Hair & Nail Disorders Flashcards
What are the clinical features of onychomycosis?
- first asymptomatic, usually patient comes in for cosmetic purposes
- as disease progresses: pain, numbness
- can interfere with walking, exercise, standing
- subungal hyperkeratosis
- onycholysis: white/yellow color
What is onychomycosis?
- fungal infection of nails
- can involve any part: matrix, nail bed, nail plate
- can come from direct skin contact or invasion from nearby affected skin (fungus grow in dark moist places, such as feet)
How is onychomycosis diagnosed?
- scraping for KOH (in office)
- nail clipping for PAS stain (sent away)-more applicable if you suspect another nail disease
What is the treatment for onychomycosis?
- topical + oral decreases recurrence rates
- risk vs. benefit w/ tx–cost, labs, side effects, med interactions
- topical– generally ineffective, unable to penetrate nail plate: daily application for almost a year
- oral: most effective– use lamisil (terbinafine): 1 pill/day for 1 month (fingernails), 1 pill/day for 3 months (toenails), but costs a lot of $$, patient must wait until nail grows out to see improvement, labs needed: LFTs baseline and 6 weeks
- Nail avulsion
- Laser (? benefit)
What is paronychia?
soft tissue infection that occurs around fingernail
- acute-painful/purulent-caused by STAPH
- chronic (6+weeks)-swelling, non-purulent-caused by FUNGUS
- breakdown of nail fold due to cracks, fissures, trauma–allows entry way for organisms
What are the clinical features of paronychia?
- acute: pain, swelling at nail fold, erythema, pus
- chronic: 6+ weeks, erythema, swelling, tenderness at nail fold, nail plate may become thickened and discolored
What is the workup for paronychia?
- bacterial culture
- KOH smear
- imaging if osteomyelitis suspected
What is the treatment for paronychia?
acute: oral antibiotics, soaks, incise and drain
chronic: topical/oral antifungal, warm soaks
How do you educate patients on paronychia avoidance?
avoid nail biting
trim hang nails
trim nails flush to tip
avoid excessive moisture exposure
What is alopecia areata?
- recurrent non scarring alopecia that can affect any hair bearing area
- scalp, beard, eyebrows (localized 50% involvement)
- alopecia areata: discrete patches of loss
- alopecia totalis: entire scalp is bald
- alopecia universalis: all hair bearing areas of body are bald
- can affect children and adults
- benign but cosmetically unappealing
What is the cause of alopecia?
unknown
probably autoimmune
What are the clinical features of alopecia areata?
- asymptomatic
- mild pruritis or burning
- discrete bald patch with smooth non inflamed underlying skin
- exclamation hairs are pathognomonic (sign o symptom indicative of a particular disease/condition)
What are exclamation point hairs? (alopecia areata)
-not seen in any other type of alopecia, they border new patches of alopecia areata, indicating the patch is expanding
What is the diagnostic evaluation of alopecia areata?
- pull test: pull from the periphery of patch, if hair easily pulls out disease is active and more loss can be expected
- diagnosis made clinically
What is the treatment for alopecia areata?
depends upon extent of disease topical or intralesional steroids SADE-immunotherapy wigs/hair prosthesis disease unpredictable change of regrowth great with limited disease, worse with extensive dz when hair regrows it will be white and fine no preventative treatment
