Lecture 7: Hair and Digit Tip Disorders Flashcards
(103 cards)
1
Q
How does hair grow?
A
Intermittently
2
Q
What are the 4 phases of hair growth?
A
- Anagen: Growth
- Catagen: degenerate/Catabolic stage, stoppage of growth.
- Telogen: resting/timeout phase
- Exogen: hair shedding/exit phase
3
Q
How long do leg hairs usually grow for?
A
5-7m
4
Q
What are the 4 types of hair?
A
- Lanugo (soft hair in fetus)
- Vellus hair (peach fuzz), not affected by hormones
- Intermediate hair: scalp
- Terminal hairs: thick, pigmented hairs whose growth IS affected by hormones
5
Q
How many hairs should a normal hair pull dislodge?
A
3-5
> 5 = sus
6
Q
What does a trichogram measure?
A
Anagen to Telogen ratio
7
Q
Describe a normal trichogram.
A
- Epilate/plick 50+ hairs from scalp.
- Ideally you see 80%-90% anagens, which are characterized by Long encircling hair sheaths.
Telogen hairs are largest at the base.
Tiny amt of Telogens
8
Q
What is the most common form of alopecia?
A
Androgenic alopecia
Aka sex pattern hair loss
9
Q
What is the underlying pathophysiology of androgenic alopecia?
A
Terminal hairs are regressed into indeterminate/vellus hairs due to androgens.
Terminal hairs are affected by hormones!
10
Q
What androgenic alopecia classification describes females?
A
Ludwig-Savin
MC type is diffuse thinning. Women wear wigs
11
Q
What androgenic alopecia classification describes males?
A
Norwood Hamilton
Alexander Hamilton was a man or men have morning wood
12
Q
When does androgenic alopecia commonly occur for men?
A
After puberty, done by 40s
13
Q
When does androgenic alopecia commonly occur for women?
A
After 50!
14
Q
Overall, what sex and ethnicity is androgenic alopecia MC in?
A
White males
toby.
15
Q
What hormone specifically causes androgenic alopecia and the long-term result of exposure to it?
A
- DHT
- Successive cycles will produce shorter and thinner hairs
16
Q
What associated S/S should we ask for a woman regarding androgenic alopecia?
A
- Acne
- Hirsutism
- Irregular Menses
All hormone related
17
Q
Generally, how does male androgenic alopecia present?
A
Anterior or central hair loss.
18
Q
If I do a biopsy of androgenic alopecia, what do I expect to see?
A
Telogen phase & atrophic follicles
19
Q
What hormone studies are indicated for androgenic alopecia workup?
A
- Testosterone (total & free)
- DHEAS
- Prolactin
20
Q
What conditions can cause androgenic alopecia?
A
- Thyroid
- Anemia
- Autoimmune
21
Q
What is the preferred topical tx for androgenic alopecia?
A
Minoxidil/Rogaine BID
let pts know hair shedding initially is COMMON.
Can also be taken orally.
22
Q
What are the oral medications for androgenic alopecia?
A
- Finasteride for men
- Spironolactone for women
Finasteride slows hair loss for 3 months, then grows it back over 6.
Finasteride inhibits conversion of test to DHT. It is the 5-alpha-reductase inhibitor also used for BPH.
Spironolactone prevents DHT from working.
23
Q
What are the key descriptors of alopecia areata?
A
Random hair loss with NO inflammation of skin.
No scarring!
T-cell mediated autoimmune.
AReata = At Random
24
Q
Who is alopecia areata MC in?
A
Children < 25 yo
MCC of hair loss in children
25
Describe the pathology that occurs in alopecia areata
1. Hair follicle is damaged in anagen phase.
2. Transforms to catagen and telophase rapidly.
3. Cannot progress beyond anagen phase if active.
| However, **no scarring = regrowth is possible.**
26
What is probably the buzzword for alopecia areata?
There is NO SKIN SCARRING
27
Where is alopecia areata MC found?
* Scalp
* Beard
* Eyebrows
* Extremities
28
What would dermoscopy show for alopecia areata?
* **Black dots** representing broken hair pushed out of the follicle.
* **Exclamation Hairs**
| Hair follicle broken early.
29
What are the subtypes of alopecia areata?
* Alopecia areata: solitary/multiple areas of hair loss
* AA totalis: total loss of **terminal scalp hair**
* AA universalis: Total loss of **all terminal body & scalp hair**
* Ophiasis: Headband-shaped hair loss
* Nails: fine pitting/hammered brass of dorsal nail plate
30
How is alopecia areata typically treated?
* Typically just **remits on its own.**
* Mainly decreasing inflammation and reducing growth inhibitors (see next card)
* Psych consult
31
What are the poor prognostic factors for alopecia areata?
* Began in childhood
* Body hair involved
* Nail involvement
* Atopy
* FHx
32
What medications are used to reduce inflammation in alopecia areata?
* Topical CS (class 1 or 2) with minoxidil
* Intralesional Kenalog Q6wks into alopetic plaques
33
What is the systemic tx for alopecia areata?
Short term prednisone
34
What is the specific kid tx for alopecia areata?
Anthralin
| Keratolytic agent that regrows hair.
## Footnote
Must avoid face
35
What is keratosis pilaris?
Hyperkeratinization of skin and keratotic follicular plugging
| Goosebumps skin
##FOOTNOTE
little pils of keratin
36
Primary risk factor for keratosis pilaris?
FHx
37
When is keratosis pilaris worst?
Winter
| Better in summer, cold = goosebumps
38
How does the early childhood pattern of keratosis pilaris present?
* Face/arm involvement
* Improves as they grow
39
How does adolescence onset keratosis pilaris present?
* Arms/legs
* Improves by mid-20s
| Face is only in early childhood!
40
What is the only symptom usually with keratosis pilaris?
Occasional pruiritis
| Can have erythema if associated inflammation
41
Where specifically is keratosis pilaris MC?
Upper outer arms and thighs.
42
Dx of keratosis pilaris is made...
Clinically
| Biopsy showing follicular orifice distended by keratin plug if atypical.
43
Main treatments for keratosis pilaris
* Skin hydration via gentle **Dove soaps** and unscented moisturizer lotions
* **Lac-Hydrin** (lactice acid lotion) BID
* Reduction of inflmmation (if present) via **steroid creams** 1-2x/d for 7-10d
* Keratolysis via SA, topical urea, or topical retinoids
44
What is the main SE of keratolytic agents like SA or topical retinoids?
Inflammation
45
Nail growth into one or both sides of the paronychium/nail bed is...
Onychocryptosis
| creeping in
46
Who is onychocryptosis MC in?
Males in their 20s
47
What does the impingement of the nail into the dermal tissue result in?
| Onychocryptosis
* Erythema
* Edema
* Purulence
* Granulation tissue
| It functions as a foreign body
48
What is onychocryptosis more commonly known as?
Ingrown nails
49
Where is onychocryptosis MC?
Big toe
| Gotta wear looser shoes
50
Tx for onychocryptosis
* Warm soaks
* Topical mupirocin BID
* Nail trimming
* Cotton training
* Surgery (nail or matrix removal)
51
Post-op care for onychocryptosis/ingrown nail
* Antibacterial soap
* Mupirocin
| Resume activity after 48-72hrs
52
Where is onychomycosis/tinea unguium MC?
| Prepare yourself
Toes
53
Causative organism for tinea unguium/onychomycosis
Trichophyton rubrum
| Fungi
54
What structure does tinea unguium/onychomycosis invade specifically in the nail?
Hyponychium
| H & M(ycosis)
55
What is the MC complaint of onychomycosis?
Discoloration
| Nail thickens and cause sometimes lift off bed.
## Footnote
No other symptoms really. its just gross.
56
What kind of person might get onychomycosis?
A daily goer to the Gym who **wears no shoes in the shower**
57
Although onychomycosis is mianly just a gross looking condition, what do you need to workup?
MELANOMA WORKUP FOR ANY TOENAIL DISCOLORATION
| Either rule out clinically or biopsy it
## Footnote
Especially if its like a dark band
58
How do you workup onychomycosis?
Toenail clipping under KOH prep
| No antifungals 2 weeks prior
59
Topical tx for onychomycosis
* Ciclopirox (Penlac)
* Efineconazole (Jublia)
| **48 WEEKS of treatment for jublia**
60
What is the home remedy for onychomycosis?
1:1 ratio of apple cider vinegar and water for 10 mins a day
| Soak those dogs
61
If you want to treat onychomycosis orally, what would you give?
* Terbinafine for 6 weeks for the fingers.
* 12 weeks for the Toes/Dogs
| Dogs need lots of care
62
What do you need to monitor in onychomycosis lab-wise during pharm tx?
* CBC
* LFTs
| **Baseline & monthly!!**
## Footnote
Hepatoxicity
Pancytopneia
Agranulocytosis
63
How long might it take a nail to regrow with onychomycosis?
1 year
| Might be discolored for a while
64
What is onycholysis?
Detachment from nail bed
65
What color suggests bacteria caused onycholysis?
Green
| Gray-black is just air
66
What is unique about onycholysis presentation?
1. No inflammation
2. Nails are smooth
| Loose Lysis
67
How do you treat onycholysis?
Tx underlying cause if there is one
68
What does paronychia start as and progress to?
Inflammation of proximal/lateral nail fold into cellulitis into abscess
| The classic cellulitis => abscess
69
MCC of paronychia
Trauma
| 2nd is bacteria
70
How much hand washing is a RF for paronychia
50-100 times a day?
| OCD ppl prob could meet this
71
MCC bacteria for acute paronychia
Staph
72
If acute paronychia has GREEN purulence, what might be the bacteria?
Pseudomonas
73
If you do a Tzanck for acute paronychia, what are you prob considering in your DDx
Herpetic Whitlow
74
Normal tx of non-cellulitis acute paronychia
* Warm soaks
* I&D if it becomes fluctuant
75
Tx of cellulitis acute paronychia
Augmentin BID x 10d
| Clinda, Keflex
76
Besides treating acute paronychia, what should u do?
Consult hand surgeon IF significant cellulitis or lymphangitis, Tenosynovitis, deep space infection, osteomyelitis
77
How does chronic paronychia typically present?
* Waxing and waning inflammation
* Pain
* Swelling for 6 weeks
78
Tx of chronic paronychia
* Keep dry
* Don't touch
* Warm antiseptic soaks
* Topical antifungals
| Oral antifungals if severe
79
Where is Herpetic whitlow MC?
Distal finger
80
Who is HSV1 herpetic whitlow MC in and why?
Children because they suck their fingers
| Can also be caused by gingivostomatitis
81
Who is HSV2 herpetic whitlow MC in?
Adults working in healthcare
82
**PRIOR** to the herpetic whitlow lesions, what symptoms occur?
* Burning
* Pruritis
| Its like shingles for your fingers
83
How is herpetic whitlow Dx?
Clinical
| Tzanck if ya want
84
What should you NOT do with herpetic whitlow tx?
DO NOT I&D
85
How do you tx herpetic whitlow?
* Acyclovir/Valcyclovir
* OTC pain meds
| Self-limiting over 3 weeks
86
What is Felon?
Soft tissue infection of pulp space of distal phalanx due to infection
87
Where is Felon MC?
* Thumb
* Index finger
88
Why is Felon scary
Rapid and severe progression
| Can turn into osteitis, osteomyelitis, septic joint, or tenosynovitis.
##FOOTNOTE
A Felon is much more SEVERE than a misdemeanor
89
How do you workup Felon
* Gram stain + C&S
* Tzanck to r/o herpetic whitlow
* **XR**
| a thorough bkg check on felons
90
How do you manage a Felon?
Augmentin BID x 10 days
Surgical decompression
| Treat it like its in a CELLulitis
91
Why do clubbed nails occur?
**Primarily idiopathic**, but can occur due to prolonged hypoxia.
| I have a clubbed pinky :(
92
What condition is the MCC of clubbed nails besides being idiopathic?
Lung CA
| hypoxia?
93
What is melanonychia?
Nail pigmentation due to melanin
| Melanin nails
94
Who is melanonychia MC in?
Darker skinned
95
What are the possible underlying conditions that can result in melanonychia?
* Infections
* Skin conditions
* Trauma
* **Tumors (Bowens or SCC)**
* Addisons/Cushing's
* Iatrogenic
96
What is the MCC of melanonychia in children?
Nail matrix nevus
97
MC associated condition with pitted nails?
Psoriasis
98
MCC of splinter hemorrhages
Trauma to nail
99
Medical conditions that can cause splinter hemorrhages
* APS
* **IE**
* IVDU
* Psoriasis
* **Rheumatic HD**
* SLE
100
Who are terry nails MC in?
Liver dz/Cirrhosis
101
What happens to the nail bed in terry nails?
* Less blood
* More connective tissue
| Increased pallor
102
What does a single beau line suggest in terms of etiology?
Repeated trauma/infection
103
What do multiple beau lines suggest for etiology?
* Acute kidney failure
* Mumps
* Thyroid
* Syphilis
* Chemo
* Endocarditis
* Melanoma
* DM
* PNA
* Scarlet Fever
* Zinc Deficiency
| not memorizing this grrr
