Hair, Nails & Adnexal Disorders

A 28-year-old woman notes increased hair shedding 2–3 months after a febrile illness. Scalp exam shows diffuse thinning with positive hair pull (telogen hairs). Best initial management?

A 34-year-old man with bitemporal recession and vertex thinning; family history similar. Best first-line therapy?

A 9-year-old with patchy alopecia shows black dots and broken hairs; occipital nodes present. Best treatment?

A 24-year-old woman has round smooth patches of hair loss with “exclamation-point” hairs at the periphery; nails show pitting. Best first-line therapy for limited areas?

A 38-year-old woman with tight hairstyles has frontal/temporal hairline recession and retained “fringe” along hairline. Diagnosis?

A 55-year-old woman with violaceous perifollicular papules on scalp, “lonely” hairs, loss of follicular openings, and eyebrow thinning. Most likely diagnosis?

A 30-year-old postpartum patient complains of handfuls of hair loss 3 months after delivery. Counseling?

A 42-year-old man with hidradenitis suppurativa (HS) in axillae, Hurley stage II. Best initial systemic regimen?

A 19-year-old with inflammatory nodulocystic acne fails oral antibiotics and topicals. Next step?

A 27-year-old woman with hirsutism and irregular menses asks for medical therapy. She is not trying to conceive. Best option?

A 63-year-old with scaly erythematous plaque on scalp and scarring alopecia; biopsy shows interface dermatitis with follicular plugging. Diagnosis?

A 7-year-old with boggy tender plaque and pus on scalp; KOH positive for hyphae. What adjunct reduces scarring risk?

A 26-year-old picks hair during stress; trichoscopy shows hairs of different lengths with coiled/“V” hairs. Best management?

A 61-year-old man with nail pitting, onycholysis, and “oil drop” discoloration but no skin plaques. Most likely cause?

A 45-year-old dishwasher with chronic paronychia and nail fold swelling; nails show ridging. Best management?

A 52-year-old with green-black nail discoloration and onycholysis after frequent wet work. Diagnosis and treatment?

A 33-year-old runner has recurrent ingrown toenail with granulation tissue (Stage II). Best office management?

A 29-year-old man with sudden proximal nail plate detachment on several nails after a severe viral illness 6 weeks ago. Diagnosis?

A 57-year-old with a single, slowly enlarging firm blue subcutaneous nodule on cheek; “tent sign” and calcifications on imaging. Diagnosis?

A 15-year-old girl with monomorphic papules on forehead/upper back after starting high-dose oral steroids. Diagnosis?

A 60-year-old woman with multiple yellow lobulated papules on forehead; central umbilication; dermoscopy shows crown vessels. Diagnosis?

A 48-year-old with multiple flesh-colored papules on lower eyelids; histology: tadpole-shaped ducts in fibrous stroma. Diagnosis?

A 11-year-old with rough papules on cheeks resembling “sandpaper,” worse in winter; background keratosis pilaris on arms. Likely diagnosis and first-line?

A 68-year-old with a bald, yellow-orange plaque with alopecia on scalp since birth that recently developed verrucous nodules. Diagnosis and management?

A 36-year-old woman complains of excessive sweating of axillae affecting quality of life. First-line medical therapy?

A 41-year-old with refractory axillary hyperhidrosis failed topicals. Next effective office option?

A 27-year-old woman with widening central part and decreased hair density over crown; Ferritin 10 ng/mL. Best next step?

A 59-year-old male with nail clubbing, periostosis, and arthritis; exam shows cyanosis. Which systemic disease is most associated?

A 25-year-old with longitudinal pigmented band on nail 2 mm wide, stable, multiple nails involved (Fitzpatrick V). Management?

A 46-year-old with a single dark longitudinal band on thumb that is widening with periungual pigment (Hutchinson sign). Best step?

A 35-year-old with “greasy scale” scalp and thinning hair; gentle hair pull negative; eyebrows involved. Most likely explanation for hair loss?

A 22-year-old with recurrent painful nodules and double comedones in groin with sinus tracts. Lifestyle advice proven to help HS?

A 68-year-old woman with longitudinal ridging and thinning of several fingernails; pterygium formation on two nails; lacy white oral plaques. Diagnosis?

A 14-year-old swimmer with painful lateral toenail edge and mild cellulitis. Most appropriate initial care?

A 40-year-old woman with median canaliform dystrophy of thumbnails (inverted “Christmas tree”). Best counseling?

A 52-year-old with multiple skin-colored papules on central face; biopsy shows basaloid islands with papillary mesenchymal bodies; family history similar. Diagnosis?

A 33-year-old with oily skin and multiple open/closed comedones, few papules. Best first-line regimen?

A 47-year-old with a tender dome-shaped nodule on upper arm; excision shows “ghost” (shadow) cells and calcification. Diagnosis?

A 58-year-old with painful axillary nodules and malodor; failed antibiotics; Hurley II. Biologic with best evidence?

A 26-year-old with brittle hair that breaks easily; microscopy shows nodes with fraying resembling “paintbrush” ends. Diagnosis and counseling?

A 32-year-old woman with progressive widening of the central part and crown thinning, normal labs. Best first-line therapy?

A 36-year-old Black woman with central scalp thinning and perifollicular scale/tenderness radiating from the vertex. Diagnosis/initial management?

A 58-year-old postmenopausal woman with band-like frontotemporal recession, eyebrow loss, subtle facial papules. Best disease-modifying regimen?

A man has patchy scarring alopecia with follicular pustules and “tufted” hairs. Best systemic regimen?

A 28-year-old man with painful boggy nodules, abscesses, and sinus tracts on the scalp; cultures negative. Preferred disease-modifying therapy?

A 22-year-old with firm papules/keloidal plaques on the nape after close shaving. Key management?

A 6-year-old girl’s hair “won’t grow long,” pulls out painlessly; trichogram shows many loose anagen hairs. Best approach?

A patient starting taxane chemotherapy asks about hair loss prevention. Evidence-based option?

A 14-year-old boy with “beaded” hair shafts and fragility; family history positive. Most likely diagnosis?

A 2-year-old with eczematous skin has “bamboo hair” on microscopy and recurrent infections. Diagnosis?

A 41-year-old man with thick dystrophic toenails; KOH negative twice. Most sensitive confirmatory test?

An HIV+ patient with proximal white subungual onychomycosis of toenails. Best systemic therapy?

A runner with chalky white patches on the superficial nail plate of the great toe; KOH shows hyphae in superficial plate. Best therapy?

A patient with candidal fingernail onychomycosis unresponsive to topicals. Next step?

Which antifungal requires caution/avoidance in heart failure due to negative inotropy?

A patient on terbinafine asks about drug interactions. Correct counseling?

A beachgoer on doxycycline develops painful onycholysis with subungual hemorrhage after sun exposure. Diagnosis?

A 27-year-old with proximal nail fold swelling and “double proximal” nail plate indicates ingrowth proximally. Diagnosis and treatment?

A 45-year-old with longitudinal erythronychia of a single fingernail and a distal V-shaped notch. Likely tumor?

A 17-year-old with painful mass under the great toenail; X-ray shows bony outgrowth from distal phalanx. Management?

A 29-year-old with periungual fibromas and facial angiofibromas. Nail lesions management?

A 66-year-old woman with yellow, slow-growing nails, lymphedema, and chronic cough. Syndrome?

A patient’s nails are mostly white with a narrow distal pink band; liver disease present. Name?

Paired transverse white lines that blanch with pressure; albumin 2.0 g/dL. Finding?

Transverse white bands that do not blanch and move distally with growth after arsenic exposure. Name?

A patient with chronic kidney disease shows half-white, half-brown nails. Diagnosis?

Multiple splinter hemorrhages on several nails after carpentry; no fever or murmur. Most likely cause?

A 52-year-old with severe nail psoriasis (matrix and bed). Targeted interventions?

A 60-year-old with painful longitudinal ridging, thinning, and dorsal pterygium; early disease. Best initial therapy?

A man with multiple dystrophic nails “treated” empirically with terbinafine for 6 months without improvement; culture shows non-dermatophyte mold. Best step?

A 23-year-old with painful, pruritic papules in axillae that worsen with sweating; hair follicles plugged. Diagnosis/therapy?

A 55-year-old with translucent, dome-shaped cystic papules on lower eyelids that enlarge with heat. Diagnosis and office treatment?

A 49-year-old with a pink lesion on the sole arising from an eccrine duct; bleeds with friction. Diagnosis and management?

A woman with multiple scalp nodules coalescing into a “turban-like” mass; biopsy: cylinders of basaloid cells with hyaline sheaths. Syndrome to consider?

A 35-year-old with a solitary, intensely tender blue nodule on trunk; “painful skin tumor.” Best management?

A 21-year-old wrestler with beard-area pustules after close shaving; KOH negative; culture shows S. aureus. Best regimen?

A 24-year-old Black man with papules/ingrown hairs on beard area after shaving (“razor bumps”). Best non-drug intervention?

A 40-year-old woman with diffuse shedding 4 months after COVID-19; ferritin 7 ng/mL. Best management?

A 27-year-old with inflammatory nodules and double comedones in axillae/groin, Hurley II, failed tetracyclines. Next systemic option?

A 19-year-old man with sudden diffuse hair loss 1–2 weeks after starting doxorubicin. What type and counseling?