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162 Cards in this Set
- Front
- Back
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Clinical sign always present with keratinization disorders.
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Scaling
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Keratinization disorder characterized by excessive sebum production
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Seborrhea oleosa
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Keratinization disorder characterized by deficient serum production
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Seborrhea sicca
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Keratin surrounding the follicular portion of the hair shaft, often seen with epilated hairs.
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Follicular casts
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Concurrent infections commonly seen with keratinization disorders
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Malassezia and bacterial infections
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Px of secondary keratinization disorders
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Excellent if underlying problem addressed
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Px of primary keratinization disorders
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Lifelong therapy required
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This keratinization disorder has:
-White loose scales -Dryness -Dull, dry hair coat -No odor |
Seborrhea sicca
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This keratinization disorder has:
-Greasy yellow-brown scales -Oily hair coat -Keratin deposits adhere to hairs -Rancid fat odor -Secondary infections with yeast/bacteria |
Seborrhea oleosa
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Way to distinguish seborrhea sicca and seborrhea oleosa on physical exam
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Touch the animal with your hands and see if fingers become oily
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Multifocal hyperketatotic plaques and scaling with or without greasiness and inflammation characterize this keratinization disorder.
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Seborrheic dermatitis
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How frequently is seborrheic otitis externa seen with generalized seborrheic dermatitis?
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Frequently seen together
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3 types of primary keratinization defect
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Hereditary
Idiopathic Nutritional |
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3 idiopathic keratinization disorders
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Acne
Ear margin seborrhea Nasodigital hyperkeratosis |
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Primary keratinization disorder seen in animals with blue and fawn colored dilution mutations
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Color dilution alopecia
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The keratinizing epithelium of the hair follicle, and the hair cuticle are affected in this primary keratinization disorder. Defective melaninization also plays a role in the pathenogenesis of this condition.
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Color dilution alopecia.
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In this primary keratinization disorder, one may see large, irregularly shaped melanin granules in the hair shafts and follicles. The extensive melaninization of hair shafts may cause fragility and breaking of the hair shaft.
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Color dilution alopeica
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Slowly progressive alopecia in a blue or fawn colored dog. Recurrent superficial pyoderma is commonly seen.
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Color dilution alopecia
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Color dilution alopecia most commonly presents for the first time at what age range?
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6 months to 3 years
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How is color dilution alopecia diagnosed?
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Trichogram with large clumps of melanin in the hair shaft
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Treatment for color dilution alopecia
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Symptomatic
Keep follicles clear of keratinous debris with benzoyl peroxide shampoo followed by moisturizer Antibiotics as needed for secondary infection Don't breed |
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Hyperproliferation of the epidermis, causing severe scaling of the skin and footpads
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Ichthyosis
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Tx and Px for ichthyosis
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Warm water soaks
Moisturizers Antiseborrheic shampoos (sulfur and salicylic acid) Antiseborrheic gels (Tretinoin and salicylic acid) Oral cephalexin and prednisone may work in some Long term Px poor b/c lifelong management |
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Sebaceous adenitis is a condition seen most commonly in these breeds
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Standard poodle
Akita Havanese Vizsla Samoyed |
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The etiology of this disease is unknown but possible causes include abnormal lipic metabolism, keratinization abnormality, or autoimmune destruction of the sebaceous glands
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Sebaceous adenitis
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Age of onset for sebaceous adenitis
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1-5 years
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A standard poodle presents with symmetrical, partial alopecia of the dorsal trunk, neck, head, bridge of the nose, and pinnae. The skin has tightly adhered, white scales, follicular casting, and hairs that epillate very easily, There are signs of a secondary bacterial folliculitis. What is a likely differential diagnosis?
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Sebaceous adenitis
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An Akita presents with generalized erythema, papules, pustules, scaling, and hair loss. He also have fever and a history of weight loss. What disease could cause these signs in this dog?
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Sebaceous adenitis
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How is sebaceous adenitis diagnosed?
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Breed and PE tentatively
Skin biopsy confirms Rule out parasites, bacterial infections, hypothyroidism, fungal infections, etc. |
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How is sebaceous adenitis treated?
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Antiseborrheic shampoos
Topical sprays and rinses with propylene glycol Fatty acid supplements in high doses Isoertinoin or acitretin for 4-8 weeks Vitamin A Cyclosporine |
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Potential SE of cyclosporine
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Vomiting, diarrhea
Gingival hyperplasia Increased incidence of infections Hirusitism Papillomatous skin disease |
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Breed most refractory to treatment of sebaceous adenitis
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Akita
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Hereditary follicular keratinization effect seen in miniature Schnauzers
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Schnauzer comedo syndrome
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Does Schnauzer comedo syndrome typically cause clinical signs?
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No, not unless there is a secondary infection present
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CS of Schnauzer comedo syndrome
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Blackheads along dorsal midline of the back from the neck to the tail
Commonly secondary superficial pyoderma Rarely furunculosis Alopecia with moth eaten coat appearance Chronic affliction |
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How is Schnauzer comedo syndrome diagnosed?
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Blackheads on a Schnauzer
Skin biopsy Rule out other issues with trichogram and skin scraping |
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How is Schnauzer comedo syndrome treated?
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Topical therapy with anti-seborrheic shampoo
Benzoyl peroxide gels to remove comedones Systemic antibiotics if secondary infection Isoretinoin |
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How does isoretinoin work?
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Reduces sebum production by acting on the sebaceous glands
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Severe hereditary keratinization disorder seen only in West Highland White terriers
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Epidermal dysplasia
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Typical age of onset for epiderma dysplasia
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6 to 12 months
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Primary CS assoicated with epidermal dysplasia
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Pruritus and erythema
Lesions initially distributed on ventrum, extremities, and face Later generalization, alopecia, lichenification, hyperpigmentation, greasy skin |
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How is epidermal dysplasia diagnosed in a West Highland WHhte Terrier?
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Age of onset
Onset of severe ventral erythema and pruritus progressing to chronic lesions Skin biopsy |
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Challenge of diagnosis epidermal dysplasia in the Westie
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Determine how much of the severity of CS is attributable to secondary infection. Need to treat secondary infections before evaluating severity of CS.
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Tx for epidermal dysplasia
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Usually not responsive to therapy
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Prognosis for epidermal dysplasia
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Poor, especially if chronic and secondary changes have taken place
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Most common chronic keratinization disorder of dogs
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Primary idiopathic seborrhea
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Breeds predisposed to primary idiopathic seborrhea include...
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Basset hound, Cocker spaniel, Dachshund, Doberman, English Springer Spaniel, German shepherd, Irish setter, Shar-Pei, West Highland White Terrier
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In dogs with primary idiopathic seborrhea, do the epidermal cells renew faster or slower than in normal dogs?
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62% faster
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Typical age of onset for primary idiopathid seborrhea
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Under 2 years
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Degree of pruritus seen with primary idiopathic seborrhea
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Variable
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Focal to diffuse accumulations of a dry, nonadhered white to gray scaling. Dull and dry haircoat. Syndrome seen in Doberman pinchers, Irish setters, German shepherds, and Dachshunds.
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Seborrhea sicca
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Breeds predisposed to this seborrheic form include the Basset hound, Cocker spaniel, English springer spaniel, Labrador retriever, Shar-Pei, and West Highland White Terrier.
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Seborrhea oleosa
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How is diagnosis of primary idiopathic seborrhea made?
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Age
Breed History Elimination of secondary diseases Skin biopsies |
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Goal in treatment of primary idiopathic seborrhea
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Control scale formation
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Treatment for primary idiopathic seborrhea
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Moisturizing shapoos and rinses for sicca form
Keratolytic/keratoplastic and degreasing shampoos and acitretin for oleosa form +/- systemic antibiotics Prednisone in cases of severe inflammation and pruritus |
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Common disorder of follicular keratinization resulting in comedones, secondary bacterial folliculitis, and furunculosis. CS include chin lesions that typically begin at the time of sexual maturity in short-coated breeds.
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Canine acne
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Organism typically isolated from cases of canine acne
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Staphylococcus intermedius
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Hereditary predisposition for canine acne seen in these breeds
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English bulldogs
Boxers Doberman pinchers Great Danes |
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How is canine acne diagnosed?
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History, clinical signs, age, and breed
Skin scrapings, fungal cultures, trichograms to rule out other causes C/S in cases of deep infection |
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How is canine acne treated?
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Mild cases will resolve at sexual maturity without Tx
If active papules and pustules, treat topically with antibacterial shapoos and gels qd to bid May use mupirocin (antibacterial) ointment Systemic antibiotics for 7-14 days past resolution of CS Prednisone with other Tx if very severe |
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Uncommon idiopathic keratinization defect of the pinnal margins. Typically bilateral, seen in breeds with pendulous ears.
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Ear margin dermatosis
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Most common complaint in animals with ear margin dermatosis
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Scaling
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CS of ear margin dermatosis
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Follicular casts tightly adhered to skin surface and hair shafts of lateral and medial margins of pinnae
Hairs epilate easily Often bilateral lesions May progress to ulceration and necrosis due to capillary thrombosis No pruritus |
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How is ear margin dermatosis diagnosed?
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History, breed, presence of ear margin lesions
If ulcerated, consider vasculitis (SLE, cutaneous vasculitis, frostbite, etc) Rule out other diseases with CBC, chem, biopsies, ANA testing |
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Treatment for ear margin dermatosis
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Symptomatic
Early on: Topical antiseborrheic agents Topical glucocorticoid creams or prednisone systemically Pentoxiphylline for ulcerations, tx TID for 4-8 weeks In refractory cases, surgical removal of the ear margin (not effective if systemic cause) |
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A genetically predisposed inflammatory and pruritic allergic skin disease with characteristic clinical features associated with IgE antibodies directed against environmental allergens.
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Atopic dermatitis
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Most common cause of pruritus in dogs
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Flea allergy dermatitis
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Second most common cause of pruritus in dogs
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Atopic dermatitis
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Most dogs with atopic dermatitis develop CS by this age
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3 years
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Signs of atopic dermaitis are clinically indistinguishable from what other skin disease?
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Food allergy dermatitis
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True or false: Atopic dermatitis is a seasonal disorder.
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Sort of true...28% of the time
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Some of the diagnostic criteria used to screen for atopic dermatitis...
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Age of onset under 3 years
Mostly indoor Corticosteroid-responsive pruritus Chronic or recurrent yeast infections Affected front feet Affected ear pinnae Non-affected ear margins Non-affected dorso-lumbar area |
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Allergic dermatologic disease caused by cross-linked IgE triggering mast cell degranulation.
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Atopic dermatitis
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Pathogenesis of atopic dermatits.
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Defective epidermal lipid barrier
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3 criteria for diagnosing atopic dermatitis
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Suggestive history
Typical CS Rule out other differential diagnoses |
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True or false: If a dog is not pruritic, it is unlikely to be allergic
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True
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Regions of the body typically affected by atopic dermatitis
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Face
Ears Ventrum Distal limbs |
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Do atopic dogs respond to corticosterioid therapy?
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Yes, at least inititally
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Most common presenting problems seen with atopic dermatitis
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Pruritus
Recurrent pyoderma Recurrent Malassezia dermaitits Recurrent otitis |
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List some differential diagnoses with CS very close to those of atopic dermatitis
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Food allergy
Scabies Flea allergy dermatitis Contact dermatitis Superficial pyoderma Primary keratinization defect |
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Best way to visualize cocci bacteria associated with atopic dermatitis and secondary infection.
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Impression smear
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Can flea allergy dermatitis happen concurrently with atopic dermatitis?
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Yes
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Problems with allergen-specific IgE serology for diagnosis of atopic dermatitis
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Low accuracy, high number false results
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Purpose of using allergen-specific allergy tests to diagnose atopic dermatitis
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Allergen specific immunotherapy
Implement allergen avoidance |
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Test that detects the presence of antigen-specific IgE to dermal mast cells as well as the ability of the mast cells to release mediators following exposure to the specific antigen
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Intradermal test
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Advantages of intradermal allergen testing
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Test the organ that is directly affected by the disease
Less false positive reactions compared to serology Fast: Interpret and start Tx same day |
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Disadvantages of intradermal allergen testing
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Influenced by drugs used to treat pruritus
Need to purchase and maintain allergens for testing Training to perform and interpret test Sedate and shave the dog Lack of sensitivity in some classic AD cases |
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Advantages of IgE specific serology for diagnosing atopic dermaitis
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No sedation or shaving
Quantitiative results Readily available to all veterinarians |
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Gold standard test for identifying atopic dermatitis
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intradermal test
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If given the choice, should you do an intradermal test or an IgE serology test to diagnose atopic dermatitis?
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Ideally both. If only one, do the intradermal test
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List some methods for allergen avoidance
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Vacuuming
Anti-dust mite treatment Dehumidifier Avoid dampness Wash blankets twice weekly in 60-70 degree hot water Keep indoors at dawn and dusk for pollen avoidance AC with pollen filter Frequent baths |
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Treatment of choice for atopic dogs with non-seasonal CS
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Allergen-specific immunotherapy
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How successful does allergen-specific immunotherapy tend to be?
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60-70% of dogs show at least 50% improvement
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Factors that affect the success of allergen-specific immunotherapy
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Accuracy of the diagnosis and diagnostic testing
Formulation of the vaccine Adjustment of dose and frequency of injections for each patient Compliance of the owner |
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When allergen-specific immunotherapy is instituted, how long before improvement is typically seen? For how long should treatment be administered before ASIT is discontinued.
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Usually see improvement in 3-4 months
Discontinue if no improvement after 12 months |
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How likely is it that an atopic dog will return to normal with allergen-specific immunotherapy?
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Unlikely
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Treatment for allergic reactions associated with allergen specific immunotherapy
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Decrease allergen dose
Premedication with antihistamine 30 mins prior to injection |
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Local anesthetic used in topical treamtent of atopic dermaitis. Seen in sprays and shampoos.
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Pramoxine
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Essential fatty acid found in shampos used to treat atopic dermatitis
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Linoleic acid
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Topical antihistamine used to treat atopic dermatitis
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Diphenhydramine
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Topical corticosteroid solution used to treat atopic dermatitis.
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1% hydrocortisone
0.0015% triamcimolone |
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How does tacrolimus treat atopic dermatitis?
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Affects T cells, which are an important part of the pathogenesis of atopic dermatitis
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Dietary supplement that may be beneficial in cases of atopic dermatitis
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Essentail fatty acids
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Proper dose of EPA/DHA in treating atopic dermatitis
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180mg/5kg
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Adverse effects of essentail fatty acid supplementation are uncommon and include:
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Weight gain
Diarrhea Flatulence Fish-breath Pancreatitis Decreased platelet aggregation |
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When are antihistamines most likely to be effective in treating atopic dermatitis?
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When the skin is minimally inflammed
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How long should one antihistamine be tried in treating atopic dermatitis before switching to another?
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1-2 weeks
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Should systemic glucocorticoids used for treating atopic dermatitis be injected or administered per os?
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Per os
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3 short acting glucocorticoids used to treat atopic dermatitis
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Prednisone
Prednisolone Methylprednisolone |
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Treatment protocol for using glucocorticoids to treat atopic dermatitis
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Start with 0.5-1 mg/kg sid until remission of CS
Then give EOD and decrease dose until lowest maintenance dose reached (<0.25 mg/kg EOD) |
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Adverse effects of systemic glucocorticoid therapy
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Iatrogenic hyperadrenocorticism
Secondary skin infections UTI Pancreatitis GI perforation Obesity Muscle wasting |
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Potent inhibitor of cell-mediated immunity
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Cyclosporine
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Purpose of having cyclosporine in a microemulsion
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Better absorbed
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How long may it take to see improvement of atopic dermatitis with cyclosporine?
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4 weeks
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Cyclosporine may be given in conjunction with what drug for quicker control of atopic dermatitis?
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Corticosteroids
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Should cyclosporine be given with food or on an empty stomach for optimal absorption?
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Empty stomach
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Side effects of cyclosporine therapy
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Vomiting and diarrhea most common (give maropitant)
Gingival hyperplasia Hypertrichosis Papillomatosis Lameness Muscle tremors |
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How should cyclosporine therapy be monitored?
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CBC and Chem /UA every 4-6 months
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Major downside of cyclosporine therapy
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EXPENSE!
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When is a good time to treat atopic dermatiis with cyclosporine?
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When CS year-round
Before performing IDT or during induction of ASIT Failure of ASIT When corticosteroids must be given long term |
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List some skin diseases seen in puppies under 6 months
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Juvenile Demodicosis
Dermatophytosis Impetigo (puppy pyoderma) Juvenile cellulitis Oral papillomatosis |
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List some skin diseases seen in dogs aged 1-5 years
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Allergic dermatitis
Alopecia X Color dilution alopecia Primary idiopathic seborrhea Autoimmune dermatoses |
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Atopic dermaititis is classically seen on these aread of a dog's body.
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Neck and ventrum
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List some causes of skin disease seen in dogs over 6 years old.
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Cushings' disease
Feminization syndrome (testicular tumor) Neoplasm Decubital ulcers |
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Chows have a predisposition for this autoimmune skin disease
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Pemphigus foliaceus
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Dachshunds are predisposed to this alopecia disorder.
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Pattern baldness
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Circumanal adenomas occur almost exclusively in...
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Intact males
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Describe the 2 levels of a dermatologic history
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General health history
Specific questions pertaining to the chief complaint |
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List some questions that can help pin down the cause of pruritus
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Did rash or itching come first?
How many times a day does dog scratch? Itching at many sites or just a few? Licking or chewing at paws? Does dog shake head? Does dog rub face or body against things? Does pet stop playing to itch? |
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List two bilaterally symmetrical skin conditions.
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Hypothyroidism
Pemphigus foliaceus |
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List two causes of asymmetric skin disorders.
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Ectoparasites
Fungal infections |
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IInflammation of the nail beds
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Paronychia
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3 skin lesions often missed:
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Paronychia
Interdigital lesions Lip fold lesions |
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Diffuse skin disorders may be caused by...
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Endocrine disorders
Keratinization disorders Immunomediated Hypersensitivity disorders |
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Epidermal collarettes, scars, excoriations, erosions, fissures, lichenifications, and calluses are examples of which: Primary or secondary skin lesions?
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Secondary
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Macules/patches, papules, pustules, vesicles, wheals, nodules, and cysts are examples of which: Primary or secondary skin lesions?
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Primary
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Potential causes of linear skin lesions
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Scratching
External trauma BV or lymphatic involvement Congenital malformations Linear granulomas |
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Skin disease that is diagnosed on a deep skin scraping where the skin is squeezed and capillary bleeding is achieved
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Demodex
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Active growth phase of hair cycle
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Anagen
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Resting stage of hair cycle
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Telogen
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Indications for swab cytology
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Ears, exudative, and moist skin lesions
Claw folds |
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Indications for impression smear
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Surface of intact exudative lesions
After lancing papules, pustules Following crust removal |
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Indications for Scotch tape cytology preparation
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Dry and waxy lesions
Lesions difficult to reach with a slide |
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Indications for a FNA skin cytology
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Nodule, tumor
Plaque Abscess |
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How many yeasts of Malassezia are significant if taken from an inflammed ear or inflammed skin?
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0.5-1 yeast/oil immersion field
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Staphylococcus intermedius is a normal inhabitant of both...
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Ears and skin
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This rod bacteria is visualized in chains, is common in ear samples, is always pathogenic, and has a high incidence of antibiotic resistance
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Pseudomonas
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Mycobacteria require this special stain to visualize on cytology
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Acid-fast stain
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Large rods that inhabit vertebrate oral cavity. Seen on skin that has been licked
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Simonsiella
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Three possible differentials for visualization of non-degenerate neutrophils on a skin cytology
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Pemphigus foliaceus
Primary allergic reaction Irritant reaction |
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2 inflammatory cell types associated with chronic and deep skin lesions
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Macrophages and lymphocytes
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Two differentials for sparse numbers of mast cells on skin cytology
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Parasitic disease
Allergic disease |
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Non-nucleated epithelial cells are called
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Corneocytes
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Nucleated epithelial cells are called
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Keratinocytes
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Indications for tissue culture include
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Plaques, nodular lesions, fistulous tracts
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Woods lamp is used to to diagnose...
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Dermatophytosis
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How do hair shafts affected with Dermatophytosis react when under a Woods lamp?
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Fluoresce apple green
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Only dermatophyte species to fluoresce under UV light.
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Microsporum canis
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True or false: 75% of Microsporum canis infections will fluoresce under a Woods lamp.
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False. 50%
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Causes of false positive Woods lamp fluorescence reactions.
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Keratin, soap, petroleum, Pseudomonas and Corynebacterium
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Most sensitive method of diagnosing dermatophytosis
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Fungal culture on DTM
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What are 4 components of dermatophyte test medium?
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Sabouraud's dextrose agar
Cyclohexamide (antifungal) Gentamicin and chlortetracycline (antibacterial) pH phenol red |
