Hair + Nail Problems Flashcards

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1
Q

2 types of excess hair

A

Hirsutism
Hypertrichosis

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2
Q

Define hirsutism

A

Androgenic hair growth

  • male pattern areas (eg. Moustache, chest, beard)
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3
Q

Define hypertrichosis

A

Not androgen-dependent
Hair can be anywhere

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4
Q

What is vellus hair?

A

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

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5
Q

What makes up a pilosebaceous unit?

A

Sebaceous gland
Hair follicle

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6
Q

What physical signs do you look for in hair loss?

A

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

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7
Q

Where is hair loss in alopecia areata totalis?

A

Loss of total skull hair

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8
Q

Where is hair loss in alopecia areata universalis?

A

Whole body affected

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9
Q

Alopecia areata treatment

A

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

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10
Q

Other causes of non-scarring hair loss

A

Trichotillomania (associated with OCD)
Telogen effluvium
Androgenic alopecia

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11
Q

List some causes of scarring alopecia

A

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

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12
Q

Name a skin disease that is associated with hirsutism

A

Acne Vulgaris

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13
Q

List causes of hirsutism

A

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

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14
Q

What investigations should be done in hirsutism?

A

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

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15
Q

Hirsutism treatment

A

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

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16
Q

Androgenic alopecia treatment

A

Minoxidil topically
Finasteride 1mg od po
Hair transplantation
Wig

17
Q

Localised hypertrichosis causes

A

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

18
Q

Generalised hypertrichosis causes

A

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

19
Q

Nail pitting potential causes

A

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

20
Q

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

A

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

21
Q

Examination features that would distinguish between atopic eczema and psoriasis

A

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

22
Q

Differential diagnosis of pigmented nail streak

A

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