hair/nail disorders (see DM)

Question 1

what is the hair shaft

Answer 1

the part of the hair not anchored to the follicle - mostly exposed on the skin’s surface

Question 2

what is the part of the hair that is below the surface

Answer 2

the hair root

Question 3

what does the hair bulb contain

Answer 3

it surrounds the hair papilla, which is made of connective tissue and contains blood capillaries and nerve endings from the dermis

Question 4

what is the hair cycle

Answer 4

growth (Anagen, lasts a number of years) -> regression (Catagen) -> rest for several months (Telogen) -> shedding (Exogen)

each individual hair has its own cycle

Question 5

important factors in hair Hx

Answer 5

1. diffuse or patches;
2. age of onset;
3. scalp discomfort;
4. other sites effected (eyebrows, axillary etc.);
5. triggers (streses, hair care, diet etc.);
6. PMH (autoimmune, atopy);
7. FH (alopecia areata, autoimmune)

Question 6

2 main things to look for on examination for hair loss

Answer 6

1. scarring (no hair follicles, associated inflamation/scale);
2. exclamation mark hair (tapering hair shaft, seen on the peripheries of alopecia areata

Question 7

what should be tested for if a moth eaten pattern of hair loss is seen

Answer 7

syphillis

Question 8

what is trichotillomania

Answer 8

self induced pulling of hair

Question 9

presentation of trichotillomania

Answer 9

broken hair shafts; patchy; hairs at different lengths

Question 10

trichotillomania treatment

Answer 10

adults - treat underlying psychogenic disorder;
children - behaioural therapy, gloves, cut hair close

Question 11

tinea capitis presentation

Answer 11

kerion (boggy, puss filled lump), marked inflammation

Question 12

what is central centrifugal cicatricial alopecia

Answer 12

a scarring alopecia commonly seen in black people; hair loss occurs at vertex and extends outwards

Question 13

what is folliculitis decalvans

Answer 13

a rare condition that causes ongoing (chronic) inflammation of your hair follicles and scalp; tufted hair and scales seen

Question 14

what is traction alopecia

Answer 14

hair loss that occurs after years of hair styling (bleaching, hot combing, weaving, tight hair styles); affects bitempotal/frontal scalp line

Question 15

what is hirsutism

Answer 15

androgen dependent hairgrowth in a female: often appearing on the upper lip, chin and chest

Question 16

what is hypertrichosis

Answer 16

non androgen dependent excessive
hairgrowth e.g. over temples or ears

Question 17

what are the 3 types of hair

Answer 17

1. lanugo - long fine hair, normally shed in utero/first weeks of life;
2. vellus - short, fat hair that covers most of the body;
3. terminal - thick pigmented hair

Question 18

what is the nail matrix

Answer 18

the area where nail grows from

Question 19

what other areas should be conisdered when examening nails

Answer 19

oral mucosa, skin (rash), alopecia; other nails; scalp scale

Question 20

what is wickham’s striae

Answer 20

fine white or gray lines or dots seen on the top of the papular rash and oral mucosal lesions of Lichen planus

Question 21

what are 4 common nail problems

Answer 21

1. clubbing - loss of angle between posterior nail fold and nail plate;
2. koilonychia - spooning depression in the nail plate;
3. onchyolysis - spearation of the distal end of the nail plate from the nail bed;
4. pitting - punctate depressions in the nail plate

Question 22

3 changes to the nails seen in psoriasis

Answer 22

1. pitting;
2. salmon patches/oil drops;
3. subungual hyperkeratosis with distal onchylsis

Question 23

management of nail psoriasis

Answer 23

very potent topical steroids (dermovate); intralesional steroids (injected); systemic treatments - Mtx, ciclosporin (severe cases)

Question 24

2 classes of common nail infections and their managements

Answer 24

1. pseudomonal - green discoloration treated with vinegar soaks or ciprofloxacin;
2. fungal - dystrophic nails treated with topical antifungals (e.g. amlorolfine lacquer), oral antifungals (e.g. terbinafine)

Question 25

what is melanonychia

Answer 25

pigmentation of the nail; can occur in multiple bands (usually in those with darker skin) or from trauma

Question 26

melanonychia differential

Answer 26

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

Question 27

what investigation is done for acral melaona suspicion

Answer 27

urgent nail matrix biopsy

Question 28

what other differentials are there for nail pigmentation

Answer 28

trauma (subungual hamotoma); benign naevus; hormonal (addison’s disease); infectious; post inflammaotry; drugs (e.g. cancer, psoralen)