Nail, Hair And Scalp Disorders Flashcards

1
Q

Pigmentation of the nail plate is where?

A

Suprabasalar layers of the distal matrix

- high levels of melanocytes

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2
Q

Beaus lines

A

Transverse furrows that progress dismally

  • due to temporary arrest of the nail matrix
  • depth = extent of damage, width = duration for systemic insult

Usually bilateral but can be single nails

Causes = mechanical trauma is most common but can also be eczema or paronychia issues
- also systemic illness or major illness that are febrile and last decently long

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3
Q

Onychomadesis

A

Essentially more severe beaus lines. Shows proximal detachment of nails and a sulcus forms (looks kind of like a new nail is growing underneath the actual nail
- complete arrest of nail matrix activity

Most common cause = trauma to the nail

less common Causes:

  • very common in infants with hand/foot/mouth disease that isnt treated well
  • the fever associated causes onychomadesis
  • neurological damage or marathon runners are also common

**takes 6-8 months to look normal again though since that’s how long it takes for a brand new nail to grow

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4
Q

Pitting

A

Abnormal keratinization of proximal nail matrix
- clusters of parakeratotic cells in the dorsal nail plate

common in psoriasis, eczema and alopecia areata

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5
Q

Onychorrhexis

A

Longitudinal ridging of the nail plate
- diffuse damage to the nail matrix and thinning of the nail

Casues = aging, reptitive trauma and vascular diseases

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6
Q

Trachyonychia

A

Proximal nail matrix damage
- looks like worse onychorrhexis

Causes = alopecia areata is #1 but also psoriasis, eczema and autoimmune disorders

Treatment = treat underlying cause and it resolves spontaneously

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7
Q

Leukonychia

A

Opaque discoloration of the distal nail matrix

  • signifies nail matrix damage
  • **looks white and does not disappear with pressure to the nail

usually caused by trauma but can also be due to onychomycosis

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8
Q

mee’s lines

A

True type of Leukonychia
- single broad transverse white band

  • always should signify possible arsenic poisoning**
  • can also be sepsis, thallium poisoning, AAA/TAA, parasitic infections, chemotherapy
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9
Q

Koilonychia

A

Thinning and “spooned-shaped” (concave) nails

Is normal in children!!

  • however in adults means pathology = ****chronic iron deficiency!!
  • can also be hemochromatosis and hyperthyroidism
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10
Q

Onycholysis

A

Seperation of the nail plate form the nail beds
- shows nail discoloration of the nails (looks more white and yellow (like nail is being peeled off kinda))

causes

  • bacterial/fungal infections (especially candida/pseudomonoas)
  • however #1 = trauma and psoriasis**
  • **thyroid dysfunctions
  • malignancy
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11
Q

Apparent Leukonychia

A

Leukonychia that is false

- goes away with pressure and DOES NOT grow with the nail or move distally

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12
Q

Half and half (Lindsay nails)

A

Apparent Leukonychia

Very heavily tied to renal dysfunctions and hemodialysis patients

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13
Q

Muehrckes lines

A

Apparent Leukonychia with narrow multiple white transverse bands
- must grow in pairs

Chronic hypoalbuminemia (nephrotic syndromes) and combo chemotherapy are the msot common causes

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14
Q

Terry nails

A

Apparent Leukonychia where almost the whole nail is taken up by white nail

Due to telangiecasias in the nail beds

Casues = metabolic issues with CHF/diabetes/liver cirrhosis

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15
Q

Splinter hemorrhages

A

Dark-red thin longitudinal lines on the distal or proximal nails

Proximal causes:

  • **endocarditis!!
  • also vasculitis and trichinosis or mountain sickness

Distal causes:
- trauma and psoriasis are most common

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16
Q

Hutchinson sign

A

Hyperpigmentation along the entire nail that also includes the proximal and lateral nail fold

highly suspect of malignant melanoma

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17
Q

Green nail syndrome

A

Green-blue/black nail discoloration
- caused by pyocyanin pigments due to pseudomonas aeruginosa infections

Treatment = topical quinolone and acetic acid for 1-4 months

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18
Q

Pyogenic granuloma

A

Red growths under nails that can be cancerous
- common in pregnancy, trauma and drugs

must rule out amelanotic melanoma with biopsy

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19
Q

Clubbing of the nails

A

Very highly associated with pulmonary or cardiac diseases

*can be asymmetric which leads to likely hood of sarcoidosis or takayasu arteritis

20
Q

What medications can mimic onychocryptosis (ingrown toe nails)

A

Isotretinoin

Lamuvidrinae

21
Q

Phases of hair growth

A

Anagen

Telegen

Catagen

22
Q

Telegenic effluvium

A

Very common in postpartum patients or acute physical illness

  • can also be thyroid dysfunction
  • occurs within 2-4 months

Hair shifts to telegenic phase which causes hair to shed but scalp appears normal

  • treatment = reassurance and it will grow black
  • *should check meds and vitamin deficencies however if present
23
Q

Two components of the nail apparatus

A

1) epithelia

2) nail palate
- produced by stratum germinativum

24
Q

Nail immune system

A

Distal = rich innate and adaptive immune system
- possess onychocorneal band which separates distal from proximal nail

Proximal nail matrix = immune privilege
- upregulation of HLA-G and decreased MHC-2

25
Q

Anagen effluvium

A

Disruption of hair matrix cells
- same as telogen effluvium except hair DOESNT grow back
Common in chemotherapy, radiotherapy and heavy metal poisoning
- occurs within 1-4 weeks

26
Q

Alopecia Areata

A

Circular area on non-scarring hair loss

  • typically multiple hair loss circles
  • rarely can involve entire scalp

Regrown hair often is white

Treatment = steroids ultra potent and topical sensitizers

Prognosis = spontaneous regrowth
- poor factors = young age of onset, duration > 5years

27
Q

Androgenetic alopecia

“Patterned baldness”

A

Males = frontoparietal recession

Females = widening of the part and preserved frontal hairline

Caused by increased activity of type 2 5-alpha reductase

Treatment:

  • finasteride/dutasteerides (type 2 5-alpha reductase Inhibtors)
  • minoxidil (increases anagen phase)
  • spironolactone (women only)
28
Q

What labs do you check in women with hair loss?

A

CBC
Iron panel

Ferritin

TSH

DHEA-S

Free testosterone

B12/folate

Vitamin D

Zinc

29
Q

Differential diagnosis of hirsutism (excessive male-patterned hair growth)

A

Ovarian or adrenal androgen excess (PCOS, CAH, Cushings,m tumors)

Pituitary disorders

Iatrogenic medications (anabolic steroids, phenytoin, Diazoxide, cyclosporine, hexachlorobenzene)

30
Q

Red flags for hirtuism

A

Rapid virilizarion and hirsutism

New onset hypertension and/or diabetes = signals Cushing syndrome

Galactorrhea = prolactinoma or thyroid dysfunction

Gigantism = pituitary growth

Testosterone > 200 = ovarian or adrenal tumors

DHEAS score > 7000 = adrenal tumors

31
Q

Congenital adrenal hyperplasia

A

Most common form of 21 hydroxylase deficiency

  • will show testosterone and/or DHEAS elevated
  • cortisol will be normal

if rapid symptoms = adrenal tumor instead

32
Q

Treatment of hirsutism

A

Correct underlying cause if possible

Medications

  • spironolactone 100mg p.o day
  • finasteride 2.5-5 mg daily
33
Q

What medications cause hypertrichosis

A

1 = cyclosporine

Minoxidil, latanoprost, corticosteroids, streptomycin, topical androgens

34
Q

6 major components of the nail unit

A

Nail matrix

Nail plate

Cuticle

Nail bed

Anchoring portion

Framing portion (lateral/proximal/distal folds)

Lunula = only visible portion

35
Q

Eyebrows, eyelashes and vellus hairs are androgen-dependent?

A

NO they are the only hairs that are not

36
Q

Ferritin levels need to be at least what to treat iron-deficiency related telogen effluvium

A

40ng/dL

37
Q

Erythronychia

A

Longitudinal red bands on nails seen in dariers disease

- mutation in ATP2A2 gene

38
Q

Longitudinal melanonychia

A

Is casued by melanin in the nail plate

Very common in darkly pigmented skin patients

  • 90% of adult African Americans present with this
  • 20% of melanomas show this as well

While its usually caused by trauma or normal Variant, need to screen for melanoma if seen
- has a very low threshold for biopsy for potential melanoma (especially if Hutchinson sign is present)

39
Q

Red lunula

A

Seen in CO poisoning always

Can also be alopecia areata, SLE or CHF as well

40
Q

Blue lunala

A

Seen in Wilson disease of medication most commonly

- medications = 5-FU, minocycline, anti malaria drugs

41
Q

Yellow nails

A

Most commonly associated with lymphedema and/or compromised respiratory system

Tx = vitamin E

42
Q

Trichotillomania

A

Irresistible urge to remove or pull ones own hair

Most commonly arises as OCD

Shows irregularly shaped patches of alopecia variable lengths of hair

Complications = trichobezoar

43
Q

Acute chronic lupus hair loss

A

Shows telogen hair loss and does NOT scar

Can also show ear hair loss

Treatment = IL steroids

44
Q

Central centrifugal scarring alopecia

A

Scarring alopecia that begins at the crown and expands over the central scalp

VERY common in African Americans

Unknown etiology

Difficult to treat = antibiotics and steroids

45
Q

Dissecting cellulitis of the scalp

A

Hair loss that is accompanied by multiple painful inflammatory nodules over the vertex and occiput regions of the scalp
- produces scaring over time

The nodules can also turn to abscesses that are interconnected via sinus tracts

Treatment = isotretinoin if possible

46
Q

Sebopsoriasis

A

Is a hybrid term which covers a spectrum between psoriasis and seborrheic dermatitis

Can be anywhere but more likely in oily areas of the forehead and scalp line
- most common pathogen = malassezia yeast

Treatment = seborrheic derm = ketoconazole 
Psoriasis = topical steroids