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derm > hair and nails made by Billie > Flashcards

hair and nails made by Billie Flashcards

1
Q

What is the pattern of hair growth

A

intermittent activity with phases of growth that are followed by periods of inactivity and then expulsion

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2
Q

name the phases of hair growth and what occurs during each phase

A
  1. anagen - growth stage, phase of normal active growth (connected to blood supply)
  2. catagen - degenerative stage, brief transition in which hair growth stops (detach from blood supply)
  3. telogen - resting phase (no blood = dies)
  4. exogen - hair shedding phase (hair falls off)
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3
Q

what is the duration of hair growth based off of body location

A
  • scalp: 2-8 years
  • arms: 1.5-3 years
  • legs: 5-7 months
  • eyelashes: 4-6 months
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4
Q

what is lanugo hair

A

sodt and fine hari covering a fetus, usually shed prior to birth

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5
Q

what is vellus hair

A

fine, non pigmented hair that covers the body of children and adults. NOT influenced by hormones.

peach fuzz

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6
Q

what is intermediate hair

A

occurs on the scalp! has characteristics of both vellus and terminal hairs

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7
Q

what is terminal hair

A

thick pigmented hair found on scalp, beard, axilla, pubic area, eyelash and eyebrows. this IS influenced by hormones

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8
Q

which hair is and is not influenced by hormones

A

vellus hair IS NOT
terminal hair IS

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9
Q

what is the hair pull test? what is a positive test?

A
  • gently pull hair on the scalp
  • abnormal is >5 hairs dislodged.
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10
Q

what is a scalp biopsy

A

scraping/shaving of scalp to evaluate for pathology

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11
Q
A
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12
Q

what do you call the microscopic evaluation of hairs pulled from the scalp

A

trichogram

this is google

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13
Q

what is the goal of trichograms

A

to determine the anagen to telogen ratio

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14
Q

How do you perform a trichogram? what is a normal result?

A

pluck 50 or more hairs from the scalp and assess the ratio of anagen hairs to telogen hairs.

normal = 80-90% of hairs are anagen

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15
Q

how do you differentiate anagen hairs and telogen hairs

A
  • anagen hairs - long encriculating hair sheath
  • telogen hairs - resting hairs w inner root sheath and root that is largest at the base
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16
Q

what is alopecia

A

hair loss

comes in a variety of patterns and causes!

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17
Q

what is the MC form of alopecia

A

androgenic

male and female patterned baldness

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18
Q

what occurs during androgenic alopecia

A

a gradual conversion of terminal hairs into indeterminate and vellus hairs

genetic predisposition!!!

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19
Q

what are the names for the male and female classifications of androgenic alopecia

A
  • female: ludwig-savin classification (widening part)
  • male: norwood hamilton classification

women wear wigs: lud-“wig”
Men have morning wood: nor”wood”

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20
Q

when is androgenic alopecia MC?

A
  • men - after puberty (as early as 20’s and fully expressed by 40)
  • women - MC after 50

Men>women MC in white men followed by black and asian

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21
Q

what is the pathology of androgenic alopecia

A
  1. DHT causes terminal follicles to transform into vellus like hair follicles (atrophy)
  2. hairs are then produced at shorter lengths and decreased diameter.
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22
Q

How do you diagnose androgen alopecia? what would you see on diagnostics?

A

typically clinical but can do:
- biopsy: telogen phase follicles and atrophic follicles
- trichogram: ^ telogen hairs
- hormone studies: testosterone, DHEAs, prolactin

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23
Q

How do you treat androgenic alopecia

A
  • Topical minoxidil (Rogaine)
  • oral finasteride (MEN ONLY)
  • spirinolactone (Female)

warn about initial shedding of hair. can also do hair transplant or wig.

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24
Q

what is the MOA of finasteride

A
  • inhibits conversion of testosterone to DHT
  • slows hair loss in 3 months and regrowth occurs in 6 months
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25
Q

what is the MOA of spirinolactone for hair loss

A

blocks action of DHT

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26
Q

what is the usual cause of alopecia areata

A
  • Family History
  • Stress
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27
Q

What is the pathology of alopecia areata

A
  • damage to hair follicle in the anagen stage
  • causes rapid transfomation to catogen and telogen hairs -> dystrophic
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28
Q

what is the presentation of alopecia areata

A
  • patchy hair loss over weeks to months.
  • skin will be NORMAL, no scarring.
  • well defined borders
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29
Q

where are common areas for alopecia areata

A
  • scalp
  • beard
  • eyebrows
  • extremities
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30
Q

what would you see on dermoscopy for alopecia areata

A
  • black dots due to the hair breaking off before it surfaces
  • exclamation hairs (blunt distal end and tapered proximally)
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31
Q

what are the subtypes of allopecia areata

A
  1. alopecia areata (AA) - solitary/multiple areas of hair loss
  2. AA totalis - total loss of terminal scalp hair
  3. AA universalis - total loss of all terminal body and scalp hair
  4. ophiasis - bandlike pattern of hair loss over periphery of scalp
  5. nails - fine pitting (“hammered brass”) of dorsal nail plate.
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32
Q

what diagnostics should you obtain for alopecia? what differentials would these rule out

A
  1. biopsy
  2. RPR - syphilis
  3. KOH - fungal
  4. ANA - autoimmune
  5. thyroid panel - endocrine
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33
Q

what is the likelihood for spontaneous remission of alopecia areata

A

If onset after puberty - 80%

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34
Q

what suggests poor prognosis of remission of alopecia areata

A
  • childhood onset
  • body hair involvement
  • nail involvement
  • atopy
  • family Hx
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35
Q

what is the goal when treating alopecia areata

A
  • no cure!!
  • goal = decrease inflammation and reduce growth inhibitors
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36
Q

what are possible treatment options for alopecia areata

A
  • topical minoxidil + topical corticosteroid
  • short term prednisone
  • anthralin (safe in kids)
37
Q

what is anthralin

A

a keratolytic agent that is safe to use in children. promotes hair regrowth in 2-3 months.

avoid using on face.

38
Q

what is keratosis pilaris?

A

an excess formation and/or buildup of keratin that leads to abrasive goose-bump texture of the skin

39
Q

how common is keratosis pilaris

A
  • 50-80% of adolescents
  • 40% adults

30-50% have genetic predisposition

40
Q

what is the timeline of keratosis pilaris

A

worsens in the winter and improves in the summer

41
Q

what are the 2 different patterns of keratosis pilaris

A
  1. early childhood - affects face/arms. gradual improvement in later childhood or adolescence
  2. affects the extensor arms/legs. improves by mid 20s
42
Q

what is the clinical presentation of keratosis pilaris

A
  • small 1-2mm rough plaques scattered over affected area
  • asymptomatic, occasional pruritus. +/- erythema if inflammation

chicken/goose bumps

43
Q

where is the MC area for keratosis pilaris

A

upper outer arm and thighs

43
Q

How do you diagnose keratosis pilaris

A
  • clinically
  • biopsy can be used if atypical presentation

histology = follicular orifice distended by keratin plug

44
Q

What is the treatment for keratosis pilaris

A
  • maintain skin hydration (cetaphil OTC, Rx Lac-Hydrin)
  • steroid cream for inflammation (7days)
  • keratolysis (topical retinoids, salycic acid, urea)

gentle soaps, unscented lotion.

45
Q

what is onychocryptosis

A

nail grows into one or both sides of the paronychium or nail bed

ingrown toenail?

46
Q

who and where is onychocryptosis MC in?

A

males in their 20’s

MC on the big toe!!!!

47
Q

what is the pathology of onychocryptosis

A

impingement of the nail into the dermal tissue distally or into the distolateral nail groove

48
Q

what are risk factors for onychocryptosis

A
  • shoes
  • sweating
  • genetics
  • dystrophy
  • fungus
  • improper cutting
  • neuropathy/diabetes
49
Q

what are possible complications of onychocryptosis

A
  • paronychia
  • cellulitis
  • osteomyelitis
  • bacteremia
  • sepsis
50
Q

what is the treatment for onychocryptosis

A
  • warm soaks, trim nail
  • mupirocin BID until healed.
  • surgery (complete/partial matrixectomy)
51
Q

How soon after matrixectomy for onychocryptosis can a patient resume activity?

A

48-72 hrs

52
Q

what is onychomycosis

A

fungus of the nail

aka tinea unguium

53
Q

where is onychomycosis MC and what is the MCC?

A
  • on the toes!!
  • trichophyton rubrum
54
Q

where does fungus invade the nail in onychomycosis

A

the hyponychium

55
Q

what is the presentation of onychomycosis

A
  • asymptomatic
  • CC usually discoloration and thickening of the nail.
  • nail may lift from nailbed
56
Q

what are risk factors for onychomycosis

A
  • FMHx
  • old age
  • poor health
  • trauma
  • climate
  • fitness
  • immunosuppression
  • communal bathing
  • footwear
57
Q

what must be ruled out any time there is discoloration of the toenail?

A

melanoma!!!

r/o clinically based on hx or with biopsy

58
Q

what diagnostics are used in onychomycosis

A
  • clip toenail and send for biopsy
  • KOH scraping from under nail

no antifungals 2 weeks prior to samples

59
Q

what is the treatment of onychomycosis

A
  • topical Ciclopirox or Efinaconazole daily x 48wks
  • oral Terbinafine (6wks fingers, 12wks toes)
  • 50/50 apple cider vineger and water. 10 min soak/day
60
Q

what labs must be monitored when a patient is on terbinafine

A

CBC and LFTs at baseline then monthly while on medication

risk of hepatotoxicity, pancytopenia, agranulocytosis

61
Q

how long does it take for onychomycosis discoloration to resolve

A

can take up to a year for the nail to grow out and therefore the discoloration may remain until then

62
Q

what is onycholysis

A

detachment from the nail bed

63
Q

what is the presentation of onycholysis

A
  • whitish or opaque discoloration
  • gray-black = air
  • green = bacteria
  • NO inflammation
  • smooth nail.
64
Q

how do you diagnose onycholysis

A

clincially

65
Q

what is the treatment goal for onycholysis

A

eliminate whatever is causing the nail to lift

probs fungus

66
Q

what is paronychia

A
  • inflammation of the proximal or lateral nail fold
  • starts as cellulitis and progresses to abscess
67
Q

what is the MCC of paronychia

A
  • trauma!!

causes secondary bacterial inefction

68
Q

what are RF for paronychia

A
  • nail biting
  • sucking
  • trauma
  • chemical irritants
  • nail glue
  • sculpted nails
  • frequent hand washing
69
Q

what is the MCC of acute paronychia

A

Staph!!

70
Q

what is the presentation of acute paronychia

A
  • painful, tender
  • swelling, erythema
  • +/-purulence (green = psuedomonas)
71
Q

How do you diagnose acute paronychia

A
  • gram stain
  • C&S
  • KOH
  • Tznack for herpetic whitlow
  • Xray (I assume for necrosis)
72
Q

what is the treatment for acute paronychia

A
  • warm soaks
  • fluctuant = I&D
  • cellulitis = abx
  • significant infection/cellulitis/lymphangitis = consult surgery
73
Q

what antibiotics are used in acute paronychia with cellulitis?

A
  • augmentin
  • clinda
  • cephalexin
74
Q

what is the etiology and presentation of chronic paronychia

A
  • fungal/mechanical/chemical repeat exposure
  • Inflammation, pain and swelling that waxes and wanes
  • possible thickening and fungal infection
75
Q

how do you treat chronic paronychia

A
  • avoid RF’s
  • keep dry
  • warm antiseptic socks then dry ones
  • topical antifungals PRN (oral if severe)
76
Q

what is herpetic whitlow

A

HSV with distal finger involvement

77
Q

which strain of HSV is MC in children with herpetic whitlow and what are the risk factors for it

A

HSV - 1 (gingivostomatitis)

Risks - sucking thumbs/fingers

2-14 day incubation

78
Q

which strain of HSV is MC in adults with herpetic whitlow and what are the risk factors for it

A

HSV - 2

risks - healthcare workers

2-14 day incubation

79
Q

what is the presentation of herpetic whitlow

A
  • burning and pruritus prior to lesion formation
  • vesicular lesions that are tender, swollen and indurated
80
Q

how do you dx herpetic whitlow

A

clinically but tznack can def help

81
Q

what is the treatment of herpetic whitlow

A
  • DO NOT I&D
  • OTC pain meds
  • Acyclovir or valcyclovir

self limiting x 3 weeks, very contagious

82
Q

what is felon

A

soft tissue infection of pulp space of distal phalanx caused by infection

83
Q

what is expected in the history of felon

A
  • penetrating injury
  • splint
  • paronychia
84
Q

what are the clinical findings for felon

A
  • pain, erythema, swelling
  • Abscess formation on thumb/index finger
85
Q

what are the possible compications of felon

A
  • osteitis
  • osetomyelitis
  • septic joint
  • tenosynovitis
86
Q

how do you describe the disease course of felon

A

rapid and severe!

87
Q

How do you diagnose felon

A
  • gram stain w C&S
  • Tznack if HW suspected
  • Xray (severe)
88
Q

Management for felon

A

augmentin

surgical decompression if severe

derm (16 decks)

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