Hair, Nails, Oral Mucosa

Question 1

3 types of hair

Answer 1

Terminal: large, pigmented
Vellus: short, non-pigmented
Lanugo: fine hair on fetal body, shed after birth

Question 2

Phases of the hair follicle cycle

Answer 2

Anagen (growth)
Catagen (regression or involution)
Telogen (rest phase)
Exogen (shedding)
Kenogen (empty follicle)

Question 3

Ciciatricial vs non cicatricial

Answer 3

Scarring vs non scarring alopecia

Question 4

Scarring alopecia

Answer 4

Less common
Irreversible loss of hair
Destruction of the hair follicle with subsequent scarring of the surrounding dermis
Inhibits further growth of hair

Question 5

Signs of scarring alopecia

Answer 5

History of burning, painful or itching
Shiny, taut scarred skin
Erythema and scaling of scalp
Peri follicular scale
Lonely hairs
Tufted hairs

Question 6

Non scarring alopecia

Answer 6

Generally reversible

Pattern hairloss, hair cycling disorders, immune mediated, trichotillomania

Question 7

Telogen effluvium

Answer 7

Non scarring hairloss
10% of hairs are shed (significant impact)
Triggered stress (major illness, hospitalization, post partum)
Generalized diffuse alopecia

Question 8

Miniaturization

Answer 8

Change in terminal hairs to vellus hairs
Due to conversion of testosterone to DHT
Found in pattern hairloss

Question 9

Treatment for pattern hairloss

Answer 9

Topical Minoxidil solution or foam
Systemic 5a reductase inhibitors (finasteride)
Hair transplantation (still need to continue oral finasteride or topical minoxidil)

Question 10

Trichotillomania

Answer 10

Pulling out hair - often due to stress or psych disorder
Hairs of varying lengths
Broken ends
Irregular, angular shaped bald patches

Question 11

Alopecia areata

Answer 11

Bald, round "peach" coloured patches
Exclamation point hairs
Regrowth with white hairs
Can progress to totalis or universalis subtypes
Check for geometric nail pitting

Question 12

Exclamation point hairs

Answer 12

Inflammation at the bulb of the follicle thins the hair

Question 13

What part of the nail does the
1. proximal
2. distal
matrix form?

Answer 13

1. dorsal nail plate

2. ventral nail plate

Question 14

Oil drop sign

Answer 14

Focal nail bed parakeratosis (retention of nuclei from accelerated keratinization)
Subsequent onycholysis and accumulated serum and cellular debris

Question 15

Lichen planus

Answer 15

White reticulate patch on oral mucosa
Do a full cutaneous exam when you see it
Inflammatory mucosal condition