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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)?
Pyoderma
Demodicosis
Dermatophytosis
What are the 2 categories of falling out/non-pruritic alopecia
Inflammatory
Non-inflammatory
What are the 2 categories of alopecia?
Pruritic
Non-pruritic
What are the 2 categories of non-pruritic, non-inflammatory alopecia?
Dystrophy/dysplasia
Hair cycle arrest
What are 5 types of inflammatory, non-pruritic alopecia
Sebaceous adenitis
Dermatomyositis
Alopecia areata
Traction alopecia (groomer)
Injections site reaction (rabies and distemper, often seen months after injection)
What are 4 types of pruritic alopecia
Allergies
Parasites
Pyoderma
Malassezia
What are 3 types of non-pruritic, non-inflammatory alopecia due to dystrophy
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)
What are 6 types of non-pruritic, non-inflammatory alopecia due to hair cycle arrest
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)
What is more common cause of alopecia, dystrophy/dysplasia or hair cycle arrest?
Hair cycle arrest
Major cause of alopecia in K9 and Fe?
self-trauma associated with pruritis
What are the 4 initital diagnostics in animals with non-pruritic alopecia?
Depp skin scrapes
Surface cytology
Wood's lamp
Dermatophyte culture
What is the most common additional diagnostic test in animal with non-pruritic alopecia
skin biopsy
What is demodicosis?
INFLAMMATORY parasitic disease characterized by larger than normal numbers of demodectic parasites
What are the 2 demodectic mites in dogs and which is bigger
D. injai > D. canis
Where do D. injai and D. canis live in the dog?
Follicles
D. canis spends the entire life cycle on the ____
SKIN
Can you differentiate the larvae of D. canis from the adult?
YES
Larvae = 6 legs
Nymph and Adult = 8 legs
How do 2-3 day old nursing puppies get infected with democidosis?
Mom
What is the current proposed pathogenesis of Demodicosis?
Mite-specific immunoincompetence - depressed T cell function
What are the 2 main types of Demodicosis and their subtypes?
Localized
Generalized - juvenile and adult onset
Does pododemodicosis occur with adult or juvenile onset demodicosis?
It may occur with either
What body parts are localized demosicosis seen?
Face
Forelimbs
Name 2 DDX for localized demodicosis?
Pyoderma
Dermatophytosis
Should you treat localized demodicosis?
HECK NO - 90% spontaneously resolve (10% will become generalized and you should treat these)
What are the 3 types of generalized demodicosis?
Squamous
Pustular
Pododemodicosis
Are secondary infections common in squamous generalized demodicosis?
NO
Are secondary infections common in pustular generalized demodicosis?
YES - mostly gram neg
Describe squamous generalized demodicosis
Scaly, alopecic patches that may coalesce, erythema, crusting, follicular plugging, comedones, hyperpigmentation
Describe pusutlar generalized demodicosis
Alopecia, papules, pustules, furuncles, draining tracts, cellulitis, edema, ulcers, erosions, nodules, depressed, lethargic, febrile, septicemia, lymphadenopathy
What is the age cut off for adult/juvenile-onset demodicosis?
Small breed - 1 year
Large breed - 1.5 years
What are some concurrent diseases you may see in animals with adult onset generalized demodicosis?
Glucocorticoid admin - MOST COMMON
Hyperadrenocorticism
Chemo
Hypothyroidism
Neoplasia
What are the number of body parts involved requirements for generalized demodicosis?
Entire body region
2+ feet
5+ localized lesions
In what 2 scenarios might you not see demodex mites on a deep skin scrape and what should you do?
Fibrotic lesions (feet)
Chinese shar-pei
Biopsy!!
What 3 other diagnostics do you run of the animal has juvenile-onset localized and generalized demodicosis?
HW test
Fecal exam
Make sure on good diet
What 6 additional diagnostics do you run if the animal has adult-onset generalized demodicosis?
CBC
Biochem profile
Urinalysis
Diet check
HW test
Fecal float
What do you do if the dog has localized demodicosis with a secondary pyoderma infection? Should you use steriods?
Oral antibiotics
Topical benzoyl peroxide
NEVER USE STEROIDS ON A DEMODICOSIS DOG
What do you do if the dog has generalized demodicosis?
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
What is the only FDA approved therapy for demodicosis?
Amitraz - Mitaban, a borad spectrum MAOI and an a-adrenergic agonist
What is the protocol for doing a Mitaban dip?
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
How often are Mitaban dips performed?
Every 2 weeks (do skin scrapes prior to dip)
When is demodicosis controlled with Mitaban dips?
2 consecutive visits when all skin scrapings are negative (still need to perform 2 more dips)
When is demodicosis cured with Mitaban dips?
1 year from last dip
What are the side effects of Mitaban dips?
sedation, depression, pruritis, vomiting, anorexia, hypothermia, bradycardia, hypotension, hyperglycemia, mydriasis
What do you do if the side effects of Mitaban are severe?
Give Yohimbine (0.1 mg/kg IV) and RINSE THE DOG!!
What is the cure rate for juv and adult onset demodicosis using Mitaban?
Juv-onset: 60-80% cured
Adult onset: 21% cured and 65% improved
What do you do with generalized demodicosis resistant cases?
Use Mitaban weekly and increase concentration to 0.05%
Ivermectin - most commonly used in private practice, not FDA approved
Milbemycin - not FDA approved
Which breeds can Ivermectin NOT be used on?
Herding breeds-collies, shelties, Old Eng Sheepdogs
What are signs of Ivermectin and Milbemycin Oxime toxicity?
ataxia, hypermetria, disorientation, hyperesthesia, tremors, hyperreflexia, mydriasis, hypersalivation, depression, blindness, coma, death, vomiting, diarrhea, anorexia
What is the physiology behind collies with sensitivity to ivermectin?
Deletion mutation of mdr1 gene; homozygous for deletion display signs
mdr = multidrug resistance
What percent of collies are sensitive to ivermectin?
35%
What is control and cure for demodicosis using ivermectin or milbemycin oxime?
Control = 2 negative consecutive deep skin scrapes (continue treatment for 1-2 weeks)
Cure = 1 year after last dose
Which dosage of ivermectin controlled the demodicosis 5 weeks sooner than the others?
0.6 mg/kg q 24 hours
What must you make sure before treating demodicosis with ivermectin or milbemycin oxime?
HW NEGATIVE!!
Should you use Taktic (amitraz) or doramectin to treat demodicosis?
NOPE
What is in ProMeris and should it be used to treat demodicosis?
Amitraz and metaflumizone
Efficacy is questionable
What is in Advantage Multi and should it be used to treat demodicosis?
Moxidectin and imidicloprod
Efficacy is questionable
Is feline demodicosis common?
NO it is rare
Name the 3 types of demodex mites in cats and where they live on host?
D. cati - follicular mite
D. gatoi - st. corneum
Undescribed mite - ??
What are the clinical signs associated with D. cati (localized vs. generalized)?
Localized (chin,periorbital) - alopecia and scaling
Generalized (entire body, flank, groin, head, neck) - alopecia, scaling, papules, crusting, erythema, hyperpigmentation
Ceruminous otitis externa
What are the 3 presentations of D. gatoi?
Alopecia, scaling, crusted lesions of head, neck, elbows
Erythema, hyperpigmentation, stubby hairs of proximal rear legs, flanks, and ventrum
Ventral alopecia - MOST COMMON PRESENTATION
If your cat has demodicosis and papules, what mite is it infected with?
D. cati
If your cat has demodicosis and is pruritic, what mite does it have?
D. gatoi
How do you treat feline localized and generalized demodicosis?
Localized - no TX - usually self-limiting
Generalized - 2% lime sulfur dips 4-6 times per week; treat all contact animals if D. gatoi
Why do you need to determine if your cat with demodicosis is infected with D.cati or D. gatoi
D .gatoi is contagious and all contact animals should be treated
What is the most common endocrine disorder?
Hypothyroidism
What is primary hypothyroidism, how common is it, and what will the lab values be for TSH and T4
A problem with the thyroid
95% of hypothyroidism cases
Inc TSH
Dec T4
What is secondary hypothyroidism, how common is it, and what will the lab values be for TSH and T4?
A problem with the pituitary
5% of hypothyroidism cases
Dec TSH
Dec T4
What is tertiary hypohyroidism, how common is it, and what will the lab values be for TSH and T4?
A problem with hypothalamus
Very rare
Dec TSH
Dec T4
What are the 2 types of primary hypothyroidism and which is more common?
Lymphocytic thyroiditis (autoimmune) - 50-60%
Idiopathic thyroid atrophy
What is the typical age of onset with canine hypothyroidism?
6-10 years (may be younger in larger breeds)
What are the classic signs (4) of canine hypothyroidism?
Lethargy
Depression
Weight gain
Cold intolerance
What are the 4 most common cutaneous signs associated with canine hypothyroidism?
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
What are the classical (4) systemic signs of canine hypothyroidism?
Lethargy
Depression
Obesity
Cold intolerance

Other sgns include cardiovascular, ocular, neuromuscular (myxedema coma), reproductive
Uusally hypothyroidism is not a dx you need to rush, except when animal presents with ______
Myxedema coma - mucin accumulates in CSF and will go into coma
What lab abnormalities might you see on CBC with hypothyroidism?
Nonreg anemia
What lab abnormalities might you see on Biochem profile with hypothyroidism?
Hypercholesterolemia (may also increase with Cushing's or recently fed)
Mild inc ALP
Inc creatinine kinase
What 3 things might cause a low T4?
Hypothyroidism
Euthyroid sick syndrome
Drug effects
What are some drugs (5) that lower T4?
Corticosteroids
NSAIDS
Anticonvulsants (phenobarb)
Sedatives/anesthetics
Sulfa antibiotics
What is TT4 and when is it most useful to measure??
Total T4 - free and protein bound T4
Rule out hypothyroidism if normal
(affected by concurrent drugs/dz)
What is T3?
Intracellular product of circulating T4
Should you use TT3 and fT3?
Not helpful and more likely to confuse
What is fT4?
Unbound T4 that will be taken up by cells (affected by drugs and disease)
Which thyroid measurement is least affected by concurrent disease, drugs, and T4AA
Free T4 by equilibrium dialysis (fT4D) - still decreased by corticosteroids
What non-thyroid issue will artifactually decrease fT4D?
corticosteroids
What thyroid blood measure is the most expensive?
fT4D
Is cTSH inc or dec in primary hypothyroidism?
Increased
Is cTSH inc or dec in secondary and tertiary hypothyroidism?
Decreased
How can you imrprove the accuracy of the cTSH test?
Evaluate in addition to TT4, fT4, fT4D
Which of the following is the most useful: TgAA, T4AA, T3AA
TgAA
Why would TgAA be increased?
Lymphocytic thryoiditis - do not breed!!
What is the best single thyroid test?
fT4D
Are skin biopsies helpful in diagnosing endocrinpoathies?
Not really - results say "endocrinopathy" but not specific for what endocrinopathy specifically
What drug do you treat hypothyroidism with?
L - thyroxine
What is the maximum L-thyroxine dose?
0.8mg q 12 hours
If the dog has ___, ____, or ____ concurrent diseases, you should use a lower leve of L-thyroxine
Heart disease
DM
Hypoadrenocorticism
What are 7 side effects of L-thyroxine?
Tachycardia
Polyphagia
PU
PD
Panting
Excitability
Nervousness
When should you re-evaluate TT4 levels in dog on L-thyroxine?
6 weeks afer beginning treatment and 6 hours post-pill
What are 6 reasons for a hypothyroid dog's poor response to L-thyroxine treatment?
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
What are the 2 types of hypercortisolism?
Spontaneous
Iatrogenic
What are the 2 types of spontaneous HC?
Pituitary dependent (PDH)
Adrenocortical tumor (AT)
What is more common - PDH or AT?
PDH (80-90%)
What is pituitary dependent hypercortisolism?
ACTH - secreting pituitary neoplasia
Is ACTH high or low in PDH?
High
Is ACTH high or low in AT?
Low
What is an adrenocortical tumor (AT)?
an adenoma/carcinoma; usually unilateral
What are typical clinical signs of endocrine alopecia?
Truncal hair loss
Bilateral alopecia
Non-pruritic
How old is the typical Cushing's dog?
>6y
Which form of spontaneous hypercortisolism is more common in dogs <20kg; >20kg?
<20 kg = 75% are PDH
>20 kg = 50% are AT
What are the (4) most common clinical signs of a dog with hypercortisolism?
PU/PD
Polyphagia
Abdominal enlargement
Weakness/lethargy
What does the haircoat look like on a dog with hypercortisolism?
Loss of sheen/luster
Alopecia mostly truncal
Patchy - bilaterally symmetric
Poor hair regrowth
What does the skin look like on a dog with hypercortisolism?
Thin and hypotonic
Easily bruised
Comedones
Poor healing
Hyperpigmentation (more common in hypoT4)
What are some common secondary infections in a dog with hypercortisolism?
Pyoderma
Yeast
Demodicosis
What is the most common underlying disease in adult-onset generalized demodicosis?
Hypercortisolism
Calcinosis cutis is pathoneumonic for what diesease?
Hypercortisolism
What 4 locations on the body do you normally see calcinosis cutis?
Dorsal neck
Rump
Axilla
Inguinal
What are some systemic signs you see with hypercortisolism?
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
What abnormalities (5) might you see on a CBC of a dog with hypercortisolism?
Leukocytosis
Neutrophilia
Lymphopenia
Eosinopenia
Erythrocytosis
What abnormalities (4) might you see on a Biochem panel of a dog with hypercortisolism?
Hyperglycemia
Increased cholesterolemia (90%)
Increased ALP and ALT
Decreased TT4 and fT4
What abnormalities (2) might you see on a Urinalysis of a dog with hypercortisolism?
Low SG
Bacturia and UTI
**Do not catheterize**
What abnormalities (5) might you see on radiographs of a dog with hypercortisolism?
Hepatomegaly
Full bladder
Dystrophic calcification
Osteoporosis
Calcified adrenal glands
What are the most commonly used best 2 tests to confirm hypercortisolism? What are 3 other tests?
ACTH stim
Low dose dex
Urine cortisol:creatinine ratio
CiALP
17-OHP
What is the best test to differentiate iatrogenic from sponteneous hypercortosolism?
ACTH stim
What drug do you give for the ACTH stim test?
Cortrosyn
What if the 1 hour post ACTH stim sample of cortisol is >26ug/dL?
Spontaneous hypercortisolism
What if the 1 hour post ACTH stim sample of cortisol is <normal?
Iatrogenic hypercortisolism (Addison's disease)
What is the protocol for ACTH stim test?
Pre- and 1 hour post-ACTH cortisol levels; give Cortrosyn
What is the protocol for the Low Dose Dex Suppression test?
Serum samples for cortisol assay at 0 and 8 hours; give 0.015 mg/kg dex
What if the 8 hour sample of a LDDS test is <1.0 ug/dL?
Normal
What if the 8 hour sample of a LDDS test is >1.8 ug/dL?
Hypercortisolism
What if the urine cortisol:creatinine ratio is <35 units of nmol/L
Rules out hypercortisolism
What is a good screening test for hypercortisolism?
Urine cortisol:creatinine ratio (if neg it rules out HC)
What if the urine cortisol:creatinine ratio is positive?
Suggestive (but not diagnostic) of hypercortisolism - the dog could be highly stressed
What if the CiALP results came back >90 IU/L?
Suggestive but not diagnostic of hypercortisolism
What is the CiALP results came back <90 IU/L?
Normal
Why is the 17-OHP test better than ACTH stim and LDDS test?
More sensitive
What if the 17-OHP test comes back >1.32 ng/mL
Hypercortisolism
What are 3 ways to differentiate PDH from AT?
HDDS
U/S, CT, MRI
cACTH
Why do you use HDDS?
To differentiate PDH from AT (not to dx HC)
Why do we use LDDS?
To dx HC
What is the protocol for HDDS?
Measure serum cortisol at 0h and 8h; give 0.1 mg/kg dex IV after taking 0h measurement
What if the 8 hour sample of HDDS test is <1.5 ug/dL?
PDH
What if the 8 hour sample of HDDS test is >1.5 ug/dL?
100% dogs with AT
20-30% dogs with PDH
What do the adrenals look like on U/S with PDH?
Bilat adrenal hyperplasia
What do the adrenals look like on U/S with AT?
Unilat adrenal enlargement
What if the cACTH assay comes back 20-100 pg/mL?
Normal or maybe PDH
What if the cATCH assay comes back <20pg/mL?
AT
What if the cATCH assay comes back >40pg/mL?
PDH or maybe normal (20-100 is normal)
What are your treatment options if you dx PDH?
Medical - Lysodren or Trilostane
Surgery
Radiation
What are your treatment options if you dx AT?
Medical (only if SX is not possible) - Lysodren, Trilostane, Ketoconazole
Surgery - adrenalectomy (BEST OPTION!)
Why would you use Lysodren in a patient with AT?
Only if surgery is not possible.
What does Lysodren do in a patient with PDH?
Controlled destruction of adrenals to limit production of cortisol
What is a concern of using Lysodren in a patient with PDH and what 6 things should you monitor for?
Total destruction of adrenals causing iatrogenic hypoadrenocorticism

Decreased water intake
Anorexia
Vomiting
Diarrhea
Weakness
Ataxia
What is op'DDD?
Lysodren - used to treat PDH
What are some side effects (7) of Lysodren? How would you overcome an acute crisis?
Anorexia
Weakness
Lethargy
Ataxia
Coma
Hypoglycemia
Electrolyte disturbances

Dispense pred to overcome an acute crisis
When would you monitor a patient's response to long-term Lysodren
every 3-6 months
How does Trilostane compare to Lysodren?
Trilostane is imported from Canada and is safer than Lysodren because it does not destroy the adrenal gland
What are your surgery options in a PDH patient?
Hypophysectomy
Bilateral adrenalectomy
What are your surgery options in an AT patient?
Unilateral adrenalectomy
What is the px for a PDH patient?
2 y life expectancy
What is the px for an AT patient?
Unilateral adrenalectomy - curative
No sx - 1 year
What are the origins of sex hormones in an animal?
ADRENAL GLANDS
GONADS
MALE - sertoli cell tumor, testosterone-responsive dermatosis
FELMAE - hyperesrogenism, estrogen-responsive dermatosis
What should you do if an intact animal is developing an endocrine alopecia?
Castrate them and see if it gets better
What happens to an animal with adrenal sex hormone related alopecia that had a biopsy or trauma?
Hair regrowth
What is the typical age and hair coat of a dog with adrenal sex hormone-related alopecia?
1-3 years old
Plush coat breeds
What 2 diseases should you rule out if you think you have adrenal sex hormone-related alopecia?
HypoT4
Hypercortisolism
Does Alopecia X harm the animal systemically?
NO
How can you treat Alopecia X?
STERILIZATION!!
Mitotane
Melatonin
Trilostane
ABOVE ALL ELSE - DO NO HARM (ALOPECIA X DOES NOT HARM ANIMAL SYSTEMICALLY)
If a dog looks like it has dermatophytosis, it probably has...
Pyoderma
What are 2 issues if a human/animal is infected with dermatophytosis and is immunosuppressed?
Easily infected
Difficult to treat (body must be able to respond to antifungals for the antifungals to actually work)
What is dermatophytosis?
Cutaneous infection with keratinophilic fungi that invades hairs in the anagen phase.
Where is M. canis from?
Infected cats
Where is M. gypseum from?
Soil
Where is T. mentagrophytes from?
Rodents
What is the most common dermatophyte of cats?
M. canis
Can dermatophytes be isolated from normal animals?
YES (~35% of long haired cats)
What is the pathogenesis of dermatophytosis?
Infected cats/env/fomites - invasion of anagen hairs - production of arthrospores - folliculitis
What are the 3 DDX for folliculitis?
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)
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
How do you treat gasterophilus?
IVM or MOXI
Wash legs with warm water and mild detergent
How do you treat cuterebra?
Remove grub - sx, vaseline over breathing hole
Clean wound after removal
How do you control cuterebra?
Heartworm prophylaxis - IVM
How do Oestrus ovis affect their host?
Live in nasal cavities of wild ruminants
Compression of pharyngeal pouches - affects vagus n. - rumenal atony
What is fly strike?
Myiasis secondary to filth; underlying skin has lesions (due to moisture, bac, fungi) entered by maggots
How do you treat fly strike?
Clip hair
Debride lesions
Supportive treatment if septic
Antibiotics
Topical insecticides - macrocyclic lactones
What size wound do screw worms need to enter host?
V. small - tick bite size
Why are screw worms so impt?
Reportable dz
Why are screw worms so destructive?
Eat living tissue
What is Habronemia and what is its intermediate host?
Stomach worm of horses that causes proud flesh
IH is fly
What does Habronemia cause?
Proud flesh (summer sores)
Why is Habronemia of little concern anymore?
IVM
What are the 4 groups of life-threatening skin diseases?
Common uncontrolled skin diseases
Primary skin diseases
Skin markers of systemic disease
Drug effects
What are 3 common skin diseases that are difficult to control.
AD
Demodicosis
Otitis externa/media
Name 2 primary life-threatening skin diseases
Mocardia infection
Sporotrichosis
Name 2 life-threatening systemic diseases that manifest as skin diseases
Hypothyroidism
Hypercortisolism
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
What is EM?
Erythema multiforme - minor and major
What is SJS?
Stevens-Johnson syndrome
What is TEN?
Toxic epidermal necrolysis
Is EM usually due to a drug reaction?
NO
Are SJS and TEN usually due to a drug reaction?
YES (abx)
How do you treat EM/SJS/TEN?
Drug withdrawl (SJS/TEN)
Supp care
Pentoxyfylline (Trental)
Immunoglobulin
What lesions (6) are associated with vasculitis
Purpura
Necrosis
Ulcers
Erythematous urticaria
Inflamm nodules
Ischemia and atrophy
What is the prognosis for EM?
Poor
What is the prognosis for TEN?
Grave
What is the therapy for vasculitis?
Address cause (drug, food, vaccine)
Glucocorticoids
What should you suspect in a case with focal truncal vasculitis?
Rabies vaccine
What should you suspect caused urticarial vasculitis?
Food allergy (2/3 of time)
What is the most likely cause of vasculitis?
Idiopathic
What is the diagnostic of choice with life-threatening skin disease?
Histopath
At what age are dogs typically affected witha n autoimmune skin disease?
Middle age (3-8 years)
What are the 3 causes of autoimmune skin diseases?
Drug induced
Solar induced
Systemic disease
What is required for dx of an autoimmune skin disease?
Histopath
What is the pathogenesis of pemphigus foliaceus?
Autoab get into intercellular cement (desmosomes) between keratinocytes
Loss of adhesion (acantholysis)
Pustule formation - attracts inflamm cells
What is the difference between PF pustules and pyoderma pustules?
PF pustules are larger and span across hair follicles
What is the lesion distribution difference between cats and dogs with PF?
Cats- more localized lesions
Dogs - more generalized
What is the primary lesion of PF?
Pustule
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
Are the lesions of PF proliferative or ulcerative?
Proliferative (except ulcerative on footpad)
What are 7 DDX for PF?
Dermatophytosis
Demodex
Pyoderma
Zn-responsive
PE
Lupus
Hepatocutaneous syndrome
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
What are 4 systemic signs associated with PF?
fEVER
Lethargy
Inappetance
Lymphadenopathy
What is always your first concern and rule out with PF?
PYODERMA
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)
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!!