PAS dermatology: disorders of the hair and nails Flashcards
What is the pathophysiology and clinical presentation of androgenetic alopecia ?
It is a genetically determined androgen mediated follicular miniaturisation presents with progressive hair loss from the scalp.
What are the treatment options for androgenetic alopecia ?
It is a benign condition, treatment options include topical minoxidil, or oral finasteride a 5 alpha reductase inhibitor.
What is the pathophysiology of alopecia areata ?
Immune system attacks hair follicles leading to patchy hair loss in scalp and face normally. The exact etiology is unknown. May co-occur with Vitiligo and thyroiditis. Maybe triggered by recent infections, newly prescribed and emotional stress.
What is the clinical management of alopecia areata ?
-Often resolves spontaneously, may become chronic.
-Corticosteroids: intralesional injections vs topical vs oral
– Topical antralin cream – short duration of exposure then washed off
– Co-treatment with topical minoxidi
What is the aetiology and pathophysiology of paronychea ?
It is an acute infection of the periungal tissue often due to a break in the skin microbes such as staph, strepto, psudomonoas, or proteous invades the tissue and causes pustular lesions.
How to diagnose and manage paronychea ?
It is a clinical diagnosis as it presents as erythema of the nail matrix , which may progress to puss filled lesions due to bacterial infections. Treat it with warm compression at the erythematous stage + antibiotic coverage for the susceptible organism. The fluctuant pyogenic lesion has to be drained.
what are the risk factors for onychomycosis ?
- Communal showers, swimming pools
- Age
- Male > Female
- Occlusive footwear
- Occupation
- Immunocompromised state
- Exposure to others with onychomycosis
What is the clinical presentation of onycomycosis ?
- Yellow, brown and/or white discoloration
- Subungual hyperkeratosis
- Onycholysis
What is the diagnostic approach to onychomycosis ?
It is a clinical diagnosis. KOH and Wet mount can be used to identify the exact organism involved.
What are the topical treatments for onychomycosis ?
- 5% amorolfine nail lacquer once weekly for 6 months on finger nails and 9 to 12 months with three monthly revisions on toe nails.
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What is the first line oral treatment for onychomycosis ?
Terbinafine 250 mg every 24 hourly 6 weeks to 3 months.
Contraindicated in patients with liver disease and pretreatment LFT should be done. If prolonged treatment is needed LFT should be done again.
What is the second line treatment for onychomycosis ?
Itraconazole 200 mg daily 6 weeks for finger nails, 12 weeks for toe nails.
or
Itraconazole pulse therapy 200mg Itraconazole every 12 hour for one week / month.
Contraindicated in liver disease and pregnancy. LFT should be done, if the treatment is for > 1 month.
