hair/nail disorders (see DM) Flashcards
what is the hair shaft
the part of the hair not anchored to the follicle - mostly exposed on the skin’s surface
what is the part of the hair that is below the surface
the hair root
what does the hair bulb contain
it surrounds the hair papilla, which is made of connective tissue and contains blood capillaries and nerve endings from the dermis
what is the hair cycle
growth (Anagen, lasts a number of years) -> regression (Catagen) -> rest for several months (Telogen) -> shedding (Exogen)
each individual hair has its own cycle
important factors in hair Hx
- diffuse or patches;
- age of onset;
- scalp discomfort;
- other sites effected (eyebrows, axillary etc.);
- triggers (streses, hair care, diet etc.);
- PMH (autoimmune, atopy);
- FH (alopecia areata, autoimmune)
2 main things to look for on examination for hair loss
- scarring (no hair follicles, associated inflamation/scale);
- exclamation mark hair (tapering hair shaft, seen on the peripheries of alopecia areata
what should be tested for if a moth eaten pattern of hair loss is seen
syphillis
what is trichotillomania
self induced pulling of hair
presentation of trichotillomania
broken hair shafts; patchy; hairs at different lengths
trichotillomania treatment
adults - treat underlying psychogenic disorder;
children - behaioural therapy, gloves, cut hair close
tinea capitis presentation
kerion (boggy, puss filled lump), marked inflammation
what is central centrifugal cicatricial alopecia
a scarring alopecia commonly seen in black people; hair loss occurs at vertex and extends outwards
what is folliculitis decalvans
a rare condition that causes ongoing (chronic) inflammation of your hair follicles and scalp; tufted hair and scales seen
what is traction alopecia
hair loss that occurs after years of hair styling (bleaching, hot combing, weaving, tight hair styles); affects bitempotal/frontal scalp line
what is hirsutism
androgen dependent hairgrowth in a female: often appearing on the upper lip, chin and chest
what is hypertrichosis
non androgen dependent excessive
hairgrowth e.g. over temples or ears
what are the 3 types of hair
- lanugo - long fine hair, normally shed in utero/first weeks of life;
- vellus - short, fat hair that covers most of the body;
- terminal - thick pigmented hair
what is the nail matrix
the area where nail grows from
what other areas should be conisdered when examening nails
oral mucosa, skin (rash), alopecia; other nails; scalp scale
what is wickham’s striae
fine white or gray lines or dots seen on the top of the papular rash and oral mucosal lesions of Lichen planus
what are 4 common nail problems
- clubbing - loss of angle between posterior nail fold and nail plate;
- koilonychia - spooning depression in the nail plate;
- onchyolysis - spearation of the distal end of the nail plate from the nail bed;
- pitting - punctate depressions in the nail plate
3 changes to the nails seen in psoriasis
- pitting;
- salmon patches/oil drops;
- subungual hyperkeratosis with distal onchylsis
management of nail psoriasis
very potent topical steroids (dermovate); intralesional steroids (injected); systemic treatments - Mtx, ciclosporin (severe cases)
2 classes of common nail infections and their managements
- pseudomonal - green discoloration treated with vinegar soaks or ciprofloxacin;
- fungal - dystrophic nails treated with topical antifungals (e.g. amlorolfine lacquer), oral antifungals (e.g. terbinafine)
what is melanonychia
pigmentation of the nail; can occur in multiple bands (usually in those with darker skin) or from trauma
melanonychia differential
acral melanoma - usually a single band, look for hutchinson’s sign (pigmentation extending to the nail fold skin) or for broadening of the pigment band
what investigation is done for acral melaona suspicion
urgent nail matrix biopsy
what other differentials are there for nail pigmentation
trauma (subungual hamotoma); benign naevus; hormonal (addison’s disease); infectious; post inflammaotry; drugs (e.g. cancer, psoralen)
