Scalp, Hair and Nails

Traction Alopecia

Tight braids and ponytails can pull hard enough on hairs to make them fall out. If this happens, it's best to choose hairstyles that put less pressure on hair roots. The sooner this is done the better in order to avoid permanent damage.

Alopecia Areata

A common hair loss condition, alopecia areata, usually starts as a single quarter-sized circle of perfectly smooth baldness. Alopecia patches often regrow in three to six months without treatment. Sometimes, hair regrows in white coloration. In another variant, alopecia areata can produce two or three bald patches. When these grow back, they may be replaced by others. The most extensive form of hair loss is called alopecia totalis, in which the entire scalp becomes bald. It's important to emphasize that patients who have localized hair loss generally don't lose hair throughout the scalp. Alopecia can affect hair on other parts of the body, too (for example, the beard).

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Trachyonychia

Trachyonychia (twenty nail dystrophy of childhood). Any skin disease that affects the nail matrix may result in an abnormal nail plate. There are children, though, who only manifest dystrophy of the nail without any other cutaneous lesions, a condition that has been termed twenty nail dystrophy of childhood. The nails have a rough, sandpaper-like quality as well as longitudinal ridging and occasional splitting at the distal nail edge. Similar nail changes can be seen in lichen planus and alopecia areata. In many patients the condition spontaneously regresses.

Razor Bumps

Razor bumps, also called pseudofolliculitis barbae, are small, irritated bumps on the skin. They develop after shaving, when strands of hair curl back on themselves and grow into the skin. Razor bumps cause irritation and the development of pimples. They also may cause scarring. Razor bumps are common among African-Americans and people with tightly coiled hair. Razor bumps tend to be more of a problem for men than women, because many men shave daily.

Premature Gray Hair

"Premature graying is genetically determined for the most part," David Bank, MD, tells WebMD. Bank is director of the Center for Dermatology, Cosmetic, and Laser Surgery in Mount Kisco, N.Y. "Graying is natural. We all do it eventually." When more than half the hair is white by age 40, though, this is considered "premature." Bank also points out that head hair grows more actively than body hair. So the head can go gray while other hairy parts remain your normal color. Correction: Your former color.

Low Level Light Therapy: Sunetics Device

Low level light laser therapy (LLLT) has been used to treat a variety of medical disorders from ulcers to musculoskeletal disorders. In 2007, a low level light device was approved by the U.S. Food and Drug Administration (FDA) to treat male pattern hair loss. There are various manufacturers of light therapy devices that are sold to physician's offices that are not handheld, such as the Sunetics device.

Low Level Light Therapy: Laser Comb

Low level light laser therapy (LLLT) has been used to treat a variety of medical disorders from ulcers to musculoskeletal disorders. In 2007, a low level light device was approved by the U.S. Food and Drug Administration (FDA) to treat male pattern hair loss. The laser comb is a handheld device that was approved as a device which has a different standard for FDA approval than a medication. The device is sold over the counter without physician prescription or physician monitoring.

Hair Transplant

Surgical approaches include various versions of hair transplantation (taking hair from the back and putting it near the front) or scalp reduction (cutting away bald areas and stitching the rest together). Transplant procedures have improved greatly in recent years. They can produce much more attractive and natural-looking results than older methods that sometimes left a "checkerboard" look. Many transplant patients now take Propecia to keep what they've transplanted. When considering a hair transplant, check the surgeon's credentials and experience carefully.

Male Pattern Baldness

Male Pattern Baldness: The male pattern baldness (MPB) form of androgenetic alopecia (there is also a female pattern baldness) accounts for more than 95% of hair loss in men. By age 35, two-thirds of American men will have some degree of appreciable hair loss and by age 50 approximately 85% of men have significantly thinning hair. About 25% of men who suffer from male pattern baldness begin the painful process before they reach 21. Contrary to societal belief, most men who suffer from male pattern baldness are extremely unhappy with their situation and would do anything to change it. Hair loss affects every aspect of their life. It affects interpersonal relationships as well as their professional life. It is not uncommon for men to change their career paths because of hair loss.

Female Pattern Baldness

Female Pattern Baldness: Mistakenly thought to be a strictly male disease, women make up a significant percentage of American hair loss sufferers. Forty percent of women have visible hair loss by the time they are age 40, according to the American Academy of Dermatology. Hair loss in women can be absolutely devastating for self image and emotional well-being. The American Hair Loss Association recognizes that hair loss in women is a serious life-altering condition that can no longer be ignored.

Yellow Dandruff

If dandruff flakes are greasy and yellow, the probable cause is the skin condition known as seborrheic dermatitis; seborrhea is usually associated with redness as well. Dry, thick lesions consisting of large, silvery scales may be traced to the less-common psoriasis of the scalp. These scaly conditions become a hazard only if you scratch to the point of causing breaks in the skin, which can place you at greater risk for infections, particularly from staph and strep bacteria.

Dandruff

Dandruff: A mild skin condition that produces white flakes that may be shed and fall from the hair. Dandruff is due to the sebaceous glands overworking. (The sebaceous glands keep the skin properly oiled.) Another cause of dandruff is fungus, especially one called Pitrosporum ovale. (Most people have this fungus, but people with dandruff have more.) For dandruff, there are several tiers of treatment: First-tier dandruff treatment: A good quality upper-end shampoo (e.g., Paul Mitchell, Aveda, Redken). If several weeks using a good quality shampoo does not stop the dandruff, it can be helpful use the second-tier of dandruff treatment. Second-tier dandruff treatment: An antifungal shampoo, (e.g., (in alphabetical order) Denorex, DHS Targel, ionil-T plus, MG217, Neutrogena T/Gel, Scalpicin, Sebulex, Selsun Blue, Tegrin, Zircon). The active ingredients approved for dandruff treatment by the U.S. Food and Drug Administration (FDA) include tar, pyrithione zinc, salicylic acid, selenium sulfide, sulfur, and ketoconazole. Ketoconazole, once only available by prescription, was approved in 1997 by the FDA for over-the-counter (OTC) sale in the form of Nizoral A-D shampoo. This medication can be helpful for particularly difficult cases, according to some pharmacists.

Telogen Effluvium

Telogen effluvium: Excessive temporary loss of telogen hair (hair in the telogen, or resting, phase) caused by trauma such as childbirth, surgery, starvation, certain drugs, and high fever. A normal human hair goes through 3 successive stages of growth: The growing, or anagen, stage is the predominant phase (80% to 90% of a person's hair is usually in the anagen phase). A transitional, or catagen, stage. Resting, or telogen, stage. When new hair growth is initiated, the new anagen hair pushes the old telogen hair out, and shedding occurs. Typically a person sheds no more than 50 to 100 hairs per day. A severe stress such as childbirth can "shock" an excessive number of hairs into the telogen stage. Approximately 3 months after this stress, the new mother may experience excessive hair loss on the order of 100 or more hairs per day. This excessive hair loss is termed telogen effluvium. Up to 90% of postpartum women experience it. The condition can occur immediately after delivery but, more typically, it occurs between 2 and 6 months' postpartum. The shedding rate returns to normal in 4 to 6 months.

Trichotillomania

Trichotillomania: Compulsive hair pulling. A disorder characterized by the repeated urge to pull out scalp hair, eyelashes, eyebrows or other body hair. It is believed to be related to obsessive-compulsive disorder. Treatment may include cognitive-behavior therapy and medications such as Prozac. From tricho-, hair + Greek till(ein) to pluck, pull out + -o- + -mania.

Leukonychia Totalis

Leukonychia totalis. This is a rare nail disorder that is inherited in autosomal dominant fashion. The color of normal nail plates beyond the lunulae is largely pink from the blood in the blood vessels of the nail bed. The whiteness shown here is due to an abnormality in the nail plate. The nails may also be brittle.

Leukonychia Striata

Leukonychia striata. The horizontal white streaks pictured here are the result of abnormal keratinization of the nail plate. The tendency toward leukonychia striata is sometimes inherited in an autosomal dominant fashion. In other cases, it can be attributed to vigorous manicuring, to trauma, or to a wide variety of systemic illnesses. In many patients, there is no obvious cause, and the streaks resolve spontaneously.

Nail-Patella Syndrome

Nail-patella syndrome. This entity, also known as hereditary osteo-onychodysplasia, is a genetic disease linked to a mutation in the gene encoding transcription factor LMX1B, mapped on the long arm of chromosome 9 (9q34). The manifestations include fingernail dysplasia, absent or hypoplastic patellae, the presence of posterior conical iliac horns, and abnormalities of the radial heads. Patients are also at risk for kidney disease and glaucoma.

Discoloration of Nail Plates

Discoloration of nail plates. Many chemicals can discolor nail plates. Solutions of potassium permanganate and silver nitrate stain nail plates brown-purple and jet black, respectively. In the case illustrated here, the stain derived from resorcinol. Such stains are harmless and can be easily removed by superficial scaling with the edge of a glass slide.

Clubbed Nails

Clubbed nails. Increased curvature of the nail plate may be due to a wide variety of causes. In this patient, the large, convex nails are a hereditary anomaly and were found to be present in both father and brother. Other causes of clubbing of the nails in children include cyanotic congenital heart disease, cystic fibrosis, and chronic inflammatory bowel disease.

Ingrown Toenail

Ingrown toenail: A common disorder that occurs when the edge of the toenail grows into the skin of the toe particularly on the big (great) toe. The corner of the nail curves down into the skin, often due to mis-trimming of the nail, or due to shoes that are too tight. An ingrown toenail can be painful and lead to infection. Sometimes simply removing the corner of the nail from the skin is enough to cure this problem, although you may need to have this done by a doctor, podiatrist, or foot-care specialist. If there is infection present, that also requires treatment. In some cases the entire nail must be removed. If ingrown toenails are caused by congenital nail malformations, the nail bed can be treated to permanently prevent regrowth. Known also as onychocryptosis and unguis incarnatus.

Onychomycosis (Fungal Nail Infection)

Fungal nail infection: The most common fungus infection of the nails is onychomycosis. Onychomycosis makes the nails look white and opaque, thickened, and brittle. Those at increased risk for developing onychomycosis include: People with diabetes; People with disease of the small blood vessels (peripheral vascular disease); and Older women (perhaps because estrogen deficiency increases the risk of infection); and Women of any age who wear artificial nails (acrylic or "wraps"). Artificial nails increase the risk for onychomycosis because, when an artificial nail is applied, the nail surface is usually abraded with an emery board damaging it, emery boards can carry infection, and water can collect under the artificial nail creating a moist, warm environment favorable for fungal growth. Alternative names include tinea unguium and ringworm of the nails.

Onycholysis

Onycholysis: Loosening of the nail from the nail bed, usually starting at the border of the nail. The nail tends to turn whitish or yellowish, reflecting the presence of air under it. The treatment is to trim the nail short, do not clean under the nail, and be patient. It generally takes 2 to 3 months to clear up.

Alopecia Areata (Nails)

Alopecia areata, nails. Pitting in organized transverse rows giving the nail a "hammered brass" appearance.

Alopecia Areata

Alopecia areata is a type of hair loss that occurs when your immune system mistakenly attacks hair follicles, which is where hair growth begins. The damage to the follicle is usually not permanent. Experts do not know why the immune system attacks the follicles. Alopecia areata is most common in people younger than 20, but children and adults of any age may be affected. Women and men are affected equally. Alopecia areata cannot be "cured" but it can be treated. Most people who have one episode will have more episodes of hair loss. Read more about alopecia areata.

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