Hair and Nail Disorders Practice Questions

Q: A male patient presents with patchy loss of hair involving the scalp, eyebrows, and beard with presence of grey hair in the affected areas. What is the most likely diagnosis?

Alopecia areata. ***Alopecia areata*** - This condition is characterized by **patchy hair loss** that can affect the scalp, eyebrows, and beard, and is often associated with the presence of **grey hairs** in the affected areas. - It is an **autoimmune disorder** where the immune system mistakenly attacks **hair follicles**, leading to non-scarring hair loss. *Androgenic alopecia* - This is commonly known as **male-pattern baldness** and typically presents as a receding hairline and thinning at the crown. - It is primarily driven by **genetics** and **androgen hormones**, and does not usually involve patchy loss or affect eyebrows and beard in the same way. *Anagen effluvium* - This condition is often caused by **chemotherapy** or other strong chemical exposures, leading to an abrupt and widespread loss of hair during the **anagen (growth) phase**. - Hair loss is typically diffuse and rapid, not usually localized to patches or accompanied by grey hair in specific areas. *Telogen effluvium* - This is a common form of **temporary hair loss** that occurs following a stressful event, fever, childbirth, or severe illness, causing premature shedding of hairs in the **telogen (resting) phase**. - It results in diffuse thinning rather than discrete patchy hair loss and is not typically associated with grey hair in the manner described.

Q: Pterygium of nail is seen in?

Lichen planus. ***Lichen planus*** - **Pterygium of the nail** refers to the forward growth of the proximal nail fold over the nail plate, often seen as a V-shaped scarring, which is a characteristic feature of severe **nail lichen planus**. - Other nail changes in lichen planus can include **longitudinal ridging**, thinning, splitting, and anonychia. *Pemphigoid* - Bullous pemphigoid typically affects the **skin with tense blisters** and rarely involves the nails significantly. - Nail changes are uncommon but if present, are usually non-specific, such as **subungual hematomas** or **onycholysis**, not pterygium. *Psoriasis* - Nail psoriasis presents with characteristic features like **pitting**, **onycholysis**, **oil-drop spots**, and **subungual hyperkeratosis**. - While significant nail dystrophy can occur, true pterygium formation from the proximal nail fold is **not a typical finding** in psoriasis. *Pemphigus* - Pemphigus is an autoimmune blistering disorder characterized by **flaccid blisters** and erosions, primarily affecting the skin and mucous membranes. - **Nail involvement is rare** and usually secondary to periungual blistering, leading to non-specific changes like paronychia or onychomadesis, not pterygium.

Q: Nail is involved in all except-

Androgenetic alopecia. ***Androgenetic alopecia*** - This condition is characterized by **progressive hair loss** due to the effects of androgens on genetically susceptible hair follicles, primarily affecting the scalp. - **Nails are not involved** in the pathogenesis or clinical presentation of androgenetic alopecia. *Psoriasis* - **Nail involvement is common in psoriasis**, presenting in various forms such as **pitting**, onycholysis, subungual hyperkeratosis, and discoloration. - These nail changes are caused by psoriatic inflammation affecting the nail matrix and nail bed. *Fungal infection* - Fungal infections of the nail, also known as **onychomycosis**, are a common condition that can affect one or more nails. - They lead to **thickening, discoloration, brittleness**, and crumbling of the nail plate. *Lichen planus* - **Nail involvement** occurs in about 10% of patients with lichen planus, ranging from subtle changes to complete nail destruction. - Manifestations include **longitudinal ridging, thinning of the nail plate, pterygium formation**, and onycholysis.

Q: A female presented with complaints of hair fall. Her delivery was 2 months ago. Physician diagnosed her condition as Telogen Effluvium. All of the following are true regarding telogen effluvium, EXCEPT:

Scarring. ***Scarring*** - **Telogen effluvium** is a **non-scarring alopecia**, meaning it does not cause permanent damage to the hair follicles or lead to scar tissue formation. - The hair loss is temporary and reversible, as the follicles remain intact and capable of regrowth. *Diffuse hair thinning* - Telogen effluvium typically presents as **generalized or diffuse hair thinning** across the scalp, rather than localized patches of baldness. - This thinning is because a large number of hair follicles prematurely enter the **telogen (resting) phase**, leading to increased shedding. *Metabolic stress* - **Metabolic stressors** such as childbirth, severe illness, surgery, significant weight loss, or nutritional deficiencies are common triggers for telogen effluvium. - These stressors disrupt the normal hair growth cycle, causing a greater proportion of hairs to shift into the resting phase. *Recovery within 6 months* - Telogen effluvium is usually a **self-limiting condition**, with hair regrowth typically occurring within 3 to 6 months after the inciting event has passed and the body has recovered. - Complete recovery of hair density may take longer, but significant improvement is often seen within this timeframe.

Q: The above nail changes are seen in:

Psoriasis. ***Psoriasis*** - **Nail pitting**, **onycholysis**, subungual hyperkeratosis, and oil drop spots are classic nail manifestations of psoriasis. - These changes result from abnormal keratinization and inflammation in the nail matrix and nail bed. - Nail involvement occurs in **50-80%** of psoriatic patients and can occur without skin involvement. *Alopecia areata* - Primarily a non-scarring **hair loss disorder**, but can sometimes cause nail changes like pitting, trachyonychia (rough nails), and longitudinal ridging. - The nail changes are usually **less prominent** than in psoriasis and typically geometric/regular pitting pattern. - The nail changes are often **non-specific** and typically secondary to the autoimmune process. *Fungal infection* - Onychomycosis presents with **yellow-brown discoloration**, subungual debris, and onycholysis, but typically lacks the characteristic **pitting** seen in psoriasis. - Usually starts from the **distal edge** and progresses proximally, unlike psoriatic nail changes. - **KOH mount** and fungal culture help differentiate from psoriatic nails. *Lichen planus* - Can affect nails, leading to features such as **longitudinal ridging**, splitting, pterygium formation, and anonychia (complete nail loss) due to inflammation of the nail matrix. - Nail changes in lichen planus are typically more focused on **scarring** and structural damage to the nail unit rather than the distinct pitting and oil spots of psoriasis. - May see **trachyonychia** (20-nail dystrophy) in severe cases.

Q: A child presenting with localized patches of complete hair loss with normal appearance of scalp. The diagnosis is:

Alopecia areata. ***Alopecia areata*** - This condition is characterized by **localized, well-demarcated patches of complete hair loss** on the scalp. - The underlying skin typically appears **normal, smooth, and healthy**, without inflammation or scaling. *Tinea capitis* - This fungal infection usually presents with **scaly patches**, inflammation, pustules, or "black dots" where hairs have broken off. - The scalp appearance is typically **abnormal** due to scaling and inflammation, unlike the normal scalp seen here. *Cradle cap* - Also known as **seborrheic dermatitis in infants**, it presents as greasy, yellowish, scaly patches on the scalp. - It does not cause **complete hair loss** in localized patches, but rather diffuse scaling and sometimes mild thinning. *Telogen effluvium* - This condition involves **diffuse hair shedding** (increased number of hairs falling out), often triggered by stress, illness, or medications. - It does not present as **localized patches of complete hair loss**, and the hair thinning is generally widespread.

Q: Pterygium of nail is characteristically seen in -

Lichen planus. ***Lichen planus*** - **Pterygium** of the nail, where the **proximal nail fold fuses with the nail matrix**, is a classic feature of nail lichen planus. - This condition can lead to permanent nail deformity or even **nail loss (anonychia)** through progressive scarring. *Alopecia areata* - While alopecia areata can affect nails, it typically causes **pitting, trachyonychia (rough nails)**, or longitudinal ridging, not pterygium. - It's primarily an autoimmune condition targeting **hair follicles**, leading to patchy hair loss. *Tinea unguium* - Tinea unguium (onychomycosis) is a **fungal infection** of the nail, characterized by discoloration, thickening, and subungual hyperkeratosis. - It does not typically cause the specific nail fold fusion seen in pterygium. *Psoriasis* - Nail psoriasis presents with various features like **pitting, oil drops (salmon patches)**, onycholysis, and subungual hyperkeratosis. - While it can cause severe nail dystrophy, **true pterygium** is not a characteristic feature of nail psoriasis.

Q: Which of the following is characteristically seen in alopecia areata?

Exclamatory mark hair. ***Exclamatory mark hair*** - **Exclamatory mark hairs** are short, broken hairs that get progressively narrower towards the scalp, resembling an exclamation mark. - They are a **pathognomonic sign** of **alopecia areata**, indicating active disease where the hair follicle immune attack is occurring. *Fungal infection* - **Fungal infections** of the scalp (tinea capitis) typically present with **scaling**, inflammation, and often **broken hairs** but not typically exclamatory mark hairs. - Diagnosis is usually confirmed by **KOH microscopy** or fungal culture. *Traumatic* - **Traumatic alopecia** (e.g., traction alopecia, trichotillomania) results from physical damage to the hair shafts or follicles. - It usually presents with **irregular patches** and broken hairs of varying lengths, without the specific exclamatory mark morphology. *Scarring* - **Scarring alopecia** (cicatricial alopecia) involves **permanent destruction** of the hair follicles, leading to irreversible hair loss and replacement by fibrous tissue. - The scalp in these conditions often appears **smooth** and devoid of follicular ostia, distinguishing it from non-scarring alopecia like alopecia areata.

Q: What is the characteristic nail finding in lichen planus?

Pterygium. ***Pterygium*** - **Pterygium** in lichen planus refers to the growth of **scar tissue from the proximal nail fold onto the nail plate**, often leading to nail destruction. - This is a highly characteristic sign of **nail lichen planus**, indicating inflammation and scarring of the nail matrix. *Beau's Lines* - **Beau's lines** are transverse depressions across the nail plate, signifying a temporary arrest of nail growth. - They are typically associated with **acute systemic illness**, severe stress, or trauma, rather than chronic inflammatory conditions like lichen planus. *Pitting* - **Nail pitting** presents as small, pinpoint depressions on the nail surface. - It is a classic finding in **psoriasis** and sometimes in alopecia areata, but not a primary feature of lichen planus. *Hyperpigmentation of nails* - **Hyperpigmentation of nails** refers to a darkening of the nail plate, often appearing as longitudinal streaks. - While it can be seen in various conditions, including drug reactions or melanonychia, it is **not a specific or characteristic finding** of lichen planus.

Q: All of the following are true for pseudopelade of Brocq except?

Presence of pustules. ***Presence of pustules*** - Pseudopelade of Brocq is a type of **scarring alopecia** characterized by **atrophic, hairless patches** without significant inflammation or pustules. - The absence of pustules is a distinguishing feature; their presence would suggest a different condition like folliculitis decalvans or dissecting cellulitis. *Foot print in snow appearance is seen* - This description is characteristic of the **atrophic, irregularly shaped** patches of hair loss seen in pseudopelade of Brocq. - The smooth, white, and often depressed areas of skin resemble footprints in freshly fallen snow. *Inflammation is absent* - Pseudopelade of Brocq is known for being a **lymphocytic scarring alopecia** with **minimal to absent clinical inflammation**. - While microscopic inflammation of lymphocytes around the hair follicles is present, it is not outwardly visible, which helps differentiate it from other inflammatory scarring alopecias. *Scarring Alopecia* - Pseudopelade of Brocq is indeed a form of **scarring alopecia**, meaning the hair loss is permanent due to the destruction of hair follicles and subsequent replacement by fibrous tissue. - This leads to irreversible hair loss in the affected areas.

Question 1

A male patient presents with patchy loss of hair involving the scalp, eyebrows, and beard with presence of grey hair in the affected areas. What is the most likely diagnosis?

Accepted Answer

Alopecia areata

Answer

Androgenic alopecia

Answer

Anagen effluvium

Answer

Telogen effluvium

Question 2

Pterygium of nail is seen in?

Accepted Answer

Lichen planus

Answer

Pemphigoid

Answer

Psoriasis

Answer

Pemphigus

Question 3

Nail is involved in all except-

Accepted Answer

Androgenetic alopecia

Answer

Psoriasis

Answer

Fungal infection

Answer

Lichen planus

Question 4

A female presented with complaints of hair fall. Her delivery was 2 months ago. Physician diagnosed her condition as Telogen Effluvium. All of the following are true regarding telogen effluvium, EXCEPT:

Accepted Answer

Scarring

Answer

Diffuse hair thinning

Answer

Metabolic stress

Answer

Recovery within 6 months

Question 5

The above nail changes are seen in:

Accepted Answer

Psoriasis

Answer

Alopecia areata

Answer

Fungal infection

Answer

Lichen planus

Question 6

A child presenting with localized patches of complete hair loss with normal appearance of scalp. The diagnosis is:

Accepted Answer

Alopecia areata

Answer

Tinea capitis

Answer

Cradle cap

Answer

Telogen effluvium

Question 7

Pterygium of nail is characteristically seen in -

Accepted Answer

Lichen planus

Answer

Alopecia areata

Answer

Tinea unguium

Answer

Psoriasis

Question 8

Which of the following is characteristically seen in alopecia areata?

Accepted Answer

Exclamatory mark hair

Answer

Fungal infection

Answer

Traumatic

Answer

Scarring

Question 9

What is the characteristic nail finding in lichen planus?

Accepted Answer

Pterygium

Answer

Beau's Lines

Answer

Pitting

Answer

Hyperpigmentation of nails

Question 10

All of the following are true for pseudopelade of Brocq except?

Accepted Answer

Presence of pustules

Answer

Foot print in snow appearance is seen

Answer

Inflammation is absent

Answer

Scarring Alopecia

Hair and Nail Disorders — MCQs

Hair and Nail Disorders — MCQs

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