Andrews Ch 33

Front 1

growing hairs

Back 1

anagen

Front 2

hairs undergoing transition from growing into resting

Back 2

catagen

Front 3

resting hairs

Back 3

telogen

Front 4

the phenomenon of telogen hairs remaining for variable lengths of time before they fall out

Back 4

teloptosis

Front 5

lag period between loss of telogen hair and growth of a new anagen hair

Back 5

kenogen

Front 6

NOTE: Anagen hairs typically grow for about 1000 days (3 years), but maybe up to 6 years

Back 6

n

Front 7

The hair growth rate of terminal hairs is ___ (mm/day)

Back 7

roughly 1/3

Front 8

rapid and complete loss of hair in one or more round or oval patches, usually on the scalp, bearded area, eyebrows, or eyelashes

Back 8

alopecia areata

Front 9

in alopecia areata, the loss of scalp hairs confluently along the temporal and occipital scalp

Back 9

ophiasis

Front 10

clues to the diagnosis of ___ include a history of periodic hair regrowth, nail pitting, and the presence of tapered fractures or exclamation point hairs

Back 10

alopecia areata

Front 11

NOTE: Alopecia areata is associated with a higher incidence of atopic dermatitis, Down syndrome, LP, and autoimmune disease

Back 11

n

Front 12

___ of the scalp may represent a forme fruste of alopecia areata. Patients with this disorder present with migrating patches of white hair, but never lose hair

Back 12

migratory poliosis

Front 13

Familial alopecia areata has been associated with this systemic lab finding

Back 13

hereditary thrombocytopenia

Front 14

sharply circumscribed patch of alopecia with exclamation point hairs at the periphery and the absence of scarring are indicative of ___

Back 14

alopecia areata

Front 15

presents with excessive shedding of normal telogen club hairs

Back 15

telogen effluvium

Front 16

This type of alopecia / hair loss occurs 3-5 months after the premature conversion of many anagen hairs to telogen hairs induced by surgery, parturition, fever, drugs, dieting, or traction

Back 16

telogen effluvium

Front 17

How do you explain the large degree of hairloss that occurs after childbirth?

Back 17

During pregnancy, many hairs remain for a prolonged time in anagen phase. They are released simultaneously into telogen phase with parturition. Also many hairs are restricted to telogen phase during pregnancy and teloptosis occurs at parturition

Front 18

NOTE: Superimposed papulosquamous disease, Fe deficiency, thryoid disease can result in even more telogen shed in cases of telogen effluvium

Back 18

n

Front 19

disorder in which anagen hairs may be pulled from the scalp with little effort. Usually occurs in blond girls and improves with age.

Back 19

loose anagen syndrome

Front 20

pelade is French for ___

Back 20

alopecia areata (therefore psuedopelade is 'like alopeciea areata but not alopecia areata')

Front 21

doll's hair-like bundling of follicular units; compound hairs

Back 21

tufted folliculitis

Front 22

also known as twisted hairs; hairs are fragile; may be associated with patchy alopecia and short, broken hairs

Back 22

pili torti

Front 23

gray or white hair occurs in circumscrbied patches

Back 23

poliosis (may be found in Waardenburg syndrome, piebaldism, Tietz syndrome, Alezzandrini syndrome, NF, and tuberous sclerosis)

Front 24

Graying of hair a/w aging is due to reduction of ___ within hair bulb melanocytes

Back 24

tyrosinase activity

Front 25

X-linked rare disorder; mapped to Xp21.2-22.2; KP of the face in infancy, progressive cicatricial alopecia; photophobia is prominent

Back 25

keratosis follicularis spinulosa decalvans

Front 26

hair loss in the immediate vicinity of either benign or malignant tumors of the scalp

Back 26

tumor alopecia

Front 27

patient has bald spot on the back of their head after prolonged anesthesia or bed rest

Back 27

pressure alopecia

Front 28

form of cicatricial alopecia; periodic crops of pustules or crusts at the periphery of an alopecic patch

Back 28

folliculitis decalvans

Front 29

alopecia in the area of hair braids

Back 29

traction alopecia

Front 30

term encopasing a finding associated with a wide range of hair conditions; doll's hair-like bundling of follicular units; multiple hair shafts within one follicular ostia

Back 30

tufted folliculitis / compound hairs

Front 31

expanding eroded patches with moist granulation tissue of the scalp; looks nasty (I've seen it); usually follows trauma or a surgical procedure and is chronic / progressive

Back 31

erosive pustular dermatitis of the scalp

Front 32

form of cicatricial alopecia; multiple round, oval, or irregularly shaped hairless scarred patches; "onion skin surface;" no inflammation; no pustules / crusts, etc; may represent an end stage of LPP or may overlap with CCCA

Back 32

pseudopalade (of Brocq), which means pseudo alopecia areata

Front 33

Andrews reports that pseudopalade may represent an end stage of ___

Back 33

LPP

Front 34

discrete excoriated follicular papules in the scalp; no associated scarring alopecia; bx with inflammatory crust and suppurative folliculitis

Back 34

acne necrotica

Front 35

crops of pustules within the scalp that result in cicatricial alopecia; successive crops of pustules, crusts, or erosions lead to expansion of the alopecic patches

Back 35

folliculitis decalvans

Front 36

Although not definative, some think that folliculitis decalvans represents a chronic ___ infection; it often responds to long-term treatment with ___

Back 36

staph
tetracycline

Front 37

most commonly seen in African American women; slowly progressive alopecia with scarrin gof the crown with peripheral spread

Back 37

CCCA (central centrifugal cicatricial alopecia) - difficult to treat

Front 38

NOTE: Most patients with LPP only have involvement of the scalp, but some can have the classic LP

Back 38

n

Front 39

Frontal fibrosing alopecia appears to be a variant of ___

Back 39

LPP

Front 40

older woman with band-like frontotemporal alopecia

Back 40

consider frontal fibrosing alopecia

Front 41

cicatricial alopecia; KP on the trunk / extremities; non-cicatricial alopecia of axillae / pubis

Back 41

Graham Little (Piccardi-Lassueur) syndrome

Front 42

NOTE: Chronic cutaneous lupus is another cause of cicatricial alopecia

Back 42

n

Front 43

What does DIF of chronic cutaneous lupus show?

Back 43

"full house" granular deposition at DEJ of IgG, IgA, IgM and C3

Front 44

NOTE: Andrews does not recommend suturing scalp 4mm punch biopsies, rather recommends the use of a 4mm strip of gel foam

Back 44

n

Front 45

List the most common inflammatory causes of cicatricial alopecia (4)

Back 45

DLE
LPP
sarcoidosis
folliculitis decalvans

Front 46

what are the hair findings of hypothyroidism

Back 46

coarse, dry, brittle, sparse hair

Front 47

what are the hair findings of hyperthyroidism

Back 47

fine, sparse hair

Front 48

alopecia mucinosa may occur without underlying disease in young people; the secondary type is usually associated with ___

Back 48

MF-type CTCL

Front 49

moth-eaten appearance on the occipital scalp; generalized thinning of the hair

Back 49

alopecia syphilitica

Front 50

boggy red plaque or hypopigmented patch with hair loss and maybe comedone-like papules

Back 50

consider alopecia mucinosa

Front 51

what is the typical patient with trichotillomania?

Back 51

girl under age 10 (but any age/sex can be affected)

Front 52

Both women and men with pattern alopecia have higher levels of ___ and ___ in frontal hair follicles compared to occipital follicles

Back 52

5-alpha-reductase
androgen receptors

Front 53

The conversion of testosterone into ___ by the enzyme ___ is increased in the scalp of balding individuals

Back 53

dihydrotestosterone
5-alpha-reductase

Front 54

also known as beaded hairs

Back 54

monilethrix

Front 55

Monilethrix (beaded hairs), often associated with KP, is associated with a mutation in ___

Back 55

desmoglein 4

Front 56

some patients with uncomable hair syndrome have responded to ___

Back 56

biotin

Front 57

pili torti + monilethrix (beaded hair) + trichorrhexis nodosa; XR inheritance; hair resembles steel wool; early death (drowsiness, lethargy, seizures, neurologic deterioration, periodic hypothermia)

Back 57

Menkes kinky hair syndrome

Front 58

congenital deafness (cochlear type)
pili torti

Back 58

Bjornstad syndrome

Front 59

Bjornstad syndrome is caused by a mutation in ___

Back 59

BCS1L (encodes an ATPase)

Front 60

pili torti + nerve deafness + hypogonadism

Back 60

Crandall syndrome

Front 61

entire body covered in fine vellus hairs with normal-appearing scalp hair; X-linked dominant; may be associated with de3ntal anomalies and gingival fibromatosis

Back 61

congenital hypertrichosis lanuginosa

Front 62

acquired hypertrichosis lanuginosa is an ominous sign of ___

Back 62

internal malignancy "malignant down"

Front 63

REVIEW: Signs of hirsutism

Back 63

hair growth of the upper lip, cheeks, chin, central chest, breast, lower abdomen, groin. VIRILIZATION: temporal balding, masculine habitus, deepening of voice, cliteral hypertrophy, amenorrhea, acne

Front 64

Most medically-significant hirsutism is associated with ___

Back 64

PCOS

Front 65

NOTE: When virilization accompanies hirsutism, especially when progression is rapid, neoplastic cause is likely

Back 65

n

Front 66

NOTE: It should be noted that women of southwest asian, eastern european, and southern european heritage commonly have facial, abdominal, and thigh hair

Back 66

n

Front 67

adrenal androgens in women are ___ and ___

Back 67

DHEA (dehydroepiandrosterone) and androstenedione (both are pre-androgens that require conversion in skin and liver to testosterone)

Front 68

The androgens ___ and ___ are secreted in women by the ovary

Back 68

testosterone and androstenedione

Front 69

NOTE: PCOS may relate to insulin resistance with resultant elevated insulin levels leading to ovarian overpoduction of androgesn

Back 69

n

Front 70

REMEMBER: 21-hydroxylase deficiency (CAH) is AD-inherited. Onset is generally in childhood with ambiguous genitalia, precocious growth, and virilism

Back 70

n

Front 71

What is the treatment for axillary and palmar hyperhidrosis?

Back 71

First line is topical AlCl applied to a blown-dry axilla nightly (without occlusion) starting at low concentration (10-30%). For the palms use up to 50% concentration nightly under occlusion with plastic gloves

Front 72

excessive sweating of the forehead, scalp, upper lip, perioral region, or sternum a few moments after eating spicy food, tomato sauce, chocolate, coffee, tea, or hot soup

Back 72

gustatory hyperhidrosis

Front 73

what typically happens to the feet/soles of someone with palmoplantar hyperhidrosis?

Back 73

they become soggy and are often affected by pitted keratolysis and foul odor

Front 74

what is the word for getting rid of hair

Back 74

epilation

Front 75

REMEMBER: A dignosis of PCOS does not require labratory confirmation

Back 75

n

Front 76

Determination of ___ and testing for ___ may be the most important laboratory evaluation in those diagnosed with PCOS

Back 76

lipid panel
glucose tolerance

Front 77

When the history and physical exam of someone with virilization suggests the possibility of neoplasm, a serum ___ should be checked

Back 77

testosterone level

Front 78

NOTE: I'm not sure abou this, and I need to look it up, but it looks like Andrews recommends both spironolactone (100-200mg/day) and metformin for PCOS

Back 78

n

Front 79

___ is the OCP that provides good cycle control for women with PCOS

Back 79

Yasmin

Front 80

1-2mm nodules attached firmly to the hair shafts of axillary / pubic hair. Yellow coloration of nodules and maybe skin. May coexist with erythrasma and pitted keratolysis

Back 80

trichomycosis axillaris

Front 81

trichomycosis axillaris usually involves large numbers of ___ (organism)

Back 81

corynebacterium (treat with topical clinda or erythromycin)

Front 82

thick, asbestos-like (amiantaceous) shiny scales on the scalp with localized or generalized crusting and matted-together hairs; maybe some purulent exudate

Back 82

pityriasis amiantacea (usually due to untreated psoriasis or seb derm)

Front 83

pityriasis amiantacea is usually associated with large numbers of ___ (organism)

Back 83

staph (but treatment is with selenium sulfide and/or steroid shampoo along with peanut oil to thin the scale)

Front 84

small pustules near the tip of the inside of the nose a/w hair follicles; crusts; maybe staph cultured

Back 84

folliculitis nares perforans

Front 85

in pts with renal failure or DM; umbilicated dome-shaped papules on the legs (less often on trunk, neck, arms, scalp); maybe pustular lesions; later resembles prurigo nodules; central hyperkeratotic cone; coalescing verrucous plaques frequently seen

Back 85

acquired perforating dermatosis (seen in 4-10% of dialysis pts)

Front 86

___ is treatment for acquired perforating dermatosis a/w pruritus of renal disease

Back 86

nbUVB

Front 87

reddish-brown, sharply demarcated, symmetrical discoloration of pre-auricular and maxillary face; follicular papules and erythema; telangiectases

Back 87

erythromelanosis follicularis faciei et colli

Front 88

lichen spinulosis is primarily a disease of ___

Back 88

kids

Front 89

what is the treatment for lichen spinulosis

Back 89

keratolytics, emollients (SA, LA, urea), maybe tretinoin