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Disorders of the hair and nails

Onychomycosis

• A fungal infection of the toenail

Clinical Presentation

• Nail changes
  • Thickened
  • White, yellow or green
  • Brittle
• Typically painless

Labs and studies

• KOH prep
• Culture

Treatment

• Systemic antifungal
  • These are effective, but may cause hepatotoxicity
  • Terbinafine
  • Itraconazole
• Topical antifungal
  • Not as effective, but improving
• Good hygiene

Paronychia

• An infection of the periungal area (area around next to fingernail or toenail
• Most commonly caused by Staphylococcus aureus

Clinical Presentation

• Red, swollen at the place where the nail meets the skin
• PAINFUL
• Pus is often present

Treatment

• Stop biting your nails
• Warm soaks several times a day
• Anti Staph Antibiotics
  • Cephalexin
  • Dicloxacillin
• I & D may be necessary

Alopecia (Baldness)

• The most common cause is androgenetic alopecia (male-pattern or female-pattern hair loss)
• Alopecia is broken down into two major categories, scarring and non scarring.
• Scarring alopecia may occur with
  • Trauma
  • Infections
  • Radiation
  • Scleroderma
  • and others
• Non scarring alopecia may occur with
  • Androgenetic baldness (the common kind of baldness)
  • Hyper or hypothyroidism
  • Pituitary insufficiency
  • Secondary syphilis
  • Iron deficiency
  • and others

Labs and Studies

• Pull test
• Pluck test with microscopic examination
• Biopsy may be necessary
• Testosterone
• DHEAS
• Iron
• Thyroid panel
• CBC

Treatment

• Androgenetic baldness
  • Minoxidil 5% solution applied BID
  • Finasteride (Propecia)
  • OCP may be helpful in female baldness
• Treat the underlying issue
• Treat the cause of scarring
• Surgery
• Laser therapy

Pigment disorders

Melasma

• Dark brown areas of hyperpigmentation on the face which have sharp margins
• Most commonly affects pregnant females or women taking OCPS
• The “mask of pregnancy”

Clinical Presentation

• Dark brown areas of hyperpigmentation on the face which have sharp margins
• Most commonly affects pregnant females or women taking OCPS

Labs and Studies

• A woods light may be helpful
• Usually a clinical diagnosis

Treatment

• Typically resolves on its own several months after pregnancy or stopping OCPs thought it may not completely fade
• Avoid sun exposure as this can enhance the hyperpigmentatoin
• Topical steroids
• Chemical peels
• Maybe laser treatment

Vitiligo

• Believed to be attributed to autoimmune disease but cause is unkown
• Patches of depigmented skin of different sizes
• Typically affects one area of the body like the hands or the feet

Clinical Presentation

• Depigmentation patches of skin
• Usually begins in the extremities
• Well defined Irregular borders

Labs and Studies

• Clinical diagnosis
• A Woods lamp may be helpful

Treatment

• UVB light therapy – narrow band ultraviolet light
• PUVA – Ultraviolet light with psoralen which makes the skin more susceptible to the light.
• Melanocyte transplant
• Camouflage,
  • Depigment surrounding skin
  • Make up