Transcript HAIR AND NAILS

HAIR AND NAILS
CM I- Dermatology Module
Tory Davis, PA-C
Hair Loss
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Normal = 100 hairs/day
– Not noticeable among the 100,000 we have
– Grows 1 cm/month
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Permanent loss
– Androgenic alopecia
– Scarring alopecia
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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
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Male Androgenic
Alopecia
A physiologic reaction induced by
androgen in genetically predisposed
men
 Gradual recession of hair on central
scalp and frontotemporal region
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Female Pattern Alopcia
Central scalp hair loss with retention of
normal hair line
 Studies suggest adrenal dysfunction
as one possible cause
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Androgenic Alopecia
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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
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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
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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
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Causes of Telogen
Effluvium
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Childbirth
Severe illness
Crash diets
Drugs
High fever
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Acute blood loss
Thyroid disease
Physiologic stress
Physical stress
Psychologic stress
Anagen Effluvium
Less common
 Caused by
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– Chemotherapy
– Poisoning
– Radiation therapy
Alopecia Areata
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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
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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
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Making the Dx in Hair
Loss
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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
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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
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– Most cases mediated by androgens,
which originate in adrenals or ovaries in
women
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Many pts have no physiologic cause
Hirsutism Etiologies
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Polycystic Ovarian Syndrome
– Endocrine disorder involving abnl
hormone levels, irregular menses,
infertility and ovarian cysts
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Cushing’s Disease
– Overproduction of cortisol from pituitary
gland
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Ovarian or adrenal gland tumors
Hirsutism Dx/Tx
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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
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Tx aimed at underlying cause
Nails and skin ds
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PSORIASIS
– 10-50%
– Pitting (ice pick-like depressions)
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LICHEN PLANUS
– Longitudinal grooving and ridging
– Severe, early destruction of nail matrix
– with scarring
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ALOPECIA AREATA
– Shallow pitting or stippling
Aquired nail disease
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Paronychia
– Usually Staph infection
– Rapid onset of painful, bright red swelling
of the proximal and lateral nailfold.
– Relieved by draining
– May require antibiotics
Onychomycosis
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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
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Nail changes with
systemic disease
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YELLOW NAIL SYNDROME
– Response to respiratory disease
– Nail growth slows to half normal rate
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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
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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