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Derm Exam 1 > Hair and Digit tip disorders > Flashcards

Hair and Digit tip disorders Flashcards

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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
Q

Treatment – Conservative of Onychocryptosis

A

● Well-fitted shoes
● Trim toenails properly
● Soaking and retraction
○ Cotton wick insertion
● Dental floss technique

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26
Q

Onychocryptosis treatment - surgical

A

● Partial nail avulsion
● Total nail avulsion

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27
Q

Onychomycosis AKA

A

“Tinea unguium”

28
Q

Onychomycosis Symptoms

A

● 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
Q

Onychomycosis Diagnosis

A

● KOH direct microscopy
o Will show hyphae
● Fungal culture

30
Q

Onychomycosis treatment

A

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
Q

Onycholysis

A

● Detachment of nail from its bed at distal and/or lateral attachments
● Creates subungual space that collects dirt and debris; malodorous

32
Q

Onycholysis causes

A

● 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
Q

Onycholysis treatment

A

● 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
Q

Paronychia

A

● Infection of the soft tissue around the
fingernail
● Usually associated with a break in the
integrity of the epidermis

35
Q

Paronychia pathogens

A

○ Acute – Staph aureus
○ Chronic – Candida

36
Q

Paronychia S/S

A

● Presents with throbbing pain, erythema,
swelling, warmth (cellulitis)
● Infection may extend deeper forming a
felon

37
Q

Paronychia treatment

A

● 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
Q

Felon – Pulp Abscess S/S

A

● 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
Q

Felon treatment

A

● 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
Q

Herpetic Whitlow

A

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
Q

Herpetic Whitlow pathophysiology

A

● Spreads by direct contact with secretions
● Usually on lateral portions of finger
● Can be a single vesicle or cluster

42
Q

Herpetic Whitlow course

A

● 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
Q

Herpetic Whitlow Diagnosis

A

● Clinical diagnosis
● Definitive diagnosis – Tzanck test, viral
cultures, serum antibody titers

44
Q

Herpetic Whitlow treatment

A

● 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
Q

Subungual Hematoma

A

● 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
Q

Subungual Hematoma S/S

A

● Patient will present with nail
discoloration a red, brown, black
● Pressure, pain with throbbing sensation
● X-ray – rule out possible phalanx
fracture

47
Q

Subungual Hematoma treatment

A

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
Q

Beau Lines

A

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
Q

Seeing Beau Lines can indicate

A

● High fever
● Cytotoxic drugs
● Severe drug reactions
● Measles
● Scarlet fever
● Peripheral ischemia
● Chemotherapy

50
Q

Terry Lines

A

● 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
Q

Seeing Terry Lines may indicate

A

● Liver failure
● Cirrhosis
● Diabetes mellitus
● Congestive heart failure
● Hyperthyroidism
● Malnutrition

52
Q

Splinter Hemorrhages

A

● 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
Q

Seeing Splinter Hemorrhages can indicate

A

● Minor trauma (most common cause)
● Psoriasis
● Anemia
● Bacterial endocarditis
● Altitude sickness

54
Q

Bulbous uniform swelling of the soft tissue of the distal phalanx with subsequent loss of normal angel of the nail

A

Clubbing of the Nail

55
Q

Nail clubbing etiology

A

Exact mechanism is unknown. Hypothesized link between
hypoxia and distal digital vasodilation

56
Q

Nail clubbing can indicate

A

● 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
Q

Yellow Nail Syndrome

A

● Arrest in nail growth
● Nails are hard, excessively curved from side to side, diffuse pale
yellow to dark yellow-green. Cuticles absent

58
Q

Yellow Nail Syndrome may indicate

A

Lymphedema (localized fluid
retention and tissue swelling
caused by a compromised
lymphatic system), chronic
bronchitis, malignant neoplasms

59
Q

Acral Lentiginous Melanoma

A

● 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
Q

Longitudinal Melanonychia

A

● 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
Q

Drugs that can cause Nail discoloration

A

● Antimalarials
● Chemotherapy
● Antiretrovirals (HIV)
● Beta blockers
● Retinoids (i.e. Isotretinoin
(accutane), retinol)

62
Q

Pitting of the Nails

A

● Characterized by depressions in the
surface of the nail
● Caused by defective development of the
layers of the superficial nail plate

63
Q

Pitting of the Nails may indicate

A

● Psoriasis
● Alopecia areata
● Sarcoidosis
● Eczema

64
Q

Leukonychia

A

● Nails that have opaque, white patches or striae
● Common
● Often due to trauma of some sort
● Zinc deficiency

65
Q

Onychoschizia AKA

A

“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
Q

Koilonychia AKA

A

“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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