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DERM > HAIR & NAIL DISORDERS > Flashcards

HAIR & NAIL DISORDERS Flashcards

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Dermatology Board Prep flashcards
1
Q

tinea unguium

A

onychomycosis

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2
Q

all tineas (except for versicolor) = caused by what fungus

A

trichophyton

almost always caused by dermatophytes

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3
Q

most common locations for onychomycosis

A

distal subungual region

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4
Q

RISK FACTORS FOR ONYCHOMYCOSIS

A 
⦁	DIABETES**
⦁	older age
⦁	swimming
⦁	tinea pedis
⦁	psoriasis
⦁	immunodeficiency
⦁	living with family members who have onychomycosis
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5
Q

CLINICAL PRESENTATION OF ONYCHOMYCOSIS

A
  • brittle
  • lusterless
  • hypertrophic

Begins with whitish, yellowish or brownish discoloration in one region of the nail, then gradually spreads to involve the entire width of the nail plate

⦁ nail plate then starts to break away or is picked away by the patient
⦁ mostly cosmetic concern, but can cause physical discomfort for some

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6
Q

DIAGNOSIS OF ONYCHOMYCOSIS

A
  • nail dystrophies often clinically indistinguishable from onychomycosis
  • nail dystrophies can occur with psoriasis, eczematous conditions, senile ischemia, trauma and lichen planus
  • onychomycosis = responsible for only 50-60% of abnormal appearing nails, so HAVE to make the diagnosis before treating

⦁ KOH prep
⦁ nail culture
⦁ Nail plate Biopsy

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7
Q

onychomycosis is often clinically indistinguishable from

A

nail dystrophy

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8
Q

nail dystrophies can occur with

A

psoriasis, eczematous conditions, senile ischemia, trauma and lichen planus

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9
Q

most sensitive test for diagnosis of onychomycosis

A

⦁ Nail plate Biopsy

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10
Q

who should get treatment for onychomycosis

A

⦁ patients with hx of cellulitis of the LE who have an ipsilateral toenail onychomycosis
⦁ patients with diabetes who have additional risk factors for cellulitis (prior cellulitis, venous insufficiency, PAD, edema)
⦁ patients with discomfort or pain
⦁ patients who desire tx for cosmetic reasons

  • onychomycosis can trigger cellulitis
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11
Q

terbinafine for onychomycosis = CANNOT BE USED WITH

A

STATINS

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12
Q

TREATMENT FOR ONYCHOMYCOSIS

A
  • topical therapies = generally ineffective - unable to penetrate nail plate
  • there is a high rate of treatment failure & recurrence even with oral therapy

⦁ Oral Terbinafine (Lamisil) - success = about 75% = treatment of choice - has greater efficacy and fewer SE than alternative oral regimens

⦁ Alternatives = Itraconazole (Sporanox), Griseofulvin, and Fluconazole (Diflucan)

**Careful with the liver - no alcohol!
and don’t take with a statin - will make LFTs skyrocket

Treatment Monitoring

  • can cause increased LFTs, hepatotoxicity, hepatic failure
  • assess LFTs prior and during course of treatment
  • CANNOT USE WITH STATINS***

recurrence rate = 20-50%; high rate of treatment failure & recurrence with oral therapy

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13
Q

digit tip infections =

A

paronychia = infection around the nail

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14
Q

DIGIT TIP INFECTIONS ARE USUALLY CAUSED BY

A

STAPH AUREUS

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15
Q

paronychia treatment

A
  • antibiotics
  • warm soaks for mild, well-localized cases
  • may require I&D in more serious cases
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16
Q

pulp space infection in a CLOSED COMPARTMENT - comprising the pulp space of the tip of the digit
- swollen, exquisitely tender, erythematous

A

FELON

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17
Q

paronychia vs felon

A

paronychia = just around nail bed

felon = whole finger is swollen / red / tender

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18
Q

herpetic infection in cuticle region = herpes infection of the finger

A

herpetic whitlow

19
Q

HERPETIC WHITLOW

A

herpetic infection in cuticle region = herpes infection of the finger; is very infectious / contagious

  • commonly seen in children & healthcare workers
  • dewdrop on rose petal - usually only on one finger
  • difference between whitlow & paronychia = paronychia is right around the nail
20
Q

HERPETIC WHITLOW TREATMENT

A

oral acyclovir, particularly if immunocompromised; (topical acyclovir not shown to be effective)

no point in treating past 72 hours; self-limited disease

21
Q

the lateral nail plate pierces the lateral nail fold and enters the dermis

A

ONYCHOCRYPTOSIS

22
Q

PRESENTATION OF ONYCHOCRYPTOSIS

A
  • pain
  • edema
  • exudate
  • granulation tissue
23
Q

PREDISPOSING FACTORS FOR ONYCHOCRYPTOSIS

A

⦁ poorly fitting shoes***
⦁ excessive trimming of lateral nail plate
⦁ trauma

24
Q

after removing nail, treat with

A

treat with PHENOL to destroy matrix - nail will never grow there again

25
Q

nail grows curved rather than laterally

A

onychogryphosis

26
Q

loss of hair in areas where it usually grows

A

ALOPECIA

27
Q

TYPES OF ALOPECIA

A

Androgenic alopecia
Alopecia areata
Telogen effluvium
Trichotillomania

28
Q

androgenic alopecia begins in the

A

begins in fronto-parietal scalp –> progressive recession

29
Q

4 main risk factors for androgenic alopecia

A

⦁ genetic predisposition
⦁ hormonal activity
⦁ age
⦁ gender - more common in men

30
Q

androgenic alopecia

A

The hair loss is permanent

  • Dihydrotestosterone (DHT) inhibits the growth of scalp hair (also stimualtes the growth of facial hair); have loss of scalp hair, but stimulates hair growth in other locations
  • Male-pattern hair loss in women suggests androgen excess (PCOS, hirsutism, etc)
31
Q

_______________ inhibits the growth of scalp hair (also stimualtes the growth of facial hair); have loss of scalp hair, but stimulates hair growth in other locations

A

Dihydrotestosterone

32
Q

Male-pattern hair loss in women suggests

A

androgen excess

33
Q

treatment for androgenic alopecia

A

⦁ Finasteride (Propecia) = 5-alpha reductase inhibitor - blocks the conversion of testosterone to Dihydrotestosterone (also known as Proscar in greater doses - used for BPH)

- continued use is necessary for sustained growth
- effects may not be seen until 6+ months of use

⦁ Minoxidil (Rogaine) = 5% solution - OTC

- works better in younger men who have been balding for < 10 years
- requires 6 months of treatment before hair growth becomes apparent
- persists only as long as BID applications are continued
34
Q

autoimmune process in which the body is attacking the hair follicles

A

alopecia areata

COMPLETE hair loss, not just thinning of the hair

rapid

35
Q

ALOPECIA AREATA

A
  • thought to be an AUTOIMMUNE process - directed against the hair follicle
  • have rapid hair loss in distinct, well-defined round or oval patches of COMPLETE hair loss (not just thinning of the hair)
  • the body is attacking hair follicles
  • can see short hairs broken off a few mm from the scalp at the edges of expanding patches
36
Q

***Alopecia areata is associated with other autoimmune conditions

A

⦁ Vitiligo
⦁ Hashimoto’s thyroiditis
⦁ Pernicious anemia
⦁ Addison’s disease

37
Q

clinical course of alopecia areata

A
  • clinical course is variable; may have 1 episode followed by spontaneous regrowth, however, may also progress to

Alopecia Totalis (loss of all scalp hair)

or Alopecia Universalis (complete loss of scalp & body hair)

38
Q

treatment for alopecia areata

A

Up to 80% of patients with alopecia areata that is limited and of less than 1 year’s duration may expect spontaneous regrowth of hair.

Intralesional steroids (best for isolated patches)

Potent Topical steroids (isolated patches)

Topical immunotherapy (extensive >50% hairloss)

2nd line: Minoxidil, Anthralin

39
Q
  • alteration of the normal hair cycle

- thinning / shedding of hair resulting from the early entry of hairs into the telogen phase (resting phase)

A

telogen effluvium

40
Q

risk factors for telogen effluvium

A 
⦁	stress
⦁	postpartum
⦁	malnutrition (anorexia)
⦁	crash dieting
⦁	metabolic changes (TSH, ferritin, CBC, CMP)
41
Q
  • impulse control disorder - pull hair out
A

trichotillomania

42
Q

Trichotillomania

A
  • impulse control disorder - pull hair out
    ⦁ irregular, short growth hairs
    ⦁ unilateral to patient’s dominant hair
43
Q

Trichotillomania treatment

A

SSRIs

Cognitive behavioral therapy

DERM (12 decks)

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