Hair + Nail Problems Flashcards
2 types of excess hair
Hirsutism
Hypertrichosis
Define hirsutism
Androgenic hair growth
- male pattern areas (eg. Moustache, chest, beard)
Define hypertrichosis
Not androgen-dependent
Hair can be anywhere
What is vellus hair?
Short, soft, fine non-pigmented hair on most of body
Eg. On forehead
What makes up a pilosebaceous unit?
Sebaceous gland
Hair follicle
What physical signs do you look for in hair loss?
Scarring = scarring (cicatrial) alopecia
Exclamation mark hairs = alopecia areata
Where is hair loss in alopecia areata totalis?
Loss of total skull hair
Where is hair loss in alopecia areata universalis?
Whole body affected
Alopecia areata treatment
Consider none
Steroids - topical, interlesional or oral
Local PUVA
Minoxidil (topical)
Diphencycrone
Systemic immunosuppression
Wigs
Other causes of non-scarring hair loss
Trichotillomania (associated with OCD)
Telogen effluvium
Androgenic alopecia
List some causes of scarring alopecia
Immunological:
- lichen planopilaris/frontal fibrosing
- lupus
Bacterial/fungal infection
Trauma/iatrogenic:
- burns
- radiotherapy
Developmental:
- aplasia cutis
Skin cancers and their treatment
Blistering diseases:
- cicatricial pemphigoif
- epidermolysis bullosa
Other dermatoses:
- erosive pustular dermatosis of the scalp
Name a skin disease that is associated with hirsutism
Acne Vulgaris
List causes of hirsutism
Idiopathic
Post menopausal
PCOS
Drugs (eg. Anabolic steroids)
Ovarian tumours secreting androgens
Congenital adrenal hyperplasia
Cushing syndrome
Prolactinoma
Obesity
What investigations should be done in hirsutism?
Fasting blood glucose
Ovarian ultrasound
Serum testosterone
Sex-hormone binding globulin
Cortisol 9am and midnight
Prolactin
LH
FSH
Progesterone
Androstenedione
Dihydroepiandrostenedione
Hirsutism treatment
Treat underlying cause
Hair removal (temporary)
Electrolysis
Laser
Eflornithin
Finasteride
Spironalactone
Some combined oral contraceptive pills
Androgenic alopecia treatment
Minoxidil topically
Finasteride 1mg od po
Hair transplantation
Wig
Localised hypertrichosis causes
Naevus-related
Spina bifida
Chronic Rubin’s
Porphyria cutanea tarda
Generalised hypertrichosis causes
X-linked and autosomal dominant generalised hypertrichosis
Hypertrichosis lanuginosa
Fetal alcohol syndrome
Anorexia nervosa
Paraneoplastic effect
Drugs (diazoxide, ciclosporin, phenytoin)
Porphyria cutanea tarda
Nail pitting potential causes
Psoriasis
Atopic eczema
Reiter’s disease
Alopecia areata
Pityriasis rosea
Syphilis
History features that would help to distinguish between psoriasis and atopic eczema
Atopic eczema = childhood, asthma + hay fever also often present, familial rash, specific allergic triggers may be known
Psoriasis = uncommon in childhood, some will get arthritis, rash may be familial, no allergic triggers
Examination features that would distinguish between atopic eczema and psoriasis
Atopic eczema = excoriated appearance, flexures, scalp sometimes affected, behind ears uncommon, nail disease less severe, plantar involvement uncommon, wheeze, rhinitis
Psoriasis = scaly appearance, elbows + knees (extensor surfaces), scalp commonly affected, behind ears common, nail disease more severe, plantar involvement common, joint stiffness
Differential diagnosis of pigmented nail streak
Physiological (eg. Africans)
Traumatic
Benign Naevus in nail matrix
Addison’s disease
AIDS, Zidovudine therapy
Busulphan, cyclophosphamide
Laugier-Hunziker syndrome (with lentigines of lips, mouth and hands)
Malignant melanoma
