Hair & Nails Flashcards by Natalie Kudlak

Half and half nails

Chronic renal disease (also called Lindsay’s nails)

Proximal 1/2 with white zone, distal 1/2 with red brown zone

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Nail finding in kidney disease

Half and half nails (Lindsay’s nails), proximal 1/2 with white zone, distal 1/2 with red brown zone

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Proximal 1/2 with white zone, distal 1/2 with red/brown zone

1/2 and 1/2 nails (Lindsay’s nails) - found in renal disease

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Beaded appearance of hair due to periodic thinning of hair shaft (like necklace with string of beads)
Normal at birth, develops in a few months with short fragile brittle hair

Monilethrix

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Large uneven bubbles in hair due to trauma

Bubble hair

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Bamboo hair

Trichorrhexis invaginata

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Two paint brushes against each other (incomplete fracture with frayed ends), seen in which diseases?

Trichorrhexis nodosa

*Seen in Nethertons, Menkes disease, TTD, arginosuccinic aciduria

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Name the hair finding found in Nethertons, Menkes, TTD, and arginosuccinase deficiency?

Trichorrhexis nodosa

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Trichorrhexis Nodosa found in what disease(s)?

Menkes
TTD
Netherton
Arginosuccinase deficiency

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Alternating light and dark bands under polarizing light

Trichothiodistrophy (due to sulfur deficiency), found in TTD duh

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Twisting and flattening of the hair fiber

Pili torti

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Pili torti found in what disorders

Bjornstad, Crandall Syndrome, Menkes, Netherton

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Clean transverse fracture of hair shaft, mechanical or aquired

Trichoscisis

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What disease is trichoscisis found in?

TTD

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Name the hair findings in Trichothiodystrophy

Trichoscisis

Trichorrhexis nodosa

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Name the hair findings in Menkes

Pili torti (most common)
Trichorrhexis nodosa

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Pili torti
Trichorrhexis nodosa
Short brittle "steel wool" hair
Cupid's bow upper lip
Torturous arteries
Progressive CNS deterioration

Menkes Disease, due to defect in copper transporter

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Pili trianguli et canaliculi

Uncombable Hair syndrome

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Spun glass hair

Uncombable hair syndrome

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Triangular cross-section with central linear groove along one side

Pili trianguli et canaliculi (seen in uncombable hair syndrome)

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Spun glass hair (Pili trianguli et canaliculi) is due to premature keratinization of what part of the hair follicle?

Inner root sheath

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Which part of the hair is derived from the mesoderm?

Dermal papilla

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The infundibulum of the hair extends from the surface of the epidermis Down to which structure?

Opening of sebaceous gland

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The isthmus extends from the opening of the sebaceous gland Down to what structure?

Insertion of arrector pili muscle (bulge)

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Where is the bulge located in the hair follicle?

At the junction of the isthmus and the inferior segment. It is where the arrector pili muscle inserts

The outer root sheath occurs where in the hair follicle?

EVERYWHERE! It's just that going up during the isthmus it will undergo trichilemmal differentiation, and then in the infundibulum is essentially keratinized like the rest of the epidermis

The inner root sheath is found in what part of the hair follicle?

Starts in the dermal papilla but disintegrates by the time it reaches the bulge which is in the isthmus

Which portion of the hair follicle is the inner root sheath never present?

The infundibulum

How long is anagen phase for each hair?

2-6 years

In which phase of the cell cycle are hairs located higher up in the epidermis?

Telogen

Causes of: Dorsal pterygium Ventral pterygium

Dorsal pterygium: lichen planks Ventral pterygium: systemic sclerosis

Lichen planus nail findings: ventral or dorsal pterygium

Dorsal! *ventral pterygium is cause by systemic sclerosis

Alternative treatment for LPP

Pioglitazone

Pioglitazone can be used to treat which hair disorder

LPP

Name a few scaring neutrophilic hairloss conditions

Dissecting cellulitis of the scalp | Folliculitis decalvans

Name a few lymphocytic scaring hairloss disorders

LPP (which includes frontal fibrosing alopecia, graham little syndrome) CCCA DLE Pseudopalade of broq Alopecia mucinosa Keratosis follicularis spinularis decalvans

Which hairloss starts in the vertex scalp then spreads outwards, usually due to traumatic treatments

CCCA

How can you tell the difference between LPP and DLE on biopsy?

There will be no interface dermatitis seen at the DEJ in LPP! VS present in DLE

How can you tell the difference between LPP and CCCA on biopsy?

The lymphocytic infiltrate will Be WAY more intense in LPP (bc CCCA is just from hair products

What enzyme catalyzes the conversion of testosterone to DHT

5 alpha reductase

What does 5-alpha reductase catalyze the conversion of?

Testosterone to DHT

Where is type II 5 alpha reductase found?

Prostate mainly, but also the INNER ROOT SHEATH of the hair!

Where is - type I alpha reductase found? - type II 5 alpha reductase found?

- skin, hair follicles, and sebaceous glands | - type II found mostly in the prostate, but also in INNER root sheath of hair!

Which type if 5 alpha reductase is found in the inner root sheath of the hair?

Type II!!! Typically you think of type I only in the hair skin and nails and type II only in the prostate, but actually type II is in the prostate but can ALSO be in the inner rooth sheath!!!

Androgenetic alopecia will show what type of hairdo on biopsy

Vellus hairs, and MINIturized hairs

Which type of alopecia gives you vellus hairs and miniaturized hairs on biopsy?

Androgenetic alopecia

What is the difference between vellus hairs and miniturized hairs?

Vellus hairs have always been there | MINIturized hairs were previously large terminal hairs that have shrunk over time to become small hairs

Which are bigger - vellus hairs or miniturized hairs?

Neither they are the same size!

What is anisotrichosis and what condition is it found in?

Anisotrichosis is increased in variability of hair shaft size *due to progressive miniturizationof terminal hairs in androgenetic alopecia

How does minoxidil treat alopecia?

Lengthens the anagen phase and increases blood flow

What part of the scalp is minoxidil most effective at treating?

The VERTEX scalp (>frontal scalp)

Finasteride is which type of 5 alpha reductase inhibitor? (Type I or Type II)

Type II!! (Found in the testicles and in the INNER root sheath)

Where does finasteride stop the reduction of testosterone to DHT?

In the inner rooth sheath - bc its a type II 5 alpha reductase inhibitor

What is the risk of women taking finasteride should they get pregnant?

Risk of abnormal male genitalia in fetuses

Which hairloss pill targets both type I AND type II 5-alpha reductase inhibitor?

Dutasteride!! (DUAL reductase) not yet approved in US tho technically

How many hairs is normal to lose a day?

100-150

How many hairs do you have to lose per day to be considered in telogen effluvium?

>150 (100-150 hairs is normal to lose daily)

How many telogen hairs in a hair pull test of 40 hairs does it take to count as telogen effluvium?

4 out of 40

On biopsy - 1. If you see >20% of hairs (but less than 50%) are telogen hairs, what condition do you think of? 2. How abt >50% of hairs in telogen phase?

1. 20-50% in telogen phase = telogen effluvium | 2. >50% hairs in telogen phase = alopecia areata

What percentage of hairs are seen in telogen phase on biopsy in: 1. Telogen effluvium 2. Alopecia areata

1. 20-50% (<15% in telogen is normal) seen in telogen effluvium 2. >50% seen in alopecia areata

What is a normal amount of hairs in telogen phase?

0-15% hairs should be in telogen phase normally. Anything greater is telogen effluvium or alopecia areata

Drug treatment of choice for trichotillomania

Clomipramine

Clomipramine is the TOC for what disorder?

Trichotillomania!

Prognosis is better for which age group with trichotillomania? Children or adults?

Better prognosis in children!!

What type of cells attack the hair follicle in alopecia areata?

Cytotoxic CD8 T cells!

What is a poor prognostic factor in alopecia areata?

Ophiasis pattern

Is ophiasis pattern alopecia areata a good or bad prognostic factor?

It is bad :(

What is the opposite of ophiasis pattern? In alopecia

Sisapho pattern

What is sisapho pattern in aa?

The opposite of ophiasis pattern

What do you see on dermoscopy in alopecia areata?

Exclamation point hairs, also perifollicular yellow dots

What other common skin condition is associated wtih alopecia areata and is a/w a poor prognostic factor?

Eczema (Atopic)

A person with atopic dermatitis is more or less prone to get alopecia areata? Is this a good or bad prognostic factor?

Atopy is actually a risk factor for AA, and it carries a poor prognostic factor :(

What is the condition called where you dont regrow any of your normal terminal hairs after shedding of their initial hairs after birth

Congenital atrichia with papules | Can also see follicular cysts and milia later in life

Congenital atrichia with papules

Congenital disorder where the patient does not regrow their terminal hairs after the shedding of their first hair after birth *Can also see milia cysts and follicular cysts in a/w this disorder

Name this syndrome: scarring hairloss on the scalp, nonscarring hair loss of the axilla and pubic areas, KP like papules on the trunk

Graham-Little-Picarde syndrome

Hair & Nails Flashcards

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