Hair and Nail Disorders Lecture Powerpoint Flashcards
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Nail clubbing
A nail angle <180 degrees associated with heart and lung diseases and chronic hypoxia, believed to be caused by vasodilation
Beau’s lines
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
Onychomadesis
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
3 causes of pitting nails
-psoriasis -alopecia areata -eczema
Leukonychia
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)
Striate or Mee’s lines leukonychia can be a sign in these 2 pathologies
-heavy metal poisoning -chemotherapy
Muehrcke’s lines
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
How do we differentatate between Striate/Mee’s lines leukonychia and muehrcke’s lines?
Muehrcke’s lines do NOT grow out with the nail
Subungual hematoma
Collection of blood under nail bed resulting in throbbing high pressure pain under nail
Nail drilling
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!
Lichen planus nail presentation
Fissuring with atrophy creating angel wing like appearance
A common onychomycosis is ____ ____ and it responds ____ to topical antifungals
Tinea pedis (athletes foot), very poorly
The most common type of onychomycosis is distal subungual onychomycosis caused by the dermatophyte…
…trichophyton rubrum
Why do we need to confirm a fungus presence before beginning oral antifungal treatment? How do we confirm a fungus?
-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
1st, 2nd, and 3rd choices for distal subungual onychomycosis treatment
-terbinafine -fluconazole -itraconazole
Proper ___ can help prevent ingrown toenails
Cutting technique
Partial nail avulsion
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)
Paronychia
Infection along the lateral or proximal nail fold usually from staph aureus that requires I&D or antibiotics to treat
Felon
A pus pocket infection forming in the fat pat of the toe, often seen in needle injuries or dog bites and requires drainage
Pincer nail deformity
Transverse over curvature of nail plate either inherited or acquired and of unknown etiology
White bulb at end of hair indicates it was in the ___ phase, while no bulb indicates it was in the ___ phase
Telogen (arrest) anagen (growth)
Reasons for scarring hair loss (4)
-lupus -infection -lichen planus -traction alopecia (pulling from wearing certain styles)
Kerion
A fungal infectious cause of hair loss with distinct roundness that distinguishes it
Reasons for non-scarring hair loss (3)
-pattern hair loss -hair breakage -shaft abnormality
Androgenic alopecia
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
Male pattern baldness
Starts in the front of the scalp and progresses backward
Female pattern baldness
Diffuse baldness starting centrally and going out to the sides
Male pattern baldness in females is indicative of…
….androgen excess
Telogen effluvium
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
Alopecia Areata
Autoimmune disease that impacts young patients resulting in complete hair loss with the hallmark finding of exclamation point hairs
3 subtypes of alopecia areata
Areata - patches totalis - total scalp universalis - complete body
Androgenic alopecia treatment (3)
-5a reductase inhibitor (lower testosterone) -Topical minoxidil -hair transplant
Pull test for alopecia
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
What is this condition?
Striate Leukonychia
What condition is this?
Mehurk’s lines
What condition is this?
Paronychia
