The Dermatologist`s Board Review - December 2019

The contents of these questions are taken from the Galderma Pre-Board Webinar. The Pre-Board Webinar is now an online course. For details, go to https://www.galdermausa.com/Our-Commitment/PreBoard-Webinar.aspx.

1. This 45-year-old patient has male pattern hair loss. Which of the following is characteristic of this condition?

a) It occurs in complete androgen insensitivity syndrome.

b) The conversion of dihydrotestosterone to testosterone is catalyzed by type 2 5-α reductase.

c) There are 10 known isoforms of 5-α reductase.

d) This type of hair loss is absent in men with genetic deficiency of type 1 5-α reductase.

e) Inheritance of this type of hair loss is mostly polygenic.

2. This young woman has her nails done professionally every week. She recently developed multiple areas of nontender swelling that involve the proximal and lateral nail fold. Which one of the following systemic agents is likely to help this condition?

a) Griseofulvin

b) Ciprofloxacin

c) Itraconazole

d) Tetracycline

e) Interferon alpha 

1. This 45-year-old patient has male pattern hair loss. Which of the following is characteristic of this condition?

e) Inheritance of this type of hair loss is mostly polygenic.

Male pattern hair loss does not occur in complete androgen insensitivity syndrome. Type 2 5-α reductase catalyzes the conversion of testosterone to dihydrotestosterone through the type 2 5-α reductase. Type 1 5-α reductase is widely expressed, but its physiologic actions are uncertain. Male pattern hair loss is polygenic in origin.

References
Garza LA, Liu Y, Yang Z, et al. Prostaglandin D2 inhibits hair growth and is elevated in bald scalp of men with androgenetic alopecia. Sci Transl Med. 2012;49(126):126ra34. doi:10.1126/scitranslmed.
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Rajput RJ. Controversy: is there a role for adjuvants in the management of male pattern hair loss? J Cutan Esthet Surg. 2010;3(2):82-86. doi:10.4103/0974-2077.69016

Olsen EA, Messenger AG, Shapiro J, et al. Evaluation and treatment of male and female pattern hair loss. J Am Acad Dermatol. 2005;52(2):301-311. doi:10.1016/j.jaad.2004.04.008

2. This young woman has her nails done professionally every week. She recently developed multiple areas of nontender swelling that involve the proximal and lateral nail fold. Which one of the following systemic agents is likely to help this condition?

c) Itraconazole

The most probable diagnosis is candidal paronychia, which may follow manicures particularly if there has been vigorous butting, pushing, or other cuticle manipulation. Of the choices listed, only itraconazole is effective against yeast organisms. Griseofulvin is for dermatophyte therapy; tetracycline and ciprofloxacin are antibacterial, which this infection is not; and interferon alpha has been used experimentally on periungual warts. n 

References
Pandhi D, Verma P. Nail avulsion: indications and methods (surgical nail avulsion). Indian J Dermatol Venereol Leprol. 2012;78(3):299-308. doi:10.4103/0378-6323.95444

Montgomery BD. Chronic paronychia—putting a finger on the evidence. Aust Fam Physician. 2006;35(10):811,813. 

Tosti A, Piraccini BM, Ghetti E, Colombo MD. Topical steroids versus systemic antifungals in the treatment of chronic paronychia: an open, randomized double-blind and double dummy study. J Am Acad Dermatol. 2002;47(1):73-76. doi:10.1067/mjd.2002.122191

Dr McMichael is professor and chair in the department of dermatology at Wake Forest Baptist Health in Winston-Salem, NC.