Lecture 7 Part 2

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Questions and Answers

What is a common characteristic of Tinea Cruris (Jock Itch)?

It usually affects the scrotum and penile shaft.

It presents as bright red patches on the glans penis.

It presents as chronic, brown to red patches in the groin folds. (correct)

It includes satellite pustules or papules.

Which fungi are responsible for causing Tinea Cruris?

Malassezia furfur and Trichophyton tonsurans.

Candida albicans and Aspergillus niger.

Trichophyton rubrum, Trichophyton mentagrophytes, and Epidermophyton floccosum. (correct)

Microsporum canis and Rhodotorula glutinis.

What is an appropriate treatment for Tinea Cruris?

Topical antifungal cream. (correct)

Corticosteroid injections.

Oral antibiotics.

Antiviral medication.

Why is it important to examine patients with Tinea Pedis for Tinea Cruris?

They commonly co-exist. Signup and view all the answers

What is a potential complication if Tinea Cruris does not respond to treatment?

Serious undiagnosed dermatoses. Signup and view all the answers

What is the most common cause of fingernail dystrophy?

Chronic low grade trauma. Signup and view all the answers

What might indicate a permanent nail dystrophy?

Healing of the matrix with a scar. Signup and view all the answers

What should be used weekly after treatment for Tinea Cruris to prevent recurrence?

Miconazole 2% powder. Signup and view all the answers

Which of the following statements about vitiligo is true?

Depigmented patches can appear anywhere on the body. Signup and view all the answers

What is the most common age range for the onset of vitiligo?

In the first three decades of life Signup and view all the answers

Which of the following treatments is most effective for facial vitiligo?

Topical steroids and immunomodulators Signup and view all the answers

What condition is associated with vitiligo?

Autoimmune thyroid disease Signup and view all the answers

Which of the following hypotheses is currently most accepted regarding the cause of vitiligo?

It represents an autoimmune response against melanocytes. Signup and view all the answers

What factor is commonly associated with chronic injuries affecting the matrix?

Ill-fitting shoes Signup and view all the answers

Which area of the body is commonly resistant to treatment for vitiligo?

The hands Signup and view all the answers

Which of the following statements about the biopsies of vitiligo patients is accurate?

It is rare to find inflammatory cells in biopsies. Signup and view all the answers

What is the prevalence of alopecia areata in the population?

0.2% Signup and view all the answers

Which area of the body is most commonly affected by alopecia areata?

Scalp Signup and view all the answers

What characterizes exclamation point hairs observed in alopecia areata?

They have a thicker distal portion than proximal. Signup and view all the answers

What is the likelihood of spontaneous resolution in patients with a few small patches of alopecia areata?

Very likely within 2 years Signup and view all the answers

Which treatment is effective for localized alopecia areata?

Steroid injections Signup and view all the answers

What autoimmune diseases are weakly associated with alopecia areata?

Thyroid disease, diabetes, and lupus Signup and view all the answers

How does male pattern baldness commonly present on the scalp?

Loss in bi-temporal areas and the vertex Signup and view all the answers

When does female pattern baldness typically begin?

Around peri-menopause or menopause Signup and view all the answers

Which area of the scalp is typically spared in cases of male pattern baldness?

Far lateral parietal scalp Signup and view all the answers

What role does the enzyme 5-alpha-reductase play in male pattern baldness?

Converts testosterone to dihydrotestosterone (DHT) Signup and view all the answers

Which treatment is commonly used for both male and female pattern baldness?

Surgical hair transplant Signup and view all the answers

What typically triggers telogen effluvium in individuals?

Severe physiological or psychological stress Signup and view all the answers

In patients experiencing telogen effluvium, what phase do most hairs shift from due to stress?

Anagen to telogen Signup and view all the answers

How effective is treatment for male pattern baldness in halting the progression of balding?

Around 66% Signup and view all the answers

Which of the following is NOT a characteristic of female pattern baldness?

Complete loss of scalp hair Signup and view all the answers

What is a common symptom faced by individuals with telogen effluvium?

Finding excess hair in the shower drain Signup and view all the answers

What primarily triggers the shedding of hair in telogen effluvium?

Duration of three months in telogen phase Signup and view all the answers

Which group of individuals is most commonly affected by melasma?

Young adult females Signup and view all the answers

What is a common symptom associated with melasma?

Flat, asymptomatic areas of hyperpigmentation Signup and view all the answers

How can melasma be effectively treated?

Topical medications combined with lifestyle changes Signup and view all the answers

What is the most effective initial treatment for melasma in pregnant women?

Effective sunscreen use Signup and view all the answers

What is the common characteristic of dermatofibromas?

They are firm, slightly raised papules Signup and view all the answers

What sign is observed when a dermatofibroma is squeezed?

It sinks deeper into the skin Signup and view all the answers

What likely causes dermatofibromas according to the information provided?

Abnormal scarring response to minor trauma Signup and view all the answers

What is the typical size of angiofibromas?

1-3 mm Signup and view all the answers

Where are angiofibromas almost exclusively found?

On the nose Signup and view all the answers

What are pearly penile papules a specific type of?

Angiofibroma Signup and view all the answers

Which factor is believed to contribute to the formation of angiofibromas in normal individuals?

Abnormal scarring response to minor trauma Signup and view all the answers

What distinguishes infundibular cysts from isthmic cysts?

Infundibular cysts have a central punctum. Signup and view all the answers

What can happen if an infundibular cyst ruptures?

It becomes very painful and inflamed. Signup and view all the answers

Which statement about cysts is true?

Cysts can be caused by blocked hair follicles. Signup and view all the answers

What is a primary reason patients may seek treatment for cysts?

Due to recurrent inflammation or cosmetic reasons. Signup and view all the answers

What distinguishes Tinea Cruris from Candidiasis in terms of appearance?

Candidiasis is usually bright red and may involve the scrotum. Signup and view all the answers

Which statement best describes the commonality of Tinea Cruris in different age groups?

It is uncommon before the 20s. Signup and view all the answers

What should be considered if Tinea Cruris does not respond to the standard treatment?

A dermatologist referral is necessary. Signup and view all the answers

What is the recommended prophylactic measure after successful treatment of Tinea Cruris?

Use of an antifungal powder at least once a week. Signup and view all the answers

Which of the following is a cause of toenail dystrophy?

Low grade trauma due to repetitive exercise. Signup and view all the answers

Which aspect of the nail matrix is critical for nail health?

Any disruption may cause abnormalities in the nail plate. Signup and view all the answers

What immediate course of action is recommended if acute trauma leads to nail loss?

No treatment is needed if the matrix is undamaged. Signup and view all the answers

What is a potential outcome if the nail matrix heals with a scar after trauma?

Dystrophy may become permanent. Signup and view all the answers

What distinguishes alopecia universalis from other forms of alopecia?

It results in hair loss across the entire body. Signup and view all the answers

In alopecia areata, the presence of exclamation point hairs is indicative of what?

Hair shaft thickness variation. Signup and view all the answers

What is the primary mechanism involved in the hair loss experienced in alopecia areata?

Attacks by CD4 and CD8 cells on hair bulbs. Signup and view all the answers

Which feature is common to both male pattern baldness (MPB) and female pattern baldness (FPB)?

They both involve genetic predisposition. Signup and view all the answers

Which of the following statements is accurate regarding the likelihood of spontaneous resolution in alopecia areata?

Patients with a few patches are likely to resolve in 2 years. Signup and view all the answers

What treatment is primarily used for localized alopecia areata?

Steroid injections. Signup and view all the answers

What condition is least likely to be associated with alopecia areata according to the mentioned associations?

Anemia. Signup and view all the answers

Which statement accurately describes the characteristics of angiofibromas?

They can become confluent, particularly in patients with tuberous sclerosis. Signup and view all the answers

What is a characteristic onset trend for female pattern baldness (FPB)?

Usually starts at perimenopause or menopause. Signup and view all the answers

What is a common cause of cyst formation?

Blockage of hair follicles leading to accumulation of secretions. Signup and view all the answers

What is a distinguishing feature of isthmic cysts compared to infundibular cysts?

They usually do not have a central punctum. Signup and view all the answers

In what location are angiofibromas most commonly found?

On the nose. Signup and view all the answers

What could potentially indicate the presence of tuberous sclerosis in a patient?

Numerous facial angiofibromas becoming confluent. Signup and view all the answers

Which treatment option is commonly considered for cysts?

Cyst excision for cosmetic reasons. Signup and view all the answers

What enzyme is specifically related to male pattern baldness (MPB)?

5-alpha-reductase, type 2 Signup and view all the answers

What treatment option is effective for both male and female pattern baldness?

Topical minoxidil Signup and view all the answers

What is a primary characteristic of infundibular cysts?

They typically have a visible opening or punctum. Signup and view all the answers

What is the usual intervention for excessive numbers of angiofibromas?

Consideration for tuberous sclerosis evaluation. Signup and view all the answers

Which area of the scalp is typically unaffected in cases of male pattern baldness?

Far lateral parietal scalp Signup and view all the answers

What is the most common triggering event for telogen effluvium?

Labor and delivery Signup and view all the answers

What typically happens to hair follicles in the process of telogen effluvium?

An abnormal number transition from anagen to telogen phase Signup and view all the answers

What is the approximate effectiveness of treatments for halting the progression of male pattern baldness?

66% Signup and view all the answers

Which hormone increases relatively in female pattern baldness?

Androgenic hormones Signup and view all the answers

Which treatment for female pattern baldness (FPB) has shown efficacy in post-menopausal women?

Anti-androgen agents like spironolactone Signup and view all the answers

What is the most challenging aspect of treating vitiligo?

The resistance of vitiligo on the hands to treatment Signup and view all the answers

Which factor is least likely to contribute to the onset of vitiligo?

Ill-fitting footwear Signup and view all the answers

What percentage of the body may be affected in severe cases of vitiligo?

Up to 100% Signup and view all the answers

Which condition is least likely to be associated with other autoimmune diseases in patients with vitiligo?

Sesame seed allergies Signup and view all the answers

Which hypothesis about vitiligo pathogenesis has the weakest supporting evidence?

Infection by a viral agent Signup and view all the answers

What typical symptom might be observed in the depigmented areas of skin affected by vitiligo?

Erythema Signup and view all the answers

In the treatment of vitiligo, which type of ultraviolet light treatment is considered most effective?

Narrowband UVB or PUVA Signup and view all the answers

What critical factor impedes the healing of the matrix, potentially resulting in permanent dystrophy?

Failure to resolve the source of chronic injury Signup and view all the answers

What primarily triggers the resolution of telogen effluvium?

Resolution of stress Signup and view all the answers

Which of the following factors must be addressed to effectively treat melasma?

Increased sun exposure and excess estrogen Signup and view all the answers

What is the typical presentation of dermatofibromas?

Small, firm, slightly raised papules Signup and view all the answers

In which phase do most hairs shift prior to shedding in telogen effluvium?

Anagen Signup and view all the answers

What condition is primarily associated with melasma development?

Increased estrogen and sun exposure Signup and view all the answers

What is a recommended approach for treating pregnant women who develop melasma?

Effective sunscreen use only Signup and view all the answers

What is the expected long-term outcome for patients with telogen effluvium?

Spontaneous resolution Signup and view all the answers

Which of the following statements about the pathogenesis of dermatofibromas is accurate?

They are likely an abnormal scarring response to minor trauma Signup and view all the answers

Study Notes

Tinea Cruris (Jock Itch)

More common in men, rare before puberty, uncommon before age 20
Presents as brown to red patches in groin folds (Figure 7.24)
May have mild itching, often asymptomatic
Spares the scrotum, penis shaft, and glans penis
Differentiate from candidiasis (bright red color, involves scrotum and glans, satellite pustules/papules)
Caused by Trichophyton rubrum, Trichophyton mentagrophytes, and Epidermophyton floccosum
Treat with topical antifungal cream; hydrocortisone 1% cream for itching
Patients with Tinea pedis should be examined for Tinea cruris
Use antifungal powder (miconazole 2% powder) weekly to prevent recurrence
Refer to dermatologist if no response to treatment, some rare dermatoses mimic the condition

Nail Dystrophy

Common abnormal appearance of toenails and fingernails due to trauma
Chronic low-grade trauma (jogging, repetitive impact) is most common cause of toenail dystrophy
Nail tissue trauma (picking cuticles) is most common cause of fingernail dystrophy. (Figure 7.25)
Acute trauma to nail itself may lead to the nail falling off
Damage to the nail matrix can cause temporary or permanent nail dystrophy
Disruption in nail matrix anatomy leads to nail plate abnormalities
Treatment for acute trauma isn't necessary; if the matrix doesn't heal the dystrophy will be permanent
Chronic injuries resolved by addressing the cause (i.e., ill-fitting shoes, picking habit)

Vitiligo

Commonly presents in darkly pigmented individuals in the first three decades of life, with familial predisposition
Presents as asymptomatic, completely depigmented patches with minimal erythema; hairs within the patches are usually depigmented (Figures 7.27, 7.28, 7.29)
Multiple depigmented areas are common, frequently affecting hands, elbows, knees, perioral, periocular, and genital areas
Pathogenesis is unclear, likely autoimmune response against melanocytes
Treatment is difficult; facial vitiligo responds best to topical steroids and topical immunomodulators (tacrolimus, Protopic), and ultraviolet light (narrowband UVB or PUVA)

Alopecia Areata (AA)

Affects 2% of people at some point, 0.2% currently affected
Young adults and children most commonly affected
Presents as sharply circumscribed areas of complete hair loss, typically 1-5 cm in diameter; may include exclamation point hairs (Figures 7.30, 7.31)
Involves scalp most commonly, but can affect beard, eyelids, eyelashes, or other hair-bearing areas
Localized disease treatable with steroid injections
Widespread disease treated with immunosuppressants, often ineffective
Associated with thyroid disease, diabetes, and lupus

Pattern Baldness (Male and Female)

Extremely common; male-pattern baldness (MPB) can begin in mid-teens, while female-pattern baldness (FPB) typically begins around peri-menopause/menopause
MPB involves the bi-temporal areas and the vertex; FPB involves the vertex and crown
MPB likely involves multiple genes, linked to 5-alpha-reductase type 2 enzyme and its conversion of testosterone to DHT
Treatments include finasteride, minoxidil, and hair transplantation; topical minoxidil and anti-androgen agents (such as spironolactone)

Telogen Effluvium

Presents with increased hair shedding; commonly in young adult females
Occurs three months after a severe physiologic/psychologic stress
Typically resolves spontaneously with stress resolution
Usually does not cause permanent hair loss

Melasma

Primarily affects young adult females; symptomatic flat areas of hyperpigmentation on the face (most frequently forehead, nose, cheeks, perioral area, or frequently cheeks alone) (Figure 7.34)
Often associated with increased estrogen levels and sun exposure, such as in pregnancy or oral contraceptive use
Treatment focuses on reducing sun exposure, sunscreen, tretinoin cream, and perhaps hydroquinone (4%)

Dermatofibroma

Firm, slightly raised papules (3-6mm)
Common in women, brown or pink with a rim of hyperpigmentation
Often benign scarring in response to minor trauma; no treatment is usually necessary

Angiofibroma (Fibrous Papule)

Small (1-3 mm) skin-colored or pink papules
Almost exclusively on the nose (Figure 7.37), and sometimes on glans penis
Patients with tuberous sclerosis may have hundreds of confluent facial angiofibromas (Figure 7.39)
No treatment needed

Cysts

Common on the trunk in men, scalp in women
May be infundibular (epidermal inclusion cyst, epidermoid cyst, sebaceous cyst) or isthmic (pilar cyst); ranging in size from 1-3cm
May be inflamed, painful or express material
Often cosmetic treatment or excision as necessary

Lipoma

Benign subcutaneous fat tumors
Commonly found on the trunk and extremities
Usually asymptomatic, but can be tender or painful if pressing on nerves

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Explore the characteristics, causes, and treatments of Tinea Cruris and Nail Dystrophy in this informative quiz. Gain an understanding of common fungal infections and their differentiation from other conditions. Ideal for students in dermatology and healthcare fields.