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Skin Test Theresa Coyner SKINTEST Skin Test Theresa Coyner 1. Finasteride is frequently used in men for hair loss but 6. Which of the following terms describe where the contraindicated in women capable of reproduction distal nail tip detaches from the underlying structures? because of which of the following teratogenic problem? a. Matrix a. Cleft palate b. Eponychium b. Esophageal atresia c. Paronychium c. Hypospadias d. Hyponychium d. Microcephaly 7. Which condition below is associated with nail pitting? 2. Which of the following terms describes hair loss in a a. Alopecia areata wave or band pattern encompassing the occipital b. Lupus erythematosus and temporal areas? c. Lichen planus a. Ophiasis d. Tinea unguium b. Trichotillomania c. Alopecia totalis 8. Superficial grooves in the nail plate leading to distal d. Alopecia universalis splitting describe which of the following terms? a. Onychomadesis 3. Which of the following alopecia is associated with b. Onychorrhexis scarring? c. Onycholysis a. Androgenic alopecia d. Onychoschizia b. Lichen planopilaris c. Loose anagen syndrome 9. Terry’s nails are associated with which of the following d. Telogen effluvium conditions? a. Liver disease 4. Drug-induced paronychia is commonly associated b. Kidney disease with which of the following medication classes? c. Lung disease a. Ace inhibitors d. Polycythemia vera b. Antibiotics c. Proton pump inhibitors 10. Asymmetric growth of the toenail appearing like a d. Retinoids ram’s horn describes which of the following terms? a. Koilonychia 5. Approximately 5% of women with vulvar lichen b. Onychotillomania sclerosis may develop which of the following conditions? c. Onychogryphosis a. Scleroderma d. Onychomatricoma b. Leukoplakia c. Lichen planus d. Squamous cell carcinoma Readers are encouraged to submit Skin Test questions to be considered for future issues. Please submit as many or as few questions as you’d like (with answers and references) to [email protected]. Thank you. VOLUME 11 | NUMBER 2 | MARCH/APRIL 2019 93 Copyright © 2019 Dermatology Nurses' Association. Unauthorized reproduction of this article is prohibited. SKINTEST ANSWERS 7. a. Pitting appears in longitudinal rows with an occur- rence in approximately 46% of patients with alopecia 1. c. Hypospadias, the urethra occurring on the under- areata (Roest, van Middendorp, Evers, van de Kerkhof, side of the penis, may occur in male fetuses when & Pasch, 2018). exposed to finasteride in utero. Pregnant women 8. d. Onychoschizia is the term that describes splitting should not handle crushed or broken 5-alpha reduc- of the distal nail plate progressing toward the tase inhibitors such as finasteride (AlSaad, Lee, & proximal portion of the nail. It may be associated Al-Obaidly, 2018). with repetitive wet work involving the hands as well 2. a. Ophiasis describes hair loss in a wave or band as trauma. Onycholysis is separation of the nail pattern that usually starts in the occipitut and extends plate from underlying structures starting at the distal to the temporal area. Alopecia totalis describes loss of tipandisoftenseeninnailpsoriasis. Onychorrexis all scalp hair, whereas alopeciauniversalisislossofall describes brittle nails that can lead to onychoschizia. body hair. Trichotillomania describes self-induced Onychomadesis is shedding of the nail from under- loss of scalp hair, eyebrows, or eyelashes due to lying structures at the proximal tip (Tosti & Piroccini, anxiety or habit-tic disorders (Byrn, 2015). 2018). 3. b. Lichen planopilaris is characterized by hyper- 9. a. Terry’s nails have a whitish appearance often keratotic follicular scaly papules often located in a termed ‘‘ground glass’’ with an absent lunula and is centrifugal pattern that involves the frontal and vertex associated with liver disease (Singal & Arora, 2015). areas of the scalp leaving atrophic patches of alopecia 10. c. Onychogryphosis often involves the hallux of in the central area. Androgenic alopecia is the term the great toenail area in elderly men leading to utilized to describe male-patterned hair loss. Telogen problems with properly fitting footwear and cutting effluvian occurs when an alteration in the hair growth the nail. Koilonychia describes nails that are spoon cycle shifts from anagen (growth phase) to telogen shaped mimicking the upward curve of a spoon. (shedding phase) causing large hair quantities to shed Onychotillomania describes nail changes occurring in a diffuse pattern (Byrn, 2015). Loose anagen when an individual habitually picks at his or her nails syndrome is a condition where there is abnormal such as median nail dystrophy. Onychomatricoma is a anchorage of the hair, which is easily and painlessly tumor located in the nail matrix (Tosti & Piroccini, plucked from the scalp (Swink & Castelo-Soccio, 2016). 2018). 4. d. Drugs most commonly associated with paronychia include antiretrovirals, epidermal growth factor recep- tor inhibitors, methotrexate, and retinoids (Tosti & REFERENCES Piroccini, 2018). AlSaad, D., Lee, B. H., & Al-Obaidly, S. (2018). Finasteride use during 5. d. Vulvar lichen sclerosus is associated with develop- pregnancy and early neonatal outcome: A case report. International ment of squamous cell carcinoma. It is postulated the Journal of Clinical Pharmacology, 40(4), 803Y805. https://doi.org 10. 1007/s11096-018-0661-5 immune dysregulation and inflammation associ- Brodrick, B., Belkin, Z. R., & Goldstein, A. T. (2013). Influence of treatments ated with lichen sclerosus may lead to squamous on prognosis for vulvar lichen sclerosus: Facts and controversies. Clinical Y cell carcinoma in the vulvar area (Brodrick, Belkin, & Dermatology, 31(6), 780 786. Byrn, N. (2015). Disorders of hair and nails. In Bobonich, M. A., & Nolen, Goldstein, 2013). M. E. (Eds.), Dermatology for advanced practice clinicians, (ed., pp. 6. d. The area where the distal nail tip separates from 215Y230). Philadelphia, PA: Wolters Kluwer. underlying structures is termed hyponychium. Roest, Y. B. M., van Middendorp, H. T., Evers, A. W. M., van de Kerkhof, P. C. M., & Pasch, M. C. (2018). Nail involvement in alopecia areata: Paronychium is the term for the lateral nail folds. The A questionnaire-based survey on clinical signs, impact on quality of life eponychium is often synonymous with the cuticle and review of literature. Acta Dermato-Venerologia, 98(2), 212Y217. Singal, A., & Arora, R. (2015). Nail as a window of systemic diseases. area where the skin surrounding the nail plate is Indian Dermatology Online Journal, 6(2), 67Y74. thickened. The matrix is the area of the nail root that Swink, S. M., & Castelo-Soccio, L. (2016). Loose anagen syndrome: A is surrounded by the epidermis and is the location retrospective chart review of 37 cases. Pediatric Dermatology, 33(5), 507Y510. Tosti, A., & Piroccini, B. M. (2018). Nail disorders in Bolognia. In where new nail growth occurs (Tosti & Piroccini, Schaffer, J. V., & Cerroni L. (Eds.), Dermatology, 4th edition. Philadelphia, 2018). PA: Elsevier. 94 Journal of the Dermatology Nurses’ Association Copyright © 2019 Dermatology Nurses' Association. Unauthorized reproduction of this article is prohibited..
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