Hair and Nail Disorders Lecture Powerpoint

Question 1

Nail clubbing

Answer 1

A nail angle <180 degrees associated with heart and lung diseases and chronic hypoxia, believed to be caused by vasodilation

Question 2

Beau’s lines

Answer 2

Transverse depressions that result from temporary interruption of proximal nail matrix often due to trauma unless presenting in multiple digits, depth of depression indicates extend of damage and width longitudinally indicates duration of insult, grows out with the nail itself

Question 3

Onychomadesis

Answer 3

Proximal detachment of the nail most often due to untreated trauma, results in complete arrest of nail growth for a period and might imply systemic cause if multiple nais

Question 4

3 causes of pitting nails

Answer 4

-psoriasis -alopecia areata -eczema

Question 5

Leukonychia

Answer 5

White opaque discoloration on nails that can either present punctate (spot that moves with growth due to trauma), striate (mee’s lines) (transverse parallel lines that migrate distally) or diffuse (spread evenly over the nail)

Question 6

Striate or Mee’s lines leukonychia can be a sign in these 2 pathologies

Answer 6

-heavy metal poisoning -chemotherapy

Question 7

Muehrcke’s lines

Answer 7

Transverse pale lines in the vascular nail beds that do not move with nail growth and are grooveless, due to decreased protein synthesis indicative of systemic disease such as nephrotic syndrome or hypoalbuminemia

Question 8

How do we differentatate between Striate/Mee’s lines leukonychia and muehrcke’s lines?

Answer 8

Muehrcke’s lines do NOT grow out with the nail

Question 9

Subungual hematoma

Answer 9

Collection of blood under nail bed resulting in throbbing high pressure pain under nail

Question 10

Nail drilling

Answer 10

A treatment for subungual hematoma that involves the drilling into the nail plate to release the pressure and drain the blood (must be done early otherwise blood may clot and not drain out), as long as you don’t go too deep and hit the nailbed which does have nerves (unlike the nail plate) then you won’t cause any pain!

Question 11

Lichen planus nail presentation

Answer 11

Fissuring with atrophy creating angel wing like appearance

Question 12

A common onychomycosis is ____ ____ and it responds ____ to topical antifungals

Answer 12

Tinea pedis (athletes foot), very poorly

Question 13

The most common type of onychomycosis is distal subungual onychomycosis caused by the dermatophyte…

Answer 13

…trichophyton rubrum

Question 14

Why do we need to confirm a fungus presence before beginning oral antifungal treatment? How do we confirm a fungus?

Answer 14

-antifungals are hard on the liver and take a long treatment course -Fungus culture is preferred but can also do KOH exam or biopsy nail clippings

Question 15

1st, 2nd, and 3rd choices for distal subungual onychomycosis treatment

Answer 15

-terbinafine -fluconazole -itraconazole

Question 16

Proper ___ can help prevent ingrown toenails

Answer 16

Cutting technique

Question 17

Partial nail avulsion

Answer 17

Procedure to remove recurrent ingrown toe nails by supplying a digital blocking agent (numbing medication), then scalpaling down the nail to the matrix and pulling out that portion of it completely (so the nail is literally thinner on that side)

Question 18

Paronychia

Answer 18

Infection along the lateral or proximal nail fold usually from staph aureus that requires I&D or antibiotics to treat

Question 19

Felon

Answer 19

A pus pocket infection forming in the fat pat of the toe, often seen in needle injuries or dog bites and requires drainage

Question 20

Pincer nail deformity

Answer 20

Transverse over curvature of nail plate either inherited or acquired and of unknown etiology

Question 21

White bulb at end of hair indicates it was in the ___ phase, while no bulb indicates it was in the ___ phase

Answer 21

Telogen (arrest) anagen (growth)

Question 22

Reasons for scarring hair loss (4)

Answer 22

-lupus -infection -lichen planus -traction alopecia (pulling from wearing certain styles)

Question 23

Kerion

Answer 23

A fungal infectious cause of hair loss with distinct roundness that distinguishes it

Question 24

Reasons for non-scarring hair loss (3)

Answer 24

-pattern hair loss -hair breakage -shaft abnormality

Question 25

Androgenic alopecia

Answer 25

Most common cause of hair loss, localized and systemic and follows either male or female pattern in either gender, due to an androgen excess in all cases

Question 26

Male pattern baldness

Answer 26

Starts in the front of the scalp and progresses backward

Question 27

Female pattern baldness

Answer 27

Diffuse baldness starting centrally and going out to the sides

Question 28

Male pattern baldness in females is indicative of…

Answer 28

….androgen excess

Question 29

Telogen effluvium

Answer 29

Sudden loss of large amounts of hair from premature conversion from anagen to telogen state, often due to diet, hormonal variation, drugs, stress, or pregnancy

Question 30

Alopecia Areata

Answer 30

Autoimmune disease that impacts young patients resulting in complete hair loss with the hallmark finding of exclamation point hairs

Question 31

3 subtypes of alopecia areata

Answer 31

Areata - patches totalis - total scalp universalis - complete body

Question 32

Androgenic alopecia treatment (3)

Answer 32

-5a reductase inhibitor (lower testosterone) -Topical minoxidil -hair transplant

Question 33

Pull test for alopecia

Answer 33

No shower for 24 hrs then 60 hairs pulled from scalp gently, removal of 6 or more hairs is positive result and indicates active shedding

Question 34

What is this condition?

Answer 34

Striate Leukonychia

Question 35

What condition is this?

Answer 35

Mehurk’s lines

Question 36

What condition is this?

Answer 36

Paronychia