Management of Hair and Nail Disorders

Management of Hair Loss - Follicle Fortifiers

Aims to stimulate hair growth, prolong anagen phase, and improve hair shaft quality.

• Topical Minoxidil:
  • Potassium channel opener, vasodilator.
  • Available in 2%, 5%, 10% solutions/foams.
  • Stimulates hair growth, prolongs anagen.
  • Side effects: Scalp irritation, unwanted facial hair (hypertrichosis).
  • Initial telogen effluvium (shedding) common before growth.
• Nutritional Support:
  • Biotin (Vitamin B7): Co-factor for carboxylase enzymes; deficiency (rare) causes hair loss.
  • Iron: Deficiency linked to telogen effluvium.
  • Zinc: Essential for hair tissue growth and repair.
  • Amino Acids (L-cysteine, L-methionine): Building blocks of keratin.
• Peptide Serums:
  • E.g., Copper peptides. May promote follicle health and ECM protein synthesis.
• Low-Level Laser Therapy (LLLT):
  • Photobiomodulation stimulates cellular activity in follicles.
  • Increases ATP production, reduces inflammation.

⭐ Minoxidil typically shows visible results after 4-6 months of consistent use, with peak effects around 12 months. Initial shedding in the first 2-8 weeks is common and indicates a positive response (follicles shifting to anagen).

Other Hair Conditions Management - Beyond Baldness

• Hirsutism: (Excess terminal hair, female, male-pattern; Ferriman-Gallwey score >8)
  • Causes: PCOS (most common), idiopathic, adrenal/ovarian tumors, drugs (e.g., minoxidil, steroids).
  • Rx:
    • Lifestyle: Weight loss (if PCOS).
    • Cosmetic: Laser, electrolysis.
    • Pharmacological: OCPs (1st line for PCOS), Spironolactone (50-200 mg/day), Finasteride, Eflornithine cream.
• Tinea Capitis: (Fungal scalp infection)
  • Dx: Wood's lamp (Microsporum spp. fluoresce green), KOH microscopy, culture.
  • Rx: Systemic antifungals essential.
    • Griseofulvin: 20-25 mg/kg/day for 6-8 weeks (DOC for Microsporum). Take with fatty meal.
    • Terbinafine: For 4-6 weeks (effective for Trichophyton).
    • Adjunctive: Ketoconazole or Selenium sulfide shampoo (↓spores).

  ⭐ Kerion (inflammatory, boggy swelling) may require short course of oral corticosteroids to prevent scarring alopecia.

• Pediculosis Capitis (Head Lice):
  • Rx:
    • Topical: Permethrin 1% (1st line), Malathion 0.5% lotion.
    • Wet combing.
    • Oral Ivermectin for resistant cases.
    • Treat contacts.

Management of Nail Disorders - Nail Savvy

• Onychomycosis (Fungal):
  • Dx: KOH, culture.
  • Topical (mild, <50% nail, no matrix): Ciclopirox, Amorolfine, Efinaconazole.
  • Systemic (DLSO/Proximal): Terbinafine (250mg OD; Fingernails 6 wks, Toenails 12 wks). Alt: Itraconazole, Fluconazole.

  ⭐ Terbinafine is first-line for dermatophyte onychomycosis; requires LFT monitoring due to hepatotoxicity risk.

• Paronychia (Nail Fold Inflammation):
  • Acute: Warm soaks, antiseptics. Oral antibiotics (anti-Staph) if cellulitis. I&D for abscess.
  • Chronic (occupational, irritant, Candida): Avoid irritants/moisture. Topical steroids (mid-potency), topical antifungals (Clotrimazole).
• Psoriatic Nails:
  • Common: Pitting, onycholysis, oil drop, subungual hyperkeratosis.
  • Topical: High-potency corticosteroids (Clobetasol), Calcipotriene, Tazarotene.
  • Intralesional steroids (Triamcinolone 2.5-5 mg/mL to matrix/bed).
  • Systemic: Severe/refractory or with significant skin/joint psoriasis (MTX, Biologics).
• Ingrown Toenail (Onychocryptosis):
  • Conservative: Proper trimming (straight), soaks, cotton/floss elevation.
  • Surgical: Partial nail avulsion + chemical (Phenol 88%) or surgical matricectomy.

High‑Yield Points - ⚡ Biggest Takeaways

• Androgenetic alopecia: Treat with topical Minoxidil and oral Finasteride.
• Alopecia areata: Use intralesional corticosteroids for patches; systemic therapy for severe cases.
• Tinea capitis: Requires systemic antifungals like Griseofulvin or Terbinafine.
• Onychomycosis: Oral Terbinafine or Itraconazole are the most effective treatments.
• Paronychia: Acute needs antibiotics ± drainage; chronic requires topical antifungals, avoid irritants.
• Psoriatic nails: Treat underlying psoriasis with topical steroids or systemic agents.
• Nail Lichen Planus: Corticosteroids (intralesional/systemic) prevent permanent nail dystrophy.