Dermatology

Question 1

Causes of hypertrichosis?

Answer 1

Congenital (trisomy 18, porphyria)
Acquired (thyroid, foetal alcohol, malnutrition)
Drugs (cortisone, penicillinamine, phenytoin, cyclosporin, streptomycin)
Repeated dermal irritation (burns, chronic rubbing)

Question 2

Treatment options for Androgenic alopecia?

Answer 2

Surgical (hair transplant)
Cosmetic (wigs, styling)
Medical (topical minoxidil, oral finasteride)

Question 3

What percentage of men have androgenic alopecia at 50yo?

Answer 3

50%

Question 4

Outline Telogen Effluvium

Answer 4

Hair loss as a transient condition occurring 2-4 months after a stressful event. Self resolves.

Question 5

What should be considered with acute hair loss?

Answer 5

Thyroid disease
Iron deficiency
Protein deficiency

Question 6

What are the typical findings of alopecia areata?

Answer 6

Well circumscribed, totally smooth patch/patches of alopecia that most commonly occur in the first two decades of life. “Exclamation marks” at borders with sparing of white hair

Question 7

Is alopecia areata more common in men or women?

Answer 7

Neither; equal

Question 8

What is the aetiology of alopecia areata?

Answer 8

Unknown, could be infective, autoimmune, emotional, chromosomal…

Question 9

What are the treatment options in alopecia areata?

Answer 9

Steroids; topical, intralesional, systemic
Cyclosporine
Minoxidil
Chemotherapy
Wait and see- 95% better at 1 year

Question 10

What are poor prognostic factors for aloepcia areata?

Answer 10

Widespread involvement
Coexisting atopic eczema
< 5yo onset

Question 11

What are the features of trichotillomania related alopecia?

Answer 11

Asymmetrical patchy hair loss

Twisted fragmented hairs of different lengths

Question 12

What are the categories of scarring folliculitis?

Answer 12

Lichen planopilaris
Discoid lupus erythematosis
Folliculitis;
- folliculitis decalvans
- erosive pustular dermatitis
- dissecting folliculitis (African-American people)

Question 13

What are the features of discoid lupus erythematosis?

Answer 13

Scarring, erythema, hypopigmentation, follicular plugging of the scalp.

Tx; steroids topically

Question 14

Cause of acute vs chronic paronychia?

Answer 14

Acute –> staph/strep

Chronic –> candida

Question 15

Management of chronic paronychia?

Answer 15

Keep skin dry
Avoid manicures
Topical imidazoles
Time

Question 16

What are the classic features of onychomycosis?

Answer 16

Asymmetrical nail discolouration and nail thickening wit subungal hyperkeratosis

Question 17

Differentials for onychomycosis?

Answer 17

Psoriasis

SCC of nail plate bed

Question 18

What is the cause for 95% of onychomycosis?

Answer 18

Nail fungi

Question 19

Treatment of onychomycosis?

Answer 19

Biopsy/clippings/scrapings first
Topical (usually unsuccessful); canesten, amorolfine
Systemic: terbinafine, itraconazole, fluconazole

Question 20

What are the differentials for altered nail colour?

Answer 20

Warts
Pyogenic granuloma
Benign melanocytic lesions
Osteoid osteomas
SCC
Melanoma
Metastatic (50% from lung)

Question 21

What are the nail signs of psoriasis?

Answer 21

Pitting
Transverse ridges
Oil spots
Onycholysis
Subungal hyperkeratosis

Question 22

Indications for drainage of subunctal hematoma?

Answer 22

> 50% nail plate involvement

Significant pain

Question 23

Causes of leukonychia?

Answer 23

Alopecia areata
Darier disease
Trauma
Psoriasis
Fungal infections
Cirrhosis
Congenital hepatic fibrosis
DM
Hyperthyroidism
Malnutrition

Question 24

Causes of clubbing?

Answer 24

IBD
Bronchial carcinoma
Cirrhosis
Bronchiectasis

Question 25

What is the false negative rate of nail clippings in onychomycosis?

Answer 25

40%

Question 26

Outline treatment with terbinafine for onychomycosis?

Answer 26

PBS- proven infection 250mg daily; 42 tabs + 1 repeat (can take the second dose at 2 tabs/week) Takes up to one year for infection to grow out FBC/LFT at one month post starting treatment (agranulocytosis and LFT abnormality)

Question 27

Outline all treatment options for onychomycosis?

Answer 27

Topical; generally poor, amorolfine has best evidence Systemic; terbinafine, itraconazole, fluconazole, griseofulvin, ketoconazole Surgical; nail removal, physical orwit urea paste- needs topical therapy to prevent recurrence

Question 28

Management of nail psoriasis?

Answer 28

``` Minimise trauma; do not clean out under nail (Koebner phen) Cosmetic measures Topical steroids Topical calcipotriol Intralesional steroid injection + local PUVA Methotrexate (rare for just nail involvement) Acirecitin (derm only) ```

Question 29

What can help differentiate between fungal nail infection and psoriasis nail change?

Answer 29

Fungal nail change rarely resolves spontaneously | Psoriasis-often all nails involved

Question 30

What are causes of onycholysis?

Answer 30

``` Idiopathic Trauma Psoriasis Photosensitivity (includes secondary to tetracyclines) Hyperthyroidism Hereditary ```

Question 31

Causes of green, blue or black discolouration of nails?

Answer 31

Pseudomonas Aspergillus Often coexistant candida

Question 32

Management of onycholysis?

Answer 32

``` Keep nails short Do not insert objects under the nail avoid artifical nails Wear gloves/shoes Dry nail bed several times a day with hairdrier Miconazole lotion ``` If candida --> oral ketoconazole (terbinafine is useless) If pseudomonas -->white vinegar (10% white vinegar in water) soaks for 10-20 min bd

Question 33

Outline 20 nail dystrophy

Answer 33

Nail disorder predominantly affecting children causing all nails to become thin and rough. Generally settles over 2-3 years