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Derm > Hair and Digit Tip Disorders - Exam 2 > Flashcards

Hair and Digit Tip Disorders - Exam 2 Flashcards

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1
Q

What is the normal cycle of hair growth?

A

cycles of intermittent activity

Phases of growth are followed by periods of inactivity and then expulsion

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2
Q

What are the 4 phases of hair growth? Give a brief description of each

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

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3
Q

What determines the ultimate length of hair? Give the lengths for the following types of body hair: scalp, legs, arms, eyelashes

A

Duration and rate of growth of anagen phase

Scalp: 2-8 y
Legs: 5–7 m
Arms: 1.5–3 m
Eyelashes: 4-6 w

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4
Q

______ soft, fine hair that covers much of the fetus; usually sheds before birth

A

lanugo hair

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5
Q

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

A

vellus hair

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6
Q

_____ characteristics of vellus and terminal hairs (occur on scalp)

A

intermediate hair

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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 hair

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8
Q

What am I?

A

vellus hair

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9
Q

What am I?

A

lanugo

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10
Q

How you do evaluate hair loss? What are normal and abnormal results?

A

gently pull scalp

Normal: 3 - 5 hairs are dislodged

Abnormal: > 5 hair suggest pathology

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11
Q

When should you do a scalp biopsy?

A

Scraping or shave biopsy to offer insight into pathogenesis

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12
Q

What is the goal of a trichogram? How do you perform it? What are the difference between anagen and telogen hairs?

A

determine the anagen to telogen ratio

Performed by epilating (plucking) 50 hairs or more from scalp

Anagen hairs - growing hairs with a long encircling hair sheath.

Telogen hairs - resting hairs with an inner root sheath and roots usually largest at the base.

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13
Q

What is a normal result for a trichogram?

A

80-90% of hairs are anagen

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14
Q

_____ is hair loss. What is the most common form?

A

Alopecia -> comes in a variety of patterns and causes

androgenic alopecia

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15
Q

What is androgenic alopecia? What is happening ? Usually _____ predisposition due to ______ effect on the hair follicle

A

Male and female pattern baldness

Gradual conversion of terminal hairs into indeterminate vs vellus hairs

genetic predisposition due to ANDROGEN effect on hair follicles

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16
Q

What is the classification system for female pattern hair loss? What age?

A

ludwig

Women - MC after 50

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17
Q

What is the male pattern hair loss classification system? What age? What ethnicity?

A

hamilton

Men - after puberty (early as 20’s)
Typically fully expressed by 40

Incidence is highest in white men, followed by black & Asian men

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18
Q

In androgenic alopecia, _____ causes terminal follicles to transform into vellus like hair follicles. What happens during successive follicular cycles?

A

DHT

hairs produced are shorter lengths and of decreased diameter

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19
Q

What is appreciated on PE in androgenic alopecia? What are some additional findings in women?

A

gradual thinning noted and typically everything else is normal

women: increased androgen, acne, hirsutism, irregular menses

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20
Q

What will the bx show of a pt with androgen alopecia? What will the trichogram show?

A

Will see telogen phase follicles & atrophic follicles

^ telogen hairs

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21
Q

What are some treatable causes of androgen alopecia? What is the tx? What is the pt education?

A

Thyroid
Anemia
Autoimmune

Minoxidil (Rogaine) 2% or 5% solution BID

warn about hair loss

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22
Q

What is the PO tx for androgenic alopecia in men only? What is the MOA? When can they expect to see results?

A

Finasteride 1mg PO daily

MOA: Inhibits testo to DHT

Slows hair loss in 3 months, regrowth in 6 months

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23
Q

What is the PO tx for androgenic alopecia in women? What is the MOA?

A

Spironolactone 50-100 mg QD

blocks action of DHT

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24
Q

______ localized loss of hair in round or oval areas with no apparent inflammation of the skin. What is the underlying condition?

A

Alopecia Areata

T cell mediated autoimmune disorder that does NOT scar and may/may not involve the nails

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25
_____ is the MC for of hair loss in children and those <25 yo
Alopecia Areata
26
What am I? This there a genetic component?
alopecia areata YES! usually a family hx stress might be a contributing factor
27
What is the pathology behind alopecia areata? What does it lead to? Does it scar?
damage to hair follicle in anagen stage Leads to rapid transformation to catagen and telogen = dystrophic Active = cannot progress beyond anagen NOT scarring
28
patchy hair loss over weeks to months oval/round with defined borders bald patches with normal skin no scarring What am I? What are the top 4 MC areas?
Alopecia Areata Scalp Beard Eyebrows Extremities
29
_____ are usually seen on dermoscopy with alopecia areata. What does it mean?
"black dots" hair breaks before reaching the surface
30
What are exclamation hairs? What dx are they associated with?
Blunt distal end and taper proximally Appear when broken hair (black dots) are pushed out of the follicle
31
What are the 5 different 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.
32
_____ Solitary or multiple areas of hair loss
Alopecia areata (AA)
33
_____ Total loss of terminal scalp hair
AA totalis (AAT)
34
______ Total loss of all terminal body and scalp hair
AA universalis (AAU)
35
_____ Bandlike pattern of hair loss over periphery of scalp.
ophiasis
36
_____ Fine pitting ("hammered brass") of dorsal nail plate.
nails alopecia areata
37
What are approperiate tests to order when trying to confirm dx of alopecia areata?
Biopsy RPR – syphilis KOH – fungal ANA – autoimmune Thyroid Panel – endocrine
38
What is the tx goal for alopecia areata? What is the prognosis for alopecia areata?
NO CURE!! goal is to decrease inflammation and reduce growth inhibitors spontaneous remission but if it occurs after puberty likely 80% remission with recurrence
39
What are poor prognosis factors for alopecia areata?
Childhood onset Body hair involvement Nail Atopy Family hx
40
What are the tx options for alopecia areata?
class 1 or 2 topical steroids WITH minoxidil ILK oral predinisone 20-40mg daily and then taper by 5mg minoxidil 5% solo anthralin cream: kids only
41
_____ is used in kids with alopecia areata and is a _____ agent. When can they start seeing results? Should avoid use on ______
Anthralin keratolytic agents Hair regrowth = 2-3 months avoid face
42
What am I? What does it result from?
keratosis pilaris A common condition resulting from hyperkeratinization of the skin and keratotic follicular plugging
43
How common is keratosis pilaris? Is there a genetic component?
Affects nearly 50-80% of all adolescents and approximately 40% of adults Genetic predisposition with 30-50% having a positive family history
44
______ is an excess formation and/or buildup of keratin leads to the abrasive goose-bump texture of the skin. When does it get better and worse?
Keratosis Pilaris worse in winter and improves in summer
45
What are the 2 patterns of onset for keratosis pilaris? What areas of the body do each affect? When do each start to improve?
early childhood and adolescence early childhood: face and arms Gradual improvement in later childhood or adolescence adolescence: Affects the extensor arms and legs Improves by the mid-20s
46
What am I? What is it often referred to as? What will the pt complain of?
keratosis pilaris Referred to as chicken/goose bumps or chicken/goose skin Often asymptomatic with occasional pruritus, (+/-) Erythema if associated inflammation
47
What size are keratosis pilaris? Where are the 2 MC locations?
Small 1-2 mm rough papules scattered over the affected area Upper outer arm and thighs - MC
48
How do you dx keratosis pilaris?
usually clinical can bx if presentation is atypical
49
What is the tx for keratosis pilaris? What is inflammation present?
mild gentle soap (dove) unscented moisturizer 2-3 times a day inflammation: steroid cream keratolysis: Salicylic acid, topical urea, topical retinoids
50
_____ is a prescription moisturizer lotion, a lactic acid lotion - provides moisture and gentle exfoliation; use BID. What dx?
Lac-Hydrin Keratosis Pilaris
51
_____ is nail grows into one side or both of the paronychium or nail bed. What is the MC pt population?
Onychocryptosis males in their 20's
52
What is the pathology behind Onychocryptosis?
impingement of the nail into the dermal tissue distally or into the distolateral nail groove that causes inflammation, erythema, edema, purulence and granulation tissue
53
What are risk factors for onychocryptosis?
Shoes Sweating Genetics Dystrophy Fungus Improper cutting Neuropathy/diabetes
54
What digit is onychocryptosis the worst on? What makes it worse?
MC on great toe movement or pressure
55
What are complications of Onychocryptosis?
Paronychia Cellulitis Osteomyelitis Bacteremia Sepsis
56
What is the tx for onychocryptosis?
57
What should you do after the onychocryptosis procedure? When can you resume normal activity?
After procedure Keep clean with normal soap and water Antibacterial is best Mupirocin (antibiotic ointment) Resume activity after 48-72 hours
58
What is onychomycosis? Where is it MC? What is the underlying cause?
tinea unguium fungus of the nail MC on the toes trichophyton rubrum
59
In onychomycosis, how does the fungus invade the nail? What is the MC complaint?
via the hyponychium The hyponychium is the thin layer of skin located beneath the free edge of the nail plate, at the tip of the finger or toe discoloration! but usually asymptomatic with thickening and lifting of the nail from the bed
60
What are risk factors for onychomycosis?
Family History Old age Poor health Trauma Climate Fitness Immunosuppression Communal bathing Footwear
61
If there is any discoloration of the nail/toenail, what needs to be ruled out?
need to rule out melanoma!!
62
What is the w/u for onychomycosis? What should you NOT do before?
nail clipping or scraping -> send off for bx scrap from under the nail -> KOH prep no antifungals for 2 weeks prior to sample
63
What is the tx for onychomycosis? What is the home remedy?
Topical or oral antifungal Ciclopirox (Penlac) Efinaconazole (Jublia) home: 50/50 apple cider vinegar and water 10 minutes a day soaks
64
What is the strong antifugal used in onychomycosis? How long do you use it in fingers? toes? What is the associated monitoring?
Terbinafine (Lamisil) 6 weeks for fingers 12 weeks for toes CBC and LFT’s @ baseline and then monthly very hard on your liver
65
**What is the pt education for onychomycosis?
**may take up to a year for nail to completely grow out therefore discoloration may still be present
66
What is onycholysis? What are the 3 categories?
Detachment from the nail bed primary, trauma or secondary
67
What is considered primary onycholysis?
idiopathic or fake fingernails in women that pull real nail away from bed
68
What are some secondary causes of onycholysis?
contact derm, HSV, onychomycosis, psoriasis, nail bed tumors
69
What will onycholysis look like on PE? How do you dx?
Whitish or opaque discoloration gray-black = air green = bacteria NO inflammation and nail will be smooth dx is clinical
70
What is the tx for onycholysis?
eliminate the cause of why the nail is lifting
71
What is paronychia? What does it begin as? What does it progress to?
Inflammation of the proximal or lateral nail fold Begins as cellulitis and progresses to abscess
72
What is the MC cause of paronychia? What is the MC pathogen? What does green discharge indicate?
trauma that leads to secondary bacterial infection staph green = pseudomonas
73
What are risk factors for paronychia?
Nail biting Sucking Trauma Chemical irritants Nail glue Sculpted nails Frequent hand washing
74
What diagnostic tests should you order for acute paronychia?
can order: gram stain C&S KOH Tzank: for Herpetic whitlow xray
75
What is the tx for acute paronychia?
Warm soaks 3-4x daily until resolution may need abx for cellulitis
76
What is the abx of choice for acute paronychia?
Augmentin 500mg-> first choice clinda or keflex
77
When should you consult a hand surgeon for acute paronychia?
Significant cellulitis or lymphangitis Tenosynovitis Deep space infection Osteomyelitis
78
What are causes of chronic paronychia? What will it present like? For how long?
Fungal/mechanical/chemical From repeat exposure Inflammation waxes and wanes Pain Swelling and erythema +/- thickening or discoloration Usually x 6 weeks
79
What is the tx for chronic paronychia?
avoid risk factors keep dry and avoid manipulation warm antiseptic soaks -> then dry topical antifungals if necessary
80
What am I? What causes it? Where is it found? What is the incubation?
herpetic whitlow MC: HSV found on the distal finger 2-14 day incubation
81
herpetic whitlow HSV 1 is found in what population? What are the 2 risk factors?
MC in children, gingivostomatitis risk factors: sucking thumb or finger
82
herpetic whitlow HSV 2 is found in what population? What is the risk factors?
adults healthcare workers
83
What will happen in herpetic whitlow before the pt physically has the lesion? ____ is used to dx
Burning Pruritus tender swelling induration Tzanck can help dx
84
What is the tx for herpetic whitlow lesion? What should you NOT do?
self limiting in about 3 weeks CONTAGIOUS!! Acyclovir Valacyclovir DO NOT I&D
85
What am I?
herpetic whitlow
86
What is a felon? What is it caused by? What 3 things are likely in the pt's history?
Soft tissue infection of pulp space of distal phalanx Caused by infection (created by fibrous septa passing between the skin and periosteum) penetrating injury, splint, and paronychia
87
What am I? Where are the 2 MC places to see them?
felon thumb and index finger
88
What are 4 complications of felon? Describe the course?
Osteitis Osteomyelitis Septic joint Tenosynovitis rapid and severe
89
What is the management of felon?
Augmentin may need surgical decompression
90
What are splinter hemorrhages caused by?
caused by blood that is enclosed in the subungual keratin They develop either from thrombosed or ruptured capillaries that run longitudinally in the nail bed
91
What am I?
Splinter hemorrhages are narrow red to almost black longitudinal lines in the distal nail bed
92
What are some underlying conditions that can cause splinter hemorrhages?
trauma psoriasis lupus RA antiphospholipid syndrome bacterial endocarditis
93
What am I? Describe it in words
Beau lines horizontal dents in fingernails and toenails
94
What causes beau's lines?
illness/trauma or severe stress interrupts nail growth long term health problems that interfere with blood flow to the nail severe skin conditions that damage nail matrix
95
What am I? What conditions can cause it?
pitting of the nails nail psoriasis: deep alopecia areata: shallow atopic derm: shallow
96
What am I?
terry's nails Terry’s nails is when most of your fingernail or toenail looks white, like frosted glass, except for a thin brown or pink strip at the tip
97
What are some underlying conditions that lead to terry's nail?
can be part of the normal aging process liver disease CHF DM kidney failure viral hepatitis
98
What are some underlying conditions that cause clubbing of the nails?
lung cancer heart defects chronic lung infects celiac dz cirrhosis of the liver graves disease overactive thyroid gland hodgkin lymphoma
99

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