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Hair and nail disorders 

Hair and nail disorders

Hair and nail disorders

David de Berker


November 28, 2013: This chapter has been re-evaluated and remains up-to-date. No changes have been necessary.

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date: 28 April 2017

Nails grow continuously throughout life, except after exceptional physiological or traumatic events when they are shed. All other less disruptive influences result in changes in the colour, thickness, texture, and growth of nails and may also affect the periungual tissues. The most common local diseases affecting the nail are psoriasis, fungal nail infections, periungual eczema, and viral warts. Looking at the nails is an important part of the general examination, since changes such as clubbing or splinter haemorrhages can indicate systemic disease.

Hair growth in a healthy person is determined by body site, gender, and age. Within these parameters there are accepted norms. Disease may affect hair growth by direct action on the follicle or by indirect effects sustained through generalized physiological disturbance. Clinicians may be called to assess specific diseases of the scalp with implications for hair growth, or specifically to address pathological patterns of hair growth where there may be underlying systemic disease.

Common diseases of the scalp include psoriasis, eczema, fungal infection, alopecia areata, and the scarring alopecias. Telogen effluvium is the most common hair problem related to general medical or surgical upset, characterized by massive shedding of hair about 6 to 10 weeks after a period of significant physiological disturbance. Where scalp hair loss presents in association with increased hair on the body or at sites associated with masculinity (hirsutism), a pathological source of androgen should be sought.

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