Hair and Nail Disorderes

Question 1

Identify the physical findings for onychomycosis

Answer 1

• Sublingual hyperkeratosis
• Onycholysis (white/yellow color)
• May be symptomatic, may have pain/numbness. May interfere with walking, exercise, standing

Question 2

Identify the diagnostic tests used to dx onychomycosis

Answer 2

• In office scraping for KOH (potassium hydroxide)
• Send away nail sample for PAS stain

Question 3

Describe tx options available for onychomycosis, including patient education points

Answer 3

Topical (generally ineffective)
- daily application for almost a year

Oral (First line Tx)
- Lamisil (terbinafine) 1 pill a day for 6 weeks (finger) or 3 months (toe)
- *needs LFTs baseline and 6 weeks
- can be expensive
- Need to wait 6 months to a year to see improvement as nail grows

Question 4

Differentiate acute and chronic paronychia, including treatments

Answer 4

Acute (<6 weeks): painful, purulent, red, hot, swollen (caused by staph infection)
- Tx: topical or oral antibiotics, soaks, I&D

Chronic (6+ weeks): swelling, non purulent, nail plate may become thickened and discolored
- Tx: topical steroid and skin protection

Question 5

Identify the clinical features of Alopecia Areata

Answer 5

• Usually asymptomatic
• Possible mild pruritis or burning
• Discrete bald patch with smooth non inflamed underlying skin
• Exclamation hairs are indicative **

Question 6

Identify the treatment for Alopecia Areata

Answer 6

Depends on extent of disease
- can watch and wait
- topical or intralesional steroids
- immunotherapy
- wigs or hair prosthesis

Question 7

Differentiate the clinical presentation of hair loss in men vs women with Androgenic Alopecia

Answer 7

Men present with gradual thinning at temporal hairline.

Women present with thinning at crown of scalp.

Question 8

Identify the diagnostic studies for a suspected dx of Androgenic Alopecia

Answer 8

Labs - hormonal testing for females (DHEAS and testosterone) only with sudden/significant loss

Scalp biopsy- need 2 punch biopsy samples

Question 9

List treatments for Androgenic Alopecia

Answer 9

No cure, treatment is an attempt to maintain not regrow

Minoxidil (Rogaine) - topical solution
- 2% (female) or 5% (male) once or twice daily

Finasteride (Propecia) - oral medicine
- Not for use in females: teratogenic and can produce feminization in male fetus
- Can be used with topical minoxidil
- Risk of ED

Spironolactone for females

Hair transplant - small punches from occipital scalp transfer to area of loss

Question 10

Discuss the pathophysiology of Telogen Effluvium

Answer 10

Prolonged resting (telogen) phase of hair cycle. “increased hair shedding with no hair growth”. No associatied scalp inflammation or balding spots

Question 11

Identify inciting factors and management for Telogen Effluvium

Answer 11

• Surgery with general anesthesia
• Pregnancy, especially childbirth
• Significant weight loss in short period of time
• Significant stress
• Febrile illness ( >102)
• Dietary restrictions
• Certain medications

Will resolve on its own but may take 6-12 months, no treatment will speed up process.

Question 12

Identify CCCA based on epidemiological factors and signs/symptoms

Answer 12

• Permanent hairless starting at crown of scalp and progressing outward
• Scarring alopecia
• Almost exclusive to black women 30yo+
• Possibly related to hair care practices or genetics

Symptoms:
- hair breakage and thinning
- burning
- pruritis
- pain
- erythema
- flaking
- inflammatory papules

Question 13

Identify treatment for CCCA

Answer 13

** Early dx and intervention is vital
- topical or IL steroids
- oral Abx
- hair transplant for stable disease
- avoid friction, damaging chemicals, heat