Nails and Hair - Fungal nail infection, Head lice

Question 1

Fungal nail infection
-causative organisms
-risk factors
-presentation

Answer 1

Dermatophytes (fungi that need keratin for growth) - trichophyton rubrum
Yeast - candidia
Non-dermatophyte moulds

Increasing age
DM
Psoriasis
Repeated nail trauma

Unsightly nails
Thickened, rough, opaque

Nail clippings/scrapings for M&C if fungal infection suspected

Asymptomatic - no treatment
Dermatophyte/candida confirmed
Superficial or early involvement - amorolfine 5% nail lacquer
-6 months for fingernails
-9-12 months for toenails

Extensive dermatophyte infection - PO terbinafine
-6wks - 3 months for fingernails
-3-6 months for toenails

Extensive candida infection - PO itraconazole

Question 2

Headlice
-causative organism
-presentation
-investigations
-management

Answer 2

Pediculus capitis - feed on blood

Eggs - grey, brown, pinheadsized
-hatch in 7-10days
Nits - white and shiny
-cannot jump, swim or fly

Spread by direct head to head contact - more common in children

Itchy 2-3wks post infection

Fine toothed combing of wet or dry hair

Treat if living lice found
-malathion, wet combing, dimeticone, isopropyl myristate, cyclomethicone

Household contacts only need treatment if affected by lice