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BLOCK F > Hair & Nails > Flashcards

Hair & Nails Flashcards

1
Q

Another name for the nail cuticle

A

Eponychium

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2
Q

Beneath the proximal nail fold is the…

A

nail root or nail matrix

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3
Q

Convex margin of the nail matrix

A

Lunula (halfmoon)

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4
Q

Keratinized structure which continues growing throughout life (nail)

A

Nail plate

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5
Q

Cutaneous folds providing the lateral borders to the nail

A

Lateral nail folds

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6
Q

Cutaneous fold providing the proximal border of the nail

A

Proximal nail fold

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7
Q

Cutaneous margin underlying the free nail

A

Hyponychium

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8
Q

The bed upon which the nail rests, extending from the lunula to the hyponychium

A

Nail bed

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9
Q

The nail bed extends from … to…

A

The nail bed extends from the LUNULA to the HYPONYCHIUM

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10
Q

Onychomadesis

A

Complete separation of the nail plate from the nail bed. Accompanied by a full but temporary arrest of growth from the nail matrix.

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11
Q

Causes of onychomadesis (5)

A
  1. Trauma
  2. Eczema, erythroderma
  3. Severe systemic conditions
  4. High fever
  5. Viral illness
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12
Q

Common viral disease that causes onychomadesis (kids)

A

Hand-foot-mouth disease

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13
Q

Management of onychomadesis

A

Reassurance - nails will grow back with time

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14
Q

Punctate depressions on the nail plate are called…

A

nail pitting

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15
Q

Nail pitting can be associated with… (4)

A
  1. Psoriasis
  2. Atopic dermatitis
  3. Alopecia
  4. Trauma
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16
Q

Painful, erythematous, indurated swelling of nail fold(s) with purulent drainage developing over a few hours

A

Acute paronychia (acute infection of the nail essentially)

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17
Q

Acute paronychia is usually caused by…

A

Staphylococcus aureus

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18
Q

Acute paronychia treatment

A

Drainage + antibiotics (topical or oral)

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19
Q

Non-purulent, glistening erythema with nail dystrophy common in nail suckers

A

Chronic paronychia

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20
Q

Chronic paronychia is caused by…

A

Candida (fungus) and irritation caused by saliva

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21
Q

Herpetic Whitlow

A

HSV1 or HSV-2 infection of the fingertip and perionychium (tissues and structures surrounding the fingernail )

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22
Q

Herpetic Whitlow manifestations

A

RECURRENT episodes of pustulo-vesicular eruptions with pain, edema and erythema

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23
Q

Herpetic Whitlow treatment

A

Anti-viral medication

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24
Q

Tan, brown or black pigmented band along the length of the nail

A

Melanonychia

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25
Differential diagnosis for melanonychia (3)
1. Nail matrix nevus 2. Nail matrix lentigo 3. Melanoma
26
Ethnic melanonychia
Physiologic dark pigmentation of the nails that involves several nails. More common in darker skin phenotypes.
27
Onychomycosis
Fungal infection of the nail unit
28
In a patient with onychomycosis, we also need to look for...
tinea pedis in the patient and their family (athlete's foot i.e. fungal skin infection)
29
4 features of distal subungual onychomycosis
1. Invasion of nail bed and inferior portion of the nail plate 2. Onycholysis (separation of nail from nail bed) 3. Subungual hyperkeratosis 4. Yellow/brown discoloration
30
3 features of superficial white onychomycosis
1. Superficial infection of nail plate 2. Dorsal nail plate involved 3. White, opaque, friable areas
31
Onychomycosis treatment
Oral anti-fungal medication
32
Diagnosis of onychomycosis (2 tests)
1. Potassium hydroxide (KOH) preparation and fungal culture 2. Periodic acid-Schiff (PAS) stain
33
Difference between hair root and hair shaft
Hair root: below the surface of the scalp Hair shaft: above the surface of the scalp
34
Where to matrix cells proliferate and differentiate into the hair shaft?
Hair bulb
35
Each hair grows from a tiny, sac-like hole in the skin called...
hair follicle
36
Where do hair stem cells reside?
In the bulge (not in the hair bulb)!
37
What are the 3 hair growth phases?
1. Anagen 2. Catagen 3. Telogen
38
Anagen
* Growth phase of the hair * Matrix cells grow, divide and become keratinized to form the growing hair * Lasts 2-6 years
39
85-90% of terminal scalp hair is in the ... hair growth phase
anagen
40
Catagen
* Transitional phase * Matrix cells stop proliferating abruptly so the hair bulb involutes and regresses * Lasts 2-3 weeks
41
<1% of terminal scalp hair is in the ... hair growth phase
Catagen
42
Telogen
* Hair-shedding phase * Club-shaped proximal end of the hair sheds from the follicle * Lasts 3 months
43
10-15% of terminal scalp hair is in the ... hair growth phase
telogen
44
2 ways to classify alopecia
1. Localized vs diffuse 2. Cicatricial vs non-cicatricial
45
How can we tell that alopecia is non-cicatricial?
If you can still see the hair follicles
46
How can we tell that alopecia is cicatricial?
Lack of follicular ostia and shiny atrophic skin
47
Recurrent non-scarring, non-scaly type of hair loss (not itchy)
Alopecia areata (one of more alopecia patches)
48
Alopecia totalis vs alopecia universalis
Alopecia totalis: Loss of entire scalp hair Alopecia universalis: Loss of hair in scalp and other areas (brows, lasses, chin) *These are subtypes of alopecia areata*
49
Course of alopecia areata
The natural course is unpredictable. Spontaneous regrowth occurs in 50-80% of cases, but you can have one or multiple recurrences.
50
Infection of the scalp with a dermatophyte fungus
Tinea Capitis
51
Tinea Capitis is most common in...
preschool and school-aged children and African American children
52
Features of tinea capitis
Itchy and scaly Circular patches of alopecia with broken hairs
53
Tinea Capitis: Kerion
A type of tinea capitis * Boggy inflammatory mass surrounded by pustules * May be accompanied by fever and local lymphadenopathy
54
Tinea Capitis: Kerion may be misdiagnosed as...
Impetigo Cellulitis Abscess
55
Most common fungal species that causes tinea capitis
Trichophyton tonsurans
56
How does trichophyton tonsurans spread? (2)
* From one person to another (as it naturally infects humans) * Remains viable on combs, hairbrushes for a long time
57
Diagnosis of tinea capitis (tests) (3)
1. Scraping 2. KOH 3. Culture
58
Treatment of tinea capitis
Oral anti-fungal medication *Topical therapy can be used to reduce infectivity*
59
Habitual, compulsive plucking of hair (obsessive compulsive disorder)
Trichotillomania
60
Describe trichotillomania
A well-defined area of hair loss with shortened, broken-off hairs of different lengths
61
Trichotillomania usually affects what regions of the scalp?
Fronto-temporal Parieto-temporal *AKA areas that are easy to reach*
62
Treatment of trichotillomania
* Stop the habit * Psychiatric evaluation & medications like SSRIs
63
Genetically determined sensitivity of scalp hair follicles to adult levels of androgens
Androgenetic alopecia (AGA)
64
Androgenetic alopecia (AGA) s a common disorder that affects ~50% of men and women older than...
40 years
65
Where does hair loss occur in androgenetic alopecia (AGA)
Fronto-temporal and vertex area
66
Hair loss pattern in AGA for males
Starts with bi-temporal recession followed by diffuse thinning over the vertex (top) of scalp.
67
Hair loss pattern in AGA for females
Diffuse central thinning of the crown with preservation of the frontal hairline (Christmas tree pattern i.e. widening of the part)
68
What hormone mediates AGA hair loss?
Dihydrotestosterone (DHT) which is a metabolite of testosterone
69
Dihydrotestosterone production is regulated by the enzyme...
5-alpha-reductase
70
Pathophysiology of AGA
These patients have higher levels of 5a-reductase enzyme and more androgen receptors, so they produce more dihydrotestosterone (DHT) which causes AGA
71
How does dihydrotestosterone cause AGA?
DHT shortens the growth phase of the hair (anagen) from 3-6 years to weeks-months. The hair follicles get smaller and produce fewer and finer anagen hairs.
72
Telogen effluvium
Hair follicle gets shifted prematurely to telogen phase by various triggers (2-3 months after the trigger)
73
Telogen effluvium of physical exam
Diffuse non-scarring hair loss
74
Triggers of telogen effluvium (menmonic: SEND)
S: Stress (severe systemic disease, surgery, fever, psychological) E: Endocrine (hypo- or hyperthyroidism, postpartum) N: Nutritional (iron deficiency) D: Drug (acitretin, anticoagulant, allopurinol)
75
Natural course of telogen effluvium
Shedding continues for about 3-4 months after removal of the trigger. Hair density takes 6-12 months to return to baseline.

BLOCK F (27 decks)

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