Define Onchomycosis
Nail infections caused by ANY fungus
Risk Factors for Onchomycosis
Older age DM Swimming Tinea pedis Psoriasis Immunodeficiency Living with someone affected
Presentation of Onychomycosis
Brittle
Lusterless
Hypertrophic
White/yellow/brown discoloration
What can nail dystrophies occur with?
Psoriasis Eczematous conditions Senile ischemia Trauma Lichen planus
Diagnosis of Onychomycosis
KOH examination
Nail culture (DTM)
Nail plate biopsy
Treatment of Onychomycosis Recommended in Whom?
Hx of cellulitis of LE
DM + risk factors for cellulitis
Discomfort +/- pain
Desire treatment for cosmetic reasons
First Line Treatment of Onychomycosis
Oral terbinafine (Lamisil)
Alternative Treatment Options for Onychomycosis
Itraconazole (Sporanox)
Griseofulvin
Fluconazole (Diflucan)
Monitoring for Treatment of Onychomycosis
LFTs
Hepatotoxicity
Hepatic failure
Treatment for Onychomycosis can not be used with what medication class?
Statins
Define Paronychia
Infection around fingernail
Bug: Staph aureus
Treatment of Paronychia
Antibiotics
Warm soaks
I&D: serious cases
Define Felon
Pulp space infection
Presentation of Felons
Swollen
Exquisitely tender
Erythematous
Treatment of a Felon
I&D
Antibiotics
Referral to hand surgeon
Define Herpetic Whitlow
Herpetic infection by inoculation of the virus in the cuticle region
Treatment of Herpetic Whitlow
Self-limited
Immunocompromised: oral acyclovir
Define Onychocryptosis (Ingrown nail)
Lateral nail plate pierces the lateral nail fold & enters the dermis
Presentation of Onychocryptosis
Pain
Edema
Exudate
Granulation tissue
Predisposing Factors of Onychocryptosis
Poorly fitting shoes
Excessive trimming of the lateral nail plate
Trauma
Treatment for a Mild to Moderate Onychocryptosis
Cotton wedging or dental floss
Soak foot in warm water for 20 minutes 3 times/day
Treatment for a Moderate to Severe Onychocryptosis
Removal
Possible antibiotics
Define Onychogryphosis
Deformed, curved nail
Define Alopecia
Loss of hair in areas where it normally grows
Define Androgenic Alopecia
Male pattern baldness
4 Factors in Androgenic Alopecia
Genetic predisposition
Hormonal activity
Age
Gender
Treatment of Androgenic Alopecia
Finasteride (Propecia) Topical minoxidil (Rogaine)
MOA of Androgenic Alopecia
Blocks conversion of testosterone to DHT
Describe Alopecia Areata
Rapid hair loss in distinct, well-defined round or oval patches of COMPLETE hair loss
Possibly auto-immune
What is alopecia areata associated with?
Vitiligo
Hashimoto’s thyroiditis
Addison’s disease
Pernicious anemia
Treatment of Alopecia Areata
Intralesional steroids
Potent topical steroids
Topical immunotherapy
2nd: minoxidil, anthralin
Describe Telogen Effluvium
Thinning/shedding of hair resulting from the early entry of hair into the telogen phase
Risk Factors of Telogen Effluvium
Stress Postpartum Malnutrition Crash dieting Metabolic changes (TSH, ferritin, CBC, CMP)
Treatment of Telogen Effluvium
Treat underlying causes
Describe Trichotillomania
Impulse control disorder
Irregular, short growth hairs
Unilateral to patient’s dominant hand
Treatment of Trichotillomania
SSRI
Cognitive therapy