Hair and Nails

Question 1

What is the difference between scarring and non scarring alopecia?

Answer 1

scarring: hair follicles are destroyed and changes are irreversible
non scarring: hair follicles are preserved

Question 2

List the non scarring alopecias.

Answer 2

alopecia areata-patchy hair loss, ! point
androgenic-typical male pattern baldness
trichotillomania-pull hair out
anagen efffluvian-1-2 mos. after chemo
tellogen effluvian-insult induced, postpartum, surgery
syphillis-moth eaten, secondary syphilis
traction-braids

Question 3

List the scarring alopecias

Answer 3

dissecting cellulitis-adult black males, follicular occlusion triad
acne keloidalis nuchae-occipital scalp, black males, pustules–>nodules/plaques
dicoid lupus erythematous-
lichen planopilaris
kerion-dermatophyte, large boggy red plaque with pustules, papules, crust

Question 4

What is Hirsutism? What are causes?

Answer 4

growth of androgen dependent terminal hair in a woman or child in a male pattern
causes:
-polycystic ovarian disease
-tumors
-drugs,
-congenital adrenal hyperplasia

Question 5

What is hypertrichosis?

Answer 5

Excessive hair growth on any area of the body

• congenital and acquired form
• acquired may be paraneoplastic

Question 6

What are nail findings in psoriasis?

Answer 6

Pitting		
“Oil spots”
Trachyonychia
Subungual hyperkeratosis
Nail fragility
Onycholysis
Beau’s lines

Question 7

What are the nail findings associated with alopecia areata?

Answer 7

Geometric pitting
Grooving or roughening (if all 20 affected, then referred to as trachyonychia)
Thinning
Cracking of the nail plate
Red spots on lunula

Question 8

What are the disorders related to nail clubbing?

Answer 8

Mainly
-CV disorders
-bronchopulmonary disorders
Also
-GI problems
-familial inheritance

Question 9

What is Koilonychia? What are associated disorders?

Answer 9

• spoon nails, thin concave plate with everted edges
• normal in children
• Acquired: iron deficiency anemia
• a bunch of hereditary syndromes

Question 10

What is splinter hemorrhage and what are commence causes?

Answer 10

Extravasated blood along parallel longitudinal vessels of nail bed
Move distally with nail plate and do not blanch
Trauma is most common cause
Other causes:
Endocarditis
Lupus
Scleroderma

Question 11

What is yellow nail syndrome associated with?

Answer 11

pleural effusions
chronic pulmonary
infections
chronic sinusitis
lymphedema

Question 12

What are Beau’s lines and what are they caused by?

Answer 12

Transverse depressions in the nails
Result of a temporary interruption of the mitotic activity of the nail matrix
Most often: traumatic or related to inflammation of prox nail fold (eczema, psoriasis)
If at the same level: systemic cause

Question 13

List the apparent leukonychia and their characteristics.

Answer 13

Terry’s nails: most of proximal nail bed, cirrhosis and normal
Lindsay’s Nails:half and half, chronic renal disease, and normal
Muerhrchke’s Nails: line parallel to lunula, hypoalbuminemia, malnutrition, chemo

Question 14

List the true leukonychia and their characteristics.

Answer 14

Punctate-trauma, white curves/spots
striate-trauma, white line
Mee’s lines-variant of striate, arsenic and thallium poisoning

Question 15

What are Blue Nails and what are they caused by?

Answer 15

• whole nail plate: drugs

- lunulae only: Ag exposure, Copper- Wilson’s disease

Question 16

What are Green Nails and what are they caused by?

Answer 16

• pyocyanin due to pseudomonas aeruginosa

risks: prolonged exposure to water, trauma

Question 17

What is Tinea Unguium and its clinical presentation?

Answer 17

Dermatophyte infection of nail unit
Men> women; toenails>fingernails
Often associated with chronic tinea pedis
Can confirm diagnosis by PAS stain of nail clipping or fungal culture 
Presentation:
Onychochauxis
Discoloration
Onycholysis
Subungual hyperkeratosis and debris