Hair and Nail Disorders Flashcards
onychomycosis:
- what is this?
- MC cause
- risk factors
- presentations
- dx
- tx
What: nail infection caused by any fungus, MC the toenail
MC cause is Trichophyton rubrum
Risk factors:
- old age
- DM**
- swimming
- tinea pedis
- psoriasis
- immunodeficiency
- living with family members who have this
presentation:
- brittle, lusterless, hypertrophic
- begins as whiteish-yellowish or brownish discoloration in one region of the nail and gradually spreads to involve entire width of nail.
Dx:
- KOH
- nail culture
- nail plate bx (most sensitive)
Tx:
- oral Terbinafine (Lamisil)**
- alternative PO meds: itraconazole, Griseofulvin, and Fluconazole (Diflucan)
- can last anywhere from 1-12mo
- *high rates of tx failure
- cannot be used with statins
Paronchyia
- what is this?
- MC cause
- Tx
What: infection around fingernail
MC cause staph aureus
Tx: abx and warm soaks
-in serious cases I&D
Felon:
- what is this?
- PE findings
- tx
What: pulp space infection (infection of a closed compartment comprising the pulp space of the tip of the digit.
PE findings:
- swollen
- exquisitely tender
- erythematous
- necrosis of fingertip
Tx:
- I&D
- abx
- referral to hand surgeon for definitive tx
Herpetic Whitlow:
- what is this?
- tx
What: herpetic infection by inoculation of the virus in the cuticle region, usually one finger
Tx: usually self-limited
-PO acyclovir
Onychocryptosis
- what is this?
- sx
- cause
- Tx
What; ingrown nail, lateral nail pierces the lateral nail fold and enters the dermis
Sx:
-pain, edema, exudate, and granulation tissue
Cause
- **Poorly fitting shoes
- excessive trimming of the lateral nail plate
- trauma
Tx:
- cotton wedging or dental floww underneath the lateral nail plate, soak affected food in warm water for 20minutes 3x/day
- if severe needs removal and may need abx
Alopecia
- what is this?
- causes
What: loss of hair in areas where it normally grows.
Cause:
- androgenic alopecia
- alopecia areata
- telogen effluvium
- trichotillomania
Andorgenic ALopecia:
- what is this?
- hair loss pattern
- cause
- tx
What: permanent symmetrical hair loss
pattern: begins in fronto-parietal scalp with progressive recession
Cause:
- genetics
- hormonal activity
- age
- gender (men)
Tx:
- Finasteride (Propecia)
- Minoxidil (Rogain)
- both require 6mo before effects are seen.
ALopecia Areata:
- what is this?
- pattern of hair loss
- clinical course
- tx
What: hair loss thought to be autoimmune in nature directed against the hair follicle. (associated with vitiligo, hashimotos, addisons, pernicious anemia)
Pattern: rapid hair loss in distinct, well defined round or oval patches of COMPLETE hair loss.
Clincal course:
- may have just one episode with spontaneous regrowth
- may progress to alopecia totalis (loss of all scalp hair) or alopecia universalis (loss of all body hair)
Tx:
- Intralesional steroids (triamcinolone acetinide)
- Potent topical steroids
- topical immunotherapy
- 2nd line Minoxidil, anthralin
Telogen Effluvium
- what is this?
- risk factors
- tx
What: thinning/shedding of hair resulting from the early entry of hairs into the telogen phase.
Risk factors:
- stress
- postpartum
- malnutrition
- crash dieting
- metabolic changes (TSH, ferritin, CBC, CMP)
Tx: treat the underlying cause
Trichotillomania:
- what is this?
- Tx
What: pulling out their own hair, usually unilatera to patients dominant hand.
-impulse control disorder
Tx: SSRI, CBT
