Head & Finger Nail Abnormalities

Question 1

What are some examples of face abnormalities?

Answer 1

Acromegaly
Down Syndrome (Trisomy 21)
Cushing’s Syndrome
Myxedema
Parkinson’s Disease

Question 2

Describe acromegaly

Answer 2

• Results from excessive growth hormone
• Due to benign tumor or pituitary gland (pituitary adenoma)
• Results in excessive growth
• Generalized expansion of the skull
• Pronounced brow protrusion, often with ocular distension
• Pronounced lower jaw protrusion
• Macroglossia & teeth gapping

Question 3

Describe Cushing’s Syndrome

Answer 3

• “Hypercortisolism”
• “Moon face”
• Facial swelling (rounding)
• Red cheeks
• Hirsutisim
• “The patient appears cushingoid.”

Question 4

Describe Myxedema

Answer 4

• Severe hypothyroidism
• Dry, coarse & sparse hair
• Thin lateral eyebrows
• Puffy face
• Puffy eyes

Question 5

Describe Parkinson’s Disease

Answer 5

• Decreased facial mobility
• Stare
• Blunted expression
• Masklike face

Question 6

Describe Parotid gland enlargement

Answer 6

• One of the salivary glands
• Parotitis (infectious, blockage)
• Measles
• Chronic bilateral enlargement can be seen with obesity, diabetes, cirrhosis
• Gradual unilateral enlargement suggests neoplasm

Question 7

Describe Bell’s Palsy

Answer 7

• Idiopathic paralysis of the facial nerve (CN VII)
• Unable to perform functions involving facial nerve
• Wrinkle forehead & Squeeze eyes shut
• Smile & Puff out cheeks
• In general, Stroke spares forehead wrinkles (allows for some wrinkling of the forehead) – Bell’s Palsy does NOT

Question 8

Describe Androgenic alopecia

Answer 8

• Male pattern baldness
• Begins above both temples
• Hair also thins at the crown of the head
• Often a rim of hair around the sides and rear of the head is left
• Female pattern baldness (variant of androgenic alopecia)
• Hair thinner over the entire scalp but doesn’t recede

Question 9

Describe Alopecia areata

Answer 9

• Clearly demarcated round or oval patches of hair loss

- Usually affects young adults & children

Question 10

Describe Seborrheic dermatitis

Answer 10

• Results from overproduction of sebum (seborrhea)

- Flaky, white to yellowish scales on oily skin

Question 11

Describe Hirsutism

Answer 11

• Male pattern hair growth on a woman
• Due to excess androgens or increased androgen sensitivity
• Can be a symptom of disease, commonly Polycystic Ovarian Syndrome (PCOS)

Question 12

Describe Paronychia

Answer 12

• Acute or chronic inflammation of the proximal & lateral nail folds
• Nail folds swollen, red, tender

-Cause: Local trauma (e.g. nail biting, manicures) or frequent hand immersion in water

Question 13

Describe Leukonychia

Answer 13

• Nonuniform white spots that grow slowly out with the nail

- Cause is trauma

Question 14

Describe Koilonychia

Answer 14

-Spoon Nails
-Abnormally thin nails that have lost convexity, may become concave
-Associated with iron-deficiency anemia & Plummer-
Vinson syndrome

Question 15

Describe Onycholysis

Answer 15

• Painless separation of the whitened opaque nail plate from the pinker translucent nail bed; starts distally & progresses proximally
• Cause: Trauma (e.g. psoriasis, manicures) Some systemic diseases e.g. diabetes, anemia, hyperthyroidism, syphilis

Question 16

Describe Onychocryptosis

Answer 16

• Ingrown toenail, nail grows into dermis

- Cause: Improperly cutting toenails, Tight shoes

Question 17

Describe Onychomycosis

Answer 17

• Fungal infection of the nail bed, plate, or matrix

- Cause: Occlusive footwear, locker room exposure, susceptibility (e.g. diabetes)

Question 18

Describe Terry’s Nails

Answer 18

• Nail plate turns white with distal band of reddish brown

- Cause: Aging, Some chronic disease (e.g. liver disease – usu. cirrhosis, diabetes, heart failure)

Question 19

Describe Beau’s Lines

Answer 19

• Transverse depressions of the nail plates, usually bilateral
• Cause: Temporary disruption of proximal nail growth from systemic illness

Question 20

Describe Pitting

Answer 20

-Punctate depressions of the nail plate

-Cause: Defecting layering of the superficial nail plate
Usually assoc. with psoriasis

Question 21

Describe Clubbing

Answer 21

• Bullous swelling of the soft tissue at the nail base with loss of normal angle
• Nail bed feels spongy or floating
• Cause: Conditions associated with hypoxia (e.g. congenital heart disease, lung diseases incl. lung cancer)
• Mechanism unknown but involves vasodilation & increased blood flow to distal portion of digits & changes in the connective tissue