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Gen Med: Dermatology > Hair and Nail Disorders > Flashcards

Hair and Nail Disorders Flashcards

1
Q

Define Alopecia

A

Hair loss

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2
Q

What are the subtypes of alopecia?

A
  1. Disorders of the Hair Shaft
  2. All other forms of Hair Loss
    A. Scarring (Diffuse and Patterned)
    B. Non-scarring (Diffuse and Patterned)
    -Alopecia Areata
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3
Q

Define Alopecia areata. What are the types?

A
  1. Rapid onset hair loss
  2. Occurs in sharply defined areas
    A. Patterned type most commonly seen = Patchy, few to many
    B. Diffuse type = Alopecia Totalis involves entire scalp
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4
Q

What age is alopecia areata most commonly seen in?

A

children and young adults

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5
Q

What areas can be involved in alopecia areata?

A

May involve eyelashs, beard, and other parts of body

Alopecia Universalis if entire body is affected

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6
Q

What is the etiology of alopecia areata?

A
  1. Etiology is unknown – thought to be autoimmune

A.Stress is frequently cited as a contributing cause

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7
Q

What is the prognosis of alopecia areata?

A
  1. Few isolated areas – Total permanent regrowth probable

2. Diffuse involvement – Poorer chance for permanent regrowth

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8
Q

What are the sxs of alopecia areata?

A
  1. Non-scarring Alopecia
  2. No S/Sx’s of infl
  3. No Scale
  4. Short “Exclamation Mark” hairs seen in area
  5. Positive Hair Pull Test
  6. Fine “Vellus” hairs seen when regrowth starts, may be depigmented.
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9
Q

How is alopcia areata diagnosed?

A
  1. Clinically diagnosed
    A. Nail pitting seen in 3-30%
  2. Bx if uncertain: from edge of bald spot
  3. KOH or Fungal Cx if Tinea Capitis suspected
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10
Q

What may alopecia areata be asst. with?

A

May be associated with other autoimmune disorders (Thyroid, DM, Vitiligo, Lupus)

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11
Q

What is the treatment for small and solitary alopecia areata?

A
  1. No Tx needed
  2. Excellent Prognosis
  3. Spontaneous regrowth
  4. May use IL Steroids or Topical therapies
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12
Q

What is the treatment for large and numerous alopecia areata?

A

a. IL Steroids
b. Topical therapies: corticosteroids, immunosuppressants, Minoxidil
c. Systemic Steroids x 3mo, systemic cyclosporin
d. Controversial – Benefit short lived off tx
Weigh Risk vs Benefit

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13
Q

Define onychomycosis

A

fungal infection of the finger/toe nail plates

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14
Q

What demographic group commonly has onychomycosis?

A
  1. Incidence increases with age
    A. 15-20% of population between 40 and 60yo
    B. No spontaneous remission
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15
Q

What is the etiology of onychomycosis?

A
  1. Dermatophytes T. Rubrum and Mentagrophytes MC seen
  2. Candida and other Non-pathogen species seen (contaminants)
  3. Trauma often predisposes nail to infection
  4. May be isolated infection or seen with hand/foot tinea infections
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16
Q

What diseases may mimic onychomycosis?

A

Psoriasis, Lichen Planus, Eczema, Trauma, Habitual picking of cuticles

17
Q

What are the sxs of onychomycosis?

A
  1. Symptoms - discomfort or pain seen with thick distorted nail plate
    and/or subungual debris
  2. Signs – Four distinct patterns of nail infection
18
Q

What are the 4 types of nail infection patterns?

A
  1. Distal subungual
  2. Proximal Subungual
  3. Superficial White
  4. Candidal
19
Q

What are the characteristics of distal subungual infection?

A
  1. MC seen presentation
  2. Onycholysis, Yellow, Subungual debris
  3. Begins at the hyponychium
  4. Spreads proximally and laterally
  5. Trichophyton rubrum
20
Q

What are the characteristics of proximal subungual infection?

A
  1. Check immune status, often seen in immunosuppressed conditions
  2. Begins underneath proximal nail fold
  3. Trichophyton rubrum
21
Q

What are the characteristics of superficial white infection?

A
  1. White, crumbly nail surface due to invasion of nail plate top
  2. Trichophyton mentagrophytes or other
    non-dermatophytes associated with inf.
22
Q

What are the characteristics of candidal infection?

A
  1. Seen in pt’s with chronic mucocutaneous candidiasis, a rare disease
  2. Thick discolored nail plate
  3. Often involving all fingernails
  4. Candida albicans
23
Q

How is systemic therapy monitored?

A

Check CBC and LFT’s before, at 6wks, and at end of Tx

24
Q

Which type of therapy has the highest success rate?

A

Oral therapy has the highest success rate
50-80% effective
but 15-20% relapse within 1st year

25
Q

What are the indications for therapy?

A

Pain, functional limitations, secondary bacterial infections, or PMHx of Immunocompromised or DM

26
Q

What is the timeline for treatment success?

A

Nails do not appear clear until 6-12mo’s s/p Tx

27
Q

What are the systemic treatment options for onychomycosis?

A
  1. Fluconazole
  2. Griseofulvin
  3. Itraconazole
  4. Terbinafine
28
Q

define paronychia

A

Inflammation of the nailfold surrounding the nail plate

29
Q

What are the characteristics of acute paronychia?

A
  1. Precipitated by trauma or chemicals
  2. Painful, isolated area
  3. MC due to Staph
    Tx - Heat, I&D, +/- Oral Antibx
30
Q

What is the tx for acute paronychia?

A

Heat, I&D, +/- Oral Antibx

31
Q

What are the characteristics of chronic paronychia?

A
  1. Result from repeated wet activities
  2. Tender, occur in several fingers
  3. Exception – Habitual finger sucking favors only one finger
  4. MC due to candida
32
Q

What is the safest systemic antifungal drug?

A

Terbenafine

33
Q

What is the treatment for chronic paronychia?

A

topical systemic antifungals

Gen Med: Dermatology (10 decks)

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