Home › What is ingrown hair › Ingrown hair causes and symptoms What is ingrown hair?
Ingrown hair occurs when the sharp, cut-end of thick hair grows sideways, at an abnormal angle, penetrating into the dermal skin.
Quite often the condition resolves by itself without any clinical symptoms. In some persons ingrown hair may cause small pimple-like bumps with symptoms like reddening, inflammation, pain and pus formation. Though in most of the cases, the ingrowth involves the skin areas which are shaved, tweezed or waxed, it can occur in any hairy part on the body.
Ingrown hair causes
Shaving, tweezing or waxing are the primary causes of these ingrowths.
Coarse or tightly curling thick hairs are the predisposing factors, as the cut end is more likely to bend back and grow into the skin leading to an inflammatory reaction.
Individuals with higher levels of circulating androgenic hormones have excessive growth of thick hair and are prone to these ingrowths.
Shaving very close to the skin can cut the hair strand deep inside the follicle and increase the risk of ingrowth.
Shaving against the direction of growth causes the strands to get pulled and cut close to their root, increasing the risk of ingrowth.
Friction from tight clothing, may precipitate the situation.
Blocking of the follicle with dead skin debris may cause the strands to grow sideways.
Certain genetic factors may predispose a person and cause these bumps in the beard area.
Pseudofolliculitis barbae
Pseudofolliculitis barbae, a type of extensive ingrowth, occurs in persons with thick, coarse hair. It is a common chronic inflammatory disorder in men of African ancestry, occurring most often in regions of thick hair growth after shaving. The condition causes erythematous papules with symptoms of pain and pus formation. A common polymorphism in a keratin gene (K6hf) may be a genetic risk factor for pseudofolliculitis barbae type of ingrowth.
Ingrown hair symptoms
In most of the conditions, the symptoms may be limited to small reddish bumps. The symptoms like rash, tenderness and itching skin may also appear. Infected ingrowth may present symptoms such as pimple like inflammation, raised large bumps, abscesses and pruritic erythematous pustules. Certain other medical conditions like folliculitis, keratosis pilaris and furuncle may mimic the symptoms and are to differentially diagnosed.
Ingrown hair
Common signs and symptoms include:
inflammation,
papules,
pustules,
hyperpigmentation,
rash,
pain,
pruritus and
embedded hairs in the site.
Ingrown hair treatment
Avoiding shaving for two to three weeks may causes the existing bumps to resolve. Extrafollicular ingrowths can usually be tweezed gently and cut above the skin level. Transfollicular ingrowths as well as ingrowths with symptoms of pus and severe inflammation may require medical treatment. Chemical depilatories, topical creams, laser therapy or surgical removal are the other treatment options available.
Ingrown hair prevention
The best way to prevent the ingrowth is to refrain from shaving or using a beard trimmer. If shaving is necessary, wetting the skin with warm water and using a shaving gel may prevent the hair strand from getting pulled and getting cut close to the root. Avoiding shaving close to skin will enable the cut ends to grow out of the follicle smoothly. Shaving against the direction of the growth of strand must be avoided to prevent ingrown hair.
References on ingrown hair:
1.Ribera M, Fernández-Chico N, Casals M. [Pseudofolliculitis barbae]. Actas Dermosifiliogr. 2010 Nov;101(9):749-57.
2.Alexis A, Heath CR, Halder RM. Folliculitis keloidalis nuchae and pseudofolliculitis barbae: are prevention and effective treatment within reach? Dermatol Clin. 2014 Apr;32(2):183-91.
Paronychia is an inflammation of the proximal and/or lateral nail folds of a toe or finger.
Paronychia is usually caused by bacterial or fungal infection. It usually develops when there is damage to the bond between the nail plate and the adjacent nail fold.
Paronychia is a tender, painful condition. Depending upon the causative factors and the length of morbidity period, the nail fold infection is termed as acute, chronic, candidal or pyogenic paronychia. Damage to the junction between nail plate and nail fold or to soft nail fold tissue surrounding the nail is the primary cause. Certain occupational exposures, cancers, certain systemic diseases and suppression of the immune response may also make a person susceptible nail fold infection.
Damage to eponychium, paronychium and hyponychium
The eponychium is the proximal nail fold that produces the cuticle cover on the proximal end of nail. Together with the cuticle, eponychium form a protective seal on the proximal end of nail plate.
Damage to eponychium may occur from dropping of heavy objects on toes or fingers, manicure procedures or biting or picking at cuticle. Damage to eponychium can lead to infections and cause pyogenic paronychia.
Paronychium or perionychium is the lateral nail fold. Paronychium is the soft tissue surrounding the lateral border of the fingernail or toenail. It protects from anything getting underneath the nail. Damage to paronychium may occur when any heavy object falls on the finger or toe and from biting or picking at hangnail, dishwashing, ingrown nail or any sharp object cutting or piercing it. Such damage can cause infection and acute paronychia.
The hyponychium is the tissue found beneath the nail plate at the junction between the free edge and the skin of the fingertip. It protects the nail bed. Damage to hyponychium may occur from dishwashing, injury from a splinter or thorn or nail biting. Any injury to hyponychium can cause infection.(see image below)
Paronychia caused by certain habits
Onychophagia or nail biting, is an oral compulsive habit. Nail biting causes deleterious effects in fingers such as broken skin on the cuticle, hangnails and damage to nail bed. The fingers become susceptible to microbial infections such as paronychia.(see image below)
image of acute paronychia compared to normal finger (Picture author: DRosenbach | CC BY-SA 3.0)
picture of acute paronychia
Thumb sucking starts as an instinctive nutritional sucking behavior and continued in some children as physical and emotional fulfillment. Thumb sucking generally stops by the age of 5 years. However, continuous wetting of the nail fold with saliva can cause chronic fungal infection. (see picture below)
picture of chronic paronychia (Picture author: Rob Hille | CC BY-SA 3.0)
A hangnail or agnail is a small, torn piece of eponychium or paronychium. Dry skin, cold weather, harsh chemicals, frequent immersion in water or nail biting can cause hangnails. Though hangnail by itself is harmless, biting or picking hangnail can cause infection and paronychia. (see image below)
picture of paronychia caused by picking at a hangnail
Ingrown nail
Ingrown nail, especially toenail, is caused by the nail piercing and entering inside the paronychium. The condition leads to a microbial inflammation of the paronychium and nail fold infection. (see image below)
picture of paronychia caused by ingrown toenail
Occupational exposures
Frequent bare hand contact with chemicals, detergents and medications can disrupt the bond between the nail fold and nail plate leading infection and inflammation.
Dishwashing is an important triggering factor for chronic paronychia. The decaying food particles and dirt can get lodged between the nail plate and the skin fold. The cuticle may separate from the nail plate, leaving a gap between the proximal nail fold and the nail plate. This leads to paronychium inflammation and infection.
Dentists are frequently exposed to viral infections from oral fluids of patients and prone to develop viral nail fold infection or herpes whitlows.
Pathologists and laboratory workers handling tuberculotic cadaver and also veterinarians and butchers handling tuberculosis affected animals can develop prosector's paronychia when their nail and nail folds get inoculated by tubercle bacilli.
Other causes of paronychia
The carcinomas of the upper aerodigestive tract manifest as acrokeratosis paraneoplastica with symptoms like erythematous, keratotic rash and nail fold inflammation.
Pemphigus, a blistering autoimmune diseases can show symptoms like nail fold inflammation.
Nail fold infection is more common in adult women, diabetics and people with weak immune systems. Paronychia is also common in immunocompromised patients and those under drug-induced immunosuppression.
References:
1.Rigopoulos D, Larios G, Gregoriou S, Alevizos A. Acute and chronic paronychia. Am Fam Physician. 2008 Feb 1;77(3):339-46.
2.Shafritz AB, Coppage JM. Acute and chronic paronychia of the hand. J Am Acad Orthop Surg. 2014 Mar;22(3):165-74.
Home › Ingrown toenail › Treatment › What are the causes of ingrown toenails?
What causes ingrown toenails?
Ingrown toenail, or onychocryptosis, is a common painful disease, usually affecting the big toenail.
Ingrown toenail is usually caused when the toenail plate penetrates into the adjacent lateral skin fold. Several anatomic and behavioral factors can contribute to onychocryptosis.
Anatomical factors contributing to onychocryptosis include overgrown skin fold around the ungual plate or malformed toenails. Behavioral factors which cause onychocryptosis include poor foot hygiene, improper trimming, tearing toenails off, hyperhidrosis (excessive sweating), repetitive trauma such as running or kicking, or inadvertent trauma such as stubbing the toe.
Factors predisposing lower extremity edema such as obesity, hypothyroidism, cardiac, and renal disorders can also increase the likelihood a person developing onychocryptosis. In older persons, spicule formation and thickening of ungual plate are the causes of ingrown, painful, and infected onychocryptosis.
This condition is thought to have a genetic predisposition and family history in certain cases. There are several cases of congenital ingrown toenails in newborns.
Poor foot hygiene
Our feet are the most abused and neglected part of our body. Tired, sore and neglected feet can develop several problems. Cleaning the feet every evening before going to bed and keeping them dry will keep nearly half of the foot health problems out. Dusty, dirty and moist toenails can contract fungal infections and cause onychocryptosis.
Improper trimming
Improper trimming of toenails may cause onychocryptosis. Toenails should be trimmed straight across. Trimming too close or rounding off the ungual plate edges will result in bulging of soft tissue around it leading to soft tissue injury. Cutting back the lateral margins in a curved manner should be avoided. The toenail edges should extend past the tissue of the lateral skin fold.
Hyperhidrosis
In adolescence, feet perspire more often which causes the ungual plate to become soft and prone to splitting. Further, participation in sports or physical activities result in the production of ungual plate spicules. The excessive sweating also causes maceration of the skin of the toenail folds. Such condition makes it easier for the ungual plate or spicules to pierce the surrounding skin.
infected ingrown toenail caused by ill-fitting shoes
Overgrown skin folds
One school of thought is that the toenail is not the real culprit, and that the excess skin surrounding the ungual plate is the real problem. Some individuals have unusually wide area of tissue medial and lateral to the toenail. With weight bearing, this tissue tends to bulge up around the ungual plate, leading to pressure necrosis, and cause the ungual plate to pierce into the soft tissue. The Vandenbos procedure targets removing these excess skin fold around the toenail.
Ill-fitting footwear
Tight-fitting shoes, narrow toed or pointed shoes or high heeled shoes place constant pressure on the median skinfold and also on lateral skin fold by pushing the big toe against the second toe. Such pressure can cause the toenail plate to cut into the surrounding tissues. Proper footwear with a wide toe area is to be prefered. Tight socks also can create similar problems. If shoes are too loose, toes may constantly hit against the shoe and again increase the chances of developing ingrown ungual plate.
Toenail deformities
Ungual plate apparatus may have several congenital abnormalities. Secondary deformities may arise due to trauma or anatomical conditions. These abnormalities can initiate onychocryptosis. Excessively curved toenail is more curved from side to side rather than being flat. Such a toenail can become ingrown into the adjacent skin fold. Increased or reduced ungual plate thickness, medial rotation of the hallux and related structural abnormalities, deformed shape of the ungual plate, thickened skin folds around the plate can become contributing factors for onychocryptosis.
Congenital factors
Congenital onychocryptosis may be caused by intrauterine disorders or hereditary factors. A newborn may have excessive growth of skin folds surrounding the toenail, congenital hypertrophic lip of hallux, distal embedding with normally directed ungual plate, distal lateral embedding, congenital malalignment of the big toenail or overcurvature of the ungual plate. All these conditions may induce and cause ingrown toenails.
Ingrown toenail in old age
Toenails undergo several physiological changes and histological modifications in geriatric populations. These changes are caused by the impairment in circulation, susceptibility to infections, skin disorders, reduced mobility, foot deformities and systemic diseases. They may not be able to take adequate care of legs and feet. The toenails get thickened, hardened and brittle. Poor eyesight, trembling and inability to bend and reach their feet leads to improper trimming of toenails. They tend to stub their toes quite often due to gait problems. These conditions make them prone to have ingrown ungual plate.
Genetic predisposition
Cambiaghi S et al. in their report titled 'Congenital hypertrophy of the lateral nail folds of the hallux in twins,' published in British Journal of Dermatology (1997) described a case of onychocryptosis in twins. The report suggested the possibility of genetic predisposition to onychocryptosis in some cases.
Other common causes
Onychocryptosis and paronychia have been reported secondary to use of medications, such as indinavir, retinoids, docetaxel and cyclosporin.
Subungual neoplasms may result in chronic ingrown conditions by compression on to hard surface of ungual plate.
Stubbing of toes or repeated injuries to toes may lead to ingrown ungual plate.
As said earlier systemic diseases such as hypothyroidism, cardiac and renal disorders with predisposition to lower extremity edema can cause ingrown conditions.
Fungal infections of the toenail cause the ungual plate to become brittle and break into spicules. The spicules may pierce the surrounding skin fold and grow into it.
Picking or tearing at the corners of the toenails can also cause an ingrown condition.
Improper posture which transfers much of the body weight on to the toes can influence chances of developing ingrown toenails.
Ingrown toenail treatment
Mild, initial stages of onychocryptosis can be treated with conservative approaches, such as soaking the foot in warm, soapy water, placing cotton wisps or dental floss under the ingrown ungual plate edge, using gutter splint or applying topical antibacterial preparations. For highly infected or recurrent ingrown toenail, surgical correction is the treatment of choice.
References on ingrown toenail:
1.Heidelbaugh JJ, Lee H. Management of the ingrown toenail. Am Fam Physician. 2009 Feb 15;79(4):303-8.
2.Reyzelman AM, Trombello KA, Vayser DJ, Armstrong DG, Harkless LB. Are antibiotics necessary in the treatment of locally infected ingrown toenails? Arch Fam Med. 2000;9(9):930–932.
3.DeLauro NM, DeLauro TM. Onychocryptosis. Clin Podiatr Med Surg. 2004;21(4):617–630.
4.Khunger N, Kandhari R. Ingrown toenails. Indian J Dermatol Venereol Leprol. 2012 May-Jun;78(3):279-89.
5.Chapeskie H. Ingrown toenail or overgrown toe skin? Alternative treatment for onychocryptosis. Can Fam Physician 2008;54:1561-2.
Home › Congenital melanocytic nevus › Nevus of Ota.
What is nevus of Ota?
Nevus of Ota is a hamartoma of dermal melanocytes. Ota lesion was first described by Dr. Masao.T. Ota, from the University of Tokyo, Japan in 1939 as "nevus fuscoceruleus opthalmomaxillaris".
Ota lesion is also known as "congenital melanosis bulbi" or "oculodermal melanocytosis". Ota lesion presents as a blue/grey patch on the facial skin, ocular area and/or oral/nasal mucosal surfaces. The lesions occur in the areas covered by the first and second (ophthalmic and maxillary) branches of the trigeminal nerve. The hyperpigmentation is usually unilateral and in several cases it involves the sclera.
Nevus of Ota is caused by entrapment of melanocytes in the dermal layer. Ito lesion, Hori's macule and Mongolian spot also occur due to the entrapment and hamartomatous growth of melanocytes. In Ito lesions, only shoulder and upper arm are involved. Mongolian spots appear on lumbosacral region. Hori's macule is not present at birth and often affects both sides of the face. Though Ota lesions are mostly congenital, there are reports of a few cases acquired during puberty, indicating the possible role of hormones.
Amiya Kumar Mukhopadhyay described a very rare presentation of simultaneous presence of unilateral Ota lesion, bilateral Ito lesion and palatal lesions in a male patient.
The incidence of these lesions in women is nearly five times more than men. It is more prevalent in Asian, African and East Indian populations and very rare among caucasian people. After onset, nevus of Ota may keep pace with the child's growth and may slowly and progressively enlarge and darken in color. The lesion usually become stable in appearance once adulthood is reached. Patients had reported of fluctuations in color of these lesions with environmental and health factors. Tanino had classified Ota lesions into type I (mild), type II (moderate), type III (intensive) and type IV (bilateral).
Nevus of Ota pathogenesis
The exact etiology of Ota lesion is still unknown. These lesions are caused by the presence of melanocytes in the dermis and the bluish/greyish coloration of the lesion is due to Tyndall effect of the dermal melanocytes. The failure of the melanocytes/melanoblasts from the neural crest to migrate to the epidermis during the embryonic stage is postulated as a cause. Another view is that the lesions are formed due to active production by intradermal melanocytes or due reactivation of pre-existing latent dermal melanocytes. Though specific genetic cause is not identified, a familial case has been reported. Exogenous and endogenous factors such as warm or cold weather, emotional stress, fatigue and insomnia may alter the intensity of color. Hormonal fluctuations as in menstrual cycle and menopause may increase the intensity of pigmentation.
Nevus of Ota treatment
Small disfiguring lesions can be covered up by cosmetic camouflage. Topical therapy appears to be ineffective. Other treatment modalities such as dermabrasion, micro surgery and cryotherapy may produce scars.
Nevus of Ota
Laser treatment and intense pulsed light are used to destroy these melanocytes. Multiple treatments with a combination of devices may be required. There is always the likelihood of these lesions recurring.
Sanjeev Aurangabadkar reported his study to evaluate long-term safety and efficacy of QYAG5 Q-switched Nd:YAG Laser Treatment of Ota lesion. Fifty patients with Ota lesions underwent multiple treatments over a period of one year with a Q-switched Nd:YAG laser (QYAG5, Palomar, USA). He reported excellent improvement in a majority of the patients and there were no significant adverse effects. Transient post-inflammatory hyperpigmentation was observed in some patients with resolution in two months. There was no recurrence of Ota lesion in one year of follow up.
Nevus of Ota complications
In rare cases melanoma has been reported to arise from the Ota lesions. Most of cases of malignant melanoma developing from the lesions are mainly found in skin. Ocular melanoma has been reported in the choroid, orbit and iris, in association with a Ota lesion. Some patients may develop intracranial neoplasia. Cherungottil V Radhadevi et al. reported a rare case with malignant transformation in oculodermal melanosis.
Ota lesion may give rise to ocular complications such as increased intraocular pressure and glaucoma. Lidija Magarasevic et al. reported a case of an appearance of unilateral glaucoma in a Caucasian female patient with the acquired, ipsilateral nevus of Ota.
Reference:
1.Lidija Magarasevic, Zihret Abazi. “Unilateral Open-Angle Glaucoma Associated with the Ipsilateral Nevus of Ota,” Case Reports in Ophthalmological Medicine, vol. 2013, Article ID 924937, 3 pages, 2013.
2.Ravi Prakash Sasankoti Mohan, Sankalp Verma, Amit Kumar Singh, Udita Singh. ‘Nevi of Ota: the unusual birthmarks’: a case review. BMJ Case Rep. 2013; 2013: bcr2013008648.
3.Jitender Solanki, Sarika Gupta, Nisha Sharma, Meenakshi Singh, Sumit Bhateja. Nevus of Ota”- A Rare Pigmentation Disorder with Intraoral Findings. J Clin Diagn Res. 2014 Aug; 8(8): ZD49–ZD50.
4.Cherungottil V Radhadevi, Kakkuzhiyil S Charles, Vasu K Lathika. Orbital malignant melanoma associated with nevus of Ota. Indian J Ophthalmol. 2013 Jun; 61(6): 306–309.
5.Gaurav Sharma, Archna Nagpal. Nevus of Ota with Rare Palatal Involvement: A Case Report with Emphasis on Differential Diagnosis. Case Rep Dent. 2011; 2011: 670679.
6.Amiya Kumar Mukhopadhyay. Unilateral Nevus of Ota with Bilateral Nevus of Ito and Palatal Lesion: A Case Report with a Proposed Clinical Modification of Tanino's Classification. Indian J Dermatol. 2013 Jul-Aug; 58(4): 286–289.
7.Sanjeev Aurangabadkar. QYAG5 Q-switched Nd:YAG Laser Treatment of Nevus of Ota: An Indian Study of 50 Patients. J Cutan Aesthet Surg. 2008 Jul-Dec; 1(2): 80–84.
Home › What is hypertrichosis › Hypertrichosis causes.
Hypertrichosis, excessive growth of hair, is caused by several factors. Hypertrichosis may be congenital, being present at birth. It may also be acquired later in the life.
Hypertrichosis presence at birth is caused by congenital syndromes, autosomal mutations and hereditary diseases. Acquired hypertrichosis is induced by malignancies, endocrine anomalies and certain therapeutic medications.
The excess hair growth may be generalized, affecting the whole of the body or localized to form well defined patches. Hypertrichosis may involve all the three types of hairs; vellus hair, lanugo hair or terminal hair. The various types of excess hair growth and their causes are discussed below.
Common causes of hypertrichosis
Common health conditions like hormonal, endocrine disturbances, systemic illness and certain diseases can induce excessive growth of hair. Some of the common factors inducing acquired hypertrichosis are:
Congenital erythropoietic porphyria (Gunther disease) is a rare, autosomal recessive metabolic disorder affecting heme, caused by deficiency of the enzyme uroporphyrinogen cosynthetase. Exposure to long-wave ultraviolet light causes vesiculobullous lesions, hyperpigmentation and excessive growth of hair.
CH lanuginosa is considered to be due to autosomal dominant mutation on chromosome 8q.
Generalized CH is considered to be due to autosomal dominant mutation on chromosome x24-q27.1.
CH generalized terminalis is due to a mutation in MAP2K6 on chromosome 17.
Localized CH may be associated with nevus, especially melanocytic naevus.
Abnormal localized lumbosacral hypertrichosis or faun-tail nevus is usually a marker for spinal dysraphism like spina bifida occulta or diastematomyelia.
Drug induced hypertrichosis
Many medications have been found to induce excessive hair growth. Some of the medications and chemicals inducing excessive hair growth are listed below:
Topical minoxidil,
Glucocorticoids,
Anticonvulsants,
Cyclosporine,
Diazoxide,
Psoralen,
Streptomycin,
Latanoprost,
Acetazolamide and
Phenytoin.
Treatment options
There is no treatment for congenital forms of excessive hair growth. Acquired forms resolve when the factors responsible excessive hair growth are removed or discontinued. Hair removal methods like shaving, waxing, laser hair removal and electrolysis are the treatment options available for congenital excessive hair growth.
Herpes zoster, also known as shingles, zona or zoster is a contagious skin infection caused by the varicella-zoster virus (VZV or human herpesvirus type 3).
The primary infection caused by the VSV is the chickenpox (varicella). Varicella usually occurs in the childhood manifesting as widespread vesicular rash. Later on reactivated virus causes herpes zoster. The zoster rash appears on the respective dermatome, i.e., the area of skin to which the affected spinal nerve is supplying.
Herpes zoster is contagious
The virus after causing highly contagious chickenpox enters the nervous system and remains for life in a dormant condition in the sensory dorsal root ganglia or cranial nerve ganglia. The affected individuals develop partial immunity and the virus is not totally eliminated by the immune system. The virus may get reactivated anytime and cause zoster in the affected person and cause varicella in others coming under direct contact with lesions.
Cause of herpes zoster
After years of dormancy, VZV may get reactivated in some persons and cause contagious infection vesicles. The exact cause of relapse to active phase is not known. However the main triggering factor may be immunodeficiency and immunosuppression. After activation, the virus particles move down the nerve and reach the area of skin supplied by the nerve and cause blisters. The occurrence of this contagious disease is more common in old age. Before the advent of vaccination for VZV, most of the adults might have contracted chickenpox in their childhood. Though the virus is dormant in them, they are carriers of the virus.
course of herpes zoster infection
Stages in the progression of herpes zoster are given in the above image.
herpes zoster on neck
1.Initially there is itching and burning sensation followed by the appearance of a cluster of small bumps.
2.These swellings turns into small blisters.
3.The blisters fill with lymph and break open exuding the contents. They may get infected and pus may form.
4.The blisters start healing, crust over and disappear.
5.Postherpetic neuralgia may occur due to nerve damage and persist for sometime after healing.
Herpes zoster transmission
The transmission of either chickenpox or zoster is by direct or indirect contact with fluids exuding from the blisters or with crust formed during healing. The varicella may also get transmitted by breathing infected coughed droplets. Transmission of the infection to others occurs when the virus gets reactivated. Transmission of the VZV to those who did not have chickenpox earlier in their life will cause chickenpox in them.
1.Image source: http://en.wikipedia.org/wiki/File:A_Course_of_Shingles_diagram.png
Author: FDA | License: public domain.
2.Image source: http://en.wikipedia.org/wiki/File:Herpes_zoster_neck.png
Author: John Pozniak | License: CC BY-SA 3.0
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