Hair and Nail Disorders

Question 1

nail infections caused by ANY fungus (vast majority caused by Trichophyton rubrum)

Answer 1

Onychomycosis (Tinea Unguium)

Question 2

Most common location for Onychomycosis (Tinea Unguium)

Answer 2

distal subungual region

Question 3

What should you consider screening for in patients who present with onychomycosis because it’s a major risk factor for onychomycosis?

Answer 3

DM

Question 4

How is onychomycosis usually diagnosed?

Answer 4

KOH examination of nail scrapings

Question 5

Oral treatment of choice for onychomycosis

Answer 5

terbinafine (lamisil)

Question 6

Duration of treatment of onychomycosis

Answer 6

fingernails: 1.5-3 months. toenails: 3-12 months

Question 7

Medication class that cannot be used with terbinafine

Answer 7

statins

Question 8

What needs to be monitored when treating with terbinafine?

Answer 8

LFTs

Question 9

Infection around fingernail usually caused by S. aureus. Treated w/abx and warm soaks

Answer 9

paronychia

Question 10

Pulp space infection of digit tip. Presents as swollen, tender, erythematous.

Answer 10

felon

Question 11

Why does a felon require referral to hand surgeon in addition to I&D and abx?

Answer 11

edema due to felon can compromise arterial supply and lead to necrosis of the fingertip

Question 12

Commonly seen in children and healthcare workers. Herpetic infection that usually affects one finger

Answer 12

herpetic Whitlow

Question 13

Treatment for herpetic Whitlow

Answer 13

oral acyclovir for immunocompromised

Question 14

Lateral nail plate pierces the lateral nail fold and enters the dermis. Presents w/edema, exudate, granulation tissue

Answer 14

onychocryptosis (ingrown nail)

Question 15

Major risk factor for onychocryptosis (ingrown nail)

Answer 15

poorly fitting shoes

Question 16

Treatment for mild to moderate ingrown toenail

Answer 16

Cotton wedging or dental floss underneath the lateral nail. Soak in warm water 20 minutes TID

Question 17

Treatment for moderate to severe ingrown toenail

Answer 17

removal (partial nail avulsion)

Question 18

Symmetrical hair loss that begins in the fronto-parietal scalp w/progressive recession

Answer 18

androgenic alopecia

Question 19

Inhibits growth of scalp hair and stimulates growth of facial hair

Answer 19

Dihydrotestosterone (DHT)

Question 20

Treatment for androgenic alopecia that blocks conversion of testosterone to DHT. Needs 6 months to be effective

Answer 20

Finasteride (Propecia)

Question 21

Topical treatment for androgenic alopecia that works better in younger men who have been balding for less than 10yrs

Answer 21

Minoxidil (Rogaine)

Question 22

Autoimmune process directed against hair follicle. Rapid hair loss in round/oval patches

Answer 22

alopecia areata

Question 23

Best treatment for isolated patches of alopecia areata

Answer 23

intralesional steroids

Question 24

Thinning/shedding of hair resulting from the early entry ofhairsinto thetelogen phase due to stress, postpartum, malnutrition, crash dieting

Answer 24

telogen effluvium

Question 25

Impulse control disorder unilateral to patient’s dominant hand due to patient pulling hair out.

Answer 25

trichotillomania

Question 26

Treatment for trichotillomania

Answer 26

SSRI and cognitive therapy

Question 27

What must you educate your patient with onychomycosis about?

Answer 27

high rate of treatment failure

Question 28

What autoimmune diseases is alopecia areata associated with?

Answer 28

Hashimoto’s and pernicious anemia