence can happen

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38
Q

What are predictors of poor prognosis of alopecia areata?

A

Childhood onset
Body hair involvement
Nail
Atopy
Family history

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39
Q

Treatment goals for alopecia areata?

A

Decrease inflammation and reduce growth inhibitors

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40
Q

Treatment of alopecia areata

A

Psych consult is helpful
Noninvasive: wigs or hair piece
Topical CS: class 1 and 2 with minoxidil
Itralesional kenalog into plaques
Systemic: short term prednisone 20-40 mg daily tapered by 5 mg daily with a few weeks
Minoxidil (in combo with CS)
Anthralin

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41
Q

Can anthralin be used in kids?

A

Safe in kids

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42
Q

What is the MOA in anthralin and what do you need to be aware of?

A

Keratolytic agent
Hair regrowth takes 2-3 months
Avoid face

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43
Q

What is keratosis pilaris?

A

Common condition resulting from hyperkeratinization of the skin and keratotic follicular plugging
Affects nearly 50-80% of adolescents and 40% of adults

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44
Q

Risk factors for keratosis pilaris?

A

Family history (30-50%)

45
Q

Pathophysiology of keratosis pilaris

A

Excess formation and/or buildup of keratin leads to abrasive goose-bump texture of skin

46
Q

Historical factors for keratosis pilaris

A

Associated conditions: ichthyosis vulgaris, xerosis, and less commonly, atopic dermatitis/asthma/allergies
Worsens in winter and improves in summer

47
Q

Patterns of keratosis pilaris

A

Early childhood: affects face and arms and gradually improves in later childhood or adolescence
Adolescence: affects extensor arms and legs, improves by mid-20s

48
Q

Clinical presentation of keratosis pilaris

A

Referred to as chicken/goose bumps or chicken/goose skin
Often asymptomatic with occasional pruritis
Small 1-2 mm rough papules scattered over affected area, upper outer arm and thighs MC
+/- erythema if associated inflammation

49
Q

diagnosis of keratosis pilaris

A

clinical
biopsy if atypical presentation: see follicular orifice distended by keratin plug

50
Q

treatment of keratosis pilaris

A

maintain skin hydration with mild gentle soaps and unscented moisturizer lotions 2-3x/d
OTC cetaphil, lubriderm; rx lac-hydrin (lactic acid lotion) to provide moisture and gentle exfoliation 2x/d
Reduce inflammation (if present) with steroid cream 1-2 x/d for 7-10 days
Keratolysis: salicylic acid, topical urea, topical retinoids

51
Q

SE of keratolysis

A

inflammation

52
Q

What is the cuticle?

A

Protective area of skin that covers matrix

53
Q

What is the problem with manicures and pedicures?

A

Can cut cuticle which protects

54
Q

What is onychocryptosis?

A

Nail grows into one side or both of the paronychium or nail bed

55
Q

Who MC gets onychocryptosis

A

males in 20s

56
Q

pathology of onychocryptosis

A

impingement of nail into dermal tissue distally or into distolateral nail groove

57
Q

clinical presentation of onychocryptosis

A

FB inflammation
erythema
edema
purulence
granulation tissue

58
Q

risk factors for onychocryptosis

A

shoes
sweating
genetics
dystrophy
fungus
improper cutting
neuropathy/diabetes

59
Q

where is onychocryptosis MC located?

A

great toe worse with movement or pressure

60
Q

What is a patient education factor for onychocryptosis

A

loose shoes

61
Q

complications of onychocryptosis

A

paronychia
cellulitis
osteomyelitis
bacteremia
sepsis

62
Q

treatment of onychocryptosis

A

warm soaks
antibiotic ointment: mupirocin BID until healed
trimming of nail (properly/not over trimming)
training (cotton)
surgical: complete or partial nail removal or matrixectomy (often needed)

63
Q

what should be done after onychocryptosis procedure

A

keep clean with antibacterial soap and water
mupirocin antibiotic ointment
resume activity after 48-72 hours

64
Q

what is onychomycosis?

A

AKA tinea unguium
fungus of the nail

65
Q

where is onychomycosis MC

A

toes

66
Q

what causes onychomycosis

A

trichophyton rubrum

67
Q

pathophysiology of onychomycosis

A

fungus invades nail via hyponychium

68
Q

symptoms of onychomycosis

A

asymptomatic
discoloration MC complaint
thickening
lifting of nail from the bed

69
Q

risk factors for onychomycosis

A

family history
old age
poor health
trauma (repetitive)
climate
fitness (sweaty feet)
immunosuppression
communal bathing
footwear (treat as well if + culture)

70
Q

ddx for onychomycosis

A

psoriasis: pitting and oil stains
Lichen planus
trauma

71
Q

what needs to be ruled out with any discoloration of the toenail?

A

melanoma (clinically off history or biopsy)
would see pigmented dark band (nevus or melanoma of nail bed)

72
Q

work up for onychomycosis

A

nail clipping or scraping
clip toenail and send for biopsy
scrape under nail and do KOH with no antifungals for 2 weeks prior to sample

73
Q

Treatment of onychomycosis

A

Topical or oral antifungal

Topical Ciclopirox or Efinaconazole x 48 weeks
Oral terbinafine for 6 weeks for fingers or 12 weeks for toes

Home remedy: 50/50 apple cider vinegar and water 10 mins a day soaks

74
Q

Lab monitoring with use of terbinafine

A

CBC and LFTs @ baseline and then monthly

75
Q

What are risks of terbinafine

A

Hepatotoxicity
Pancytopenia
Agranulocytosis

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

76
Q

What is onycholysis

A

Detachment from nail bed

77
Q

Presentation of onycholysis

A

Whitish or opaque disoloration
Gray-back = air
Green = bacteria
No inflammation
smooth nails

78
Q

Treatment of onycholysis

A

Eliminate what is causing nail to lift

79
Q

What is paronychia?

A

Inflammation of proximal or lateral nail fold
Begins as cellulitis and progresses to abscess

80
Q

MCC of paronychia

A

trauma with secondary bacterial infection
most common pathogen = staph

81
Q

RFs for paronychia

A

Nail biting
Sucking
Trauma
Chemical irritants
Nail glue
Sculpted nails (over trimming of cuticle)
Frequent hand washing (ie OCD)

82
Q

S/s of acute paronychia MC due to staph

A

Painful
Tender
Swelling
Erythema
+/- purulence, green = pseudomonas

83
Q

Diagnosis of acute paronychia

A

Gram stain
C&S
KOH
Tzanck = Herpetic whitlow
Xray (if really infected)

84
Q

Treatment of acute paronychia

A

Warm soaks 3-4 x daily until resolution
Fluctuant = I&D
Oral antibiotics when cellulitis or if DM, PVD, Immunocompromised
Augmentin 500 mg BID x 10 days
Clindamycin
Cephalexin

85
Q

What are indications for consultation of hand surgeon for acute paronychia?

A

Significant cellulitis or lymphangitis
Tenosynovitis
Deep space infection
Osteomyelitis

86
Q

What can cause chronic paronychia?

A

Fungal
Mechanical
Chemical

Repeat exposure

87
Q

Symptoms of chronic paronychia

A

Inflammation waxes and wanes
Pain
Swelling
Usually 6 weeks or longer

88
Q

PE of chronic paronychia

A

Swelling
Erythema
Tenderness
+/- thickening or discoloration (possible fungal infection also)

89
Q

Treatment for chronic paronychia

A

Avoid RFs
Keep dry
Avoid manipulation
Warm antiseptic soaks - then dry
Topical antifungals if necessary, severe oral

90
Q

Where does herpetic whitlow affect?

A

Distal finger

91
Q

MC organisms in herpetic whitlow

A

HSV-1 or gingivostomatitis in children
HSV-2 in adults

92
Q

What are RF for herpetic whitlow in children? Adults?

A

Children: sucking thumb or finger
Adults: healthcare worker

93
Q

Incubation period for herpetic whitlow

A

2-14 days

94
Q

Presentation of herpetic whitlow

A

Before lesion begins:
Burning
Pruritis
Vesicular
Swelling
Tender
Induration

95
Q

Diagnosis of herpetic whitlow

A

Clinical
Can use Tzanck

96
Q

Treatment of herpetic whitlow

A

Do not I&D
Self limiting x 3 weeks but contagious
OTC pain meds
Acyclovir
Valacyclovir

97
Q

What is felon

A

Soft tissue infection of pulp space of distal pharynx caused by infection (created by fibrous septa passing between skin and periosteum)

98
Q

Hx in felon

A

penetrating injury
slint
paronychia

99
Q

clinical presentation of felon

A

pain
erythema
swelling
abscess

100
Q

distribution of felon

A

thumb
index finger

101
Q

complications of felon

A

osteitis
osteomyelitis
septic joint
tenosynovitis

102
Q

course of felon

A

rapid and severe

103
Q

workup for felon

A

gram stain with C&S
Tzanck if herpetic whitlow suspected
x ray

104
Q

management of felon

A

PO antibiotic (augmentin BID x 10 days)
surgical decompression

105
Q

causes of clubbing of the nail

A

infection
neoplasm
inflammatory
vascular diseases

106
Q

causes of pigmentation of the nails

A

melanonychia due to melanocyte proliferation due to trauma, inflammatory nail disorders, drugs, nonmelanocytic tumors
nail matrix nevi
lentigo
melanoma
blood deposition due to trauma

107
Q

causes of pitting of the nails

A

psoriasis
alopecia areata
eczema

108
Q

causes of splinter hemorrhages

A

MC trauma and nail psoriasis
lichen planus
derier disease
infective endocarditis
connective tissue disease
antiphospholipid syndrome
chronic renal failure
trichenollosis

109
Q

causes of terry’s nails

A

liver cirrhosis and chronic diseases
(leukonychia of proximal 2/3 nails)

110
Q

causes of Beau’s lines

A

caused by temporary arrest of nail proliferation and appear as transverse grooves
local trauma
local cutaneous diseases (dermatitis, paronychia)
drugs
viral infections
pemphigus
Kawasaki disease

111
Q

What are the variants of onycholysis?

A

Primary: idiopathic or mechanical/chemical damage
Trauma: occupational injury in fingers or podiatric abnormalities/improper shoes in toenails
Secondary: vesiculobullous disorders, nail bed hyperkeratosis, nail bed tumors

Dermatology (12 decks)

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