Hair and Nail Disorders Practice Questions

Q: 'Exclamation mark' hair is a feature of -

Alopecia areata. ***Alopecia areata*** - **Exclamation mark hairs** are a classic trichoscopic finding in alopecia areata, characterized by short hairs that are wider at the top and narrow towards the scalp. - This morphology indicates active hair shaft breakage and miniaturization at the follicular opening, typical of the inflammatory process in **alopecia areata**. *Alopecia mucinosa* - This condition is characterized by follicular inflammation and mucin deposition in the hair follicles, rather than specific hair morphology like exclamation mark hairs. - It often presents as **erythematous plaques** or papules with associated hair loss, without the distinctive exclamation mark pattern. *Telogen effluvium* - Telogen effluvium involves a diffuse shedding of **club hairs** (telogen hairs) due to a premature shift of follicles into the telogen phase, often triggered by stress or illness. - The shed hairs are typically uniform in appearance with a **club-shaped root**, and "exclamation mark hairs" are not a feature. *Androgenetic alopecia* - This common form of hair loss is characterized by progressive **miniaturization** of hair follicles, leading to vellus transformation of terminal hairs. - While it features varying hair shaft diameters, it does not typically present with the distinct **exclamation mark hair** morphology seen in alopecia areata.

Q: Nail involvement is not a feature of –

DLE. ***DLE (Discoid Lupus Erythematosus)*** - **DLE** primarily affects the skin, causing **coin-shaped (discoid) lesions**, scarring, and changes in pigmentation. - While other forms of lupus (e.g., systemic lupus erythematosus) can have nail involvement, **DLE itself typically does not** manifest with primary nail changes. *Psoriasis* - **Psoriasis** frequently affects the nails, causing various changes such as **pitting, onycholysis, subungual hyperkeratosis, and oil spots**. - Nail involvement can occur in up to 50% of patients with chronic plaque psoriasis and 90% of those with psoriatic arthritis. *Lichen planus* - **Lichen planus** can affect the nails in about 10% of cases, leading to characteristic findings like **longitudinal ridging, pterygium formation, and nail thinning or shedding**. - **Twenty-nail dystrophy** is a severe form of nail lichen planus affecting all 20 nails. *Dermatophytosis* - **Dermatophytosis**, specifically **onychomycosis**, is a common fungal infection of the nails. - It causes thickening, discoloration (yellow-brown), and crumbling of the nails, often starting at the distal or lateral nail plate.

Q: Which of the following conditions causes alopecia without scarring -

Alopecia areata. ***Alopecia areata*** - This condition is an **autoimmune disorder** that causes non-scarring hair loss, appearing as well-demarcated, circular patches. - The hair follicles are not permanently damaged, allowing for **potential regrowth** of hair. - Classic example of **non-cicatricial (non-scarring) alopecia**. *DLE* - **Discoid Lupus Erythematosus** (DLE) is a chronic inflammatory skin condition that typically leads to **scarring alopecia**. - The inflammatory process causes permanent damage to the hair follicles, resulting in **irreversible hair loss** and scarring. - Classic example of **cicatricial (scarring) alopecia**. *Lichen planus pilaris* - This is a form of **lichen planus** that affects hair follicles, leading to **follicular inflammation** and eventual destruction. - It results in **scarring alopecia** with noticeable follicular plugs and often leaves shiny, atrophic skin. - Another example of **cicatricial (scarring) alopecia**. *Herpes Zoster* - **Herpes Zoster** (shingles) is a viral infection caused by reactivation of varicella-zoster virus, presenting with painful vesicular eruption along a dermatome. - **Not a typical cause of alopecia** (either scarring or non-scarring). - While temporary hair loss may rarely occur in severely affected areas, herpes zoster is not classified as a primary cause of alopecia in standard dermatology literature.

Q: Contraindicated in Androgenic Alopecia –

Testosterone. ***Testosterone*** - Androgenic alopecia, or **male-pattern baldness**, is driven by **androgens**, particularly **dihydrotestosterone (DHT)**, which is derived from testosterone. - Administering exogenous **testosterone** would exacerbate hair loss in individuals with androgenic alopecia by increasing the substrate available for conversion to DHT. *Minoxidil* - **Minoxidil** is a vasodilator that is commonly used topically to treat androgenic alopecia. - It works by **prolonging the anagen phase** of hair growth and increasing follicular size, making it a treatment option, not a contraindication. *Cyproterone* - **Cyproterone** is an **anti-androgen** that blocks androgen receptors and inhibits androgen synthesis. - It is used in some cases of severe androgenic alopecia in women, making it a treatment, not a contraindication. *Finasteride* - **Finasteride** is a **5-alpha-reductase inhibitor** that blocks the conversion of testosterone to dihydrotestosterone (DHT). - By reducing DHT levels, it slows or reverses hair loss in androgenic alopecia, making it a common treatment and not a contraindication.

Q: Rapid, diffuse, excessive hair loss occurring 3 months after childbirth is due to?

Telogen effluvium. ***Telogen effluvium*** - This condition is characterized by an excessive shedding of **club hairs** from the hair follicle, typically occurring 2-4 months after a significant stressor such as **pregnancy and childbirth**. - During pregnancy, high estrogen levels increase the number of follicles in the anagen (growth) phase; after delivery, estrogen drops, and many follicles simultaneously enter the **telogen (resting) phase**, leading to synchronized shedding. *Anagen effluvium* - This type of hair loss is rapid and severe, occurring when a significant percentage of **hair follicles** in the **anagen phase** are abruptly stopped from growing. - It is often seen with **chemotherapy, radiation therapy**, or exposure to toxins, which damage actively dividing hair matrix cells. *Alopecia areata* - This is an **autoimmune condition** where the body's immune system attacks hair follicles, leading to distinct, typically **round patches of hair loss**. - It can affect any hair-bearing area and is not directly linked to hormonal changes post-pregnancy. *Androgenetic alopecia* - Commonly known as **male or female pattern baldness**, this is a genetic condition influenced by androgens, characterized by a progressive **miniaturization of hair follicles**. - It presents as a characteristic pattern of thinning, such as a receding hairline or thinning at the crown, and is not typically a rapid, diffuse postpartum event.

Q: Nail involvement is not a feature of :

Drug induced lupus erythematosus. ***Drug induced lupus erythematosus*** - **Drug-induced lupus erythematosus** primarily presents with **systemic symptoms** such as arthralgia, myalgia, and skin rashes, but typically does *not* involve the nails. - While other forms of lupus can rarely affect nails, drug-induced lupus erythematosus is characterized by a lack of significant nail pathology. *Lichen Planus* - **Lichen planus** frequently affects the nails, causing various changes like **longitudinal ridging**, **onycholysis**, and sometimes **pterygium formation**. - Nail involvement can be an isolated finding or occur alongside characteristic **violaceous papules** on the skin and mucous membranes. *Dermatophytosis/Tenia* - **Dermatophytosis** (also known as **tinea unguium** or **onychomycosis**) is a common fungal infection that specifically targets the nails. - It results in nail discoloration, thickening, subungual hyperkeratosis, and brittleness. *Psoriasis* - **Psoriasis** commonly affects the nails, leading to characteristic signs such as **pitting**, **onycholysis** (separation of the nail from the nail bed), and **oil drop discoloration**. - Nail psoriasis can occur independently or in conjunction with skin and joint involvement.

Q: The underlying cause of chronic paronychia is:

Contact dermatitis/Inflammatory. ***Correct: Contact dermatitis/Inflammatory*** - **Chronic paronychia** is fundamentally an **inflammatory/eczematous condition** of the proximal nail fold, not a primary infection - The underlying cause is **repeated exposure to irritants** (water, detergents, chemicals) or **allergens** leading to chronic inflammation - This inflammation causes **separation of the cuticle from the nail plate**, disrupting the protective barrier - **Loss of the cuticle seal** allows moisture accumulation and creates an environment for secondary colonization - The inflammatory process itself is the primary pathology that must be addressed for successful treatment *Incorrect: Bacterial (secondary colonization)* - Bacteria such as *Staphylococcus aureus* or *Pseudomonas aeruginosa* can secondarily colonize the inflamed nail fold - However, they are **not the underlying cause** but rather opportunistic colonizers after barrier disruption - Treating with antibiotics alone often fails because it doesn't address the primary inflammatory process - Bacterial colonization is much less common than candidal colonization in chronic paronychia *Incorrect: Fungal (secondary colonization)* - *Candida* species (especially *C. albicans*) are the **most common secondary colonizers** in chronic paronychia - Candida thrives in the moist environment created by cuticle disruption - While frequently present, Candida is a **consequence rather than the cause** of chronic paronychia - Antifungal therapy alone often provides temporary relief but recurrence is common without addressing the underlying inflammation *Incorrect: Viral* - Viral infections such as **herpetic whitlow** (HSV) cause **acute** painful vesicular lesions of the distal finger - Viral infections are not associated with chronic paronychia - Clinical presentation of viral nail infections differs significantly with vesicles and a self-limited course

Q: A patient presents with focal alopecia areata. All of the following are associations of alopecia areata except:

Geographic tongue. ***Geographic tongue*** - **Geographic tongue** (benign migratory glossitis) is a benign inflammatory condition of the tongue and is generally not associated with alopecia areata. - While its exact cause is unknown, it's typically linked to genetic factors or sensitivities rather than autoimmune hair loss. *Atopy* - **Atopy**, including conditions like **eczema**, **asthma**, and **allergic rhinitis**, is a well-established association with alopecia areata, suggesting a shared immune dysregulation. - Patients with alopecia areata often have a higher prevalence of **atopic diathesis**. *Exclamatory mark* - The presence of **exclamatory mark hairs** (short, broken hairs that are narrower near the scalp) is a **pathognomonic sign** of active alopecia areata. - These hairs indicate ongoing inflammation and destruction of the hair follicles. *Nail pitting* - **Nail pitting**, characterized by small depressions in the nail plate, is a common finding in patients with alopecia areata, reflecting an immune-mediated attack on the **nail matrix**. - Other nail changes, such as **trachyonychia** (roughened nails), can also occur.

Q: Alopecia areata is:

Non-cicatricial alopecia. ***Non-cicatricial alopecia*** - **Alopecia areata** is a **non-scarring** form of hair loss, meaning the hair follicles are not permanently destroyed. - The potential for hair regrowth exists because the **follicles remain intact**, even if they are inactive. - It is an **autoimmune condition** characterized by patchy hair loss with "exclamation mark" hairs at the margins. *Fungal infection* - **Fungal infections** of the scalp (tinea capitis) often cause **patchy hair loss** with scaling and inflammation. - Unlike alopecia areata, tinea capitis is caused by a **microorganism** and typically involves an inflammatory response that can be managed with antifungals. *Cicatricial scar* - A **cicatricial scar** (or scarring alopecia) results in the **permanent destruction** of hair follicles, replacing them with fibrotic tissue. - This type of hair loss is **irreversible**, as the follicles are irrevocably damaged and cannot produce hair. *Telogen effluvium* - **Telogen effluvium** is characterized by **diffuse hair shedding** following a triggering event (stress, illness, childbirth). - Unlike the **patchy, localized** hair loss in alopecia areata, telogen effluvium causes **generalized thinning** across the scalp.

Q: Pitting of nails is seen in:

Psoriasis and Alopecia areata. ***Psoriasis and Alopecia areata*** - **Nail pitting** is a very common and characteristic finding in **psoriasis**, resulting from defective keratinization of the nail matrix. - While less common, nail pitting can also occur in **alopecia areata**, typically due to inflammation affecting the nail matrix. *Psoriasis only* - While **psoriasis** is a primary cause of nail pitting, stating it as "only" is incorrect as other conditions also present with this sign. - This option incorrectly limits the differential diagnosis for nail pitting. *Psoriasis and Lichen planus* - **Psoriasis** does cause nail pitting, but **lichen planus** typically causes **longitudinal ridging**, splitting, subungual hyperkeratosis, and sometimes pterygium formation, rather than classic pitting. - This option includes a condition that usually manifests with different nail changes. *Alopecia areata and Eczema* - **Alopecia areata** can cause nail pitting, but **eczema** of the hands or fingers more commonly leads to **nail plate dystrophy**, discoloration, ridging, or thickening, rather than distinct pitting. - While eczema can affect nails, pitting is not its characteristic nail manifestation.

Question 1

'Exclamation mark' hair is a feature of -

Accepted Answer

Alopecia areata

Answer

Alopecia mucinosa

Answer

Telogen effluvium

Answer

Androgenetic alopecia

Question 2

Nail involvement is not a feature of –

Accepted Answer

DLE

Answer

Psoriasis

Answer

Lichen planus

Answer

Dermatophytosis

Question 3

Which of the following conditions causes alopecia without scarring -

Accepted Answer

Alopecia areata

Answer

DLE

Answer

Lichen planus pilaris

Answer

Herpes Zoster

Question 4

Contraindicated in Androgenic Alopecia –

Accepted Answer

Testosterone

Answer

Minoxidil

Answer

Cyproterone

Answer

Finasteride

Question 5

Rapid, diffuse, excessive hair loss occurring 3 months after childbirth is due to?

Accepted Answer

Telogen effluvium

Answer

Anagen effluvium

Answer

Alopecia areata

Answer

Androgenetic alopecia

Question 6

Nail involvement is not a feature of :

Accepted Answer

Drug induced lupus erythematosus

Answer

Lichen Planus

Answer

Dermatophytosis/Tinea

Answer

Psoriasis

Question 7

The underlying cause of chronic paronychia is:

Accepted Answer

Contact dermatitis/Inflammatory

Answer

Bacterial (secondary colonization)

Answer

Fungal (secondary colonization)

Answer

Viral

Question 8

A patient presents with focal alopecia areata. All of the following are associations of alopecia areata except:

Accepted Answer

Geographic tongue

Answer

Atopy

Answer

Exclamatory mark

Answer

Nail pitting

Question 9

Alopecia areata is:

Accepted Answer

Non-cicatricial alopecia

Answer

Fungal infection

Answer

Cicatricial scar

Answer

Telogen effluvium

Question 10

Pitting of nails is seen in:

Accepted Answer

Psoriasis and Alopecia areata

Answer

Psoriasis only

Answer

Psoriasis and Lichen planus

Answer

Alopecia areata and Eczema

Hair and Nail Disorders — MCQs

Hair and Nail Disorders — MCQs

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