HAIR AND NAILS
Download
Report
Transcript HAIR AND NAILS
HAIR AND NAILS
CM I- Dermatology Module
Tory Davis, PA-C
Hair Loss
Normal = 100 hairs/day
– Not noticeable among the 100,000 we have
– Grows 1 cm/month
Permanent loss
– Androgenic alopecia
– Scarring alopecia
Temporary loss
– Telogen effluvium
– Traction alopecia
– Alopecia areata
Alopecia Areata
Autoimmune disease, cause unknown
Possibly trigger (viral, other) in
predisposed people
Usually temporary hair loss
Can be recurrent loss
Male Androgenic
Alopecia
A physiologic reaction induced by
androgen in genetically predisposed
men
Gradual recession of hair on central
scalp and frontotemporal region
Female Pattern Alopcia
Central scalp hair loss with retention of
normal hair line
Studies suggest adrenal dysfunction
as one possible cause
Androgenic Alopecia
TREATMENT
– Minoxidil (Rogaine) solution
– Ideal in men under 30 who have been
losing hair for less than 5 years
– Approx. 1/3 of these pts will regrow hair
long enough to be cut or combed
– May stop or retard progression
– Effective in female pattern as well
Cicatricial (scarring)
alopecia
Rare condition
Inflammation damages and scars the
hair follicle, causing permanent hair
loss.
Patchy hair loss can be associated
with slight itching or pain.
Cause unknown, can be assoc with
lupus or lichen planus
Telogen Effluvium
Telogen stage of hair growth is “resting
stage.” 15% of hair is in telogen at any
given time
85% of follicles are in anagen (growth
phase)
Telogen effluvium is a loss of a larger
than normal percent of hair in telogen
phase
Telogen
Caused by change in normal hair cycle
Event causes more hair to be moved
from anagen to telogen at one time,
followed by a larger-than-normal loss
of hair about 2-4 months later
Like a reset button has been hit
Lost hair appears normal
Causes of Telogen
Effluvium
Childbirth
Severe illness
Crash diets
Drugs
High fever
Acute blood loss
Thyroid disease
Physiologic stress
Physical stress
Psychologic stress
Anagen Effluvium
Less common
Caused by
– Chemotherapy
– Poisoning
– Radiation therapy
Alopecia Areata
Rapid onset of total hair loss in sharply
defined (usually round) area
Dx by observation
Most pts under 40
Regrowth in 1-4 months, usually
Cause unknown
Whole scalp = alopecia totalis
Whole body = alopecia universalis
Alopecia Areata
Treatment Options
Observation
Intralesional injection of steroid
Systemic steroids
PUVA: Psoralen (a photosensitizing
agent) plus UVA
Minoxidil
Trichotillomania
The act of manually removing hair
Defined in the DSM IV as “an
irresistible urge to pull the hair and a
sense of relief after the hair has been
plucked”
Thinned in irregular pattern
Cases may resolve spontaneously
Treatment aimed at behavior
Making the Dx in Hair
Loss
HISTORY
– Drugs, diet restriction, vitamin A, illness,
recent childbirth
– Thyroid symptoms
– Time of onset and duration
Abrupt
= telogen
Gradual = anagen or localized
Making the Dx
PHYSICAL EXAM
– Examine scalp surface and hair shafts
– Observe pattern, thinning,
– Microscopic examination of hair
– Hair pull
– Daily counts
– Part width
HIRSUTISM
Appearance of excessive coarse hair
in pattern not normal in females
May be sign of endocrine disorder
– Most cases mediated by androgens,
which originate in adrenals or ovaries in
women
Many pts have no physiologic cause
Hirsutism Etiologies
Polycystic Ovarian Syndrome
– Endocrine disorder involving abnl
hormone levels, irregular menses,
infertility and ovarian cysts
Cushing’s Disease
– Overproduction of cortisol from pituitary
gland
Ovarian or adrenal gland tumors
Hirsutism Dx/Tx
PHYSICAL EXAM
– Look for signs of virilization
Like
what?
– Pelvic exam for ovarian tumors
– Abdomen for adrenal tumors
– Lab evaluation of hormonal levels
– Ovarian ultrasound
Tx aimed at underlying cause
Nails and skin ds
PSORIASIS
– 10-50%
– Pitting (ice pick-like depressions)
LICHEN PLANUS
– Longitudinal grooving and ridging
– Severe, early destruction of nail matrix
– with scarring
ALOPECIA AREATA
– Shallow pitting or stippling
Aquired nail disease
Paronychia
– Usually Staph infection
– Rapid onset of painful, bright red swelling
of the proximal and lateral nailfold.
– Relieved by draining
– May require antibiotics
Onychomycosis
A.k.a. tinea unguium
– Fungal infection of nail (toe more
common than finger) Some, but not all
nails- if all nails, seek other dx
– 6-8% of population affected
Increases
with age
– Thickened, yellow, cloudy nails
– Difficult to treat
Topical
vs systemic
Beau’s Lines
Transverse depressions of the nails
Appear weeks after a stressful event
Caused by temporary interruption of
nail growth
Stressors may include syphilis,
uncontrolled DM, myocarditis, high
fever, PVD, zinc deficiency
Nail changes with
systemic disease
YELLOW NAIL SYNDROME
– Response to respiratory disease
– Nail growth slows to half normal rate
SPOON NAILS- koilonychia
– Lateral elevation and central depression
– Can be seen in normal children
– May be caused by iron-deficiency anemia
Finger Clubbing
Distal phalanges become enlarged
and bulbous
Angle of proximal nail fold increases
Associated with lung ds, CVD,
cirrhosis, colitis, and thyroid disease
Terry’s nails
White or light pink nails with no lunula
Associated with liver failure, CHF,
diabetes, malnutrition
Decrease in vascularity and increase
in connective tissue in nail bed