Clinical Pearls Dermatologic Findings of Nails and Hair 临床珍珠的指甲和头发皮肤表现.ppt

* * Ddx includes trauma, psoriasis, lichen planus Tx is not without potential for side effects * the prevalence of alopecia areata is 0.1 to 0.2% with a calculated lifetime risk of 2%. Affecting an estimated 4.5 million people in the United States * * * History of acute trauma Purple-red to black in color May cause secondary nail plate dystrophy Pigmentation moves distally with nail growth * - Aug 2012- George Costarellis at UPenn- prostaglandin D2 much higher in male bald(ing) scalps than non- * - Norwood Hamilton * Extent of androgen dependence and hereditary nature are not as distinct as in men * LUDWIG * Clinical Pearl:Alopecia Areata Acute onset Well defined Oval or round patches of alopecia Gold Standard:Intralesional kenalog N ENGL J MED 2011; 364:E38 Patient 4 Chief Complaint: Toe nail discoloration N ENGL J MED 2011; 364:E38 Patient 4 History 37yo man 4 year history of gradual darkening and widening of pigmented band Examination Brown/Black extension to proximal nail fold- Hutchinson’s sign Acral Lentiginous Melanoma Palm, sole or nail bed Median age 65 50-70% of melanomas in African Americans and Asians Minocycline Anti-malarials Gold Nail matrix nevus Nail matrix nevus A patient with HIV taking zidovudine Subungual hematoma Pseudomonas nail infection Clinical Pearl:Melanonychia Check for Hutchinson’s sign- extension of pigment to proximal nail fold If negative, consider Normal variant Traumatic Drug induced Patient 5 Chief Complaint: Hair loss Patient 5 History Gradually thinning on top since age 20’s Dad’s hair also thin No known medical problems Examination ↓↓ density of frontal scalp with recession of frontal hair line Many miniaturized hairs Androgenetic Alopecia-MEN 50% by age 50 years Androgen dependent progressive decline in anagen duration Genetic predisposition Hair follicles miniaturize Hair loss occurs in the fronto-temporal regions and the vertex Uptake, metabolism, and conversion