Hair & Nail Disorders

Question 1

Define Onchomycosis

Answer 1

Nail infections caused by ANY fungus

Question 2

Risk Factors for Onchomycosis

Answer 2

Older age
DM
Swimming
Tinea pedis
Psoriasis
Immunodeficiency
Living with someone affected

Question 3

Presentation of Onychomycosis

Answer 3

Brittle
Lusterless
Hypertrophic
White/yellow/brown discoloration

Question 4

What can nail dystrophies occur with?

Answer 4

Psoriasis
Eczematous conditions
Senile ischemia
Trauma
Lichen planus

Question 5

Diagnosis of Onychomycosis

Answer 5

KOH examination
Nail culture (DTM)
Nail plate biopsy

Question 6

Treatment of Onychomycosis Recommended in Whom?

Answer 6

Hx of cellulitis of LE
DM + risk factors for cellulitis
Discomfort +/- pain
Desire treatment for cosmetic reasons

Question 7

First Line Treatment of Onychomycosis

Answer 7

Oral terbinafine (Lamisil)

Question 8

Alternative Treatment Options for Onychomycosis

Answer 8

Itraconazole (Sporanox)
Griseofulvin
Fluconazole (Diflucan)

Question 9

Monitoring for Treatment of Onychomycosis

Answer 9

LFTs
Hepatotoxicity
Hepatic failure

Question 10

Treatment for Onychomycosis can not be used with what medication class?

Answer 10

Statins

Question 11

Define Paronychia

Answer 11

Infection around fingernail

Bug: Staph aureus

Question 12

Treatment of Paronychia

Answer 12

Antibiotics
Warm soaks
I&D: serious cases

Question 13

Define Felon

Answer 13

Pulp space infection

Question 14

Presentation of Felons

Answer 14

Swollen
Exquisitely tender
Erythematous

Question 15

Treatment of a Felon

Answer 15

I&D
Antibiotics
Referral to hand surgeon

Question 16

Define Herpetic Whitlow

Answer 16

Herpetic infection by inoculation of the virus in the cuticle region

Question 17

Treatment of Herpetic Whitlow

Answer 17

Self-limited

Immunocompromised: oral acyclovir

Question 18

Define Onychocryptosis (Ingrown nail)

Answer 18

Lateral nail plate pierces the lateral nail fold & enters the dermis

Question 19

Presentation of Onychocryptosis

Answer 19

Pain
Edema
Exudate
Granulation tissue

Question 20

Predisposing Factors of Onychocryptosis

Answer 20

Poorly fitting shoes
Excessive trimming of the lateral nail plate
Trauma

Question 21

Treatment for a Mild to Moderate Onychocryptosis

Answer 21

Cotton wedging or dental floss

Soak foot in warm water for 20 minutes 3 times/day

Question 22

Treatment for a Moderate to Severe Onychocryptosis

Answer 22

Removal

Possible antibiotics

Question 23

Define Onychogryphosis

Answer 23

Deformed, curved nail

Question 24

Define Alopecia

Answer 24

Loss of hair in areas where it normally grows

Question 25

Define Androgenic Alopecia

Answer 25

Male pattern baldness

Question 26

4 Factors in Androgenic Alopecia

Answer 26

Genetic predisposition Hormonal activity Age Gender

Question 27

Treatment of Androgenic Alopecia

Answer 27

``` Finasteride (Propecia) Topical minoxidil (Rogaine) ```

Question 28

MOA of Androgenic Alopecia

Answer 28

Blocks conversion of testosterone to DHT

Question 29

Describe Alopecia Areata

Answer 29

Rapid hair loss in distinct, well-defined round or oval patches of COMPLETE hair loss Possibly auto-immune

Question 30

What is alopecia areata associated with?

Answer 30

Vitiligo Hashimoto's thyroiditis Addison's disease Pernicious anemia

Question 31

Treatment of Alopecia Areata

Answer 31

Intralesional steroids Potent topical steroids Topical immunotherapy 2nd: minoxidil, anthralin

Question 32

Describe Telogen Effluvium

Answer 32

Thinning/shedding of hair resulting from the early entry of hair into the telogen phase

Question 33

Risk Factors of Telogen Effluvium

Answer 33

``` Stress Postpartum Malnutrition Crash dieting Metabolic changes (TSH, ferritin, CBC, CMP) ```

Question 34

Treatment of Telogen Effluvium

Answer 34

Treat underlying causes

Question 35

Describe Trichotillomania

Answer 35

Impulse control disorder Irregular, short growth hairs Unilateral to patient's dominant hand

Question 36

Treatment of Trichotillomania

Answer 36

SSRI | Cognitive therapy