Hair + Nail Problems

Question 1

2 types of excess hair

Answer 1

Hirsutism
Hypertrichosis

Question 2

Define hirsutism

Answer 2

Androgenic hair growth

• male pattern areas (eg. Moustache, chest, beard)

Question 3

Define hypertrichosis

Answer 3

Not androgen-dependent
Hair can be anywhere

Question 4

What is vellus hair?

Answer 4

Short, soft, fine non-pigmented hair on most of body
Eg. On forehead

Question 5

What makes up a pilosebaceous unit?

Answer 5

Sebaceous gland
Hair follicle

Question 6

What physical signs do you look for in hair loss?

Answer 6

Scarring = scarring (cicatrial) alopecia
Exclamation mark hairs = alopecia areata

Question 7

Where is hair loss in alopecia areata totalis?

Answer 7

Loss of total skull hair

Question 8

Where is hair loss in alopecia areata universalis?

Answer 8

Whole body affected

Question 9

Alopecia areata treatment

Answer 9

Consider none
Steroids - topical, interlesional or oral
Local PUVA
Minoxidil (topical)
Diphencycrone
Systemic immunosuppression
Wigs

Question 10

Other causes of non-scarring hair loss

Answer 10

Trichotillomania (associated with OCD)
Telogen effluvium
Androgenic alopecia

Question 11

List some causes of scarring alopecia

Answer 11

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

Question 12

Name a skin disease that is associated with hirsutism

Answer 12

Acne Vulgaris

Question 13

List causes of hirsutism

Answer 13

Idiopathic
Post menopausal
PCOS
Drugs (eg. Anabolic steroids)
Ovarian tumours secreting androgens
Congenital adrenal hyperplasia
Cushing syndrome
Prolactinoma
Obesity

Question 14

What investigations should be done in hirsutism?

Answer 14

Fasting blood glucose
Ovarian ultrasound
Serum testosterone
Sex-hormone binding globulin
Cortisol 9am and midnight
Prolactin
LH
FSH
Progesterone
Androstenedione
Dihydroepiandrostenedione

Question 15

Hirsutism treatment

Answer 15

Treat underlying cause
Hair removal (temporary)
Electrolysis
Laser
Eflornithin
Finasteride
Spironalactone
Some combined oral contraceptive pills

Question 16

Androgenic alopecia treatment

Answer 16

Minoxidil topically
Finasteride 1mg od po
Hair transplantation
Wig

Question 17

Localised hypertrichosis causes

Answer 17

Naevus-related
Spina bifida
Chronic Rubin’s
Porphyria cutanea tarda

Question 18

Generalised hypertrichosis causes

Answer 18

X-linked and autosomal dominant generalised hypertrichosis
Hypertrichosis lanuginosa
Fetal alcohol syndrome
Anorexia nervosa
Paraneoplastic effect
Drugs (diazoxide, ciclosporin, phenytoin)
Porphyria cutanea tarda

Question 19

Nail pitting potential causes

Answer 19

Psoriasis
Atopic eczema
Reiter’s disease
Alopecia areata
Pityriasis rosea
Syphilis

Question 20

History features that would help to distinguish between psoriasis and atopic eczema

Answer 20

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

Question 21

Examination features that would distinguish between atopic eczema and psoriasis

Answer 21

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

Question 22

Differential diagnosis of pigmented nail streak

Answer 22

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