Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
87 Cards in this Set
- Front
- Back
|
Diagnosis of dermatophytosis
|
Wood's lamp
KOH prep (trichogram) **Fungal culture** Histopath |
|
|
When to use fecal float
|
Recommended for pruritic patients
Look for demodex, sarcoptes, cheyletiella |
|
|
Database
|
Skin scraping, trichogram, impression smear, fungal evaluation
|
|
|
Localized demodicosis
|
Any age (usually <1)
Scaling, alopecia, erythema on eyes, nose, mouth No tx |
|
|
Generalized demodicosis
|
Usually <1
Alopecia, scaling, erythema, crusts, pustules, draining tracts, *folliculitis, furunculosis*, systemic signs *Secondary infections are common* (then pruritis is present) |
|
|
Generalized demodicosis (adult)
|
Usually have systemic disease (e.g. neoplasia, immunosuppression)
Guarded prognosis |
|
|
Diagnosis of demodex
|
Skin scraping (squeeze skin)
Trichogram Biopsy |
|
|
Treatment of localized demodicosis
|
Time
Topical: Benzoyl peroxide Rotenone Amitraz |
|
|
Treatment of generalized demodicosis
|
**Treat pyoderma with antibiotic therapy and topical tx**
Shampoos, hydrotherapy Topical: Amitraz/Mitaban*, organophosphates (rinses), Metiflumazone Systemic: Milbemycin/Interceptor, Ivermectin - Not selamectin |
|
|
Feline demodicosis (surface mite, demodex gatoi)
|
May only see pruritus (symmetrical alopecia from licking)
Contagious Diagnosis by skin scrapings, fecal, histopath Treatment is lime sulfur rinses |
|
|
Demodicosis contraindications
|
**Corticosteroids**
|
|
|
Scabies
|
Highly contagious; zoonotic (ask owners about lesions)
Hallmark signs are *intense pruritus and scaling on ears*; others are lymphadenopathy, crusts, scaling, alopecia, excoriations Responds briefly to glucocorticoids Seen at periocular area, ears, elbows, extremities |
|
|
Diagnosis of scabies
|
*Skin scrapings*, history of owner's lesions histopath showing mites
|
|
|
Treatment of scabies
|
Treat immediately if suspected
Rinses (sulfur/salicylic acid for crusts, lime surfur, amitraz); shampoos for secondary infection (benzoyl peroxide, ketoconazole) Topical: Fipronil spray, *Selamectin*, Milbemycin/Interceptor |
|
|
Cheyletiella
|
Pruritis, scaling, crusts, excoriations
Observe directly; tape preparations; skin scrapings; fecal float; flea comb + KOH |
|
|
Cheyletiella treatment
|
Ivermectin, Selamectin, topical acarides (lime sulfur, amitraz), disinfecting environment
|
|
|
Notoedres/feline scabies
|
Scaling, erythema, crusts around head, possible lichenification; intense pruritus
Highly contagious |
|
|
Treatment of notoedres
|
Topical acarides (lime sulfur)
Ivermectin (oral), Selamectin (topical) Clean environment |
|
|
Otodectes
|
Pruritus in ears, dark exudate by ear canal
Visualize mites by otoscopy, cytology |
|
|
Treatment of otodectes
|
Clean ears
Topical: Ivermectin, pyrethrin, rotenone, thiabendazole; treat rest of body with insecticide Systemic acarides: Selamectin, Ivermectin Clean environment |
|
|
Fleas
|
Diagnosis: visualization of adults, flea dirt
Treatments: pyrethrin, pyrethroid (permethrin*)= shampoo, Malathion* (organophosphate), Imidacloprid (>2 months), Nitenpyram/Capstar, Fipronil/Frontline, Selamectin/Frontline Insect growth regulators: juvenile hormone analogs = methoprene, fenoxycarb, pyriproxifen; chitin inhibitors = lufenuron (prevention), cyromazine |
|
|
Dermatophytosis
|
Microsporum canis, microsporum gypseum, trichophyton mentagrophytes
Circular alopecia, erythema, crusts, scales, hyperpigmentation, nodules, pustules, brittle/broken hairs, mild/moderate pruritus, folliculitis, furunculosis Highly zoonotic |
|
|
Diagnosis of dermatophytosis*
|
*Fungal culture plus microscopic evaluation
**Diagnosis should not be based on the color change of Dermatophyte Test Medium (must differentiate sacrophyte or pathogen) |
|
|
Treatment of dermatophytosis
|
Bathe weekly (miconazole-chlorhexidine shampoo, Malaseb)
Systemic therapy: Griseofulvin, Azoles, (Lufenuron,) Terbinafine Decontaminate environment |
|
|
Malassezia
|
Yeast associated with atopy** (primary factor); malassezia is perpetuating factor
Signs: *Severe pruritus, partial response to glucocorticoids, licking feet, rubbing face, otitis externa, looks like atopy out of control, scales, crusts, lichenification, hyperpigmentation, lymphadenomegaly |
|
|
Differential diagnoses for pruritus
|
Dfdx pruritus= Scabies, flea allergy dermatitis, seborrhea
|
|
|
Diagnostics for malassezia
|
History, PE, derm database, allergy tests, endocrine tests, hematology; demonstrate by *impression smears*
|
|
|
Control of bacterial infections
|
Topical benzoyl peroxide, oral cephalexin
|
|
|
Treatment of malassezia
|
Topical: benzoyl peroxide, azoles; oral cephalexin
Shampoo: selenium sulfide for greasiness, antifungal for yeast Systemic: Imidazole (ketaconazole in dogs, itraconazole in cats) Watch for recurrence, use maintenance therapy |
|
|
Predisposing factors of pyoderma
|
Signalment (IgA deficiency); anatomic factors (skin folds, hair coat type); environmental factors (temperature, humidity, frequent swimming)
|
|
|
Primary factors of pyoderma
|
Allergies (**atopy**, adverse reactions to food); ectoparasite infestations (skin irritation/excoriation); scaling/cornification disorders (familiar seborrhea); immunodeficiencies (demodicosis); endocrinopathies (*hypothyroidism*, hypoadrenocorticism)
|
|
|
Pyoderma
|
Signs: papules, pustules, epidermal collarettes (classical sign), erythema, scales, crusts, patchy alopecia (classical for folliculitis), draining tracts (classical for furunculosis), mild pruritus
|
|
|
Differential diagnoses for pustules
|
Pyoderma*, autoimmune skin diseases, dermatophytosis, eosinophilic dermatitis, pyogranulomatous dermatitis, panniculitis, pemphigus foliaceous
|
|
|
Pyoderma diagnostics
|
Database (scrapings, trichogram, impression smear, fungal evaluation), cytology** (indicated for pustules or draining tracts); culture and susceptibility if recurring cases or unexpected cytology
|
|
|
Pyoderma treatment
|
Topical: benzoyl peroxide, mupriocin
Shampoo: benzoyl peroxide, chlorhexidine, triclosan, sulfur/salicylic acid, ethyl lactate for folliculitis Systemic: Cephalexin, fluoroquinolones, penicillins |
|
|
Acute moist dermatitis/hot spots
|
Intense painful pruritus, acute onset, hair often matted at site (crusts, ulcers, edema, self-induced alopecia)
Clip, clean, dry, systemic antibiotics, short term glucocorticoids (pred) |
|
|
Impetigo/puppy pyoderma
|
Poor nutrition etc.
<9 months Pustular formation --> crusts --> collarettes Ventral positioning Treat primary factors, use topical antibacterials (BPO), systemic antibiotics |
|
|
Canine acne
|
Folliculitis/furunculosis of chin
Spontaneous resolution or: BPO, mupirocin, systemic antibiotics |
|
|
Folliculitis
|
*Causes: demodicosis, dermatophytosis, staph infections*
Papule (may lead to furunculosis/deep pyoderma); --> pustules --> epidermal collarettes *Atopy and hypothyroidism are most likely predisposing factors* Signs (often short-haired) = *moth-eaten, patchy alopecic* hair coat (mild pruritus) |
|
|
Treatment for folliculitis
|
Topical (antibacterial shampoos, BPO), mupirocin
Systemic antibiotics (cephalexin) |
|
|
Furunculosis
|
Progression of folliculitis; --> **draining/fistulous tracts (bloody, sanguinous discharge)**; pruritic; scar-forming alopecia
|
|
|
Treatment of furunculosis
|
Whirlpools, systemic antibiotics (not antibacterial shampoos); surgical intervention; client education
|
|
|
Conditions mimicking pyoderma
|
Juvenile cellulitis, dermatophytosis, autoimmune (pemphigus), FB reactions, pyogranulomatous disease
Also - cutaneous lymphoma, malassezia, cutaneous mycoses, |
|
|
Atopy
|
Type I hypersensitivity reaction
Primary factor for: recurring pyoderma, malassezia, *otitis externa* 9 months - 3 years **Pruritus is the hallmark** (licking feet, rubbing face, perineal pruritus) **Will respond to glucocorticoid therapy unless there is a secondary bacterial or yeast infection (common)** |
|
|
Signs of atopy
|
Erythema, excoriation, scales --> hyperpigmentation, lichenification
Seen in thin-skinned areas (ventral, periocular, perianal, ear |
|
|
Diagnosis of atopy
|
Database plus intradermal allergy testing (may be seasonal)
|
|
|
Treatment for atopy
|
**Control of perpetuating factors (anti-fungal, anti-bacterial)**; short-acting glucocorticoids --> alternate day therapy [prednisone in dogs, prednisolone in cats], antihistamines, fatty acids, topicals, cyclosporine, allergen-specific immunotherapy. Consider combination therapy.
Shampoos: colloidal oatmeal (keratolytic, absorbs water) |
|
|
Responses to glucocorticoids
|
Responsive: atopy
Semi-responsive: scabies, malassezia, pyoderma, contact allergy Non-responsive: ARF and behavioral |
|
|
Treatment failure of atopy
|
*Be sure of the diagnosis and consider coexisting problems (e.g. ARF)
**Check carefully for Malassezia and pyoderma - treat!** |
|
|
Flea allergy dermatitis
|
Hypersensitivity from flea salivary injection
Signs are dorsolumbar and ventral abdomen; *fleas may not be present at time of examination* Cats may have miliary dermatitis |
|
|
Diagnosis of flea allergy dermatitis
|
Distribution (dorsolumbar, ventral abdomen), fleas/dirt, intradermal skin testing, response to flea control
|
|
|
Treatment of flea allergy dermatitis
|
Flea control, glucocorticoids (prednisone), treatment of secondary infections
|
|
|
Adverse reactions to food
|
Non-immunologic (not based on exposure)
Any age On same diet for an extended time Poorly responsive to glucocorticoid therapy |
|
|
Signs of ARF
|
Resembles atopy, non-seasonal (face rubbing, foot licking), otitis externa, recurrent (interdigital) pyoderma/folliculitis
|
|
|
Diagnosis of ARF
|
No response to glucocorticoids, NOT allergy testing; elimination diet, provocative exposure (control secondary infections simultaneously)
|
|
|
Differential diagnosis of pruritus in cats
|
Ectoparasites, dermatophytosis, malassezia, allergy, bacterial dermatitis, ulcerative dermatitis, neoplasia, behavior (last)
|
|
|
Manifestations of feline atopy
|
Eosinophilic plaque, collagenolytic granuloma, indolent ulcer, miliary dermatitis, symmetrical alopecia
|
|
|
Feline drug of choice for symptomatic treatment of pruritus
|
Prednisolone (prednisone would require twice the dose)*
May induce diabetes, etc. |
|
|
Symptomatic treatment of pruritus
|
Chlorpheniramine, fatty acids, combinations with glucocorticoids; antibiotic therapy if ruling out pyoderma
|
|
|
Feline behavior modifying agents
|
Buspirone, phenobarbitol, Prozac
|
|
|
Diagnostic process to feline pruritus
|
Database, treat perpetuating factors, screening blood tests, begin hypoallergenic diet
Chlorpheneramine (supports allergy), glucocorticoids (supports atopy, any age), selamectin/ivermectin (supports ectoparasitism), Advantage/Frontline/Program (supports fleas/glea allergy) |
|
|
*Predisposing factors leading to otitis externa*
|
Conformation of ear canal; behavior of patient (swimming); environment (high humidity, temps); trauma (excessive cleaning); obstructive ear canal disease; immunosuppressive disease
|
|
|
*Primary factors inducing otitis externa*
|
Ectoparasites (otodectes in cat); foreign bodies; **allergies** (*atopy* in the dog, ARF, contact dermatitis, flea allergy dermatitis); scaling disorders (familiar seborrhea, sebaceous adenitis); immune-mediated (drug reactions, pemphigus, lupus erythematosus); juvenile cellulitis
|
|
|
Otodectes
|
Diagnose by visualization, cytology; clean, use ascaricides, Ivermectin, Fipronil, Selamectin
|
|
|
*Perpetuating factors of otitis externa*
|
Bacterial infections, yeast infections, hyperplastic and obstructive changes, otitis media
|
|
|
Diagnostic techniques of otitis externa
|
*ID primary disease
PE, otoscopic exam of both canals, general anesthetic as needed; *cytology of both ears* (every case), |
|
|
Indications for otic bacterial culture
|
Known resistant organisms, failure to respond to therapy, single population of rods, presence of inflammatory cells
|
|
|
Treatment of otitis externa*
|
ID and treat predisposing, primary, and perpetuating factors*; *clean the ears (ceruminolytic agents with drying agents/acids)
|
|
|
Ototoxic agents
|
Aminoglycoside, chlorhexidine, chloramphenicol, ethanol, iodine; propylene glycol; salicylates + gentamicin; aminoglycosides + loop diuretics; direct instillation into ear; topical instillation into inflamed middle ear
|
|
|
Keys to successful topical otic therapy
|
Drug efficacy, removal of obstructions, ointment vs. aqueous, frequency of administration, volume per administration
|
|
|
Recommended dosages of topical otic therapy
|
0.4 - 1.0 mL
|
|
|
Panalog
|
Neomycin, thiostrepton, nystatin, triamcinolone (broad spectrum but ointment)
|
|
|
Tresaderm
|
Neomycin, dexamethasone, thiabendazole (Mild activity; broad spectrum, aqueous)
|
|
|
Best treatment for pseudomonas otitis externa in dogs**
|
Glucocorticoids in high doses
|
|
|
Malassezia infections
|
Look at atopy as underlying cause; clean ears, alter pH (vinegar and water); anti-yeast, systemic anti-fungal medications if can't be achieved (azoles, nystatin)
|
|
|
Pseudomonas otitis
|
Single rod population on cytology
Topical therapy: ticarcillin, tobramycin, polymixin B, tris-EDTA; systemics (fluoroquinolones); *concurrent glucocorticoid therapy *put on anti-yeast therapy in anticipation of malassezia |
|
|
Otitis externa hyperplastic changes
|
Perpetuating factor; represent chronic inflammation and infection (folliculitis, furunculosis, fibrosis, calcification, cystic changes)
Can treat with glucocorticoids, but usually surgery (facilitates drainage) |
|
|
Juvenile cellulitis
|
NOT bacterial; cytology = non-infectious, inflammatory; histopath = panniculitis, furunculosis
Tx = systemic glucocorticoids, systemic antibiotics, astringents if moist |
|
|
Familial seborrhea
|
Increased epithelial turnover, thick lesion at neck; malassezia usually involved. Hallmark = lichenification around nipples. Pruritus is severe. Diagnosis by exclusion. Excess of follicular plugs. **Get impression smears to see malassezia. Check for otitis externa.
|
|
|
Signs of familial seborrhea
|
Pruritus, greasy skin, secondary infections (papules, pustules, lichenification, collarettes, crusts), alopecia, hyperplastic changes (nose, feet, nipples)
|
|
|
Control of familial seborrhea
|
Shampoos (coal tar - keratoplastic, decreases epithelial turnover**; sulfur, salicylic acid; selenium sulfide; benzoyl peroxide)
|
|
|
Phytosphingosines
|
Lipids produced in lipid bilayer, available in shampoo; adjunct (seborrhea); anti-inflammatory, anti-microbial
|
|
|
Autoimmune disease
|
**Histopathology is most diagnostic
|
|
|
Discoid lupus erythematosus
|
Immune complex deposition; UV damages nasal planum (nasal flaring)
Interface dermatitis, apoptosis Tx = Vit E, glucocorticoids, tetracycline and niacinamide; more severe = azathioprine and tacrolimus, cyclosporine |
|
|
Exfoliative cutaneous lupus
|
German shorthair
Follicular casts, crusts, alopecia, pruritus, anemia, pain Interface dermatitis; pigmentary incontinence Bathe with keratolytic products Immunosuppression: Cyclosporine, pred, tetracycline/niacinamide; Vit A; fatty acid |
|
|
Lupoid onchodystrophy
|
Claws: Tetracycline/niacinamide, immunosuppression (pred, cyclo, fatty acids)
|
|
|
Pemphigus foliaceous
|
Acantholysis (cleavage cellular adhesion)
Thin-skin regions, collarettes, etc.; oral lesions are RARE Cytology: acantholytic cells Tx = topical, systemic (pred, azathio; tetra/niacin |
