pearls dermatologic findings of nails and hair 临床珍珠的指甲和头发皮肤表现课件

《pearls dermatologic findings of nails and hair 临床珍珠的指甲和头发皮肤表现课件》由会员上传分享，免费在线阅读，更多相关内容在教育资源-天天文库。

1、ClinicalPearls:DermatologicFindingsofNailsandHairAmericanCollegeofPhysicians2013VirginiaChapterAnnualMeetingandClinicalUpdateKimberlySalkey,M.D.DepartmentofDermatologyEasternVirginiaMedicalSchoolIhavenoconflictsofinteresttodeclarePatient1ChiefComplaint:Hairlo

2、ssPatient1HistoryExcessivesheddingSmallerponytailJustmarried3monthsagoExaminationDiffuse↓inhairdensityScalp,brows,lashesWNLHairpullpositiveTelogenEffluviumExcessiveandearlyentryofhairsintothetelogenphaseTriggeredbyemotionallyorphysiologicallystressfuleventsShed

3、dingbegins2-4monthsaftertrigger>25%ofhairsintelogenphaseHairlosscanapproach400-500/dayHumanHairCycle2-7yearsFewmonths90%10%100,000scalphairsUpto100scalphairsshed/dayTelogenEffluviumCausesofTelogenEffluviumChildbirthSevereinfectionSeverechronicillnessSeverepsych

4、ologicalstressMajorsurgeryHypoorhyperthyroidismCrashdietsinadequateproteinDrugsManagementofTelogenEffluviumLaboratoryevaluationDirectedbyhistoryThyroidstudies,CBC,IronstudiesCheckmedicationsβblockers,NSAIDS,anti-coagulants,HRTReassuranceReassuranceMinoxidilClin

5、icalPearlAcuteonset,diffusehairsheddingoccurringafewmonthsafteramajorstressorIdentifycauseOfferreassurancere:selflimitedcourseTelogenEffluviumPatient2ChiefComplaint:ToenaildiscolorationPatient2HistoryDiscolorationforyearsItchyfeetHealthyNoskindiseaseExamination

6、SimilarfindingsonbothfeetOnychomycosisAKAtineaunguium3typesDistal/lateralsubungualMostcommonWhitesuperficialDirectinvasionofsuperficialnailplateProximalsubungualImmunocompromisedhostsOnychomycosisOnychomycosisOnychomycosisOnychomycosisWhitespottingduetosuperfic

7、ialdermatophyteinfectionortraumaOnychomycosisEvaluationandTreatmentCulturetoconfirmdiagnosisTerbinafine250mgPOqdFingernails-6weeksToenails-12weeksItraconazole200mgPOqdx12weeksOR200mgBIDx1week/monthfor3-4consecutivemonthsGriseofulvinFluconazoleCiclopiroxnaillacq

8、uerClinicalPearl:OnychomycosisConfirmdiagnosisPatienteducationFrequentrecurrencePotentialsideeffectsoftreatmentPatient3ChiefComplaint:HairlossPatient3HistoryAbruptonsetGrad