Derm Hair, Nails, Sun Damage

Male Pattern Balding

Male - frontal hairline regression, thinning on posterior vertex

Female Pattern Balding

Female - thinning from crown down hairline without hairline regression

sudden onset of clearly demarcated hair loss, skin smooth without hair, no visible scaling or erythema

Alopecia Areata

shiny skin, complete loss of hair follicles, and discoloration

Scarring Alopecia

Round scaling patches of alopecia, broken hairs or corkscrew hairs visible on dermoscopy, may be boggy on palpation

Tinea capitis

superficial infection of proximal and/or lateral nail folds, S/Sx: red, swollen, tender

Paronychia

Paronychia Cause

Caused by localized trauma: nail biting, manicuring, frequent immersion in water

linear streak formed as the nail grows out, caused by increased pigmentation in the nail matrix, thin & uniform = nevus. Wide or irregular = concerning for subungal melanoma

Melanonychia

painless separation of whitened nail plate from nail bed (enlarged free edge), often from traumatic forces, starts distally and progresses proximally

Onycholysis

nail thickening and subungal debris, usually from dermatophyte, can also be from molds, often preceded by tinea pedis (athletes foot)

Onchomycosis

bulbous swelling of soft tissue at base of nail, angle between nail and proximal fold > 180 degrees

Clubbing of Fingers

Clubbing Associations

Associated w congenital heart disease, interstitial lung disease, lung cancer, IBD, malignancies (vasodilation, possibly from hypoxia though not largely understood)

nail plate turns white w ground-glass appearance, distal reddish brown, and obliteration of lunula

Terry Nails

Terry Nails Associations

Usually affects every nail associated w liver disease, heart failure, diabetes

Punctate depression of nail plate by defective layering by proximal nail matrix

Pitting

Pitting Associations

Commonly associated w reactive arthritis, sarcoidosis, alopecia areata, atopic or chemical dermatitis

Transverse depression of nail plate usually bilaterally

Transverse Linear Depressions (Beau Lines)

Beau Lines Association

Typically from severe illness, trauma, cold exposure

comedonal, occasional papules

mild acne

inflammatory, comedones, papules and pustules

Moderate Acne

Nodulocystic

Severe cystic acne

secondary lesions, Acne w pitting and scarring

Acne Vulgaris

bilaterally symmetric, brown macules on sun-exposed skin

Solar Lentigo

yellowish white macules on sun-exposed skin, especially forehead

Solar elastosis

ecchymosis to dorsal forearms and hands, doesn’t extend above “shirt sleeve” on upper arm

Actinic Purpura

red patches in sun-damaged areas with fine telangiectasias and area of both hyperpigmentations and hypopigmentations

Polikiloderma

start at an earlier age on sun damaged skin

Wrinkles

deep wrinkles on posterior neck in “crisscross” pattern

Cutis Rhomboidalis Nuchae