Nails and Hair Questions Flashcards
(42 cards)
What is onychomycosis?
A fungal infection of the nails: can sit on the nails, or occur subungally (under the nails, more invasive)
This can happen from direct contact/invasion of nearby skin
Fungus likes to grow in moist/dark places (feet-toenails)
Risk factors: communal showering, diabetes, tinea pedis, ^moisture, repetitive trauma (runners)
What are the physical findings of onychomycosis?
Can occur anywhere in the nail: matrix, nail bed, nail plate (lifting of nails with debris and discoloration)
May be asymptomatic at beginning/come in for cosmetic reasons
Progression can result in pain, numbness, interference with walking, exercise, standing
Subungual hyperkeratosis: crumbly debris under nail (nail itself is thick)
Onycholysis: white/yellow colors caused by nail lifting
Ddx for onychomycosis?
Nail psoriasis: not this because no nail pitting/psoriatic inflammation (differentiate with biopsy)
Trauma (will be more of a bruise under nail, no subungal debris)
Aging toenail
How can you diagnose onychomycosis?
Collect sample of subungal debris
In office: scrape for KOH (potassium hydroxide) look for hyphae
Send away: Nail clip for PAS stain (periodic acid shift) more applicable for ruling out nail psoriasis if KOH is negative
What can be seen in a KOH for onychomycosis?
Fungal hyphae (looks almost like little branches)
What is the treatment for onychomycosis?
Combo of topicals and oral meds (decreases reoccurrence)
Daily for almost a year:
Topicals (ciclopirox, efinaconazole)- alone can be ineffective, hard to penetrate the nail plate
Yet one benefit of nail lifting: easier to try to get medication to nail plate
Risks vs benefits: liver toxicity requiring labs, price $$$, med interactions, side effects
What is the first line treatment for onychomycosis?
Oral treatment Lamisil (terbinafine):
1 pill a day for 6 weeks
(1 a day for 3 months in toenails)
Can also use nail avulsion(removal)/laser if necessary for persistent/chronic cases
What information is important to give a patient when giving treatment for onychomycosis?
Toe nails and fingernails take a significant time to grow (months) and it will take a while before results are seen
What do you need to check for before using Lamisil (terbinafine) for onychomycosis?
Liver function labs (LFT), medication is metabolized by liver
What is paronychia?
Infection of skin on sides of nail (proximal and lateral nail folds)
Can be acute or chronic
What causes paronychia?
A small opening on these surfaces allows bacteria to enter
What are the clinical features of paronychia?
Acute: hot, red, swollen, painful, prurulent (staph aureus)
Chronic: more so at proximal nail fold- swelling, no prurulence, tender but not as painful (candida often found, but not the cause), nail plate thickened/discolored (not going to have subungal debris like onychomycosis)
What is the difference between acute and chronic paronychia?
Difference in presentation and symptoms
Acute- more painful, prurulent
Chrinic- less painful, discoloration of nails
How is paonychia diagnosed?
Collection of prurulent dishcarge
Bacterial culture, KOH smear, imaging (if osteomyelitis is suspected: systemic fever/chills)
What is the treatment for acute paronychia?
Topical or oral antibiotics (OTC bacitracin or prescription), soaks/I&D (separate nail fold from nail plate) to release prurulent discharge
If failure of treatment: culture bacteria and prescribe an oral antibiotic for more specific treatment
What is the treatment for chronic paronychia?
Topical steroids, skin protection (prevent moisture exposure)
-decreasing chronic inflammation
What would you tell a patient with paronychia as far as terms of education?
Avoid nail biting, trim hang nails, trim nails flush to tip, avoid excessive moisture exposure (prevents infection)
What is alopecia universalis?
When all hair bearing areas of body are bald
What is alopecia totalis?
When entire scalp is bald
What is alopecia areata?
“UNSIGHTLY” -Saint Mark
-recurrent but non-scarring hair loss (hair follicle will hopefully regrow as hair follicle will remain intact)
Usually localized, discrete round patches of hair loss (scalp, beard, eyebrows)
Can effect children and adults
What is the cause of alopecia areata?
unknown, most likely autoimmune/genetic (autoimmune attack that affects the hair follicles, not the skin around them),
*other autoimmune diseases may flare as well as alopecia
What are the clinical features of alopecia areata?
patient is usually asymptomatic, mild pruritis/burning, discrete bald patches (yet skin is smooth and NOT inflamed), !exclamation hairs! (broken hairs thinner toward the scalp/follicle than they are at the other end)
-Tinea capitis (yet will be mushy texture/boggy, itchiness, inflamed),
-traction alopecia (hair pulled tightly, frontal scalp usually effected, general distribution but no round patches),
-trichotillomania (hair usually not gone just broken, people pulling out their own hair),
-androgenic alopecia (usually has distinct pattern)
DDx for alopecia areata?
-Tinea capitis (yet will be mushy texture/boggy, itchiness),
-traction alopecia (hair pulled tightly, frontal scalp usually effected, general distribution but no round patches),
-trichotillomania (hair usually not gone just broken, people pulling out their own hair),
-androgenic alopecia (usually has distinct pattern)
How is alopecia areata diagnosed?
Clinical diagnosis
Pull test: if pulled in the patch, hair will come out very easily, may signify active alopecia
Association with other diseases: if symptoms present, test for other autoimmune diseases
