Hair and Nail Disorders

Question 1

Scarring Alopecia

Answer 1

Permanent destrustion of the hair follicular stem cell structe…loss of follicular openings…need to refer to dermatology

Question 2

Nonscarring alopecia

Answer 2

Hair growht in areas of alopeica will resume

Preservation of follicular openingns

Question 3

Anagen
Catagen
Telogen
Exogen

Answer 3

Anagen - determined by location…activity at lower follicle…grwoth and onset of mitoctic activiti yin theis region

Catagen - hair productivitiy stops…cells stop dividign via apoptosis, melanocytes stop produceing pigment,…loses length

Telogen - dermal papillae are fully destroyed

Exogen - Shedding

90% in anagen and only 1-2 in catagen

Question 4

Ishtmus

Answer 4

Inferior is bulge…cantains distinctive ketatinocytes that have characteristics of epithelial stem cells

Loss of these cells is in scarring alopecia

Question 5

Bulb

Answer 5

Matrix keratinocytes repidly proliferate during anagen…terminally differentiate while being infused with melanin

Question 6

Pattenr alopeica in men pathology

Answer 6

Androgen hyperactivity

Anagen duration duration decreases, producing shorter and thinner hairs…amount of time between exogen and new cycle increases

Question 7

Testosterone role in pattern

Answer 7

Adrenal glands release DHEAS and androsteroine…goes to gonads to produce testosterone…5alpha reudctase converts to DHT

Balding scalpes have more levels of 5alpha reducatase and DHT

Hormone receptor complex alters gene expression…angrogens may induce apoptosis of dermal pipilla cells

Question 8

Females normal scalp

Answer 8

Females have enzyme aromatase that converts tesoteronse and androstenedione to estradiol and estrone…concentration of enzyme is 5 times higher in female scalp…this lower androgen susceptibility

Question 9

Female pattern loss

Answer 9

Hyoperandrogen state may contribute…consider lab tests

Question 10

Minoxidil
Finasteride
Spironolactone

Answer 10

Increased mitogenic activity of epidermal cells of hair follciles…induces hair groth…topical solution for both

5alpha reductase inhibitor for males

Renal competitive aldosterone antagonist with mild antiandrogen effect…blocks receptor from interacting with DHT…females

Question 11

Meds and pattern

Answer 11

Use for one year…if not working then low-level light therapy and hair restoration surgery

Question 12

Telogen effluvium

Answer 12

Women

Increase in shedding of terminal hairs

Premature conversion of anagen to telogen hairs

Hair is shed with white bulb attached as opposed to seeing borken hair

Check iron and thyroid and remove precipitating cause

Question 13

Alopecia aretae

Answer 13

Men and women at young ages

CD8 cells attakc hair follicles

Demarcated oval bald spot

Black dots on the scalp from fracture hairs that have proken off

Exclamation point hairs at periphery

Nail pitting

Tx with steroids

Question 14

Traction alopecia

Answer 14

Due to traction due to hair stules and cultural…begins as nonscarring but can be turn into scarring

Question 15

Trichotillomanie

Answer 15

SHort and bristly hair

Surface of scalp is not smooth

Question 16

Onychomycosis

Answer 16

Fungal infection of nail

Dermatophytes (T. rubrum and interdigitale)

White ot brown yellow opacification of the distal nail bed that spreads promixally

KOH examination

Terbinafine for 12 weeks - inhibits enzymes needed to synthesize cell wall component

Question 17

Paronychia

Answer 17

Inflammation of lateral and proximal nail folds

S.aureus, strep pyo, eikenlla coorodens

Drain

Give amoxicillin with clavulanic acid if oral flora exposrue

Cephalexin is first if without oral flora nad not MRSA

Question 18

Felon

Answer 18

Purulent infection/ascess of fleshy mass of fingertip

S. aureus and HSV

Warm soaks, elevation, oral ABs

If HSV, then acyclovir