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Derm Exam 1 > Hair and Digit tip disorders > Flashcards

Hair and Digit tip disorders Flashcards

1
Q

Androgenetic Alopecia AKA

A

“pattern ballness”
o The most common type of progressive hair loss

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2
Q

Epidemiology/etiology of Androgenetic Alopecia

A

● Male > Female
○ Male – start after puberty, usually manifests by 40s
○ Female – 60s (postmenopausal)
● Gradual onset
● Hair is lost in a pattern
● Occurs through a combination of:
○ Genetic predisposition
○ Action of androgen on scalp hair follicles

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3
Q

Symptoms of Androgenetic alopecia in males

A

● Hair becomes finer in texture. In time, hair becomes vellus and eventually atrophies completely
● Loss of hair in the frontotemporal and vertex areas
● A rim of residual hair on the lateral and posterior scalp typically never falls out

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4
Q

Symptoms of androgenetic alopecia in women

A

● Hair loss in similar pattern as males but far less pronounced and
more diffuse
● No receding hairline (usually)
● Shortened anagen cycles - hair follicles get smalle

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5
Q

Diagnosis of androgenetic alopecia

A

● Clinical diagnosis – history, physical, pattern of alopecia, and family incidence
● Labs – Free and total testosterone and DHEAS levels
○ PSA; TSH/T4 (thyroid conditions); CBC, serum iron, serum ferritin (iron
deficiency); ANA (connective tissue disease)
○ Women – no hormonal eval unless signs of hyperandrogenism

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6
Q

Androgenetic Alopecia treatment in Men

A

No restrictions on frequency of washing, combing, hair coloring, etc
Finasteride (Propecia) – 1 mg PO daily
Minoxidil (Rogaine) – 2% or 5% solution applied topically
Hairpiece
Surgical treatment

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7
Q

Finasteride MOA

A

Inhibits type II 5-alpha-reductase, thereby reducing the conversion of
testosterone to DHT and mitigating its effects on hair follicles

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8
Q

Minoxidil (Rogaine) MOA

A

unknown
○ Vasodilator, may increase blood supply to follicle
● Helpful in reducing the rate of hair loss
○ Therapy for 4 months may be necessary for hair growth
○ May be used continuously to preserve re-growth

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9
Q

Androgenetic Alopecia treatment in women

A

Minoxidil (Rogaine) – 2% or 5% solution applied topically
Spironolactone 100-200 mg daily
Women with androgenetic alopecia, who desire an oral contraceptive should choose one with little androgenic activity
● Norgestimate
● Desogestrel

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10
Q

Surgical treatment options for Androgenetic alopecia

A

● Hair transplantation – Graft of one or two follicles from androgen-insensitive region to bald androgen-sensitive scalp areas
● Scalp reduction – stretching the hairy part
over the part with no hair (see next slide)

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11
Q

Alopecia Areata

A

● A RAPID, localized, well-demarcated, loss of hair with no apparent
inflammation of the skin

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12
Q

Etiology of alopecia areata

A

● Believe to be caused by autoimmune
destruction of hair follicles
○ T cell-mediated immune attack on
hair follicles
○ Genetically predisposed
● Can occur at any age – children (&
young adults) affected more
frequently

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13
Q

Alopecia Areata symptoms

A

● It manifests as discrete circular patches of
hair loss characterized by short broken
hairs at the margins
● Typically asymptomatic

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14
Q

Alopecia areata types

A

Alopecia areata (AA): Solitary or multiple areas of hair loss
Alopecia areata totalis (AAT): Total loss of terminal scalp hair
Alopecia areata universalis (AAU): Total loss of all terminal scalp and body hair

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15
Q

Alopecia Areata physical exam findings

A

● Circular patches of hair loss
● Yellow or black dots on skin (see next slide)
● Broken hair shafts (“Exclamation point hairs”)
● Smooth skin (terminal hair loss)
● Nail pitting and other abnormalities
● Positive “hair pull test”

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16
Q

Hair pull test

A

○ Identifies active hair loss
○ Tug on 20-60 hair fibers close to skin surface. The easy extraction of
6+ fibers (>10%) suggests active hair loss

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17
Q

What are “exclamation point hair”?

A

Exclamation point hairs are short,
broken hairs that can be extracted
with minimal traction and where the
proximal end of the hair is narrower
than the distal end

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18
Q

Alopecia Areata diagnosis

A

● Clinical diagnosis (Hx, physical)
● Hair pull test to confirm active hair loss
● Biopsy, if atypical or unclear presentation
● Assess for thyroid disorders

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19
Q

Alopecia Areata typical coarse

A

● Spontaneous remission is common in AA
o Remission is uncommon with AAT or AAU
● Poor prognosis associated with onset in childhood, loss of body hair, family history of AA
● If occurring after puberty, 80% regrow hair
○ With extensive involvement, <10% recover spontaneously
● Recurrences of AA are frequent
● Systemic glucocorticoids or cyclosporine (immunosuppressant) can induce remission of AA but do not alter the course

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20
Q

Alopecia Areata treatment

A

● No curative treatment
● Treatment focused on inflammatory causes
● Treatment not mandatory because the condition is benign
● Triamcinolone
● Systemic cyclosporine may induce hair growth but recurrence is high when drug is stopped. Often avoided.
● Photochemotherapy (Psoralen plus UV A) works in 20-78% of patients; relapse rates are high

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21
Q

Extends from the proximal nail fold
and functions as a seal

A

Cuticle

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22
Q

Onychocryptosis AKA

A

“Ingrown nail”

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23
Q

Commonly a result of poor fitting shoes,
prior trauma, abnormal shape of the
nail margin

A

Onychocryptosis
“Ingrown nail”

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24
Q

Onychocryptosis symptoms

A

● Redness or swelling of the surrounding
tissue/lateral nail fold
● Pain with ambulation
● Crusting and/or purulent material

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25
Treatment – Conservative of Onychocryptosis
● Well-fitted shoes ● Trim toenails properly ● Soaking and retraction ○ Cotton wick insertion ● Dental floss technique
26
Onychocryptosis treatment - surgical
● Partial nail avulsion ● Total nail avulsion
27
Onychomycosis AKA
"Tinea unguium”
28
Onychomycosis Symptoms
● Fungal infection of the nail bed, matrix, or plate ● Usually asymptomatic, the patient will present due to cosmetic reasons ● Nail discoloration (yellow or white) ● Thickened nail will distort and curl, can separate from the nail bed ● Prevalence increases with age (>40 yo) and easily becomes chronic
29
Onychomycosis Diagnosis
● KOH direct microscopy o Will show hyphae ● Fungal culture
30
Onychomycosis treatment
Topical antifungals ○ Ciclopirox 8% apply sol to nail qhs x 48 weeks ○ Efinaconazole 10% apply sol qd x 48 weeks Oral antifungals (gold standard) ● Terbinafine (Lamisil) 250mg PO qd x 12 wks for toenails; LFT at baseline ● Itraconazole (Omnel) 200mg PO qd x 12 wks; LFT at baseline Surgical
31
Onycholysis
● Detachment of nail from its bed at distal and/or lateral attachments ● Creates subungual space that collects dirt and debris; malodorous
32
Onycholysis causes
● Idiopathic ● Trauma ● Contact dermatitis ● Eczema ● Psoriasis ● Nail bed tumors ● Drugs Pathogens that can colonize the space ● Candida ● P. aeruginosa (results in a biofilm under the nail causing green discoloration
33
Onycholysis treatment
● Treat underlying disorders o Candidal → topical or PO antifungals o Pseudomonas → topical fluoroquinolones ● Keep nails dry ● Avoid trauma or irritants ● Protect hands from cold or windy weather ● Keep it trimmed to prevent additional infection
34
Paronychia
● Infection of the soft tissue around the fingernail ● Usually associated with a break in the integrity of the epidermis
35
Paronychia pathogens
○ Acute – Staph aureus ○ Chronic – Candida
36
Paronychia S/S
● Presents with throbbing pain, erythema, swelling, warmth (cellulitis) ● Infection may extend deeper forming a felon
37
Paronychia treatment
● If caught early without abscess, warm soaks 3-4 times daily ● Antibiotics – “Anti-staph” ○ Penicillin V K 500 mg PO q 6-8 hrs ○ Cephalexin (Keflex) 500 mg PO q 6-12 hrs ○ Clindamycin 300 mg PO q 6 hrs ● If abscess has formed, surgical incision and drainage
38
Felon – Pulp Abscess S/S
● Infection of the tissue/pulp of the closed-space of the distal phalanx ● S. aureus most common cause ● Typically occurs on the thumb and index finger ● May be caused by puncture wound, splinter, paronychia ● Presents with pain, throbbing, erythema, swelling (cellulitis/abscess)
39
Felon treatment
● Early treatment prevents osteomyelitis ● Incision and drainage (at the site of most erythema) ● Antibiotics – “Anti-staph” ○ Penicillin V K 500 mg PO q 6-8 hrs ○ Cephalexin (Keflex) 500 mg PO q 6-12 hrs ○ Clindamycin 300 mg PO q 6 hrs ● Bacteria culture of purulent material
40
Herpetic Whitlow
An intensely painful viral infection of 1 or more fingers (typically distal phalanx) caused by HSV o 60% caused by Herpes simplex 1 o 40% caused by Herpes simplex 2 ● Generally affects children less than 10 years or adults between 20-30 years
41
Herpetic Whitlow pathophysiology
● Spreads by direct contact with secretions ● Usually on lateral portions of finger ● Can be a single vesicle or cluster
42
Herpetic Whitlow course
● Eruption after 2-20 day incubation ● Prodromal tingling and burning ● Vesicle formation that lasts 7-10 days ● Viral shedding ends and vesicles crust over and heal after 10-14 days
43
Herpetic Whitlow Diagnosis
● Clinical diagnosis ● Definitive diagnosis – Tzanck test, viral cultures, serum antibody titers
44
Herpetic Whitlow treatment
● Self limiting disease ● Treatment focused on symptom relief ○ Acyclovir 400 mg PO TID x 10 days (may consider topical first) ○ NSAIDs ● I&D is contraindicated! ● Cover open or draining vesicles to prevent transmission
45
Subungual Hematoma
● Common nail bed injuries caused by blunt or sharp trauma o Bleeding from the nail bed (highly vascular) results in increased pressure under the nail ● Patient will present with nail discoloration a red, brown, black
46
Subungual Hematoma S/S
● Patient will present with nail discoloration a red, brown, black ● Pressure, pain with throbbing sensation ● X-ray – rule out possible phalanx fracture
47
Subungual Hematoma treatment
o Ice, elevation, and pain management o If more than 50% of the area is involved, it needs to be evaluated Draining the hematoma (trephination) ● If less than 24-48 hours old ● Cautery: battery operated device to burn a hole in the nail ● Needle: Used to bore into the nail ● Consider removing nail if large area of involvement. ● No follow up needed
48
Beau Lines
AKA transverse grooves ● Transverse bandlike depressions in the nail, extending from one edge to the other, affecting all nails. ● Results from a temporary arrest of nail matrix growth often due to severe, sudden illness or trauma
49
Seeing Beau Lines can indicate
● High fever ● Cytotoxic drugs ● Severe drug reactions ● Measles ● Scarlet fever ● Peripheral ischemia ● Chemotherapy
50
Terry Lines
● Opaque white plate obscuring lunula and extending to within 1-2 mm from distal edge of nail. Involves nails evenly ● Thought to be due to decrease in vascularity and increase in connective tissue within the nail bed
51
Seeing Terry Lines may indicate
● Liver failure ● Cirrhosis ● Diabetes mellitus ● Congestive heart failure ● Hyperthyroidism ● Malnutrition
52
Splinter Hemorrhages
● Tiny linear (2-3 mm long) plum discolorations that subsequently move distally with nail growth ● Thought to be caused by small slots that damage the small capillaries under the nai
53
Seeing Splinter Hemorrhages can indicate
● Minor trauma (most common cause) ● Psoriasis ● Anemia ● Bacterial endocarditis ● Altitude sickness
54
Bulbous uniform swelling of the soft tissue of the distal phalanx with subsequent loss of normal angel of the nail
Clubbing of the Nail
55
Nail clubbing etiology
Exact mechanism is unknown. Hypothesized link between hypoxia and distal digital vasodilation
56
Nail clubbing can indicate
● Cardiovascular disorders ○ Congenital heart disease, bacterial endocarditis ● Bronchopulmonary disorders ○ Lung cancer, cystic fibrosis, sarcoidosis ● Gastrointestinal disorders ○ Ulcerative colitis, Crohn disease, cirrhosis, peptic ulcer, celiac sprue
57
Yellow Nail Syndrome
● Arrest in nail growth ● Nails are hard, excessively curved from side to side, diffuse pale yellow to dark yellow-green. Cuticles absent
58
Yellow Nail Syndrome may indicate
Lymphedema (localized fluid retention and tissue swelling caused by a compromised lymphatic system), chronic bronchitis, malignant neoplasms
59
Acral Lentiginous Melanoma
● Age 55-60 yr ● Most common in people of color ● Usually asymptomatic ● Most common on palms, under the nails or soles of feet ● 5 year survival 35%-50%
60
Longitudinal Melanonychia
● Tan, brown, or black longitudinal streak ● Caused by increased melanin synthesis in the normally non functional nail matrix ● Congenital or acquired ● Most often a benign condition ○ Could be acral lentiginous melanoma ● Biopsy may be required
61
Drugs that can cause Nail discoloration
● Antimalarials ● Chemotherapy ● Antiretrovirals (HIV) ● Beta blockers ● Retinoids (i.e. Isotretinoin (accutane), retinol)
62
Pitting of the Nails
● Characterized by depressions in the surface of the nail ● Caused by defective development of the layers of the superficial nail plate
63
Pitting of the Nails may indicate
● Psoriasis ● Alopecia areata ● Sarcoidosis ● Eczema
64
Leukonychia
● Nails that have opaque, white patches or striae ● Common ● Often due to trauma of some sort ● Zinc deficiency
65
Onychoschizia AKA
“Nail Splitting” “Peeling Nails” ● Seldom due to a systemic illness ● Often due to repetitive wetting/drying – moisture imbalance ● Exposure to household chemicals ● Hypothyroid ● Trauma ● Iron deficiency anemia
66
Koilonychia AKA
“Spoon Nails” ● Concavity in the fingernail itself o Resulting in a depression in the nail, appearance of a “spoon shape” to the nail ● Iron deficiency anemia ● Exposure to harsh chemicals ● Congenital abnormality

Derm Exam 1 (5 decks)

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