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469 Cards in this Set
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If you have alopecia that is non-pruritic, what do you need to first rule-out (3)?
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Pyoderma
Demodicosis Dermatophytosis |
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What are the 2 categories of falling out/non-pruritic alopecia
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Inflammatory
Non-inflammatory |
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What are the 2 categories of alopecia?
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Pruritic
Non-pruritic |
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What are the 2 categories of non-pruritic, non-inflammatory alopecia?
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Dystrophy/dysplasia
Hair cycle arrest |
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What are 5 types of inflammatory, non-pruritic alopecia
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Sebaceous adenitis
Dermatomyositis Alopecia areata Traction alopecia (groomer) Injections site reaction (rabies and distemper, often seen months after injection) |
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What are 4 types of pruritic alopecia
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Allergies
Parasites Pyoderma Malassezia |
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What are 3 types of non-pruritic, non-inflammatory alopecia due to dystrophy
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Congenital hypotrichosis
Color dilution alopecia (abnormal clumping of melanin - Blue Doberman) Black hair follicular dysplasia (does not need to affect all black hairs but ONLY black hairs) |
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What are 6 types of non-pruritic, non-inflammatory alopecia due to hair cycle arrest
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Endocrine
Alopecia X Pattern baldness Seasonal flank alopecia (boxers, bulldogs, airedales) Post-clipping alopecia (plush coat breeds have long telogen phase) Telogen defluxion (in response to stress, chemo, whelping) |
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What is more common cause of alopecia, dystrophy/dysplasia or hair cycle arrest?
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Hair cycle arrest
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Major cause of alopecia in K9 and Fe?
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self-trauma associated with pruritis
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What are the 4 initital diagnostics in animals with non-pruritic alopecia?
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Depp skin scrapes
Surface cytology Wood's lamp Dermatophyte culture |
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What is the most common additional diagnostic test in animal with non-pruritic alopecia
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skin biopsy
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What is demodicosis?
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INFLAMMATORY parasitic disease characterized by larger than normal numbers of demodectic parasites
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What are the 2 demodectic mites in dogs and which is bigger
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D. injai > D. canis
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Where do D. injai and D. canis live in the dog?
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Follicles
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D. canis spends the entire life cycle on the ____
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SKIN
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Can you differentiate the larvae of D. canis from the adult?
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YES
Larvae = 6 legs Nymph and Adult = 8 legs |
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How do 2-3 day old nursing puppies get infected with democidosis?
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Mom
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What is the current proposed pathogenesis of Demodicosis?
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Mite-specific immunoincompetence - depressed T cell function
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What are the 2 main types of Demodicosis and their subtypes?
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Localized
Generalized - juvenile and adult onset |
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Does pododemodicosis occur with adult or juvenile onset demodicosis?
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It may occur with either
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What body parts are localized demosicosis seen?
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Face
Forelimbs |
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Name 2 DDX for localized demodicosis?
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Pyoderma
Dermatophytosis |
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Should you treat localized demodicosis?
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HECK NO - 90% spontaneously resolve (10% will become generalized and you should treat these)
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What are the 3 types of generalized demodicosis?
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Squamous
Pustular Pododemodicosis |
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Are secondary infections common in squamous generalized demodicosis?
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NO
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Are secondary infections common in pustular generalized demodicosis?
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YES - mostly gram neg
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Describe squamous generalized demodicosis
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Scaly, alopecic patches that may coalesce, erythema, crusting, follicular plugging, comedones, hyperpigmentation
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Describe pusutlar generalized demodicosis
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Alopecia, papules, pustules, furuncles, draining tracts, cellulitis, edema, ulcers, erosions, nodules, depressed, lethargic, febrile, septicemia, lymphadenopathy
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What is the age cut off for adult/juvenile-onset demodicosis?
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Small breed - 1 year
Large breed - 1.5 years |
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What are some concurrent diseases you may see in animals with adult onset generalized demodicosis?
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Glucocorticoid admin - MOST COMMON
Hyperadrenocorticism Chemo Hypothyroidism Neoplasia |
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What are the number of body parts involved requirements for generalized demodicosis?
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Entire body region
2+ feet 5+ localized lesions |
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In what 2 scenarios might you not see demodex mites on a deep skin scrape and what should you do?
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Fibrotic lesions (feet)
Chinese shar-pei Biopsy!! |
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What 3 other diagnostics do you run of the animal has juvenile-onset localized and generalized demodicosis?
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HW test
Fecal exam Make sure on good diet |
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What 6 additional diagnostics do you run if the animal has adult-onset generalized demodicosis?
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CBC
Biochem profile Urinalysis Diet check HW test Fecal float |
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What do you do if the dog has localized demodicosis with a secondary pyoderma infection? Should you use steriods?
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Oral antibiotics
Topical benzoyl peroxide NEVER USE STEROIDS ON A DEMODICOSIS DOG |
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What do you do if the dog has generalized demodicosis?
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NO GLUCOCORTICOIDS
Control secondary bacterial infections DO NOT BREED Spontaneous remission occurs in up to 50% in young dogs Monitor mite counts every 2 weeks and if counts increase or if disease worsens then start miticide therapy |
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What is the only FDA approved therapy for demodicosis?
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Amitraz - Mitaban, a borad spectrum MAOI and an a-adrenergic agonist
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What is the protocol for doing a Mitaban dip?
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Clip hair (med and long hair breeds)
Bathe with benzoyl peroxide shampoo Sponge/rinse in 0.025% Mitaban dip for 15 min (soak feet too) DO NOT RINSE Air dry Avoid getting dog wet afterwards |
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How often are Mitaban dips performed?
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Every 2 weeks (do skin scrapes prior to dip)
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When is demodicosis controlled with Mitaban dips?
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2 consecutive visits when all skin scrapings are negative (still need to perform 2 more dips)
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When is demodicosis cured with Mitaban dips?
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1 year from last dip
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What are the side effects of Mitaban dips?
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sedation, depression, pruritis, vomiting, anorexia, hypothermia, bradycardia, hypotension, hyperglycemia, mydriasis
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What do you do if the side effects of Mitaban are severe?
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Give Yohimbine (0.1 mg/kg IV) and RINSE THE DOG!!
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What is the cure rate for juv and adult onset demodicosis using Mitaban?
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Juv-onset: 60-80% cured
Adult onset: 21% cured and 65% improved |
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What do you do with generalized demodicosis resistant cases?
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Use Mitaban weekly and increase concentration to 0.05%
Ivermectin - most commonly used in private practice, not FDA approved Milbemycin - not FDA approved |
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Which breeds can Ivermectin NOT be used on?
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Herding breeds-collies, shelties, Old Eng Sheepdogs
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What are signs of Ivermectin and Milbemycin Oxime toxicity?
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ataxia, hypermetria, disorientation, hyperesthesia, tremors, hyperreflexia, mydriasis, hypersalivation, depression, blindness, coma, death, vomiting, diarrhea, anorexia
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What is the physiology behind collies with sensitivity to ivermectin?
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Deletion mutation of mdr1 gene; homozygous for deletion display signs
mdr = multidrug resistance |
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What percent of collies are sensitive to ivermectin?
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35%
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What is control and cure for demodicosis using ivermectin or milbemycin oxime?
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Control = 2 negative consecutive deep skin scrapes (continue treatment for 1-2 weeks)
Cure = 1 year after last dose |
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Which dosage of ivermectin controlled the demodicosis 5 weeks sooner than the others?
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0.6 mg/kg q 24 hours
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What must you make sure before treating demodicosis with ivermectin or milbemycin oxime?
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HW NEGATIVE!!
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Should you use Taktic (amitraz) or doramectin to treat demodicosis?
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NOPE
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What is in ProMeris and should it be used to treat demodicosis?
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Amitraz and metaflumizone
Efficacy is questionable |
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What is in Advantage Multi and should it be used to treat demodicosis?
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Moxidectin and imidicloprod
Efficacy is questionable |
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Is feline demodicosis common?
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NO it is rare
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Name the 3 types of demodex mites in cats and where they live on host?
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D. cati - follicular mite
D. gatoi - st. corneum Undescribed mite - ?? |
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What are the clinical signs associated with D. cati (localized vs. generalized)?
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Localized (chin,periorbital) - alopecia and scaling
Generalized (entire body, flank, groin, head, neck) - alopecia, scaling, papules, crusting, erythema, hyperpigmentation Ceruminous otitis externa |
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What are the 3 presentations of D. gatoi?
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Alopecia, scaling, crusted lesions of head, neck, elbows
Erythema, hyperpigmentation, stubby hairs of proximal rear legs, flanks, and ventrum Ventral alopecia - MOST COMMON PRESENTATION |
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If your cat has demodicosis and papules, what mite is it infected with?
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D. cati
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If your cat has demodicosis and is pruritic, what mite does it have?
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D. gatoi
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How do you treat feline localized and generalized demodicosis?
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Localized - no TX - usually self-limiting
Generalized - 2% lime sulfur dips 4-6 times per week; treat all contact animals if D. gatoi |
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Why do you need to determine if your cat with demodicosis is infected with D.cati or D. gatoi
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D .gatoi is contagious and all contact animals should be treated
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What is the most common endocrine disorder?
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Hypothyroidism
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What is primary hypothyroidism, how common is it, and what will the lab values be for TSH and T4
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A problem with the thyroid
95% of hypothyroidism cases Inc TSH Dec T4 |
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What is secondary hypothyroidism, how common is it, and what will the lab values be for TSH and T4?
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A problem with the pituitary
5% of hypothyroidism cases Dec TSH Dec T4 |
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What is tertiary hypohyroidism, how common is it, and what will the lab values be for TSH and T4?
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A problem with hypothalamus
Very rare Dec TSH Dec T4 |
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What are the 2 types of primary hypothyroidism and which is more common?
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Lymphocytic thyroiditis (autoimmune) - 50-60%
Idiopathic thyroid atrophy |
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What is the typical age of onset with canine hypothyroidism?
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6-10 years (may be younger in larger breeds)
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What are the classic signs (4) of canine hypothyroidism?
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Lethargy
Depression Weight gain Cold intolerance |
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What are the 4 most common cutaneous signs associated with canine hypothyroidism?
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Alopecia (truncal) - frictional areas first
Dull haircoat - may be brittle, grows back slowly Seborrhea (scales) - dry or greasy Secondary infection - pyoderma, Malassezia, MAY CAUSE PRURITIS Other signs include hyperpigmentation, comedones, lichenification, mucinosis |
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What are the classical (4) systemic signs of canine hypothyroidism?
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Lethargy
Depression Obesity Cold intolerance Other sgns include cardiovascular, ocular, neuromuscular (myxedema coma), reproductive |
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Uusally hypothyroidism is not a dx you need to rush, except when animal presents with ______
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Myxedema coma - mucin accumulates in CSF and will go into coma
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What lab abnormalities might you see on CBC with hypothyroidism?
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Nonreg anemia
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What lab abnormalities might you see on Biochem profile with hypothyroidism?
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Hypercholesterolemia (may also increase with Cushing's or recently fed)
Mild inc ALP Inc creatinine kinase |
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What 3 things might cause a low T4?
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Hypothyroidism
Euthyroid sick syndrome Drug effects |
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What are some drugs (5) that lower T4?
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Corticosteroids
NSAIDS Anticonvulsants (phenobarb) Sedatives/anesthetics Sulfa antibiotics |
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What is TT4 and when is it most useful to measure??
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Total T4 - free and protein bound T4
Rule out hypothyroidism if normal (affected by concurrent drugs/dz) |
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What is T3?
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Intracellular product of circulating T4
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Should you use TT3 and fT3?
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Not helpful and more likely to confuse
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What is fT4?
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Unbound T4 that will be taken up by cells (affected by drugs and disease)
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Which thyroid measurement is least affected by concurrent disease, drugs, and T4AA
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Free T4 by equilibrium dialysis (fT4D) - still decreased by corticosteroids
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What non-thyroid issue will artifactually decrease fT4D?
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corticosteroids
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What thyroid blood measure is the most expensive?
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fT4D
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Is cTSH inc or dec in primary hypothyroidism?
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Increased
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Is cTSH inc or dec in secondary and tertiary hypothyroidism?
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Decreased
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How can you imrprove the accuracy of the cTSH test?
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Evaluate in addition to TT4, fT4, fT4D
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Which of the following is the most useful: TgAA, T4AA, T3AA
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TgAA
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Why would TgAA be increased?
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Lymphocytic thryoiditis - do not breed!!
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What is the best single thyroid test?
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fT4D
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Are skin biopsies helpful in diagnosing endocrinpoathies?
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Not really - results say "endocrinopathy" but not specific for what endocrinopathy specifically
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What drug do you treat hypothyroidism with?
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L - thyroxine
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What is the maximum L-thyroxine dose?
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0.8mg q 12 hours
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If the dog has ___, ____, or ____ concurrent diseases, you should use a lower leve of L-thyroxine
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Heart disease
DM Hypoadrenocorticism |
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What are 7 side effects of L-thyroxine?
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Tachycardia
Polyphagia PU PD Panting Excitability Nervousness |
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When should you re-evaluate TT4 levels in dog on L-thyroxine?
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6 weeks afer beginning treatment and 6 hours post-pill
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What are 6 reasons for a hypothyroid dog's poor response to L-thyroxine treatment?
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Incorrect dx - MOST COMMON
Poor owner compliance Variable absorption, metabolism, etc. No monitoring of peak levels Poor conversion of T4 to T3 Not 6 hours post-pill |
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What are the 2 types of hypercortisolism?
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Spontaneous
Iatrogenic |
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What are the 2 types of spontaneous HC?
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Pituitary dependent (PDH)
Adrenocortical tumor (AT) |
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What is more common - PDH or AT?
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PDH (80-90%)
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What is pituitary dependent hypercortisolism?
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ACTH - secreting pituitary neoplasia
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Is ACTH high or low in PDH?
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High
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Is ACTH high or low in AT?
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Low
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What is an adrenocortical tumor (AT)?
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an adenoma/carcinoma; usually unilateral
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What are typical clinical signs of endocrine alopecia?
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Truncal hair loss
Bilateral alopecia Non-pruritic |
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How old is the typical Cushing's dog?
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>6y
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Which form of spontaneous hypercortisolism is more common in dogs <20kg; >20kg?
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<20 kg = 75% are PDH
>20 kg = 50% are AT |
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What are the (4) most common clinical signs of a dog with hypercortisolism?
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PU/PD
Polyphagia Abdominal enlargement Weakness/lethargy |
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What does the haircoat look like on a dog with hypercortisolism?
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Loss of sheen/luster
Alopecia mostly truncal Patchy - bilaterally symmetric Poor hair regrowth |
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What does the skin look like on a dog with hypercortisolism?
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Thin and hypotonic
Easily bruised Comedones Poor healing Hyperpigmentation (more common in hypoT4) |
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What are some common secondary infections in a dog with hypercortisolism?
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Pyoderma
Yeast Demodicosis |
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What is the most common underlying disease in adult-onset generalized demodicosis?
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Hypercortisolism
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Calcinosis cutis is pathoneumonic for what diesease?
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Hypercortisolism
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What 4 locations on the body do you normally see calcinosis cutis?
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Dorsal neck
Rump Axilla Inguinal |
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What are some systemic signs you see with hypercortisolism?
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Pendulous abdomen
Loss of muscle tone Weakness Systemic hypertension Hepatomegaly Increased susceptibility to infection (lower UTI) Pulmonary embolism Renal - glomerular disease Reproductive abnormalites CNS signs with PDH |
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What abnormalities (5) might you see on a CBC of a dog with hypercortisolism?
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Leukocytosis
Neutrophilia Lymphopenia Eosinopenia Erythrocytosis |
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What abnormalities (4) might you see on a Biochem panel of a dog with hypercortisolism?
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Hyperglycemia
Increased cholesterolemia (90%) Increased ALP and ALT Decreased TT4 and fT4 |
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What abnormalities (2) might you see on a Urinalysis of a dog with hypercortisolism?
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Low SG
Bacturia and UTI **Do not catheterize** |
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What abnormalities (5) might you see on radiographs of a dog with hypercortisolism?
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Hepatomegaly
Full bladder Dystrophic calcification Osteoporosis Calcified adrenal glands |
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What are the most commonly used best 2 tests to confirm hypercortisolism? What are 3 other tests?
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ACTH stim
Low dose dex Urine cortisol:creatinine ratio CiALP 17-OHP |
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What is the best test to differentiate iatrogenic from sponteneous hypercortosolism?
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ACTH stim
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What drug do you give for the ACTH stim test?
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Cortrosyn
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What if the 1 hour post ACTH stim sample of cortisol is >26ug/dL?
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Spontaneous hypercortisolism
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What if the 1 hour post ACTH stim sample of cortisol is <normal?
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Iatrogenic hypercortisolism (Addison's disease)
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What is the protocol for ACTH stim test?
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Pre- and 1 hour post-ACTH cortisol levels; give Cortrosyn
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What is the protocol for the Low Dose Dex Suppression test?
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Serum samples for cortisol assay at 0 and 8 hours; give 0.015 mg/kg dex
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What if the 8 hour sample of a LDDS test is <1.0 ug/dL?
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Normal
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What if the 8 hour sample of a LDDS test is >1.8 ug/dL?
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Hypercortisolism
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What if the urine cortisol:creatinine ratio is <35 units of nmol/L
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Rules out hypercortisolism
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What is a good screening test for hypercortisolism?
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Urine cortisol:creatinine ratio (if neg it rules out HC)
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What if the urine cortisol:creatinine ratio is positive?
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Suggestive (but not diagnostic) of hypercortisolism - the dog could be highly stressed
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What if the CiALP results came back >90 IU/L?
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Suggestive but not diagnostic of hypercortisolism
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What is the CiALP results came back <90 IU/L?
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Normal
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Why is the 17-OHP test better than ACTH stim and LDDS test?
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More sensitive
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What if the 17-OHP test comes back >1.32 ng/mL
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Hypercortisolism
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What are 3 ways to differentiate PDH from AT?
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HDDS
U/S, CT, MRI cACTH |
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Why do you use HDDS?
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To differentiate PDH from AT (not to dx HC)
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Why do we use LDDS?
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To dx HC
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What is the protocol for HDDS?
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Measure serum cortisol at 0h and 8h; give 0.1 mg/kg dex IV after taking 0h measurement
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What if the 8 hour sample of HDDS test is <1.5 ug/dL?
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PDH
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What if the 8 hour sample of HDDS test is >1.5 ug/dL?
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100% dogs with AT
20-30% dogs with PDH |
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What do the adrenals look like on U/S with PDH?
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Bilat adrenal hyperplasia
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What do the adrenals look like on U/S with AT?
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Unilat adrenal enlargement
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What if the cACTH assay comes back 20-100 pg/mL?
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Normal or maybe PDH
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What if the cATCH assay comes back <20pg/mL?
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AT
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What if the cATCH assay comes back >40pg/mL?
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PDH or maybe normal (20-100 is normal)
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What are your treatment options if you dx PDH?
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Medical - Lysodren or Trilostane
Surgery Radiation |
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What are your treatment options if you dx AT?
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Medical (only if SX is not possible) - Lysodren, Trilostane, Ketoconazole
Surgery - adrenalectomy (BEST OPTION!) |
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Why would you use Lysodren in a patient with AT?
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Only if surgery is not possible.
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What does Lysodren do in a patient with PDH?
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Controlled destruction of adrenals to limit production of cortisol
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What is a concern of using Lysodren in a patient with PDH and what 6 things should you monitor for?
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Total destruction of adrenals causing iatrogenic hypoadrenocorticism
Decreased water intake Anorexia Vomiting Diarrhea Weakness Ataxia |
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What is op'DDD?
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Lysodren - used to treat PDH
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What are some side effects (7) of Lysodren? How would you overcome an acute crisis?
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Anorexia
Weakness Lethargy Ataxia Coma Hypoglycemia Electrolyte disturbances Dispense pred to overcome an acute crisis |
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When would you monitor a patient's response to long-term Lysodren
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every 3-6 months
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How does Trilostane compare to Lysodren?
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Trilostane is imported from Canada and is safer than Lysodren because it does not destroy the adrenal gland
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What are your surgery options in a PDH patient?
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Hypophysectomy
Bilateral adrenalectomy |
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What are your surgery options in an AT patient?
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Unilateral adrenalectomy
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What is the px for a PDH patient?
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2 y life expectancy
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What is the px for an AT patient?
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Unilateral adrenalectomy - curative
No sx - 1 year |
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What are the origins of sex hormones in an animal?
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ADRENAL GLANDS
GONADS MALE - sertoli cell tumor, testosterone-responsive dermatosis FELMAE - hyperesrogenism, estrogen-responsive dermatosis |
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What should you do if an intact animal is developing an endocrine alopecia?
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Castrate them and see if it gets better
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What happens to an animal with adrenal sex hormone related alopecia that had a biopsy or trauma?
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Hair regrowth
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What is the typical age and hair coat of a dog with adrenal sex hormone-related alopecia?
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1-3 years old
Plush coat breeds |
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What 2 diseases should you rule out if you think you have adrenal sex hormone-related alopecia?
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HypoT4
Hypercortisolism |
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Does Alopecia X harm the animal systemically?
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NO
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How can you treat Alopecia X?
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STERILIZATION!!
Mitotane Melatonin Trilostane ABOVE ALL ELSE - DO NO HARM (ALOPECIA X DOES NOT HARM ANIMAL SYSTEMICALLY) |
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If a dog looks like it has dermatophytosis, it probably has...
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Pyoderma
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What are 2 issues if a human/animal is infected with dermatophytosis and is immunosuppressed?
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Easily infected
Difficult to treat (body must be able to respond to antifungals for the antifungals to actually work) |
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What is dermatophytosis?
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Cutaneous infection with keratinophilic fungi that invades hairs in the anagen phase.
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Where is M. canis from?
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Infected cats
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Where is M. gypseum from?
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Soil
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Where is T. mentagrophytes from?
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Rodents
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What is the most common dermatophyte of cats?
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M. canis
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Can dermatophytes be isolated from normal animals?
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YES (~35% of long haired cats)
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What is the pathogenesis of dermatophytosis?
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Infected cats/env/fomites - invasion of anagen hairs - production of arthrospores - folliculitis
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What are the 3 DDX for folliculitis?
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Pyoderma
Demodicosis Dermatophytosis |
|
|
What are the 2 commons clinical signs of dermatophytosis?
|
Folliculitis
+/- Scaling |
|
|
What are the 6 types of presentation of dermatophytosis in dogs?
|
Classic focal alopecia
Papular/pustular dermatitis Facial folliculitis/furunculosis - T. metagrophytes Kerion - M. gypseum - bridge of nose and distal limbs; raised, red, exudative (if discharge from kerion think staph) Onychomycosis - T .mentagrophytes - abnormal nail growth Generalized greasy seborrhea |
|
|
What areas are normally affected by dermatophytosis?
|
Head
Pinna Feet |
|
|
What are the typical clinical signs (4) of dermatophytosis in cats?
|
Alopecia
Crusting dermatitis - miliary Onychomycosis - M. canis Draining nodules - Persians |
|
|
If a dog presents with facial folliculitis/furunculosis dermatophytosis, what species is it most likely?
|
T. mentagrophytes
|
|
|
If a dog presents with kerion dermatophytosis, what species is it most liekly?
|
M. gypseum
|
|
|
If a dog presents with onychomycosis, what species is it most likely?
|
T. mentagrophytes (only deep dermatophytosis)
|
|
|
If a cat presents with onychomycosis dermatophytosis, what species is it most likely?
|
M. canis
|
|
|
What are 2 DDX for onchymycosis?
|
Dermatophytosis
Systemic lupus onic. |
|
|
What are 4 diagnostic tests in an animal with dermatophytosis?
|
Fungal culture
Histopathology Trichogram Wood's lamp (only M. canis fluoresces) |
|
|
What are 4 ways to optain dermatophytosis samples for fungal culture?
|
Mackenzie toothbrush
Nodules - biopsy for culture Paronychia - hair at nailbed Onychomycosis - nail shavings |
|
|
When do you stop treating animal for dermatophytosis (clinical cure or microbiological cure)
|
Microbiological cure
|
|
|
When (2 situations) is histopathology helpful for diagnosing dermatophytosis?
|
Granulomatous nodules
Onychomycosis Histopath is not as sensitive as culture |
|
|
Why (4)is confirmation of dermatophytosis important?
|
Clinical signs are not specific
Expense/duration of therapy Adverse effects of drugs Zoonotic importance |
|
|
What are 5 things you can do do to treat dermatophytosis?
|
Clip hair
Topical treatments Systemic drugs Env decontamination Fungal vacc |
|
|
What are the advantages (3) of clipping the hair of an animal with dermatophytosis?
|
Removed contagion
Easier topical treatment Faster recovery ? |
|
|
What are the 3 disadvantages of clipping the hair of an animal with dermatophytosis?
|
Spread infection (clippers)
Worsening of lesions Disposal of hair |
|
|
What is adjunctive therapy in a case of dermatophytosis (topical or systemic)
|
Topical
|
|
|
What are 3 disadvantages of treating an animal with dermatophytosis topically?
|
Irritation
Ingestion Owner expense |
|
|
What is 1 advantage of treating an animal with dermatophytosis topically?
|
Kills spores
|
|
|
What are 3 things used to treat dermatophytosis topically?
|
Lime sulfur
Chlorhexidine Miconazole |
|
|
What is the treatment of choice in all cases of dermatophytosis?
|
Systemic therapy
|
|
|
How long do you treat a dermatophytosis animals systemically?
|
>1 month or negative DTM
|
|
|
What are 3 systemic drugs used to treat dermatophytosis?
|
Ketoconazole
Itraconazole Terbinafine |
|
|
What is a negative side effect of Ketoconazole in cats (dermatophytosis)?
|
Vomiting
|
|
|
What is a disadvantage of Itraconazole (dermatophytosis)?
|
EXPENSIVE (may want to pulse does - week on/week off)
|
|
|
What is a disadvantage of Terbinafine (dermatophytosis)?
|
Increased ALT (but no clinical toxicity)
|
|
|
How do you environmentally decontaminate with a dermatophytosis case?
|
Vacuum
Clean all surfaces and grooming accessories Household bleach (0.05-5%) or Virkon |
|
|
Are fungal vaccines or Lufenuron recommended for dermatophytosis infections?
|
NO
|
|
|
What is otitis externa?
|
Acute or chronic inflammation of the epithelium of the external ear canal, may also involve the pinna
|
|
|
How common is otitis externa in the dog?
|
5-20%
|
|
|
How common is otitis externa in the cat?
|
2-6.6%
|
|
|
When do cats usually present with otits externa and what is the cause?
|
kitten - 2 y; ear mites
|
|
|
When do dogs usually present with otits externa and what is the cause?
|
2-5 years; allergies
|
|
|
The pinna, vertical canal, and horizontal canal are all classified as the ____
|
External ear
|
|
|
Where does the pinna become the vertical ear canal?
|
At the large tubercle of the antihelix on the medial surface of the auricular cartilage
|
|
|
What is the junction between the vert and horiz ear canal?
|
At the distinct medial turn
|
|
|
What separates the external ear canal from the middle ear?
|
Tympanic membrane
|
|
|
What 3 normal structures/shapes of the ear canal predicposes animal to ear problems?
|
Moisture, foreign debris, and glandular secretions can be trapped in the canal
Sebaceous glands are larger and more numerous in the ear canal than skin Ceruminous glands are found below the sebaceous glands in deep dermis |
|
|
What organisma (5) are part of the normal external ear canal flora?
|
Staphylococci
Micrococcus beta-Streptococcus Malassezia pachydermatitis Corynebacterium |
|
|
Define predisposing factors for otitis externa
|
Facilitate the inflamm by permitting the ext ear canal microenv to be altered allowing pathogenic or opportunisitc bac to become established
|
|
|
What are 5 examples of predisposing factors for otitis externa
|
Variations in breed confirmation (small,stenotic ear canals, hairs in canal, long, pendulous pinna)
Chronic abnormally high moisture content - maceration os st. corneum (humid, swimming, bathing) Inappropriate previous therapy Irritant antispetic solutions Improper antibiotic usage |
|
|
Define primary causes of otitis externa
|
Conditions or disorders that initiate the inflamm process within the ear canal; usually an underlying dermatologic condition
|
|
|
What are 7 primary causes of otitis externa?
|
Parasites - *Otodectes*, Demodex, O. megnini
FB Allergic diseases - AD, CAFR, contact allergy Disorders of keratiniation Juvenile cellulitis Autoimmune diseases Ear tumors and polyps |
|
|
What parasite is the most common cause of otitis externa and what age are the animals affected?
|
Otodected cynotis (50% - cats; 5-10% - dogs)
Animals usually <1y |
|
|
What are clinical signs of otitis externa caused by FB?
|
Acute, unilateral, painful ear
|
|
|
What it the primary danger of a FB in ear?
|
Perforation of tympanic membrane
|
|
|
What is the most common cause of persistent bilateral otitis externa in the dog?
|
Allergic diseases
|
|
|
When do you put CAFR high in your DDX list of causes of otitis externa?
|
Dogs <1 year and older dogs with no previous history of otic or skin problems
|
|
|
If a case of otitis externa fails to respond to appropriate topical meds (neomycin), should you tell them to clean more?
|
NO - this could be a case of contact allergy otitis externa
|
|
|
What is juvenile cellulitis?
|
Vesiculopustular disease of puppies between 3 and 16 weeks of age; present with head and facial lesions (purulent otitis, blepharitis, regional lymphadenopathy)
|
|
|
What are the 2 most common autoimmune disorders that cause otitis externa?
|
Pemphigus foliaceus
Systemic lupus erythematous |
|
|
Are ear tumors more common in dogs or cats?
|
Dogs
|
|
|
If an ear tumor is found in a cat, is it more likely to be malignant or benign?
|
Malignant
|
|
|
Define perpetuating factors for otitis externa
|
Sustain and aggravate the inflammatory process and prevent resolution or worsen an already present otitis externa
|
|
|
What are 4 perpetuating factors for otitis externa?
|
Bacteria
Mycotic infections Otitis media Progressive pathologic changes |
|
|
What are the 2 most common bacteria that are perpetuating factors in otitis externa?
|
sTAPH INTERMEDIUS
pSEUDOMONAS AERUGINOSA |
|
|
What are 2 fungal organisms that commonly cause perpetuating factors in otitis externa?
|
Malassezia pachydermatis
Candida |
|
|
The tympanic membrane, tmypanic cavity, 3 auditory ossicles are classified as what?
|
Middle ear structures
|
|
|
Is the tympanic membrane concave or convex normally?
|
Concave
|
|
|
What does the eustachian tube do?
|
Connects the nasopharynx to the middle ear
|
|
|
What are 5 organisms considered part of normal flora of middle ear?
|
Yeast
E. coli Staph Corynebacterium Streptococcus |
|
|
How can otitis media cause recurrent otitis externa?
|
Via a ruptured tympanic membrane
|
|
|
Does an intact tympanic membrane rule out otitis media?
|
No - the membrane defect may have closed (72.5% of dogs with otitis media had intact tympanic membrane)
|
|
|
If you have a case of chronic otitis externa, are they likely to also have otitis media?
|
YES - 88.9% of cases of ch otitis externa have otitis media as a perpetuating factor
|
|
|
What is the most common etiology in otitis media (and common examples)?
|
Bacteria
Pseudomonas aeruginosa Staphylococcus intermedius |
|
|
What breed do you see non-infectious otitis media (primary secretory otitis media)?
|
Cav King Charles Spaniel
|
|
|
What are the clinical signs (5) assoc with non-infxs otitis media (primary secretory otitis media)?
|
Head and neck pain
Abd scratching Neuro signs Impaired hearing Intact bluging pars flaccida (tympanic membrane usually ruptured) |
|
|
What is the treatment for non-infxs otitis media (primary secretory otitis media)?
|
Myringotomy and middle ear flush to remove mucoid exudate
|
|
|
What are 4 possible clinical signs of otitis media?
|
Recurrent otitis externa - may be the only sign
Facial nerve paralysis Horner's syndrome (droopy upper lid and miosis) Otitis interna (head tilt, circling, horz nystagmus, asymmetric ataxia) |
|
|
What is the diagnostic method for otitis media?
|
Radiology: plain films, CT, MRI
|
|
|
What are 4 pathologic changes seen with otitis externa?
|
Epidermal hyperkeratosis and hyperplasia
Dermal edema and fibrosis Calcification of auricular cartilage Stenosis of the lumen |
|
|
What is the purpose of a history in a otitis externa case?
|
R/O allergies, parasites, and env factors
Determine frequency of ear problems and treatment response |
|
|
What 3 things should you look extra hard at on a PE of a case with otitis externa?
|
Neuro exam
Examine skin Otic exam |
|
|
If otitis externa appears to be unilateral, which side should you start on?
|
Unaffected side first
|
|
|
Do you need to visualize both tympanic membranes during an otic exam?
|
YES - if yu cannot then clean ears, use abx, or glucocorticoids and re-eval several days later
|
|
|
What is the first diagnostic test for otitis externa?
|
Cytology
|
|
|
What should you look for on cytology of an externa otitis case (5)?
|
Number and type of bacteria
Number and type of yeast Type and activity of inflammatory cells Keratinocytes and glandular secretions Neoplastic cells |
|
|
What are te most common pathogens from the external ear canal and middle ear?
|
Coccoid bacteria - Staph. intermedius
Rod bacteris - Pseudomonas aeruginosa (often resistant to abx) |
|
|
What are you looking for with mineral oil exam with a case of otitis externa?
|
Mites - Otodectes cynotis, demodicosis
|
|
|
When should you do bac culture and susceptibility with otitis externa?
|
Chronic/Recurrent/Unresponsive cases
Cases with concurrent otitis media When cytology indicates rods |
|
|
Should you use ointments to treat otitis media?
|
NEVER
|
|
|
Do you use topical or systemic therapy to treat otitis externa/media?
|
Topical (unless o cannot treat topically)
|
|
|
Do you use topical or systemic therapy to treat otitis media/interna?
|
Systemic
|
|
|
Describe the in-hospital procedure for ear flushing.
|
Obtain samples from horizontal ear canal for cytology and C/S
Gen anes Soak ear for 10 min with ceruminolytic ear cleaner (potentially tot-toxic - communicate this with o) Flush with sterile, isotonic saline with a bulb syringe Flush with sterile, isotonic saline using an 8 French polypropylene urinary catheter attached to 12cc syringe passed through otoscopic cone If tympnic membrane not intact, perform cytology and C/S from middle ear Flush middle ear with sterile, isotonic saline to remove any ear cleaner to reduce chance of ototoxicity |
|
|
What is a myringotomy?
|
Incision into the tympanic membranse if the membrane is intact but abnormal
|
|
|
Where should you make your incision for a myringotomy?
|
Caudoventral quadrant of TM
|
|
|
How do you incise the TM during a myringotomy?
|
Use a Calgiswab
|
|
|
What are the 2 swabs used for in a myringotomy?
|
1st swab - C/S
2nd swab - cytology |
|
|
How soon does a normal TM heal?
|
21-35 days
|
|
|
What are 4 potential complications of ear flushing/myringotomy?
|
Horner's syndrome
Facial nerve paralysis Vestibular disturbances Deafness *1-2 of these signs are expected in the cat and will heal in 1-2 months |
|
|
What agents are contraindicated with ruptured TM but still used for in-hosp deep ear cleaning followed with mult flushings?
|
Ceruminolytic agents
|
|
|
Name 3 ceruminolytic agents
|
Panotic (dioctyl sodium sulfosuccinate)
Clearx Ear Cleansing Solution (dioctyl sodium sulfosuccinate, urea peroxide) Cerumene (squalene) (not ototoxic) |
|
|
Name 3 cleaning and drying agents used in ears
|
Epi-Otic with Spherulites
OtiCalm OtiClens |
|
|
Do you normally use cleaning and drying agents before or after ceruminolytic agents?
|
AFTER
|
|
|
When should you use an oil or ointment based topical therapy with otitis?
|
Dry lesions
|
|
|
When should you use a solution or lotion based topical therapy with otitis?
|
Moist lesions
|
|
|
What do glucocorticoids provide to the otitis patient (4)?
|
Antipruritic
Anti-inflammatory Antiproliferative Decrease sebaceous and apocrine secretions |
|
|
What should you be concerned with causing if using glucocorticoids in an otitis case?
|
Iatrogenic hyperadrenocorticism
|
|
|
How can you prevent causing iatrogenic hyperadrenocorticism in an otitis case that you are managing with glucocorticoids?
|
Use the lowest potency glucocorticoid at the lowest frequency
|
|
|
Name 4 topical therapies to treat otitis that contain glucocorticoids.
|
CortAstrin
Synotic Bur-Otic HC Clearx Ear Drying Solution |
|
|
What are aminoglycosides?
|
Antibacterials that are effective against Gram pos and most of Gram neg otitis
|
|
|
What are your 6 options for aminoglycosides for topical otitic treatment?
|
Panolog Ointment
Tresaderm Gentocin Otic Gentocin Ophthalmic Otomax Ointment Tobramycin |
|
|
What is polymixin?
|
Antibacterial that is effective against Pseudomonas; inactivated in purulent debris; used to trat otitis
|
|
|
Why would acetic acid be used to treat otitis?
|
Effective in 1 minute against Pseudomonas; works be acidification; an antibacterial
|
|
|
What would you use for a Pseudomonas resistant case of otitis?
|
Baytril Otic Emulsion
(Extra label - Silver sulfadiazine, Enrofloxacin, Timentin) |
|
|
Name 5 antifungals used to treat otitis topically.
|
Nystatin (Panalog)
Thiabendazole (Tresaderm) Clotrimazole (Clotrimazole Otic, Otomax) Miconazole (Conofite Lotion) Ketoconazole (T8Keto) (Extra label = Clotrimazole, cConofite, Ketoconazole) |
|
|
Name 4 parasiticides used to treat otitis topically.
|
Pyrethrins
Thiabendazole (Tresaderm) Milbemycin (Milbemite) Ivermectin (Acarexx) |
|
|
What will you see in the ear if there is too vigorous topical therapy?
|
Maceration of the lining of the ear canal; white ceruminous debris in the ear canal; cytologically there is no infxn (only desquamated epithelial cells)
|
|
|
Name 5 treatments used for systemic therapy for otitis media caused by S. intermedius
|
Primor
Trimethoprim-sulfadimethoxine Antirobe Cephalexin Clavamox |
|
|
What do you use (2 options) for otitis media infections caused by Pseudomonas?
|
Baytril or Zeniquin (systemics)
|
|
|
What do you use (2 options) for yeast otitis media?
|
Ketoconazole (Nizoral)
Itraconazole (Sporanox) |
|
|
What do you use (3 options) for mite otitis media?
|
Injectable Ivermectin
Selamectin Advantage Multi (Moxidectin) |
|
|
Why would you use systemic glucocorticoids for otitis media?
|
Allergic otitis
|
|
|
What should be used first for otitis: cleaning/drying agent or topical
|
Cleaning/drying
|
|
|
What products (3) should you use initially in treating an Pseudomonas otitis case?
|
Zeniquin
T8 Solution Baytril Otic |
|
|
What properties does Tresaderm have?
|
Antifungal
Antibacterial Anti-inflamm |
|
|
What properties does Gentocin Otic have?
|
Antibac
Anti-inflamm |
|
|
What are the 2 different means that UV light senstization can occur?
|
UVA
UVB |
|
|
What is UVA associated with?
|
photosensitization
|
|
|
What is UVB associated with?
|
sunburns
|
|
|
What are 3 ectoparasites that cause scaling and crusting?
|
Demodex
Chetletiella Filarid nematodes (Onchocerca - horses; Stephanofilaria - bulls) |
|
|
Where are you most likely to find feline Cheyletiella eggs?
|
Fecal (good groomers)
|
|
|
Does Cheyletiella cause pruritis?
|
NO(only flaky skin and some papules)
|
|
|
How do cats and dogs typically present with Cheyletiella?
|
Flaky skin
+/- papules (K9 Cheyletiella larger than feline) |
|
|
How do rabbits present with Cheylietella?
|
Large crusts with scaling exfoliations
Limited to ears |
|
|
How can you treat Cheyletiella on any animal?
|
Selamectin - drug of choice
Fipronil (not rabbits) Pyrethrins/Pyrethroids (no permethrins on cats) Amitraz - ProMeris - dogs only |
|
|
Does Cheyletiella spend more time on or off the host??
|
Off
|
|
|
How is O. cervicalis transmitted?
|
Culicoides
|
|
|
Does O. cervicalis cause pruritis?
|
Yes - due to flies attached to lesions
|
|
|
Where are microfilarie found on O. cervicalis?
|
Skin - dependent areas
|
|
|
What is the procedure to biopsy the skin infected with O. cervicalis?
|
Macerate skin with saline to allow MF to move into the liquid
|
|
|
What do you treat O. cervicalis with in horses?
|
Macrocyclic lactones (IVM or Moxi)
|
|
|
What is the technical terms for scaling skin?
|
Seborrhea
|
|
|
Is scaling skin normally primary or secondary?
|
Secondary (80%)
|
|
|
What is the first thing you want to do with a scaley dog?
|
Determine if it is primary or seconday
|
|
|
Define primary disorder of keratinization
|
Defect in the keratinizing epithelium or glandular function; usually hereditary
|
|
|
A scaling dermatosis should never be diagnosed as a primary keratinization without...
|
Ruling out secondary causes of scaling
|
|
|
How can you rule out secondary causes of scaling (5)
|
Deep skin scrapes - demodex
Flea comb - fleas, chyletiella Supf skin scrapes - sarcoptic mange, cheyletiella Wood's lamp, DTM - dermatophytes Surface cytology - bac, yeast |
|
|
What are the 3 most common primary keratinization disorders?
|
Zinc responsive dermatosis
Sebaceous adenitis Canine acne |
|
|
What is syndrome I Zinc responsive dermatosis?
|
Decreased abaility to absorb zinc from intestine; genetic; scaling and crusting disease
|
|
|
At what age and breeds do you normmally see zinc responsive dermatosis?
|
1-3 years
Alaskan Malamutes, Siberian Huskies, Bull Terriers |
|
|
What are the clinical signs of zinc responsive dermatosis?
|
Erythema, alopecia, scaling, and crusting around the mouth, chin, eyes, and ears
Hyperkeratotic footpads Pruritic |
|
|
Does biopsy definitively diagnose zn responsice dermatosis?
|
No, but it is suggestive - epidermal and follicular parakeratotic hyperkeratosis
|
|
|
How do you treat zinc responsive dermatosis (3)?
|
Zinc
Keratolytic shampoo FA supplementation |
|
|
What is the initial zinc does not help the zinc responsive dermatosis dog (2)?
|
Increase zinc by 50%
Low dose glucocorticoids |
|
|
What are side effects of zinc supplementation?
|
Vomiting
|
|
|
What is sebaceous adenitis?
|
An inflammatory disease directed against the sebaceous glands; scaling and crusting disease; uncommon in k9 and rare in cat
|
|
|
What are the clinical features of sabaceous adenitis (age, breeds, location of lesions)?
|
Young/middle aged dogs
St. poodle, Akita, Vizsla, Samoyed, Belgian sheepdog Bilaterally symmetrical - face, head, pinnae, trunk |
|
|
Describe the lesions of a Vizsla (short coat breed) with sebaceous adenitis
|
Annular areas of scaling and alopecia that enlarge and coalasce
Intermittent edematous swelling of muzzle, lips, and eyelids |
|
|
Describe the lesions of a st. poodle (long coat breeds) with sebaceous adenitis.
|
Alopecia, scaling, dull brittle hairs (loss of curls)
Begins on face, pinnae, neck, and dorsal trunk May progress to generalized dermatosis with tightly adherent, silver-white scales, follicular casts, matted tufts of hair |
|
|
What do the biopsy results tell you with a sebaceous adenitis dog?
|
Granulomatous inflamm at the level of the sebaceous glands
If advanced: NO sebaceous glands |
|
|
What is the first choice therapy for sebaceous adenitis.
|
Topical therapy:
Emollient then Shampoo Daily sprays Omega 3/6 (systemically) |
|
|
What is the second choice treatment for sebaceous adenitis.
|
Systemic
Isotretinoin (Accutane, Roche) Cyclosporine |
|
|
What are the side effects of using Isotretinoin to treat a sebaceous adenitis dog?
|
Anorexia
V Stiffness and bone pain KCS Elevated liver enzymes Increased triglyceride and cholesterol levela Teratogenicity |
|
|
What are the side effects of Cyclosporine in treating a dog with sebaceous adenitis?
|
V
D Gingival hyperplasia Infection (and v. expensive!!) |
|
|
Can you breed sebaceous adenitis dogs?
|
NO
|
|
|
What is the most common feline primary keratinization disorder?
|
Feline acne
|
|
|
What is feline acne?
|
Uncommon idiopathic disorder d follicular keratinization
|
|
|
Is feline acne confined to adolescence?
|
NO
|
|
|
What are the clinical features (and where) of feline acne?
|
Crusts
COMEDONES - classic lesion May progress to papules/pustules Folliculitis, furunculosis, cellulitis Alopecia Edematous Found on Chin, lower lip, upper lip |
|
|
What will the biopsy reports say for a feline acne case?
|
Follicular keratosis, plugging, dilatation
|
|
|
How do you treat feline acne if caught early?
|
Topically
Clip area Benzoyl peroxide shampoo/gel |
|
|
How do you treat feline acne if more advanced (papules, furuncles)
|
Oral abx - based on C/S
Maybe some pred |
|
|
What is myisais?
|
Invasion of living tissue by larvae (maggots); can be flies or beetles
Obligate - req living tissue Facultative - does not req living tissue Pseudo - ingested with food, appears in feces but not an infection |
|
|
What are bottle flies used for now?
|
Osteomyelitis - eat decaying material and leave wound for pupation
|
|
|
Name 3 examples of adult flies that are not feeding
|
Bots
Grubs Warbles |
|
|
Where do Cuterebra lay their eggs?
|
Near den
|
|
|
Where do gasterophilus and hypoderma lay their eggs?
|
On the host
|
|
|
Where do Dermatobia lay their eggs?
|
On mosquitoes
|
|
|
What lifecycle do flies lead?
|
Complete metamorphosis
|
|
|
What are hypoderma?
|
Cattle grubs (aka heel flies, gadflies)
|
|
|
What are Gasterophila?
|
Hores bots
|
|
|
What are cuterebra?
|
Puppy and kitten bots
|
|
|
What do hypoderma bovis do once inside host?
|
(eggs deposited on hair) Larvae migrate in body and mature in skin of back then emerge into the environment to pupate
|
|
|
When is the best time to kill hypoderma?
|
Right before the start of migration or right before they pupate
|
|
|
How (3 options)and when do you treat hypoderma?
|
IVM, MOXI, DORAMECTIN following fly season (avoid time when larvae near esophagus or spine)
|
|
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How do gasterophilus affect the horse?
|
Eghgs layed near cannon bones or under chin
Migration in mucosa of mouth - oral lesions Larvae attach to m. plicatus Pupation to the exterior |
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How do you treat gasterophilus?
|
IVM or MOXI
Wash legs with warm water and mild detergent |
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How do you treat cuterebra?
|
Remove grub - sx, vaseline over breathing hole
Clean wound after removal |
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How do you control cuterebra?
|
Heartworm prophylaxis - IVM
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How do Oestrus ovis affect their host?
|
Live in nasal cavities of wild ruminants
Compression of pharyngeal pouches - affects vagus n. - rumenal atony |
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What is fly strike?
|
Myiasis secondary to filth; underlying skin has lesions (due to moisture, bac, fungi) entered by maggots
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How do you treat fly strike?
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Clip hair
Debride lesions Supportive treatment if septic Antibiotics Topical insecticides - macrocyclic lactones |
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What size wound do screw worms need to enter host?
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V. small - tick bite size
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Why are screw worms so impt?
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Reportable dz
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Why are screw worms so destructive?
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Eat living tissue
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What is Habronemia and what is its intermediate host?
|
Stomach worm of horses that causes proud flesh
IH is fly |
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What does Habronemia cause?
|
Proud flesh (summer sores)
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Why is Habronemia of little concern anymore?
|
IVM
|
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What are the 4 groups of life-threatening skin diseases?
|
Common uncontrolled skin diseases
Primary skin diseases Skin markers of systemic disease Drug effects |
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What are 3 common skin diseases that are difficult to control.
|
AD
Demodicosis Otitis externa/media |
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Name 2 primary life-threatening skin diseases
|
Mocardia infection
Sporotrichosis |
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Name 2 life-threatening systemic diseases that manifest as skin diseases
|
Hypothyroidism
Hypercortisolism |
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Name 6 cutaneous reaction patterns
|
Acute generalized lesion
Mucosal/mucocutaneous lesions Vesicles/bulla - ulcers Skin ulceration Nodular dermatitis Draining tracts **Any skin disease with clinical signs of systemic disease |
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What is EM?
|
Erythema multiforme - minor and major
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What is SJS?
|
Stevens-Johnson syndrome
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What is TEN?
|
Toxic epidermal necrolysis
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Is EM usually due to a drug reaction?
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NO
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Are SJS and TEN usually due to a drug reaction?
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YES (abx)
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How do you treat EM/SJS/TEN?
|
Drug withdrawl (SJS/TEN)
Supp care Pentoxyfylline (Trental) Immunoglobulin |
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What lesions (6) are associated with vasculitis
|
Purpura
Necrosis Ulcers Erythematous urticaria Inflamm nodules Ischemia and atrophy |
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What is the prognosis for EM?
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Poor
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What is the prognosis for TEN?
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Grave
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What is the therapy for vasculitis?
|
Address cause (drug, food, vaccine)
Glucocorticoids |
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What should you suspect in a case with focal truncal vasculitis?
|
Rabies vaccine
|
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What should you suspect caused urticarial vasculitis?
|
Food allergy (2/3 of time)
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What is the most likely cause of vasculitis?
|
Idiopathic
|
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What is the diagnostic of choice with life-threatening skin disease?
|
Histopath
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At what age are dogs typically affected witha n autoimmune skin disease?
|
Middle age (3-8 years)
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What are the 3 causes of autoimmune skin diseases?
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Drug induced
Solar induced Systemic disease |
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What is required for dx of an autoimmune skin disease?
|
Histopath
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What is the pathogenesis of pemphigus foliaceus?
|
Autoab get into intercellular cement (desmosomes) between keratinocytes
Loss of adhesion (acantholysis) Pustule formation - attracts inflamm cells |
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What is the difference between PF pustules and pyoderma pustules?
|
PF pustules are larger and span across hair follicles
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What is the lesion distribution difference between cats and dogs with PF?
|
Cats- more localized lesions
Dogs - more generalized |
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What is the primary lesion of PF?
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Pustule
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Where are lesions normally located on dog with PF (and how does this differ from pyoderma)?
|
Bridge of nose
Nasal planum Ear pinna Footpads Pyoderma usually starts as a truncal disease |
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Are the lesions of PF proliferative or ulcerative?
|
Proliferative (except ulcerative on footpad)
|
|
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What are 7 DDX for PF?
|
Dermatophytosis
Demodex Pyoderma Zn-responsive PE Lupus Hepatocutaneous syndrome |
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What additional locations could you find lesions on a PF cat (compared to a dog)
|
Peri-nipple
Nailbeds |
|
|
Why might there be systemic signs associated with PF?
|
PF affects exclusively the epithelium
Systemic signs if large amount of inflamm of skin or secondary infxn |
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What are 4 systemic signs associated with PF?
|
fEVER
Lethargy Inappetance Lymphadenopathy |
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What is always your first concern and rule out with PF?
|
PYODERMA
|
|
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What should you do (2 things) before histopath in a suspect PF case?
|
Culture and abx trial
|
|
|
What 4 things should you warn you clients of when starting treament for PF?
|
Life long therapy
Expense - high doses of pred so need to do CBC, UA, profile Side effects Some cases are refractory (but overall px is good) |
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Is PF affected by sunlight?
|
YES - prevent UV exposure
|
|
|
What are your choices for local treatment for PF?
|
Topical corticosteroids (hydrocortisone, flucinolone, betamethasone)
FA Vit E Tetracycline/Niacinamide |
|
|
What is your treatment of choice for generalized PF?
|
Prednisone (or Methylprednisolone but v. expensive)
|
|
|
What if you have a case of PF and pred is not working at all?
|
Switch to triamcinolone or dexamethasone
|
|
|
What if you have a case of PF and pred works a little?
|
Add an adjunct: Azathioprine or chlorambucil (cats)
|
|
|
How quickly should you expect to see pred working with PF case?
|
7-14 days
|
|
|
What are the negative effects of triamcinolone and what can you use to prevent?
|
GI side effects, ulcers, perforations
Prevent with GI protectants |
|
|
What are the side effects (2) of Azathioprine
|
BM suppression
Hepatoxicity (if inc ALT then worry!!) |
|
|
What is the most common auto-immune skin disease?
|
PF
|
|
|
What is the 2nd most common auto-immune skin disease?
|
DLE
|
|
|
Does UV light affect DLE?
|
Yes - worse in summer
|
|
|
What breeds are commonly affects by DLE?
|
Collies
Huskies Germ Shep |
|
|
How does DLE always begin?
|
Nasal planum/alar folds:
Loss of pigment (slate blue/grey) Loss of cobblestone Erosions, ulcers, crusts |
|
|
What are 3 common clinical signs associated with DLE?
|
Depigmentation of lips
Erosions/ulcers/crusts - periocular, pinna, distal limbs Hyperkeratosis - nose and footpads |
|
|
What are you top 4 DDX for nasal crusts?
|
DLE
PF Dermatophytosis Pyoderma |
|
|
How do you dx DLE?
|
HISTOPATH - want to see lupus band of inflamm cells
|
|
|
How do you treat DLE (3)?
|
SAME AS TREATING LOCALIZED PF:
Topical corticosteroids Vit E/EFAs Tetracycline/niacinamide |
|
|
What is the treatment of choice for DLE?
|
Tacrolimus ointment - Protopic
|
|
|
What do you need to warn th o about if using Protopic to treat DLE?
|
Wear gloves- may cause neoplasia
|
|
|
Does DLE ever progress to SLE?
|
no
|
|
|
What should be your top 2 differentials for a weird skin disease?
|
Lupus
Drug reaction |
|
|
What is the number 1 problem in patients with SLE?
|
Polyarthropathy
|
|
|
Besides polyarthropathy (number 1 sign) what are 3 other signs of SLE?
|
PLE
Anemia Thrombocytopenia |
|
|
What are 8 DDX for oral ulcers?
|
PV
Bullous pemphigoid SLE EM Mycosis TEN Burn Drug rxn Contact dermatitis |
|
|
Juvenile Cellulitis is aka (2)
|
Puppy strangles
Juvenile pyoderma |
|
|
What age of dogs get juv cellulitis?
|
3 wks - 4 mos
|
|
|
What is juv cellulitis?
|
Granulomatous, pustular disease
|
|
|
Is juv cellulitis infectious?
|
No
|
|
|
What are clinical sigs of juv cellulitis (6)?
|
Swollen face, lips, eyelids, muzzle
Pustules which fistulate and drain Crusts Swollen lymphnodes Pustular otitis Lethargy, fever, anorexia |
|
|
What does juv cellulitis cytology look like?
|
Pyogranulomatous without organisms
|
|
|
How do you treat juv cellulitis?
|
Pred
|
|
|
What is SND and what is it aka?
|
Superficial necrolytic dermatitis
Hepatocutaneous syndrome |
|
|
What age and what siz dogs normally get SND?
|
10 YEARS
Small breeds |
|
|
What do you see first with SND - skin or hepatic/pancreatic signs?
|
Skin
|
|
|
What 2 internal organis are involved with SND?
|
Idiopathic hepatic disease
Pancreatic glucagonoma |
|
|
Where does SND skin lesions typically start?
|
Feet
|
|
|
What surfaces are usually involved in SND (2)?
|
FEET
M/C junction Also, legs, pinna, trunk, nails, muzzle, frictinal sites sometimes |
|
|
What is a DDX of SND?
|
PF
|
|
|
How do you get a definitive DX with SND?
|
Histopath - red, white, blue
|
|
|
What is the treatment for SND (2)?
|
Treat secondary infxn
Amino acid supp |
|
|
What is the px for SND?
|
guarded-poor; most survive <6 mos
|
|
|
What is term for abn claw formation
|
Onychodystrophy
|
|
|
What is term for curved, ingrown nail?
|
Onychogryphosis
|
|
|
What is term for sloughing of nail?
|
Onychomadesis
|
|
|
What is term for soft nail?
|
Onychomalacia
|
|
|
What is term for nail fold inflamm?
|
Paronychia
|
|
|
What are claw diseases usually secondary to (2)?
|
CAFR
AD |
|
|
What causes claw diseases (5)?
|
Trauma
Infections Immune-mediated (SLO) Neoplasia Idiopathic |
|
|
What is SLO?
|
Systemic lupoid onychodystrophy; an immune-mediated dz of the claw
|
|
|
What is the age and typical size of dogs affected by SLO?
|
5 YEARS
Larger dogs |
|
|
What is a typical history of dog with SLO (4)?
|
sLOUGHING NAILS (ONYCHOMADESIS)
+/- Lameness Licking feet Chronic (maybe waxing/waning) |
|
|
What is term for brittle claws with longitudinal fractures?
|
Onychorrhexis
|
|
|
What are typical clinical findings of dog with SLO (5)?
|
Onychodystrophy
Onychorrhexis Onychomadesis Paronychia Multiple feet Abnormalities limited to nail and nailfold |
|
|
What is the etiology of SLO?
|
Unknown
|
|
|
How can you get a diagnosis with SLO?
|
Biopsy (excision of P3) - need to see lupoid band
|
|
|
How do you treat SLO (4)?
|
Treat secondary infections
Tetracycline/Niacinamide +/- pred EFA Vit E |
|
|
How long do you need to treat for SLO?
|
Lifelong
|
|
|
What is the px for SLO?
|
excellent to good
|
|
|
What are 3 goals of SLO treatment?
|
Eliminate secondary infxn
Eliminate pain/paronychia Normalize majority of nails |
|
|
What is a noduule?
|
Elevated, >1cm; extends to deeper tissue
|
|
|
What is a tumor?
|
V. large mass, >10cm
|
|
|
How big is a papule?
|
<1cm
|
|
|
What could be the etiology behind an acute nodule (5)?
|
Trauma
FB Insect bite Acral lick granuloma Secondary bac infxn |
|
|
What are 3 types of chronic nodular dermatitis?
|
Infectious
Sterile Neoplastic |
|
|
When should you biopsy a chronic nodular dermatitis?
|
Day 1 (send for histopath and culture)
|
|
|
When doing a biopsy for culture or histopath, should you choose an ulcerated or non-ulcerated nodule?
|
Non-ulcerated
|
|
|
How does preparation of site for biopsy differ for histopath and culture
|
Histopath - do not clean/wipe
Culture - aseptic!! |
