hair and nails made by Billie Flashcards
What is the pattern of hair growth
intermittent activity with phases of growth that are followed by periods of inactivity and then expulsion
name the phases of hair growth and what occurs during each phase
- anagen - growth stage, phase of normal active growth (connected to blood supply)
- catagen - degenerative stage, brief transition in which hair growth stops (detach from blood supply)
- telogen - resting phase (no blood = dies)
- exogen - hair shedding phase (hair falls off)
what is the duration of hair growth based off of body location
- scalp: 2-8 years
- arms: 1.5-3 years
- legs: 5-7 months
- eyelashes: 4-6 months
what is lanugo hair
sodt and fine hari covering a fetus, usually shed prior to birth
what is vellus hair
fine, non pigmented hair that covers the body of children and adults. NOT influenced by hormones.
peach fuzz
what is intermediate hair
occurs on the scalp! has characteristics of both vellus and terminal hairs
what is terminal hair
thick pigmented hair found on scalp, beard, axilla, pubic area, eyelash and eyebrows. this IS influenced by hormones
which hair is and is not influenced by hormones
vellus hair IS NOT
terminal hair IS
what is the hair pull test? what is a positive test?
- gently pull hair on the scalp
- abnormal is >5 hairs dislodged.
what is a scalp biopsy
scraping/shaving of scalp to evaluate for pathology
what do you call the microscopic evaluation of hairs pulled from the scalp
trichogram
this is google
what is the goal of trichograms
to determine the anagen to telogen ratio
How do you perform a trichogram? what is a normal result?
pluck 50 or more hairs from the scalp and assess the ratio of anagen hairs to telogen hairs.
normal = 80-90% of hairs are anagen
how do you differentiate anagen hairs and telogen hairs
- anagen hairs - long encriculating hair sheath
- telogen hairs - resting hairs w inner root sheath and root that is largest at the base
what is alopecia
hair loss
comes in a variety of patterns and causes!
what is the MC form of alopecia
androgenic
male and female patterned baldness
what occurs during androgenic alopecia
a gradual conversion of terminal hairs into indeterminate and vellus hairs
genetic predisposition!!!
what are the names for the male and female classifications of androgenic alopecia
- female: ludwig-savin classification (widening part)
- male: norwood hamilton classification
women wear wigs: lud-“wig”
Men have morning wood: nor”wood”
when is androgenic alopecia MC?
- men - after puberty (as early as 20’s and fully expressed by 40)
- women - MC after 50
Men>women MC in white men followed by black and asian
what is the pathology of androgenic alopecia
- DHT causes terminal follicles to transform into vellus like hair follicles (atrophy)
- hairs are then produced at shorter lengths and decreased diameter.
How do you diagnose androgen alopecia? what would you see on diagnostics?
typically clinical but can do:
- biopsy: telogen phase follicles and atrophic follicles
- trichogram: ^ telogen hairs
- hormone studies: testosterone, DHEAs, prolactin
How do you treat androgenic alopecia
- Topical minoxidil (Rogaine)
- oral finasteride (MEN ONLY)
- spirinolactone (Female)
warn about initial shedding of hair. can also do hair transplant or wig.
what is the MOA of finasteride
- inhibits conversion of testosterone to DHT
- slows hair loss in 3 months and regrowth occurs in 6 months
what is the MOA of spirinolactone for hair loss
blocks action of DHT
what is the usual cause of alopecia areata
- Family History
- Stress
What is the pathology of alopecia areata
- damage to hair follicle in the anagen stage
- causes rapid transfomation to catogen and telogen hairs -> dystrophic
what is the presentation of alopecia areata
- patchy hair loss over weeks to months.
- skin will be NORMAL, no scarring.
- well defined borders
where are common areas for alopecia areata
- scalp
- beard
- eyebrows
- extremities
what would you see on dermoscopy for alopecia areata
- black dots due to the hair breaking off before it surfaces
- exclamation hairs (blunt distal end and tapered proximally)
what are the subtypes of allopecia areata
- alopecia areata (AA) - solitary/multiple areas of hair loss
- AA totalis - total loss of terminal scalp hair
- AA universalis - total loss of all terminal body and scalp hair
- ophiasis - bandlike pattern of hair loss over periphery of scalp
- nails - fine pitting (“hammered brass”) of dorsal nail plate.
what diagnostics should you obtain for alopecia? what differentials would these rule out
- biopsy
- RPR - syphilis
- KOH - fungal
- ANA - autoimmune
- thyroid panel - endocrine
what is the likelihood for spontaneous remission of alopecia areata
If onset after puberty - 80%
what suggests poor prognosis of remission of alopecia areata
- childhood onset
- body hair involvement
- nail involvement
- atopy
- family Hx
what is the goal when treating alopecia areata
- no cure!!
- goal = decrease inflammation and reduce growth inhibitors
what are possible treatment options for alopecia areata
- topical minoxidil + topical corticosteroid
- short term prednisone
- anthralin (safe in kids)
what is anthralin
a keratolytic agent that is safe to use in children. promotes hair regrowth in 2-3 months.
avoid using on face.
what is keratosis pilaris?
an excess formation and/or buildup of keratin that leads to abrasive goose-bump texture of the skin
how common is keratosis pilaris
- 50-80% of adolescents
- 40% adults
30-50% have genetic predisposition
what is the timeline of keratosis pilaris
worsens in the winter and improves in the summer
what are the 2 different patterns of keratosis pilaris
- early childhood - affects face/arms. gradual improvement in later childhood or adolescence
- affects the extensor arms/legs. improves by mid 20s
what is the clinical presentation of keratosis pilaris
- small 1-2mm rough plaques scattered over affected area
- asymptomatic, occasional pruritus. +/- erythema if inflammation
chicken/goose bumps
where is the MC area for keratosis pilaris
upper outer arm and thighs
How do you diagnose keratosis pilaris
- clinically
- biopsy can be used if atypical presentation
histology = follicular orifice distended by keratin plug
What is the treatment for keratosis pilaris
- maintain skin hydration (cetaphil OTC, Rx Lac-Hydrin)
- steroid cream for inflammation (7days)
- keratolysis (topical retinoids, salycic acid, urea)
gentle soaps, unscented lotion.
what is onychocryptosis
nail grows into one or both sides of the paronychium or nail bed
ingrown toenail?
who and where is onychocryptosis MC in?
males in their 20’s
MC on the big toe!!!!
what is the pathology of onychocryptosis
impingement of the nail into the dermal tissue distally or into the distolateral nail groove
what are risk factors for onychocryptosis
- shoes
- sweating
- genetics
- dystrophy
- fungus
- improper cutting
- neuropathy/diabetes
what are possible complications of onychocryptosis
- paronychia
- cellulitis
- osteomyelitis
- bacteremia
- sepsis
what is the treatment for onychocryptosis
- warm soaks, trim nail
- mupirocin BID until healed.
- surgery (complete/partial matrixectomy)
How soon after matrixectomy for onychocryptosis can a patient resume activity?
48-72 hrs
what is onychomycosis
fungus of the nail
aka tinea unguium
where is onychomycosis MC and what is the MCC?
- on the toes!!
- trichophyton rubrum
where does fungus invade the nail in onychomycosis
the hyponychium
what is the presentation of onychomycosis
- asymptomatic
- CC usually discoloration and thickening of the nail.
- nail may lift from nailbed
what are risk factors for onychomycosis
- FMHx
- old age
- poor health
- trauma
- climate
- fitness
- immunosuppression
- communal bathing
- footwear
what must be ruled out any time there is discoloration of the toenail?
melanoma!!!
r/o clinically based on hx or with biopsy
what diagnostics are used in onychomycosis
- clip toenail and send for biopsy
- KOH scraping from under nail
no antifungals 2 weeks prior to samples
what is the treatment of onychomycosis
- topical Ciclopirox or Efinaconazole daily x 48wks
- oral Terbinafine (6wks fingers, 12wks toes)
- 50/50 apple cider vineger and water. 10 min soak/day
what labs must be monitored when a patient is on terbinafine
CBC and LFTs at baseline then monthly while on medication
risk of hepatotoxicity, pancytopenia, agranulocytosis
how long does it take for onychomycosis discoloration to resolve
can take up to a year for the nail to grow out and therefore the discoloration may remain until then
what is onycholysis
detachment from the nail bed
what is the presentation of onycholysis
- whitish or opaque discoloration
- gray-black = air
- green = bacteria
- NO inflammation
- smooth nail.
how do you diagnose onycholysis
clincially
what is the treatment goal for onycholysis
eliminate whatever is causing the nail to lift
probs fungus
what is paronychia
- inflammation of the proximal or lateral nail fold
- starts as cellulitis and progresses to abscess
what is the MCC of paronychia
- trauma!!
causes secondary bacterial inefction
what are RF for paronychia
- nail biting
- sucking
- trauma
- chemical irritants
- nail glue
- sculpted nails
- frequent hand washing
what is the MCC of acute paronychia
Staph!!
what is the presentation of acute paronychia
- painful, tender
- swelling, erythema
- +/-purulence (green = psuedomonas)
How do you diagnose acute paronychia
- gram stain
- C&S
- KOH
- Tznack for herpetic whitlow
- Xray (I assume for necrosis)
what is the treatment for acute paronychia
- warm soaks
- fluctuant = I&D
- cellulitis = abx
- significant infection/cellulitis/lymphangitis = consult surgery
what antibiotics are used in acute paronychia with cellulitis?
- augmentin
- clinda
- cephalexin
what is the etiology and presentation of chronic paronychia
- fungal/mechanical/chemical repeat exposure
- Inflammation, pain and swelling that waxes and wanes
- possible thickening and fungal infection
how do you treat chronic paronychia
- avoid RF’s
- keep dry
- warm antiseptic socks then dry ones
- topical antifungals PRN (oral if severe)
what is herpetic whitlow
HSV with distal finger involvement
which strain of HSV is MC in children with herpetic whitlow and what are the risk factors for it
HSV - 1 (gingivostomatitis)
Risks - sucking thumbs/fingers
2-14 day incubation
which strain of HSV is MC in adults with herpetic whitlow and what are the risk factors for it
HSV - 2
risks - healthcare workers
2-14 day incubation
what is the presentation of herpetic whitlow
- burning and pruritus prior to lesion formation
- vesicular lesions that are tender, swollen and indurated
how do you dx herpetic whitlow
clinically but tznack can def help
what is the treatment of herpetic whitlow
- DO NOT I&D
- OTC pain meds
- Acyclovir or valcyclovir
self limiting x 3 weeks, very contagious
what is felon
soft tissue infection of pulp space of distal phalanx caused by infection
what is expected in the history of felon
- penetrating injury
- splint
- paronychia
what are the clinical findings for felon
- pain, erythema, swelling
- Abscess formation on thumb/index finger
what are the possible compications of felon
- osteitis
- osetomyelitis
- septic joint
- tenosynovitis
how do you describe the disease course of felon
rapid and severe!
How do you diagnose felon
- gram stain w C&S
- Tznack if HW suspected
- Xray (severe)
Management for felon
augmentin
surgical decompression if severe
