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135 Cards in this Set

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what canine breeds develop zinc responsive dermatosis most commonly?
siberian huskies, alaskan malamutes (most common) also doberman pinschers, great danes; occasionally other breeds
What is the hypothesized pathogenesis of canine zinc responsive dermatosis?
genetic defect causes decreased absorption of zinc, high Ca diets or diets high in phytates (cereal) will bind Zn, therefor predisposing sucepable animals
describe the initial and more advanced clinical lesions of zinc responsive dermatosis and note the distribution.
1.focal areas of erythema, scaling, crusting (usually quite adherent crust), variable degrees of alopecia
2.around eyes, mouth,chin, ears
3.often begin with asymmetric, focal lesions, but usually become symmetric with more advanced disease
4.mucocutaneous junctions may be affected
5.may see otitis externa (predominantly medial aspect of pinna)
6.foot pads may be hyperkeratotic- usually mild to moderate severity (not as severe as seen with pemphigus or superficial necrolytic dermatitis)
list the major differential diagnosis for a dog with zinc responsive dermatosis.
early lesions (asymmetric) bacterial pyoderma, dermatophytosis, demodicosis
for advanced lesions (symmetric) pemphigus foliaceus, superficial necrolytic dermatitis, lupus
How is the diagnosis of zinc responsive dermatosis best confirmed?
1.plasma zinc levels may be decreased (difficult to assay)
2.biopsy suggestive: marked superficail and follicular parakeratotic hyperkeratosis; superficial perivascular dermatitis
3.often made by response to trail zinc supplement therapy
What zinc product is noted to be the best tolerated treatment for zinc responsive dermatosis?
zinc methionine, but if one supplement fails try another
What is the time to onset of benefit from zinc supplementation for canine zinc responsive dermatosis?
3-4 weeks
What is the history usually preceeding the development of eosinophilic foliculitis and furunculosis and how is it clinically presented?
Acute onset. Papules rapidly progressing to ulcerative, exudative nodules. painful. primarly on the bridge of the nose, but may also invole periocular region and ears. Majority are young (< 3-4 years), medium to large breed dogs. There may be a history of arthropod bite.
What is the relatively easy to do in house diagnostic that can be used to suggest diagnosis of eosinophilic foliculitis and furunculosis?
impression smears or aspirates that show large numbers of eosinophils
What is the therapy of choice for eosinophilic foliculitis and furunculosis?
glucocorticoids 2mg/kg/day for 1 week, then 1mg/kg/day for a week then .5 mg/kg/day for a week
What are the breeds most commonly associated with dermatomyositis? Has the gentic mode of inheritance been documented?
Collie and shetland sheepdog- autosomal dominant with variable expressivity
What facial lesions are noted in dogs with dermatomyositis, and what are the most common differential diagnoses?
develop skin lesions at 3-6months of age. pustules, vesicles or papules rapidly progressing to crusted, alopecic areas most commonly over face, tips of pinnae, tip of tail and distal extermities(especially bony prominences of feet). Permentent scaring may develop where the skin is thin and hyperpigmented
What breed of dog most commonly develops myositis and what muscles are most commonly involed due to dermatomyositis?
collies- temporal muscle atrophy is most common but also masseter- esphogeal muscle involment is rare but may lead to megaesophagus
How is the diagnosis of dermatomyosis confirmed?
History clinical appearance skin biopsy(perifollicular inflammation, perifollicular and dermal fibrosis, follicular atrophy, intra and subepidermal vesicles and pustules, basal cell vacuolation with the presence of necrotic keratinocytes, superficial perivascular inlfammion) EMG (postive sharp waves fibrillation potentials) and muscle biopsy (fiber necorosis with inflammatory cell accumulation, fibrosis and fiber degerneration) biopsy temporal and extensor carpi radials
What is the natural course of the dermatomyosistis if left untreated?
a waxing, waning course may be noted over several months. In some individuals there is spontaneous remission. In others, permanent scarring is noted. In some individuals, lesions remain active. Some dogs spontaneously resolve, only to re exacerbate as adults. These recurrent adult onset problems are often more difficult to manage
Dermatomyositis is most commonly treated with either pentoxiyfyline or glucocoricoids. How does pentoxifylline work?
increases microvascular blood flow by lowering blood viscosity, increasing erythrocyte deformability, retarding platelet aggregation and reducing serum fibrinogen levels- it is also an immunomodulator
What are the differential diagnoses for canine facial dermatoses usually sparing the planum nasale?
1.bacterial pyoderma
4.zinc responsive dermatosis
5.eosinophilic folliculitis and furunculosis
7.pemphigus folicaceus (usually affects planum)
8.pemphigus erythematosus (usually affects planum)
9. uveodepigmentation syndrome (VKH) (ususally affects planum
How would you differentiate the depigmentation associated with idopathic nasal depigmentation form that of vitiligo, DLE or pemphigus?
Nose does not depigment to pink as is seen in the other immune mediated diseases
What manifestations of vitiligo could you see in a Rott?
noninflammatory asymptomatic depigmentation of the planum, lips, muzzle, and buccal mucosa. There may be focal or widespread leukotrichia and or depigmentation of the nails
At what age and breed would you most commonly see idopathic nasal hyperkeratosis?
middle aged to older dogs with cocker spaniel being over represented
Where do the secretions that normally keep the planum nasale moist originate?
the lateral nasal glands located in the mucosa of the maxillary recess
Where would you look for lesions as a cause of an unilateral nasal hyperkeratosis associated with xeromycteria?
peterous temperal bone by looking for otitis media
What breed is most commonly noted to develop bacterial dermatitis of the nasal planum?
german shephard dog
What common autoimmune disease of the planum may bacterial dermatitis of the nasal planum mimic
discoid lupus
When examining a dog with a dipigmenting, inflammatory disease of the face, why must you always also examine the eyes?
to check for uveodermatologic syndrome, Eye lesions that are not treated quickly may result in blindness
Describe the cytologic findings from a pustule in a patient with pemphigus foliaceus?
neutrophils eosinophils, acanthocytes, rafts of acantholytic keratinocytes
What is the most common pemphigus disease seen in clinical practice?
pemphigus foliaceus
What are the therapeutic alternatives for the management of pemphigus foliaceus?
PE - Tetracycline or doxycycline and niacinamide (20 – 30% respond?) nGeneralized PF - only 10% respond to T/N
Glucocorticoids – only 20% - 30% controlled on glucocorticoids alone
Glucocorticoids and azathioprine – 65 – 75 % reasonably well controlled
Glucocorticoids and chlorambucil nGold salts nTopical
List 4 cutaneous manifestations of vasculitis in the dog?
1.punched out ulcers
2.hemorrhagic bullae
3.focal inflammation/necrosis with crusting
4.purpura eccymoses
6.onychomadesis loss hyperpigmentation (vaccine induced)
Why is a diagnosis of vasculitis often considered the tip of the iceberg?
often underlying disease causing the vascultitis: local bacterial pyoderma, sepsis, rocky mountain spotted fever, ehrlichiosis, sarcocystis canis, babesiosis, SLE, dermatomyositis, rabies vaccine induced
In what area/areas of the body are the lesions of superficial necrolytic dermatitis most commonly monifest?
feet(usually first), toenail, mouth, muzzle, eyes, pressure points, vulva, scrotum
When superficial necrolytic dermatitis becomes more generalized, what other cutaneous disease does it tend to most commonly mimic?
pemphigus foliaceus or pemphigus vulgaris
What is the most common underlying cause for superficial necrolytic dermatits?
liver collapse
What is thought to mediate the necrolytic skin changes associated with superficial necrolytic dermatitis?
low plasma amino acids
how is supericial necrolytic dermatits diagnosed?
biopsy shows red (parakeratosis) white (edema) and blue (hyperplasia) lesions
What key therapy appears to be most important in palliating the cutaneous signs of superficial necrolytic dermatitis?
germicidal shampoo
What is the prognosis for superficial necrolytic dermatitis?
poor, some patients do live long if treated early with supportive diet therapy
What are the differential diagnoses for canine nail plate loss?
1.lupoid onychodystrophy
4.superficial necrolytic dermatitis
6.pemphigus foliaceus, vulgaris, bullous pemphigoid
7.systemic lupus erythematousus
9.cold agglutinin disease
10. neoplasia(scc)
11.drug eruption
What is the most common cause of wide spread nail loss in the dog?
lupiod onychodystrophy
where does most nail plate growth occur in the dog?
How is lupoid onchodystrophy diagnosed?
rule out and biopsy of p3
How is lupoid onychodystrophy treated?
1.fatty acids
2.tetracycline, or doxycycline and niacinamide
What is the distribution of pruritus one would classically associate with scabies? cheyletiella? flea bite hypersensitivity, atopy, food sensitivity?
scabies:outer aspects of pinna, head, lateral aspect of elbows, stifles, ventrum-relatively hairless areas
flea bite hypersensitivity:lower back, tail head, caudal and mdeial thighs
atopy:face, feet, anterior elbows, axilla, flanks, perianal, perivulvar, back
food:pedal, anterior elbows, axilla, inguinal regions, perivulvar, perianal region, back
For dogs with classic signs of allergic dermatitis who live in the front range: ______% would be expected to be atopic _% food sensitive and _____% a combo of both.
In the management of a non seasonal pruritus problem, why is a food trial often performed prior to a more intensive work up for atopy?
because it is nonseasonal and food sensitivities are more readily treated than atopy
What are dogs with food sensitivites most commonly sensitive to in their diets?
beef dairy products and wheat
What types of diet are most commonly used in the performance of a restrictive diet trial in the dog? Is there any commercial diet that works to benefit all? what is the general failure rate?
home made, commercial novel protein and hydrolysates
no commerical diet benfits all
failure 10-15%
How long should a restrictive diet be fed to rule out a dietary hypersensitivity?
8 weeks
After succesful diet trial, and is challenged with pervious diet when would one expect to see a flare of pruritius following the challenge?
first 3-7 days but may take as long as 10-14 days
what clinical signs would make think malassezia paronychia?
Most will be presented for the complaint of claw biting or paw licking.
Physical examination will usually reveal a reddish-brown staining of the proximal claw or a waxy exudate in the claw fold, with inflammation of the surrounding soft tissue.
The majority of cases will also have interdigital pododermatitis associated with the presence of yeast - pedal pruritus caused by the yeast may confuse the clinical evaluation of an atopic dog, especially the response to therapy.
by what route do allergens access the body to initiate and perpetuate the atopic state?
inhalation and transcutaneous absorption
How is atopy diagnosed?
history, PE and rule out
what are the pros and cons of interdermal testing versus serology for atopy?
intradermal more specific
2 week withdrawl time of antihistamines 4-6 weeks withdrawl of oral glucocorticoids and 2-3 weeks with drawl of topical steriods and 2 weeks of r fatty acids for intradermal
false neg 20-30% for intradermal
antihistamines and fatty acids don't need to be stoped with serology
2-3 week steroid withdrawl
What recommendations can be given to minimize exposure to dust mites, pollens, molds?
mites:high effeiciency vacuum of rugs and mats, cover mattresses with plastic, regular washing and drying of bedding. Keep dog away from carpeted rooms, cushioned beds and furniture. new products that kill mites are currently being evaluated
pollens:air filters, avoid fiels, keep lawn short, rinse dog after walks, keep dog inside during dusk and dawn and while mowing
molds:avoid high moisture rooms, decrease house plants, use a dehumidifier
What are the advantages of frequent bathing for atopic dogs and what shampoos can you use?
reduce allergen concentration, removal of irritating oils, and cutaneous rehydration
shampoos: oatmeal or oatmeal and pramoxine
conditioners: relief, DVM
can topical tacrolimus be used effectively to treat inflammtion and pruritus associated with focal atopy in the dog?
expensive but does not interfear with intradermal testing
What is termaril-p? what advantages does it have in the treatment of atopy over pred?
trimeprazine plus prednisolone
lowers the dose of steriods required to control pruritus
What is the advantage to oral methylprednisolone verses prednisone for atopy management?
equal in potency but less likely to produce pu/pd
What precent of atopic dogs respond to omega 3 fatty acids and what appears to dictate the degree of response that may be seen?
40-50% with high doses, at bottle doses 10-15%
ideal success is seen with a 5:1 to 10:1 ratio bt omega 6 and omega 3
Which six antihistamines are used in the treatment of atopy in the dog?
What is the success rate?
When might you use a combo antihistamine therapy?
combos in more severe patients or those that don't respond to single antihistamine therapy
Pentoxifylline has been noted to benefit about what percentage of dogs with atopy? why does it work?
phosphodiesterase inhibitor (immunemodulator)
hyposensitization helps what percent of dogs with atopy?
What is the average time to onset of benefit of hyposensitization? range?
range- 1-12 months
What percent of dogs are controlled on hyposenitization shots alone?
How long are hyposenitization shots usually given?
for life
What frequency are hyposensitization shots given/
once every 1-2weeks
what is rush immunotherapy and what are the advantages?
give all the induction dose of hyposensitization at once.
soon to produce more rapid onset of benefits and a better overall success rate
What are the side effects of hyposensitization?
increased pruritus, swelling or pain at injection site and urticarial reactions, generalized anaphylactoid reactions are rare
How beneficial is oral cyclosporine in controlling atopy associated pruritius?
What are the side effects of cyclosporine?
GI upset esp vomiting
may also see diarrhea, gas, discomfort,inappetance
gingivalhyperplasia, papillomatosis, bacteriuria, bacterial pyoderma, hirsutism, anorexia, nephropathies, bone marrow sppression, and lymphoplasmacytic dermatosis
What is the benefit of useing metoclopramide with cyclosporine?
increase absorption and less vomiting
what are the three major differential diagnoses for lesions that are characterized by focal areas of inflammation, crusting and alopecia in the dog?
1.bacterial pyoderma
How do you diagnosis superficial bacterial pyoderma?
history PE(focal areas of inflammtion and crusting) rule out of demodex with deep skin scrapings
What is the anitbiotic used to treat staphylococcal pyoderma?
good 80-85%:lincomycin, TMS, chloramphenicol, clindaymicin
better:85-90% clavamox fluroquinolones
best 98+%:cephalosporins-cephalexin, cefpodoxime
how long due you generally treat an acute 1st time focal superfical bacterial pyoderma?
3 weeks
How long would you treat a severe, generalized superficial bacterial pyoderma?
1-2weeks beyond remission
How long would you treat a deep bacterial pyoderma?
1-2weeks beyond remssion
what is the most common cause for a recurrent superficial bacterial pyoderma in the front range?
pruritic underlying cause:atopy food sensitivity, flea bite hypersensitivity
What are the most common nonpruritic underlying diseases that predispose to recurrent superficial and deep staphylococal pyoderma?
severe nutritional deficiences
systemic lupus erythematosus
food sensitivity
When given an allergic patient that is predisposed to recurrent bacterial pyoderma what is the prime goal?
controll the allergy
What factors are involed in the predispostition to recurrent folliculitis and furunculosis in the German Shephard dog?
IgA deficiencies and cell mediated immune defects
recurrent staphylococal pyoderma is more commmon in short coated breeds. what areas are these problems most commonly manifest?
what tip offs suggest and underlying immunodeficientcy as a casues to recurrent bacterial pyoderma?
recurrance after appropraite duration of antibiotics
any very generalized superficial or deep pyoderma
lack of a reactive lymphadenopathy proximal to an inflammatory site
what is pulse therapy and when is it used?
pulsing antiboitc therapy
cephalexin most commonly used
used for recurrent pyoderma due to immunoinsufficiency
What is staphage lysate and when might it be used?
staphylococcal bacterin
used to keep pyoderma from recurring
are bacteria usually plentiful in cytologic preparations from a deep bacterial pyoderma due to staphylococcus?
what are the most common causes of lick granulomas in the dog?
bacterial pyogranuloma
foregin body
underlying bone or joint pain
fungal infections
________ are noted to cause 30-50% of the lick granulomas in the dog
bacterial pyogranuloma
How would you clinically differentiate a lick granuloma from a hot spot in the dog?
hot spot is acute within 24hrs
you are presented with a 3 yr old dalmation who has multiple lick granulomas over his dorsal radial and carpal regions and lateral tarsi.
what differential diagnosis/ diagnoses would be most likely as the cause for these lick granulomas?
1.allergies allergy
which behavior modifying drugs are used most commonly in the management of lick granulomas in the dog (list 3) which is the cheapest?
1.amitriptyline (cheapest)
what is the common theme for the pathogenesis of alopecia X, post cliping alopecia, and telogen defluxion?
spares the head and distal extremities
what breeds are noted to most commonly develop alopecia X?
nordic or plush coated breeds
what is the age of onset of alopecia X?
1-3 years
what is the proposed etiology of alopecia X?
abmormal sex hormones
what innocuous therapies are there for alopecia X?
what therpies for alopecia x affect the adrenal glands?
How do you tentaively diagnose post cliping alopecia?
following clipping of lower back and dorsal pelvic region hair fails to regrow skin hyperpigments but otherwise normal
How long does it take for hair to regrow flowing post clipping alopecia?
6-24 months
what typifies the coat/skin changes associated with the generlized form of sebaceous adentits?
heavy scale adhered to the base of hairs
what is the distribution of alopecia associated with sebaceous adentities and how would this differ from the alopecia associated with hypothyroidism or hyperadrenocorticism?
head back and sides, ventrum less affected
what breeds are most commonly affected with generalized sebaceous adenitis?
long haired breeds
How is sebaceous adenitis diagnosed?
skin biopsy: moderate acanthosis and generally severe hyperkeratosis with folicular plugging, perifolicular inflammation localized in the region of the sebaceous glands, sebaceous glands are absent
what is the topical therapy for sebaceous adenitis and what is the goal of therapy with this topical?
alpha keri bath oil
propylene gycol and water
goal is to remove the scale
list 4 oral therapies for sebaceous ademitis?
fatty acids
vitamin a
tetracycline +/- niacinamide
what are the 4 most common causes of miliary dermatitis in the cat?
1.ectoparasites flea bite hypersensitvity, cheyletiellosis, pediculosis, trombiculidiasis, demodicosis
5.endoparasitic hypersensitivity
how might you suspect the cytology of an impression smear taken from a cat with miliary dermatitis due to fleas, cheyletiella, atopy or food sensitivity to differ from bacterial or dermatophytosis?
just neutrophils seen with bacteria or dermatophytosis
what are the most common etiologies noted for indolent ulcers? eosinophilic plaques? eosinopilic granulomas?
1.ectoparasite hypersensitvity
flea bite hpersenitivity
2.flea bite
flea bite
what important pruritic causes of alopecia due to self trauma must be ruled out before calling the problem psychogenic?
2.endoparasitic hypersensitivity
11.hypereosinopilic syndrome
what durg therpay is used most commonly to differeniate allergies form psychogenic causes of alopecia due to self trauma?
what are the 3 most common cause of pruritis directed at the head and neck in the cat?
notoedric mange
otodectes infestation
how might you expect the lesions of feline acene to differ from dermaitis of the chin due to allergy?
feline acne will have follicular plugging
what are the differential diagnosis for feline acne
1.bacterial pyoderma
2.atopy senitivity
how is mild to moderate feline acne managed?
2.1% topical clindamycin
3..75% metronidazole gel
4.benzoyl peroxide
5.topical alcohol topical slicylic acid
how is severe feline acne managed?
1.anesthesia expression of comedones and cysts
2.systemic antibiotics
3.maybe steriods
4.benzoyl peroxide shampoos
what dzs are most commonly complicated by malassezia colonization/infection in the cat and where are these malassezia most likely to be found?
ears face and feet
otitis externa
what is the topical total body rinse that is considered the best for dermatophytosis in the cat?
lime sulfur
you have placed a cat on griseofulvin therapy for dermatophytosis. after 3 weeks the cat becomes depressed, anorexic and ferbrile. what toxicity would you suspect? how would you document this and manage it? is it dose related?
bone marrow suppression not dose dependent
check for FIV FelV confirm with CBC
itraconazole can be used as a pulse therpay in cats for the treatment of dermatophytosis
remains at the MIC for 2 weeks after 2 days of treatment
how effective has lufenuron been in treating dermatophytosis? how might it be used?
controversial efficacy, use as an adjunctive therapy once every 2 weeks
what is the duration of therapy for treating dermatophytosis in the cat? how do you find a endpoint?
duration of therapy contiued for until 2 negative cultures separated by 2-3 weeks, recheck every 3 weeks
what are the most common dermatologic manifestations of food sensitivities in the cat?
moderate to severe excoriations, erosions, ulcers restricted to the head face and neck
what foods are cats usually allergic to?
beef, fish, milk, eggs
how responsive to steriods are cats with food sensitiivity?
variable can be quite resistant
how long due you feed a restricted food to a cat? what due you use?
strict homemade diet for 6-8weeks usually lamb, rabbit, ham, ostrich, kangaroo
reintroduction of a perivious commercial diet should result in a reexacerbation of signs with in _______ in a cat
one week most 1-3 days
what are the clinical manifestations of atopy in the cat?
alopecia due to self trauma
miliary dermatitis
eosinophilic plaque
eosinophilic granuloma
indolent ulcer
head and neck
otitis externa
feline acne
How effective are omega 3 and 6 fatty acids in the cat for treatment of atopy?
which antihistamines are used in the cat for atopy and how effective are they?
about 30% respond
how effective is hyposensitization in the cat?
60-70% reported to be 45-75%
has oral cyclosporine been effective in the management of feline atopy?
where dose pemphigus foliaceus most likely manifest on a cat? what will you see on cytology?
paronychia, feet, face, ears
neurophils and ancatholytic keratinocytes
what treatments are there for pemphigus foliaceus in the cat?
gold salts
what drug used in the dog for pemphigus is not used in the cat due to greater potential for toxicity?
what is stud tail?
feline tail gland hyperplasia
supracaudal organ located in a line along the dorsal aspect of the tail.