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Skin Test

Coyner, Theresa

Journal of the Dermatology Nurses' Association: March/April 2019 - Volume 11 - Issue 2 - p 93–94
doi: 10.1097/JDN.0000000000000450
DEPARTMENTS: Skin Test
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SDC
  1. Finasteride is frequently used in men for hair loss but contraindicated in women capable of reproduction because of which of the following teratogenic problem?
    1. Cleft palate
    2. Esophageal atresia
    3. Hypospadias
    4. Microcephaly
  2. Which of the following terms describes hair loss in a wave or band pattern encompassing the occipital and temporal areas?
    1. Ophiasis
    2. Trichotillomania
    3. Alopecia totalis
    4. Alopecia universalis
  3. Which of the following alopecia is associated with scarring?
    1. Androgenic alopecia
    2. Lichen planopilaris
    3. Loose anagen syndrome
    4. Telogen effluvium
  4. Drug-induced paronychia is commonly associated with which of the following medication classes?
    1. Ace inhibitors
    2. Antibiotics
    3. Proton pump inhibitors
    4. Retinoids
  5. Approximately 5% of women with vulvar lichen sclerosis may develop which of the following conditions?
    1. Scleroderma
    2. Leukoplakia
    3. Lichen planus
    4. Squamous cell carcinoma
  6. Which of the following terms describe where the distal nail tip detaches from the underlying structures?
    1. Matrix
    2. Eponychium
    3. Paronychium
    4. Hyponychium
  7. Which condition below is associated with nail pitting?
    1. Alopecia areata
    2. Lupus erythematosus
    3. Lichen planus
    4. Tinea unguium
  8. Superficial grooves in the nail plate leading to distal splitting describe which of the following terms?
    1. Onychomadesis
    2. Onychorrhexis
    3. Onycholysis
    4. Onychoschizia
  9. Terry’s nails are associated with which of the following conditions?
    1. Liver disease
    2. Kidney disease
    3. Lung disease
    4. Polycythemia vera
  10. Asymmetric growth of the toenail appearing like a ram’s horn describes which of the following terms?
    1. Koilonychia
    2. Onychotillomania
    3. Onychogryphosis
    4. Onychomatricoma
  1. c. Hypospadias, the urethra occurring on the underside of the penis, may occur in male fetuses when exposed to finasteride in utero. Pregnant women should not handle crushed or broken 5-alpha reductase inhibitors such as finasteride (AlSaad, Lee, & Al-Obaidly, 2018).
  2. a. Ophiasis describes hair loss in a wave or band pattern that usually starts in the occipitut and extends to the temporal area. Alopecia totalis describes loss of all scalp hair, whereas alopecia universalis is loss of all body hair. Trichotillomania describes self-induced loss of scalp hair, eyebrows, or eyelashes due to anxiety or habit-tic disorders (Byrn, 2015).
  3. b. Lichen planopilaris is characterized by hyperkeratotic follicular scaly papules often located in a centrifugal pattern that involves the frontal and vertex areas of the scalp leaving atrophic patches of alopecia in the central area. Androgenic alopecia is the term utilized to describe male-patterned hair loss. Telogen effluvian occurs when an alteration in the hair growth cycle shifts from anagen (growth phase) to telogen (shedding phase) causing large hair quantities to shed in a diffuse pattern (Byrn, 2015). Loose anagen syndrome is a condition where there is abnormal anchorage of the hair, which is easily and painlessly plucked from the scalp (Swink & Castelo-Soccio, 2016).
  4. d. Drugs most commonly associated with paronychia include antiretrovirals, epidermal growth factor receptor inhibitors, methotrexate, and retinoids (Tosti & Piroccini, 2018).
  5. d. Vulvar lichen sclerosus is associated with development of squamous cell carcinoma. It is postulated the immune dysregulation and inflammation associated with lichen sclerosus may lead to squamous cell carcinoma in the vulvar area (Brodrick, Belkin, & Goldstein, 2013).
  6. d. The area where the distal nail tip separates from underlying structures is termed hyponychium. Paronychium is the term for the lateral nail folds. The eponychium is often synonymous with the cuticle area where the skin surrounding the nail plate is thickened. The matrix is the area of the nail root that is surrounded by the epidermis and is the location where new nail growth occurs (Tosti & Piroccini, 2018).
  7. a. Pitting appears in longitudinal rows with an occurrence in approximately 46% of patients with alopecia areata (Roest, van Middendorp, Evers, van de Kerkhof, & Pasch, 2018).
  8. d. Onychoschizia is the term that describes splitting of the distal nail plate progressing toward the proximal portion of the nail. It may be associated with repetitive wet work involving the hands as well as trauma. Onycholysis is separation of the nail plate from underlying structures starting at the distal tip and is often seen in nail psoriasis. Onychorrexis describes brittle nails that can lead to onychoschizia. Onychomadesis is shedding of the nail from underlying structures at the proximal tip (Tosti & Piroccini, 2018).
  9. a. Terry’s nails have a whitish appearance often termed “ground glass” with an absent lunula and is associated with liver disease (Singal & Arora, 2015).
  10. c. Onychogryphosis often involves the hallux of the great toenail area in elderly men leading to problems with properly fitting footwear and cutting the nail. Koilonychia describes nails that are spoon shaped mimicking the upward curve of a spoon. Onychotillomania describes nail changes occurring when an individual habitually picks at his or her nails such as median nail dystrophy. Onychomatricoma is a tumor located in the nail matrix (Tosti & Piroccini, 2018).
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REFERENCES

AlSaad D., Lee B. H., Al-Obaidly S. (2018). Finasteride use during pregnancy and early neonatal outcome: A case report. International Journal of Clinical Pharmacology, 40(4), 803–805. https://doi.org10.1007/s11096-018-0661-5
Brodrick B., Belkin Z. R., Goldstein A. T. (2013). Influence of treatments on prognosis for vulvar lichen sclerosus: Facts and controversies. Clinical Dermatology, 31(6), 780–786.
Byrn N. (2015). Disorders of hair and nails. In Bobonich M. A., Nolen M. E. (Eds.), Dermatology for advanced practice clinicians, (ed., pp. 215–230). Philadelphia, PA: Wolters Kluwer.
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: A questionnaire-based survey on clinical signs, impact on quality of life and review of literature. Acta Dermato-Venerologia, 98(2), 212–217.
Singal A., Arora R. (2015). Nail as a window of systemic diseases. Indian Dermatology Online Journal, 6(2), 67–74.
Swink S. M., Castelo-Soccio L. (2016). Loose anagen syndrome: A retrospective chart review of 37 cases. Pediatric Dermatology, 33(5), 507–510.
Tosti A., Piroccini B. M. (2018). Nail disorders in Bolognia. InSchaffer J. V., Cerroni L. (Eds.), Dermatology, 4th edition. Philadelphia, PA: Elsevier.
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