Hair and nails

Question 1

the nail matrix is proximally/distally?

Answer 1

proximally

Question 2

can you use a dermatosope on nail?

Answer 2

yes

Question 3

what can looking at the proximal nail fold tell you

Answer 3

signs of rheumatological conditions e.g. dilated capillaries

Question 4

functions of nails

Answer 4

protection
tool
counter pressure - sensation

Question 5

signs of nail changes on examination

Answer 5

number of nails 
brittle 
thickening 
separation 
colour 
ridging 
striations 
growth 
systemic disease 
drugs

Question 6

fungal vs melanoma in nails vs haemorrhage

Answer 6

single vs multiple

Question 7

signs of fungal nail disease

Answer 7

black pigmentation 
yellow pigmentation  
thickened 
brittle 
look for tinea pedis between toes

Question 8

how can you differentiate between fungal nail disease and periungual melanoma

Answer 8

melanoma - usually a single nail

fungal - usually multiple nails

Question 9

RF for fungal nail infection

Answer 9

elderly
immunosuppressed
starts off in 1 nail then progresses to others

Question 10

features of subungal haematoma

Answer 10

dark pigment 
asymmetric 
nail fold involvement 
pain if acute 
chronic repetitive trauma 
D.Dx melanoma 
dermatoscope - streaky, red/brown colour
review consultation if concerned

Question 11

signs of acral / periungual melanoma

Answer 11

streaks of dark pigment
involvement of proximal nail fold - Hutchinsons sign
thick and thin pigment

Question 12

what is melanonychia and what are some causes

Answer 12

benign pigment in the nail
antimalarial drugs
chemotherapy

Question 13

features of a myxoid pseudocyst

Answer 13

benign growth around the nail 
fluid filled 
telangiectasia 
D.Dx BCC 
may recur despite treatment

Question 14

features of lichen planus of nails

Answer 14

trachonychia (looks like nail has been sandpapered)
angel winging 
disfiguring 
topical steroids 
check elsewhere for signs

Question 15

What are Beau’s lines?

Answer 15

transverse ridging of the nail
can occur during times of stress
arrest of nail growth at nail matrix

Question 16

what is paronychia

Answer 16

infection of nail tissue

Question 17

why do hair bearing regions heal better

Answer 17

presence of stem cells near the follicle

Question 18

what is the anagen phase of hair

Answer 18

growing

Question 19

What is the catagen phase of hair

Answer 19

starts to detach from blood supply

Question 20

what is the telogen phase of hair

Answer 20

stage where it can fall out

Question 21

in humans, hair loss is a/synchronous

Answer 21

asynchronous hair loss

Question 22

non-scarring hair loss features on dermatoscope

Answer 22

see follicles on dermatoscope

Question 23

questions to ask in a history of hair loss

Answer 23

timing
how much loss - little vs clumps
localised vs generalised
who noticed 
brushing, shower, shedding or thinning 
where - facial and body hair 
itch, tingling
infection, stress, pregnancy, drugs 
PMH - autoimmunity
DH 
FH 
hair care products - heat use, chemicals
diet

Question 24

androgenic alopecia

Answer 24

thinning 
follicles present 
minoxidil 
anti androgen drugs 
hair transplant

Question 25

scarring hair loss features

Answer 25

lose hair follicle hair wont grow back scalp looks smooth and shiny

Question 26

non-scarring hair loss features

Answer 26

see follicles on dermatoscope

Question 27

causes of non-scarring hair loss

Answer 27

``` androgenic alopecia telogen effluvium alopecia areata traction alopecia trichotillomania tinea capitus ```

Question 28

features of androgenic alopecia

Answer 28

``` thinning follicles present minoxidil anti androgen drugs hair transplant ```

Question 29

features of telogen effluvium

Answer 29

``` generalised hair loss hair regrowth pregnancy iron levels in time it grows back ```

Question 30

features of alopecia areata

Answer 30

``` exclamation mark hairs patches of hair loss hair can grow back on its own can grow back as white hair topical dermovate IL steroids ```

Question 31

features of traction alopecia

Answer 31

not scarring - may if over a long period of time tight pony tails tight braids relax the hair

Question 32

features of trichotillomania

Answer 32

``` hair pulling intentionally mental health conditions underlying - OCD, anxiety atypical distribution hairs of different lengths hair does grow back behavioural modification ```

Question 33

examples of scarring alopecia

Answer 33

kerion CDLE lichen planopilaris / FFA

Question 34

CDLE features

Answer 34

chronic discoid lupus erythrematosus highly potent steroids leaves large smooth plaques behind sunlight - trigger

Question 35

features of lichen planopilaris / FFA

Answer 35

``` lichen planus of the scalp clear cut affects front of head erythema around hair follicle females doesnt regrow ```

Question 36

mechanism of folliculitis decalvans and | dissecting cellulitis of the scalp

Answer 36

neutrophil mediated looks like a toothbrush antibiotics dissecting cellulitis of the scalp - more aggressive, painful associated with other adnexal diseases - acne, HS

Question 37

types of excess hair growth

Answer 37

hirsutism | hypertrichosis

Question 38

describe hirsutism

Answer 38

male pattern excess hair growth

Question 39

describe hypertrichosis

Answer 39

congenital | acquired - ciclosporin, phenytoin

Question 40

DRESS - severe

Answer 40

``` fever liver necrosis cardiac lungs lymphadenopathy blood count - eosinophilia 2 week history carbamazepine, lamotrigine, keppra, sulpha drugs ```

Question 41

features of morbilliform drug eruption - mild

Answer 41

``` most common penicillin allopurinol sulpha drugs cranial caudal distribution erythematous papules that becomes confluent intensely itchy emollients, topical steroids ```

Question 42

features of DRESS drug eruption - severe

Answer 42

``` fever liver necrosis cardiac lungs lymphadenopathy blood count - eosinophilia 2 week history carbamazepine, lamotrigine, keppra, sulpha drugs ```

Question 43

what is the difference between SJS / TEN

Answer 43

of body surface area: SJS <10% TEN >30%

Question 44

features of SJS

Answer 44

mucosal involvement mouth or eye pain genitalia involvement

Question 45

erythema multiforme

Answer 45

targeoid lesion children - HSV older - HIV, drugs, reactive

Question 46

features of fixed drug eruption - allergic

Answer 46

beefy red inflamed blistering lesion recurrent can be sore remove offending drug and they resolve on their own

Question 47

features of erythema multiforme

Answer 47

targetoid lesion children - HSV older - HIV, drugs, reactive

Question 48

types of erythema multiforme

Answer 48

major - mucosal surfaces involved | minor

Question 49

types of urticaria

Answer 49

acute - allergic | chronic

Question 50

causes of urticaria

Answer 50

foods drugs - penicillin, sulpha, anticonvulsants intensely itchy

Question 51

drug cause of angioedema

Answer 51

ACEI - non-allergic mediated

Question 52

causes of phototoxic drug reactions

Answer 52

tetracyclines thiazides psoralin for UVA treatment fruits - citrus

Question 53

areas affected by phototoxic drug reactions

Answer 53

face neck dorsal hands sharp cut off

Question 54

cause of drug induced LE

Answer 54

PPIs

Question 55

drug induced bullous pemphigoid

Answer 55

furosemide | SGLT2 inhibitors

Question 56

drug induced bullous pemphigoid causes

Answer 56

furosemide | SGLT2 inhibitors

Question 57

erythema nodosum causes

Answer 57

penicillin | sulpha drugs

Question 58

drug induced pigmentation

Answer 58

amiodarone - slate grey minocycline - irreversible antimalarials - melanonychia chemo, mushrooms - flagellate erythema

Question 59

drug induced pigmentation causes

Answer 59

amiodarone - slate grey minocycline - irreversible antimalarials - melanonychia chemo, mushrooms - flagellate erythema

Question 60

cause of oil drop sign on nails

Answer 60

psoriasis