Hair and Nail Disorders Flashcards
Define Alopecia
Hair loss
What are the subtypes of alopecia?
- Disorders of the Hair Shaft
- All other forms of Hair Loss
A. Scarring (Diffuse and Patterned)
B. Non-scarring (Diffuse and Patterned)
-Alopecia Areata
Define Alopecia areata. What are the types?
- Rapid onset hair loss
- Occurs in sharply defined areas
A. Patterned type most commonly seen = Patchy, few to many
B. Diffuse type = Alopecia Totalis involves entire scalp
What age is alopecia areata most commonly seen in?
children and young adults
What areas can be involved in alopecia areata?
May involve eyelashs, beard, and other parts of body
Alopecia Universalis if entire body is affected
What is the etiology of alopecia areata?
- Etiology is unknown – thought to be autoimmune
A.Stress is frequently cited as a contributing cause
What is the prognosis of alopecia areata?
- Few isolated areas – Total permanent regrowth probable
2. Diffuse involvement – Poorer chance for permanent regrowth
What are the sxs of alopecia areata?
- Non-scarring Alopecia
- No S/Sx’s of infl
- No Scale
- Short “Exclamation Mark” hairs seen in area
- Positive Hair Pull Test
- Fine “Vellus” hairs seen when regrowth starts, may be depigmented.
How is alopcia areata diagnosed?
- Clinically diagnosed
A. Nail pitting seen in 3-30% - Bx if uncertain: from edge of bald spot
- KOH or Fungal Cx if Tinea Capitis suspected
What may alopecia areata be asst. with?
May be associated with other autoimmune disorders (Thyroid, DM, Vitiligo, Lupus)
What is the treatment for small and solitary alopecia areata?
- No Tx needed
- Excellent Prognosis
- Spontaneous regrowth
- May use IL Steroids or Topical therapies
What is the treatment for large and numerous alopecia areata?
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
Define onychomycosis
fungal infection of the finger/toe nail plates
What demographic group commonly has onychomycosis?
- Incidence increases with age
A. 15-20% of population between 40 and 60yo
B. No spontaneous remission
What is the etiology of onychomycosis?
- Dermatophytes T. Rubrum and Mentagrophytes MC seen
- Candida and other Non-pathogen species seen (contaminants)
- Trauma often predisposes nail to infection
- May be isolated infection or seen with hand/foot tinea infections
What diseases may mimic onychomycosis?
Psoriasis, Lichen Planus, Eczema, Trauma, Habitual picking of cuticles
What are the sxs of onychomycosis?
- Symptoms - discomfort or pain seen with thick distorted nail plate
and/or subungual debris - Signs – Four distinct patterns of nail infection
What are the 4 types of nail infection patterns?
- Distal subungual
- Proximal Subungual
- Superficial White
- Candidal
What are the characteristics of distal subungual infection?
- MC seen presentation
- Onycholysis, Yellow, Subungual debris
- Begins at the hyponychium
- Spreads proximally and laterally
- Trichophyton rubrum
What are the characteristics of proximal subungual infection?
- Check immune status, often seen in immunosuppressed conditions
- Begins underneath proximal nail fold
- Trichophyton rubrum
What are the characteristics of superficial white infection?
- White, crumbly nail surface due to invasion of nail plate top
- Trichophyton mentagrophytes or other
non-dermatophytes associated with inf.
What are the characteristics of candidal infection?
- Seen in pt’s with chronic mucocutaneous candidiasis, a rare disease
- Thick discolored nail plate
- Often involving all fingernails
- Candida albicans
How is systemic therapy monitored?
Check CBC and LFT’s before, at 6wks, and at end of Tx
Which type of therapy has the highest success rate?
Oral therapy has the highest success rate
50-80% effective
but 15-20% relapse within 1st year
What are the indications for therapy?
Pain, functional limitations, secondary bacterial infections, or PMHx of Immunocompromised or DM
What is the timeline for treatment success?
Nails do not appear clear until 6-12mo’s s/p Tx
What are the systemic treatment options for onychomycosis?
- Fluconazole
- Griseofulvin
- Itraconazole
- Terbinafine
define paronychia
Inflammation of the nailfold surrounding the nail plate
What are the characteristics of acute paronychia?
- Precipitated by trauma or chemicals
- Painful, isolated area
- MC due to Staph
Tx - Heat, I&D, +/- Oral Antibx
What is the tx for acute paronychia?
Heat, I&D, +/- Oral Antibx
What are the characteristics of chronic paronychia?
- Result from repeated wet activities
- Tender, occur in several fingers
- Exception – Habitual finger sucking favors only one finger
- MC due to candida
What is the safest systemic antifungal drug?
Terbenafine
What is the treatment for chronic paronychia?
topical systemic antifungals
