Hair and nails Flashcards
the nail matrix is proximally/distally?
proximally
can you use a dermatosope on nail?
yes
what can looking at the proximal nail fold tell you
signs of rheumatological conditions e.g. dilated capillaries
functions of nails
protection
tool
counter pressure - sensation
signs of nail changes on examination
number of nails brittle thickening separation colour ridging striations growth systemic disease drugs
fungal vs melanoma in nails vs haemorrhage
single vs multiple
signs of fungal nail disease
black pigmentation yellow pigmentation thickened brittle look for tinea pedis between toes
how can you differentiate between fungal nail disease and periungual melanoma
melanoma - usually a single nail
fungal - usually multiple nails
RF for fungal nail infection
elderly
immunosuppressed
starts off in 1 nail then progresses to others
features of subungal haematoma
dark pigment asymmetric nail fold involvement pain if acute chronic repetitive trauma D.Dx melanoma dermatoscope - streaky, red/brown colour review consultation if concerned
signs of acral / periungual melanoma
streaks of dark pigment
involvement of proximal nail fold - Hutchinsons sign
thick and thin pigment
what is melanonychia and what are some causes
benign pigment in the nail
antimalarial drugs
chemotherapy
features of a myxoid pseudocyst
benign growth around the nail fluid filled telangiectasia D.Dx BCC may recur despite treatment
features of lichen planus of nails
trachonychia (looks like nail has been sandpapered) angel winging disfiguring topical steroids check elsewhere for signs
What are Beau’s lines?
transverse ridging of the nail
can occur during times of stress
arrest of nail growth at nail matrix
what is paronychia
infection of nail tissue
why do hair bearing regions heal better
presence of stem cells near the follicle
what is the anagen phase of hair
growing
What is the catagen phase of hair
starts to detach from blood supply
what is the telogen phase of hair
stage where it can fall out
in humans, hair loss is a/synchronous
asynchronous hair loss
non-scarring hair loss features on dermatoscope
see follicles on dermatoscope
questions to ask in a history of hair loss
timing how much loss - little vs clumps localised vs generalised who noticed brushing, shower, shedding or thinning where - facial and body hair itch, tingling infection, stress, pregnancy, drugs PMH - autoimmunity DH FH hair care products - heat use, chemicals diet
androgenic alopecia
thinning follicles present minoxidil anti androgen drugs hair transplant
scarring hair loss features
lose hair follicle
hair wont grow back
scalp looks smooth and shiny
non-scarring hair loss features
see follicles on dermatoscope
causes of non-scarring hair loss
androgenic alopecia telogen effluvium alopecia areata traction alopecia trichotillomania tinea capitus
features of androgenic alopecia
thinning follicles present minoxidil anti androgen drugs hair transplant
features of telogen effluvium
generalised hair loss hair regrowth pregnancy iron levels in time it grows back
features of alopecia areata
exclamation mark hairs patches of hair loss hair can grow back on its own can grow back as white hair topical dermovate IL steroids
features of traction alopecia
not scarring - may if over a long period of time
tight pony tails
tight braids
relax the hair
features of trichotillomania
hair pulling intentionally mental health conditions underlying - OCD, anxiety atypical distribution hairs of different lengths hair does grow back behavioural modification
examples of scarring alopecia
kerion
CDLE
lichen planopilaris / FFA
CDLE features
chronic discoid lupus erythrematosus
highly potent steroids
leaves large smooth plaques behind
sunlight - trigger
features of lichen planopilaris / FFA
lichen planus of the scalp clear cut affects front of head erythema around hair follicle females doesnt regrow
mechanism of folliculitis decalvans and
dissecting cellulitis of the scalp
neutrophil mediated
looks like a toothbrush
antibiotics
dissecting cellulitis of the scalp - more aggressive, painful
associated with other adnexal diseases - acne, HS
types of excess hair growth
hirsutism
hypertrichosis
describe hirsutism
male pattern excess hair growth
describe hypertrichosis
congenital
acquired - ciclosporin, phenytoin
DRESS - severe
fever liver necrosis cardiac lungs lymphadenopathy blood count - eosinophilia 2 week history carbamazepine, lamotrigine, keppra, sulpha drugs
features of morbilliform drug eruption - mild
most common penicillin allopurinol sulpha drugs cranial caudal distribution erythematous papules that becomes confluent intensely itchy emollients, topical steroids
features of DRESS drug eruption - severe
fever liver necrosis cardiac lungs lymphadenopathy blood count - eosinophilia 2 week history carbamazepine, lamotrigine, keppra, sulpha drugs
what is the difference between SJS / TEN
of body surface area:
SJS <10%
TEN >30%
features of SJS
mucosal involvement
mouth or eye pain
genitalia involvement
erythema multiforme
targeoid lesion
children - HSV
older - HIV, drugs, reactive
features of fixed drug eruption - allergic
beefy red inflamed blistering lesion
recurrent
can be sore
remove offending drug and they resolve on their own
features of erythema multiforme
targetoid lesion
children - HSV
older - HIV, drugs, reactive
types of erythema multiforme
major - mucosal surfaces involved
minor
types of urticaria
acute - allergic
chronic
causes of urticaria
foods
drugs - penicillin, sulpha, anticonvulsants
intensely itchy
drug cause of angioedema
ACEI - non-allergic mediated
causes of phototoxic drug reactions
tetracyclines
thiazides
psoralin for UVA treatment
fruits - citrus
areas affected by phototoxic drug reactions
face
neck
dorsal hands
sharp cut off
cause of drug induced LE
PPIs
drug induced bullous pemphigoid
furosemide
SGLT2 inhibitors
drug induced bullous pemphigoid causes
furosemide
SGLT2 inhibitors
erythema nodosum causes
penicillin
sulpha drugs
drug induced pigmentation
amiodarone - slate grey
minocycline - irreversible
antimalarials - melanonychia
chemo, mushrooms - flagellate erythema
drug induced pigmentation causes
amiodarone - slate grey
minocycline - irreversible
antimalarials - melanonychia
chemo, mushrooms - flagellate erythema
cause of oil drop sign on nails
psoriasis
