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Dermatology > Hair and Digit Tip Disorders > Flashcards

Hair and Digit Tip Disorders Flashcards

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1
Q

Phases of hair growth

A

Intermittent activity followed by inactivity and expulsion

Anagen
Catagen
Telogen
Exogen

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2
Q

What is anagen?

A

Growth stage, phase of normal active growth

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3
Q

What is catagen?

A

Degenerative stage, brief transition in which hair growth stops
hair follicle detaches from nourishment of blood supply

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4
Q

What is telogen?

A

Resting phase
No nourishment from blood supply, hair dies and falls out

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5
Q

What is exogen?

A

hair shedding phase

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6
Q

What is the duration of the anagen phase for scalp? Legs? Arms? Eyelashes?

A

Scalp: 2-8 years
Legs: 5-7 months
Arms: 1.5-3 m
Eyelashes: 4-6 weeks

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7
Q

What is lanugo?

A

soft, fine hair
covers fetus
usually shed before birth

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8
Q

What is intermediate hair?

A

Has characteristics of vellus and terminal hairs (on scalp)

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8
Q

What is vellus hair?

A

fine, non-pigmented hair that covers body of children and adults
not affected by hormones aka peach fuzz

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9
Q

What is terminal hair?

A

Thick, pigmented hair found on scalp, beard, axilla, pubic area
Eyelash and eyebrow hair
Growth influenced by hormones

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10
Q

What is a hair pull test?

A

Scalp gently pulled
Normal: 3-5 hairs are dislodged
Abnormal: >5 hairs dislodged

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11
Q

When would scalp biopsy be helpful?

A

Scraping or shave biopsy shows insight into pathogenesis

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12
Q

What is the goal of a trichogram? How does anagen vs telogen appear?

A

Determine anagen to telogen ratio by plucking 50 hairs from the scalp
Anagen: growing hairs with long encircling hair sheath
Telogen: resting hairs with inner root sheath and roots largest at base

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13
Q

What is alopecia?

A

Hair loss in a variety of patterns and causes
Most common = androgenic alopecia

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14
Q

What is androgenic alopecia?

A

Male and female pattern baldness
Gradual converstion of terminal hairs into indeterminate vs vellus hairs

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15
Q

Risk factors for androgenic alopecia?

A

Genetic predisposition to androgen effecting hair follicles
Male
White men>black and asian

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16
Q

Classification of androgenic alopecia?

A

Ludwig-Savin classification for females
Norwood Hamilton Classification for males

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17
Q

How does female hair loss tend to present? Male?

A

Widened hair line
Male: top of scalp

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18
Q

What age is androgenic alopecia most common?

A

Men: after puberty and fully expressed by 40
Women: MC after 50

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19
Q

What causes androgenic alopecia?

A

Atrophy of hair follicle due to DHT causing terminal follicles to transform into vellus like hair follicles
During successive follicular cycles hairs are shorter lengths and of decreased diameter

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20
Q

H&P of androgenic alopecia

A

Gradual thinning noted
Typically otherwise normal
Women: increased androgen such as acne, hirsutism, irregular menses

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21
Q

Diagnosis of androgenic alopecia

A

Typically clinical
Can do biopsy: telogen phase follicles and atrophic follicles
Trichogram: increased telogen hairs
Hormone studies: testosterone total and free, DHEAS, prolactin

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22
Q

What are treatable causes of androgenic alopecia?

A

Thyroid
Anemia
Autoimmune

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23
Q

Treatment of androgenic alopecia

A

Topical minoxidil/rogaine 2% or 5% BID
5% typically for males
Warn about hair loss
Oral finasteride 1 mg PO daily for men only

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24
What is the mechanism of action of finasteride?
inhibits testosterone to DHT to slow hair loss in 3 months, regrowth in 6 months
25
What medication for androgenic alopecia can be used in females?
Spironolactone 50-100 mg QD, blocks action of DHT
26
What additional non medication treatments can be given for androgenic alopecia?
Hair transplant (expensive $10-20,000) Hair piece/wig
27
What is alopecia areata?
Localized loss of hair in round or oval areas with no apparent inflammation of the skin due to T cell autoimmune disorder Non-scarring +/- nails
28
What is the epidemiology of alopecia areata?
MC for hair loss in children <25 yo MC Usually family history Maybe increased stress?
29
What is the pathology of alopecia areata?
Damage to hair follicles in anagen stage Leads to rapid transformation to catagen and telogen -->> dystrophic Active = cannot progress beyond anagen No scarring
30
Presentation of alopecia areata
Patchy hair loss Weeks to months Oval/round Defined borders Bald patches Skin seems normal = no scarring
31
MC areas affected by alopecia areata
Scalp Beard Eyebrows Extremities
32
What is the presence of alopecia areata on dermoscopy?
Black dots Exclamation hairs: blunt distal end and taper proximally, appear when broken hair are pushed out of follicles
33
Subtypes of alopecia areata
Alopecia areata: solitary or multiple areas of hair loss AA totalis: total loss of terminal scalp hair AA universalis: total loss of all terminal body and scalp hair
34
Patterns of alopecia areata
Ophiasis: bandlike pattern of hair loss over periphery of scalp Nails: fine pitting of dorsal nail plate
35
DDx of alopecia areata
Tinea capitis: scaly itchy Trichotillomania: psych Early scarring alopecia: shiny taut area Androgenic alopecia Secondary syphilis
36
Diagnosis of alopecia areata
Generally clinical Biopsy if not responding RPR: syphilis KOH: r/o fungal ANA: autoimmune Thyroid panel: endocrine
37
Course of alopecia areata
Majority have spontaneous remission with onset after puberty (80%) Recurrence can happen
38
What are predictors of poor prognosis of alopecia areata?
Childhood onset Body hair involvement Nail Atopy Family history
39
Treatment goals for alopecia areata?
Decrease inflammation and reduce growth inhibitors
40
Treatment of alopecia areata
Psych consult is helpful Noninvasive: wigs or hair piece Topical CS: class 1 and 2 with minoxidil Itralesional kenalog into plaques Systemic: short term prednisone 20-40 mg daily tapered by 5 mg daily with a few weeks Minoxidil (in combo with CS) Anthralin
41
Can anthralin be used in kids?
Safe in kids
42
What is the MOA in anthralin and what do you need to be aware of?
Keratolytic agent Hair regrowth takes 2-3 months Avoid face
43
What is keratosis pilaris?
Common condition resulting from hyperkeratinization of the skin and keratotic follicular plugging Affects nearly 50-80% of adolescents and 40% of adults
44
Risk factors for keratosis pilaris?
Family history (30-50%)
45
Pathophysiology of keratosis pilaris
Excess formation and/or buildup of keratin leads to abrasive goose-bump texture of skin
46
Historical factors for keratosis pilaris
Associated conditions: ichthyosis vulgaris, xerosis, and less commonly, atopic dermatitis/asthma/allergies Worsens in winter and improves in summer
47
Patterns of keratosis pilaris
Early childhood: affects face and arms and gradually improves in later childhood or adolescence Adolescence: affects extensor arms and legs, improves by mid-20s
48
Clinical presentation of keratosis pilaris
Referred to as chicken/goose bumps or chicken/goose skin Often asymptomatic with occasional pruritis Small 1-2 mm rough papules scattered over affected area, upper outer arm and thighs MC +/- erythema if associated inflammation
49
diagnosis of keratosis pilaris
clinical biopsy if atypical presentation: see follicular orifice distended by keratin plug
50
treatment of keratosis pilaris
maintain skin hydration with mild gentle soaps and unscented moisturizer lotions 2-3x/d OTC cetaphil, lubriderm; rx lac-hydrin (lactic acid lotion) to provide moisture and gentle exfoliation 2x/d Reduce inflammation (if present) with steroid cream 1-2 x/d for 7-10 days Keratolysis: salicylic acid, topical urea, topical retinoids
51
SE of keratolysis
inflammation
52
What is the cuticle?
Protective area of skin that covers matrix
53
What is the problem with manicures and pedicures?
Can cut cuticle which protects
54
What is onychocryptosis?
Nail grows into one side or both of the paronychium or nail bed
55
Who MC gets onychocryptosis
males in 20s
56
pathology of onychocryptosis
impingement of nail into dermal tissue distally or into distolateral nail groove
57
clinical presentation of onychocryptosis
FB inflammation erythema edema purulence granulation tissue
58
risk factors for onychocryptosis
shoes sweating genetics dystrophy fungus improper cutting neuropathy/diabetes
59
where is onychocryptosis MC located?
great toe worse with movement or pressure
60
What is a patient education factor for onychocryptosis
loose shoes
61
complications of onychocryptosis
paronychia cellulitis osteomyelitis bacteremia sepsis
62
treatment of onychocryptosis
warm soaks antibiotic ointment: mupirocin BID until healed trimming of nail (properly/not over trimming) training (cotton) surgical: complete or partial nail removal or matrixectomy (often needed)
63
what should be done after onychocryptosis procedure
keep clean with antibacterial soap and water mupirocin antibiotic ointment resume activity after 48-72 hours
64
what is onychomycosis?
AKA tinea unguium fungus of the nail
65
where is onychomycosis MC
toes
66
what causes onychomycosis
trichophyton rubrum
67
pathophysiology of onychomycosis
fungus invades nail via hyponychium
68
symptoms of onychomycosis
asymptomatic discoloration MC complaint thickening lifting of nail from the bed
69
risk factors for onychomycosis
family history old age poor health trauma (repetitive) climate fitness (sweaty feet) immunosuppression communal bathing footwear (treat as well if + culture)
70
ddx for onychomycosis
psoriasis: pitting and oil stains Lichen planus trauma
71
what needs to be ruled out with any discoloration of the toenail?
melanoma (clinically off history or biopsy) would see pigmented dark band (nevus or melanoma of nail bed)
72
work up for onychomycosis
nail clipping or scraping clip toenail and send for biopsy scrape under nail and do KOH with no antifungals for 2 weeks prior to sample
73
Treatment of onychomycosis
Topical or oral antifungal Topical Ciclopirox or Efinaconazole x 48 weeks Oral terbinafine for 6 weeks for fingers or 12 weeks for toes Home remedy: 50/50 apple cider vinegar and water 10 mins a day soaks
74
Lab monitoring with use of terbinafine
CBC and LFTs @ baseline and then monthly
75
What are risks of terbinafine
Hepatotoxicity Pancytopenia Agranulocytosis May take up to a year for nail to completely grow out therefore discoloration may still be present
76
What is onycholysis
Detachment from nail bed
77
Presentation of onycholysis
Whitish or opaque disoloration Gray-back = air Green = bacteria No inflammation smooth nails
78
Treatment of onycholysis
Eliminate what is causing nail to lift
79
What is paronychia?
Inflammation of proximal or lateral nail fold Begins as cellulitis and progresses to abscess
80
MCC of paronychia
trauma with secondary bacterial infection most common pathogen = staph
81
RFs for paronychia
Nail biting Sucking Trauma Chemical irritants Nail glue Sculpted nails (over trimming of cuticle) Frequent hand washing (ie OCD)
82
S/s of acute paronychia MC due to staph
Painful Tender Swelling Erythema +/- purulence, green = pseudomonas
83
Diagnosis of acute paronychia
Gram stain C&S KOH Tzanck = Herpetic whitlow Xray (if really infected)
84
Treatment of acute paronychia
Warm soaks 3-4 x daily until resolution Fluctuant = I&D Oral antibiotics when cellulitis or if DM, PVD, Immunocompromised Augmentin 500 mg BID x 10 days Clindamycin Cephalexin
85
What are indications for consultation of hand surgeon for acute paronychia?
Significant cellulitis or lymphangitis Tenosynovitis Deep space infection Osteomyelitis
86
What can cause chronic paronychia?
Fungal Mechanical Chemical Repeat exposure
87
Symptoms of chronic paronychia
Inflammation waxes and wanes Pain Swelling Usually 6 weeks or longer
88
PE of chronic paronychia
Swelling Erythema Tenderness +/- thickening or discoloration (possible fungal infection also)
89
Treatment for chronic paronychia
Avoid RFs Keep dry Avoid manipulation Warm antiseptic soaks - then dry Topical antifungals if necessary, severe oral
90
Where does herpetic whitlow affect?
Distal finger
91
MC organisms in herpetic whitlow
HSV-1 or gingivostomatitis in children HSV-2 in adults
92
What are RF for herpetic whitlow in children? Adults?
Children: sucking thumb or finger Adults: healthcare worker
93
Incubation period for herpetic whitlow
2-14 days
94
Presentation of herpetic whitlow
Before lesion begins: Burning Pruritis Vesicular Swelling Tender Induration
95
Diagnosis of herpetic whitlow
Clinical Can use Tzanck
96
Treatment of herpetic whitlow
Do not I&D Self limiting x 3 weeks but contagious OTC pain meds Acyclovir Valacyclovir
97
What is felon
Soft tissue infection of pulp space of distal pharynx caused by infection (created by fibrous septa passing between skin and periosteum)
98
Hx in felon
penetrating injury slint paronychia
99
clinical presentation of felon
pain erythema swelling abscess
100
distribution of felon
thumb index finger
101
complications of felon
osteitis osteomyelitis septic joint tenosynovitis
102
course of felon
rapid and severe
103
workup for felon
gram stain with C&S Tzanck if herpetic whitlow suspected x ray
104
management of felon
PO antibiotic (augmentin BID x 10 days) surgical decompression
105
causes of clubbing of the nail
infection neoplasm inflammatory vascular diseases
106
causes of pigmentation of the nails
melanonychia due to melanocyte proliferation due to trauma, inflammatory nail disorders, drugs, nonmelanocytic tumors nail matrix nevi lentigo melanoma blood deposition due to trauma
107
causes of pitting of the nails
psoriasis alopecia areata eczema
108
causes of splinter hemorrhages
MC trauma and nail psoriasis lichen planus derier disease infective endocarditis connective tissue disease antiphospholipid syndrome chronic renal failure trichenollosis
109
causes of terry's nails
liver cirrhosis and chronic diseases (leukonychia of proximal 2/3 nails)
110
causes of Beau's lines
caused by temporary arrest of nail proliferation and appear as transverse grooves local trauma local cutaneous diseases (dermatitis, paronychia) drugs viral infections pemphigus Kawasaki disease
111
What are the variants of onycholysis?
Primary: idiopathic or mechanical/chemical damage Trauma: occupational injury in fingers or podiatric abnormalities/improper shoes in toenails Secondary: vesiculobullous disorders, nail bed hyperkeratosis, nail bed tumors

Dermatology (12 decks)

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