Hair and Nail Conditions
Hair and nail diseases encompass such a large number of disorders that entire subspecialties of dermatology are devoted to the diagnosis and treatment of these conditions. Here, only a brief outline of these disorders can be provided. Consultation with a board-certified dermatologist is recommended for definitive diagnosis and care.
Hair Loss, also called Alopecia
Alopecia caused by autoimmunity
Hormonal Alopecia: also called male or female pattern baldness results in thinning of the hair on the crown of the head which may or may not progress to complete baldness. The pattern tends to run in families and so is also called hereditary pattern baldness. It can begin as early as the teenage years. This type of baldness can be mild and involve just the crown of the head or it can progress to complete loss of hair. In women the pattern usually involves the crown of the head with sparing of the frontal hairline. Several prescription drugs available from your dermatologist are available to treat this condition. Low level laser treatments have been shown recently to improved hair regrowth if the treatments are performed regularly (LaserCap). Hair transplants may also be an option.
Genetic Alopecia: Many variants of genetic hair loss are recognized. Hair loss is usually noted in infancy and scalp biopsy, lab tests and genetic testing may be required to sort out the diagnosis.
Metabolic Alopecia: Thyroid conditions, iron deficiency, pregnancy, poisons, and other metabolic imbalances can affect the growth of hair, which is one of the most rapidly growing tissues in the body. A thorough history and physical exam with selected laboratory tests may be required to determine the cause and therefore the proper treatment for the specific condition.
Scarring Alopecia: Many conditions can affect the hair follicles and lead to scarring, including lichen planus, lupus, chemical treatments, burns, or traction from wearing certain hairstyles. Scarring alopecias affect both men and women, most commonly adults, although all ages may be affected. These conditions are not contagious. Treatment depends on the specific cause and a board-certified dermatologist should be consulted. Scalp biopsies will probably be required to determine the specific cause of the hair loss.
Alopecia caused by medication: Chemotherapy is the classic example of drug-induced alopecia, as is radiation therapy. Hair usually regrows after these therapies but is usually thinner than previously.
Alopecia caused by infection: Bacteria or fungal infection is associated with loss of hair. Cultures of skin and antibiotic sensitivities will be required for correct diagnosis and treatment. Full hair regrowth is likely with adequate treatment unless scarring has resulted.
Alopecia of autoimmunity: The classic example here is alopecia areata, a condition where the hair falls out almost overnight in round or oval patches leaving a smooth patch of scalp or white hairs in its place. The disease is likely mediated by genetic control of autoimmune cells which attack certain proteins in the hair follicle. Treatment of small bald areas with injections of cortisone is usually effective; however cases where the entire scalp is involved, or all the hair on the body is lost are less likely to regrow. Usually control of the underlying disease improves the chances for hair regrowth.
See also Dandruff and Staph folliculitis.
Nail Disorders
Greek word for nail is "onycho"/
Brittle nails and splitting of the ends of the nails is usually caused by dehydration from excessive use of detergent or polish remover; however other chemical exposure, thyroid disorders, vitamin deficiency and anemia can also result in these disorders.
Paronychia is an infection of the soft tissue around the nail. Causes include excessive use of artificial nails which can trap moisture and allow the growth of bacteria or fungus. The treatment will require avoidance of artificial nails and possibly prescription antibiotics to clear the infection.
Ingrown nails are usually due to poor nail care or ill-fitting shoes leading to pinching of the nail plate against the tissue at the side of the nail. This can lead to pain, infection, swelling and the treatment is to cut the nails straight across, and not too short. Wider footwear is also important to avoid the pinching of the toes.
Fungus of the nails can affect one, all or only a few nails with yellowing, thickening, or separation of nailplate from the nailbed. Fungus infection may also manifest as small white spots on the surface of the nail. Oral antifungal medications until recently was the only way to clear the nails, however the length of time these drugs must be used renders their safety an issue. A new laser can eradicate toenail fungus with a high success rate in one to two treatments.
Lichen planus is associated with nail deformity that usually affects all 20 nails. Pterygium of the nails is a classic symptom of lichen planus in which there is a triangular scarring deformity from the cuticle to the end of the nail. Unfortunately, there is no treatment for this condition.
Psoriasis of the nails results in small pitting depressions, yellowing and thickening of the nail, separation of the end of the nail from the nailbed and small spots resembling oil drops under the nail plate. There is no effective treatment for nail psoriasis.
Cancer of the nailbed. A discoloration or lump under the nailplate should be examined by a dermatologist to inspect for skin cancer. A biopsy of the nailbed may require that the nail be removed however this is not as painful as it sounds. Local anesthesia is used in a 15 minute office procedure to accomplish the biopsy.
Nails can become discolored white, blue, green, red or brown due to systemic illness, poisoning, chemotherapy and other disorders.
Genetic disorders can lead to irregular shape or even absence of the nails.
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