Hair and Digit Tip Disorders Flashcards
MISSING SOME NAIL STUFF!! (73 cards)
1
Q
phases of hair growth cycle
A
- Anagen - growth stage, phase of normal active growth
- Catagen - degenerative stage, brief transition in which hair growth stops
- Telogen - resting phase
- Exogen - hair shedding phase
Phases of growth are followed by periods of inactivity and then expulsion
2
Q
Duration and rate of growth of anagen phase determines what?
A
ultimate length of hair in that area
3
Q
Duration and rate of growth of scalp?
legs?
arms?
eyelashes?
A
- Scalp: 2-8 y
- Legs: 5–7 m
- Arms: 1.5–3 m
- Eyelashes: 4-6 w
4
Q
soft, fine hair that covers much of the fetus; usually sheds before birth
A
Lanugo hair
5
Q
fine, non-pigmented hair that covers the body of children and adults; not affected by hormones - aka “peach fuzz”
A
Vellus hair
6
Q
characteristics of vellus and terminal hairs (occur on scalp)
A
Intermediate hair
7
Q
thick, pigmented hair found on the scalp, beard, axilla, pubic area; eyelash and eyebrow hair in which growth is influenced by hormones
A
Terminal hairs
8
Q
w/u for hair loss
A
- hair pull
- scalp bx - scraping or shave
- Trichogram
9
Q
nml and abnml finding for hair pull
A
- Normal: 3 - 5 hairs are dislodged
- Abnormal: > 5 hair suggest pathology
10
Q
goal of Trichogram ?
A
determine the anagen to telogen ratio
hair loss
11
Q
trichogram shows growing hairs with a long encircling hair sheath
what type of hair?
A
Anagen hairs
12
Q
Trichogram reveals resting hairs with an inner root sheath and roots usually largest at the base.
what type of hair?
A
Telogen hairs
13
Q
normal findings of Trichogram
A
80-90% of hairs are anagen
14
Q
MC form of alopecia
A
androgenic - Male and female pattern baldness
15
Q
classifications for androgenic alopecia?
A
- women: Ludwig-savin classification
- men: norwood hamilton
16
Q
Androgenic Alopecia MC in who and when?
A
- Men > Women - white > black > Asian men
- Men - after puberty (early as 20’s) - Typically fully expressed by 40
- Women - MC after 50
17
Q
what hormone causes terminal follicles to transform into vellus like hair follicles
- atrophy
A
DHT
18
Q
During successive follicular cycles - hairs produced are _____ lengths and of _____ diameter
A
- shorter
- decreased
19
Q
w/u for androgen alopecia?
findings?
A
- Bx - telogen phase follicles & atrophic follicles
- Trichogram - ^ telogen hairs
- Hormones - Testosterone total and free, DHEAS, Prolactin
20
Q
3 treatable conditions that could be causing androgen alopecia
A
- Thyroid
- Anemia
- Autoimmune
21
Q
tx for androgenic alopecia
A
- Minoxidil /Rogaine 2 or 5% solution BID; Warn about hair loss
- Finasteride - MEN ONLY
- Spironolactone - Females
- hair transplant, wigs
22
Q
MOA of Finasteride
A
- Inhibits testo to DHT
- Slows hair loss in 3 months, regrowth in 6 months
23
Q
- localized loss of hair in round or oval areas with no apparent inflammation of the skin
- T cell mediated autoimmune disorder - Non scarring; +/- nails
A
Alopecia Areata
24
Q
MC for of hair loss in children
< 25 yo MC
A
Alopecia Areata
25
pathology of Alopecia Areata
1. damage to hair follicle in anagen stage
1. rapid transformation to catagen and telogen = dystrophic
1. Active = cannot progress beyond anagen
1. No scarring
26
s/s of Alopecia Areata
MC areas
* Patchy hair loss
* Weeks to months
* Oval/round
* Defined borders
* Bald patches
* Skin seems normal = no scarring
MC areas: Scalp, Beard, Eyebrows, Extremities
27
1. “Black dots”
1. Dermoscopy - breaks before surface
1. Exclamation hairs
- Blunt distal end and taper proximally
- Appear when broken hair are pushed out of the follicle
Alopecia Areata
28
subtypes of Alopecia Areata
* **Alopecia areata (AA)** - Solitary or multiple areas of hair loss
* **AA totalis (AAT)** - Total loss of terminal scalp hair
* **AA universalis (AAU)** - Total loss of all terminal body and scalp hair
* **Ophiasis** - Bandlike pattern of hair loss over periphery of scalp.
* **Nails** - Fine pitting ("hammered brass") of dorsal nail plate.
29
w/u for alopecia areata
* Biopsy
* RPR – syphilis
* KOH – fungal
* ANA – autoimmune
* Thyroid Panel – endocrine
30
mgmt and prognosis for Alopecia Areata
* Spontaneous Remission: Onset – after puberty = 80%; Recurrence happens
* Psych consult
* Noninvasive - Wigs, Hair piece
* **Topical CS: Class 1 & 2 w/ Minoxidil; ILK**
* Systemic: Short term; **Pred** 20-40 mg daily; Taper by 5mg daily with a few weeks
* **Minoxidil** 5% - best with CS
* **Anthralin** - Safe in kids, avoid face
* Poor prognosis: Childhood onset, Body hair involvement, Nail, Atopy, Family hx
31
* A common condition resulting from hyperkeratinization of the skin and keratotic follicular plugging
* Affects nearly 50-80% of all adolescents and approximately 40% of adults
* Genetic predisposition with 30-50% having a positive family history
* Worsen in winter and improves in summer
Keratosis Pilaris
32
pathophys of Keratosis Pilaris
An excess formation and/or buildup of keratin leads to the abrasive goose-bump texture of the skin
33
associated conditions with Keratosis Pilaris
ichthyosis vulgaris, xerosis, and, less commonly, atopic dermatitis, asthma and allergies
34
presentation of Keratosis Pilaris during early childhood
* Affects the face and arms
* Gradual improvement in later childhood or adolescence
35
presentation of keratosis pilaris during adolescence
* Affects the extensor arms and legs
* Improves by the mid-20s
36
1. chicken/goose bumps or chicken/goose skin
1. asx with occasional pruritus
1. Small 1-2 mm rough papules scattered over affected area
- MC Upper outer arm and thighs
1. (+/-) Erythema if associated inflammation
Keratosis Pilaris
37
w/u for Keratosis Pilaris
1. Bx can be utilized if presentation is atypical
- histology - follicular orifice distended by a keratin plug
38
tx for keratosis pilaris
1. Mild soaps
1. unscented lotions 2-3 x/d
- OTC - Cetaphil, Lubriderm
- Rx - Lac-Hydrin
1. Steroid cream 1-2x/d x 7-10 d
1. Keratolysis - SA, topical urea, topical retinoids
39
Nail grows into one side or both of the paronychium or nail bed
MC in males
MC in 20’s
MC on great toe
Onychocryptosis
40
pathophys of Onychocryptosis
* impingement of the nail into the dermal tissue distally or into the distolateral nail groove
* Nail = FB inflammation - Erythema, Edema, Purulence, Granulation tissue
41
RF Onychocryptosis
1. Shoes
1. Sweating
1. Genetics
1. Dystrophy
1. Fungus
1. Improper cutting
1. Neuropathy/diabetes
42
complications of onychocryptosis
1. Paronychia
1. Cellulitis
1. Osteomyelitis
1. Bacteremia
1. Sepsis
43
mgmt for onychocryptosis
1. Warm soaks
1. mupirocin BID until healed
1. Trimming of nail (properly)
1. Training (cotton)
1. Surgical - Complete or partial nail; Matrixectomy
44
after procedure mgmt for Onychocryptosis
1. Keep clean with normal soap and water
1. Antibacterial
1. Mupirocin
1. Resume activity after 48-72 hours
45
Aka tinea unguium
Fungus of the nail
MC on toes
Fungus invades the nail via the hyponychium
Onychomycosis
46
cause of Onychomycosis
trichophyton rubrum
47
s/s Onychomycosis
* Asymptomatic
* Discoloration MC complaint
* Thickening
* Lifting of the nail from the bed
48
RF Onychomycosis
1. Family History
1. Old age
1. Poor health
1. Trauma
1. Climate
1. Fitness
1. Immunosuppression
1. Communal bathing
1. Footwear
49
what needs to be r/o with ANY discoloration of the toenail
MELANOMA
needs to be ruled out clinically off history or biopsy
50
w/u for Onychomycosis
Nail clipping or scraping
1. Clip toenail - bx
1. Scrap from under the nail - KOH
- No Antifungals for 2 wks prior to sample
51
mgmt for Onychomycosis
1. Ciclopirox (Penlac)
1. Efinaconazole (Jublia) Daily x 48 weeks
1. Home: 50/50 apple cider vinegar + water x 10 mins/d soaks
2. Terbinafine - 6 wks for fingers; 12 wks for toes
52
labs for Terbinafine
CBC and LFT’s @ baseline and then monthly
Risks: hepatotoxicity, pancytopenia, agranulocytosis
53
onychomycosis may take how long to be resolved?
**a year** for nail to completely grow out therefore discoloration may still be present
54
Detachment form the nail bed
Onycholysis
55
causes of Onycholysis
1. primary: idiopathic, mechanical/chemical damage
2. trauma
3. secondary: vesiculobullous dz, nail bed hyperkeratosis, nail bed tumors
56
* Whitish or opaque discoloration
* NO inflammation
* Smooth nails
Onycholysis
57
gray/black Onycholysis indicates ?
green?
1. Gray/black = air
1. Green = bacteria
58
* Inflammation of the proximal or lateral nail fold
* Begins as cellulitis and progresses to abscess
* MCC Trauma - Secondary bacterial infection
Paronychia
59
RF Paronychia
1. Nail biting
1. Sucking
1. Trauma
1. Chemical irritants
1. Nail glue
1. Sculpted nails
1. Frequent hand washing
60
MC pathogen of Acute Paronychia
staph
Green = pseudomonas
61
w/u for Acute Paronychia
* Gram stain
* C&S
* KOH
* Tzanck = HW
* Xray
62
tx for Acute Paronychia
1. Warm soaks 3-4x daily
1. Fluctuant = I&D
1. Oral abx when cellulitis (DM, PVD, Immunocomp)
- **Augmentin 500mg/125mg BID x 10 d**
- Clindamycin
- Cephalexin
63
when to consult hand surgeon for Acute Paronychia
1. Significant cellulitis or lymphangitis
1. Tenosynovitis
1. Deep space infection
1. Osteomyelitis
64
s/s of chronic paronychia
* Fungal/mechanical/chemical - From repeat exposure
* Inflammation waxes and wanes
* Pain
* Swelling - Usually x 6 weeks
* Swelling, Erythema, Tenderness, +/- thickening or discoloration (Possible fungal infection also)
65
mgmt for Chronic Paronychia
1. Avoid RF’s
1. Keep dry
1. Avoid manipulation
1. Warm antiseptic soaks – then dry
1. Topical antifungals if necessary; Severe – PO antifungals
66
Herpetic Whitlow MC what viruses?
1. MC HSV -1 or gingivostomatitis children
- RF: sucking thumb or finger
2. MC HSV -2 adults
- RF: Healthcare worker
2-14 day incubation
67
s/s of herpetic whitlow
Before lesions begins..
1. Burning
1. Pruritus - Vesicular, Tender, Swelling, Induration
68
w/u for herpetic whitlow
1. **clinical**
1. Tzanck
69
mgmt for herpetic whitlow
1. Do not I&D
1. Self limiting x 3 wks
1. Contagious
1. OTC pain meds
1. Acyclovir, Valacyclovir
70
* Soft tissue infection of pulp space of distal phalanx
* Caused by infection (created by fibrous septa passing between the skin and periosteum)
* Hx: penetrating injury, splint, and paronychia
Felon
71
distribution of Felon?
* Thumb
* Index finger
72
complications of felon
1. Osteitis
1. Osteomyelitis
1. Septic joint
1. Tenosynovitis
73
w/u and mgmt for felon
* Gram stain with C&S; Tzanck if Herpetic Whitlow suspected; X ray
* Augmentin BID x 10 d; Surgical decompression
