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188 Cards in this Set
- Front
- Back
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what is the most common etiological agent of demodicosis for dogs
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Demodex canis
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Is D. Canis, and D. Cati surface or follicular mites?
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Follicular mites
D. gatoi is a surface mite |
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Where are demodex mites acquired?
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From the bitch or queen at birth (neonatal) or by direct contact
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What is thought to be the initiating cause for demodex infections? what do the mites produce that causes further problems?
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Thought there is a genetic predisposition that allows unchecked proliferation of mites
Mites produce factors that cause further suppression of the immune system |
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What are many of the immunologic abnormalities associated with demodicosis due to?
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Immunosuppressive effects of secondary pyoderma
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What "version" of D. Canis will usually have no secondary problems (pyoderma)
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Localized (squamous) demodicosis
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What "version" of D. Canis will have 90% of lesions spontaneously resolve?
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Localized (squamous) demodicosis
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What kind of dogs have been documented more to have Generalized demodicosis?
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purebred dogs and dogs with short hair coats, but any breed or mix may be affected
more common in dogs <1yr of age Very unlikely to spontaneously resolve |
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What is adult onset demodicosis and what is the cause
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generalized demodicosis after 1-2yrs of age
Due to immunosuppressive disorder. |
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what is furunuclosis
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follicle ruptures and acts as a foreign body to the surrounding tissue
clinically usually see small draining tracts (purple points bleeding) |
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what is the prognosis for localized demodicosis
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Excellent!
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What is the treatment of choice for cats with D. Gatoi infections
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2-3% lime sulfur
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Is Selamectin effective for treatment of generalized demidocosis?
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NO
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T/F Lime sulfur is ineffective for D. canis and D. cati infestations
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True
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What is the most important initial treatment for generalized demodicosis infection of D. Canis
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Treat pyoderma with proper AB therapy and topical treatment
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Which species of Demodex is contagious?
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D. Gatoi
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What is folliculitis vs. furunculosis?
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Folliculitis - an inflammatory rx directed against hair follicles
furunculosis - a deep skin infection in which a ruptured hair follicle results in an inflammatory rxn |
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How would you describe lesions associated with Generalized (pustular) demidicosis
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lesions of generalized erythema, crusting, scaling and patchy to diffuse alopecia, sometimes with bluish or bruised appearance
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Problem solving is key to diagnosis and treatment. In each case the problems should be ______ and _____
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identified and prioritized
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In which dermatological test is it important to squeeze the skin and why?
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Skin Scraping
Need to squeeze the skin to extrude demodex mites from hair follicles |
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What is the proper depth to scrape to for a skin scraping
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Scrape to capillary hemorrhage (slight pink and bruising) but NOT bleeding
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What can give you a false result on skin scrapings/impression smears for yeast and what should you do to prevent this?
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Wear gloves b/c your skin or finger print on a slide can leave oil and give false results.
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What type of hairs are preferred for fungal culture
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Broken hairs
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Why is it applicable to include a fecal floatation for patients that present for dermatology problems
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Ectoparasites are frequently consumed by the host during the process of satisfying the sensation of pruritis and pass undamaged through the GI tract
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How does feline demodicosis caused by D. Gatoi often present as
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Symmetrical alopecia caused by licking due to pruritis
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T/F D. Gatoi is contagious
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True
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What is the diagnostic plan for demodex?
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Skin scrapings - must squeeze skin
Trichogram culture for dematophytes fecal float to r/o internal parasites as the cause of immunosuppresion, Cytology Bacterial culture Blood work |
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What is the recommended topical acaricidal agent for demodex?
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Amitraz - Mitaban - do at 1 week intervals for 8-12wks. Trxs are continued until two consecutive scrapings are negative
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You have a collie dog with generalized demodicosis and you want to treat systemically what are your treatment options
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Milbemycin oxime (interceptor) - effective in up to 60% of chronic cases - give double the dose for 1mth / $$$$
Moxidectin (advantage multi) Do not use Ivermecin or Doremectin also selamectin is not effective for demodicosis Could also trx topically with Amitraz |
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You have a patient with localized demodicosis that is pruritic, you want to give it some cortiocosteroids and send the dog home. The dog returns in a week - what happened?
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Corticosteroids are totally contraindicated in demodocosis! Patients are already immunosuppressed and by given steroids become further depressed. This patient probably had the localized infection become a generalized infection
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Where is the life cycle of sarcoptic mange completed?
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entirely on the hose in 17-21 days
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What is the hallmark sign of a patient with sarcopic mange
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Intense prurius
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What is the classical distribution of sarcoptic mange lesions
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PEEL
Periorbital area margins of Ears, Elbows, and Lateral aspects of the extremities. |
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Is general peripheral lymphadenomegaly a consistent finding with sarcoptes or demodex?
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Sarcoptes
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How is Sarcoptes diagnosed
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multiple skin scrapings
pinna-femoral relex fecal floatation human involvement / skin lesions |
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You have a patient come in that has intense pruritis with lesions on the ears, elbows, and lateral aspects of the extremities. You performed 10 skin scrapings that were negative. Should you treat this animal with out a diagnosis?
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YES! - if index of suspicion is high
Most likely Sarcoptes - mites are difficult to find on scrapings |
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An animal is diagnosed with sarcoptes and given its first treatment in the clinic. Does the owner need to be given any specific instructions to do at home?
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Yes!
The owner needs to be told to bring in any other patients in the home - all susceptible animals should be treated. Environment should be cleaned by vacuuming areas in which the animal spends time, and then spraying those areas with flea spray house treatment. Also wash any and all bedding around the house. |
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You diagnose a dog with sarcoptes mange. The owner of the dog makes comments about having red lesions on their legs. What do you tell the owner?
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That sarcoptic mange is a zoonotic disease and is NOT self limiting in humans. Highly recommend that they see a physician.
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What are some topical agents that are effective with sarcoptic mange?
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2-3% lime sulfur - highly effective and antipruritic - apply weekly for 3-6 trxs
Amitraz |
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You have a collie patient with sarcoptic mange what will you use to treat the dog?
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Selamectin (revolution) - 85-90% effective - trx of choice (second trx at 3 wks is rec)
Could also use Fipronil SPRAY - not topical - repeat in 2 wks |
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You have a lab patient that presents with sarcoptic mange. What will you use to treat the dog?
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Selamectin can be used and is the trx of choice for ivermectin sensitive dogs.
Could also use Ivermectin orally for 3-4 does but side effects are neurologic in nature and may include sudden death - also not labeled |
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Is systemic therapy with milbemycin (interceptor) effective against sarcoptes?
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Yes
2mg/kg given orally twice weekly for 3 wks is very effective Milbemycin is also effective against demodex! |
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You diagnosed a patient with sarcoptes 4 weeks ago and the patient is now back for a recheck and doing much better. The owner asks if her dog is now protected from gettting sarcoptes again. What is your response?
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No - treatment/dz does not equal immunity. The patient could get sarcoptes the very next day.
Recommend that the patient be put on a preventative that is labeled for it such as Selamectin (Revolution). |
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What are some causes of general treatment failure
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Incorrect dosages
Compounding problems Incorrect diganosis Incomplete application of insecticides /rinses Re-infection |
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Selemectin, Lime Sulfur, Metaflumazone/amitraz (Promeris), and moxidectin (advantage multi) are the only FDA approved drugs for use with Sarcopties. According to Dr. Nixon why should Promeris not be used????
note - Amitraz is approved for use in Canada but not the USA |
Promeris should not be used for treatment of Sarcoptes because published cure rates are very low at only 75% effective
Selamectin is at 85-90% effective Bottom line - better drugs available. |
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What is the most common flea to be found on dogs and cats
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Ctenocephalides felis
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Are fleas host specific
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NO
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What should treatment in fleas be directed at?
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Adults comprise less than 1% of all life forms at any given time in the environment - control should be focused on stages other than adults
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Where do fleas prefer to live
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ON the host - only are found in the environment when they fall off the host
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Where do flea larvae move once hatched from eggs?
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Are negatively phototactic (move away from light) and positively geotactic (move down). Can crawl several feet
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Why is carpet such a great living environment for flea larvae/eggs
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Temperature and humidity deep in carpet supports the life cycle of the flea
Humidity in carpet is higher than in the general room |
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What is the pathogenesis of disease caused by fleas
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Mechanical irritation
Anemia from blood loss - usually in debilitated animals Carriers/vectors of disease Dermatologic conditions |
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What area of the body is typically affected with fleas
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Caudal half of the animal particularly around the base of the tail
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T/F all animals in a house hold should be treated not just the ones infected or the ones that go out side
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True
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What is integrated flea control
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term used to reflect using multiple flea control agents and or techniques to control fleas by attacking them at different life stages or locations
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What are the important properties of insecticides
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Important properties of insecticides: cost, availability to the vet or pet owner, esthetics to the owner, efficacy, ease of application to the pet or environment and safety
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What is microencapsulation
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process where by the insecticide is packaged into small microspheres
- increases the LD50 and decreases biodegradation (extends duration of action) Products include: pyrethrins, diazinon, chlorpyrifos **microencapsulated pyrethrins are among the safest insecticide preparations available. *** |
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What are some examples of systemic insecticides for fleas
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Capstar (Nitenpyram)
Comfortis (Spinosad) |
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What is the basis of action of topical flea products
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designed to use the pet as the delivery system - as fleas feed they are exposed to insecticide.
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There is resistance to topicals and fleas, what should be recommended to decrease this problem?
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Use integrated flea control (environment and pet)
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You are sending home a month supply of advantage topical flea treatment what do you do/tell the owner before they leave the building.
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Show them specifically how to apply the medication properly. Tell them to wear gloves. Give them a sticker from the box to put on the calendar so they remember when they gave the medication. Ensure label is correct and clear to the client. Ask the client to explain the process or demonstrate correct application back to you. Discuss any preventative methods if children are in the house (separate children and pet or put on pet before bed) or look into alternative drugs (oral)
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A client phones after you applied advantage to her cat yesterday complaining that she is still seeing a TON of fleas on her cat. She vacuumed her house yesterday and is expecting that she wont' see fleas today. What do you tell her?
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Vacuuming will stimulate pre-emergent adults in cocoons to emerge so there will be increased flea activity. This is the ideal time to use a house treatment insecticide.
Explain the life cycle of the flea again to the owner and that the majority of the flea infestation in the home is NOT adult fleas but eggs, larvae and pupae that still will become adults. |
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Should you recommend to cut up flea collars and put them in things like pet bedding and the vacuum to keep flea's out of these areas?
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NO
The vacuum will get hot and then create toxic fumes If a pet destroyed their bed and consumed the piece of collar there are toxicity problems |
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How many teeth per inch does a flea comb have?
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32
so they don't work well with mats or very thick coats |
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If an owner has a flea infestation should you recommend that they treat their yards and garden areas?
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Not the yard
Fleas and larvae will not survive long in an open area of the yard Treatment of these areas is not necessary Shaded areas frequented by the pet should be treated (under trees, large bushes) |
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what is an acceptable insecticide to use for outside flea treatments (environment)
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Sevin (Ortho) powder
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A kitten that is 6 weeks old is presented you with fleas.... what do you recommend?
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Use flea comb multiple times daily
Apply citrus derivative insecticide according to label instructions Apply methoprene (IGR) topically Change bedding / clean house daily if still nursing, treat mother in similar manner |
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A family comes to you with their 10 wk old puppy and 2 year old lab both with fleas, what do you recommend?
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Use flea comb multiple times per day
apply topical monthly pour on (fipronil, imidacloprid, metaflumazone, dinoteraun, selamectin) product or use a systemic oral once monthly (confortis) Treat and control home environment Initiate long term administration of oral IGR |
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You have a 1 yr old indoor cat with fleas what do you recommend?
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Use flea comb
Apply fipronil, selamectin, metaflumazone, dinotefuran, or imidocloprid insecticide once monthly Use oral lufenuron as preventative Trx environment |
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You have a equine client with multiple barn cats with fleas what do you recommend?
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Apply fibronil, selamectin, dinotefuran, metaflumazone, or imidocloprid topically 1x per month
Trx environment with insecticide and IGR Use lufenuron if finances permit and cats comply |
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What are the most common isolates of Dermatomycosis?
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Microsporum canis (dogs, cats, zoophilic fungus)
M. Gypseum: dogs, cats, horses (geophilic) Trichophyton mentagrophytes: dogs, cats, horses (zoophilic) |
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How is dermatomycosis transmitted?
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contact with infected animals, soil, or through fomites
spores may be viable for years under ideal conditions |
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T/F older animals are more commonly affected with dermatomycosis than young
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False
young are more common |
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What are some predisposing factors to dermatomycosis infections
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poor nutrition
improper sanitation trauma immunosuppressive diseases glucocorticoid use genetic factors (persian cats) |
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What is the pathogenesis of dermatophytes?
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Invade and grow in non-viable kearatinized tissue
Grow only in non living portion of hairs in anagen, weakening the hair shaft and causing it to break while advancing down the fair follicle, the fungus releases metabolic by-products or toxins that incite an inflammatory reaction thus inducing folliculitis which may progress to furunculosis type IV hypersensitivity reaction follows |
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Why does dermatomycosis spread on an animal?
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Because it only infects the hairs in anagen. so once the hair is affected and breaks it will move on to healthier hair creating a circular lesion as it grows.
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what is the incubation period for dermatomycosis?
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2 weeks on average
(4days to 4wks) |
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T/F some animals seem to have resistance to active infection and remain asymptomatic carriers (regarding dermatophytes)
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True
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Describe the classical lesions of dermatomycosis?
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Circular area of alopecia
Patchy alopecia with broken hair and brittle hair Erythema, hyperkeratinization and crusting, pustules nodular hyperkeratotic erythematous lesions with follicultitis (kerion) Mild-moderate pruritis may be reported, esp in cats Hyperpigmentation in chronic cases or as lesions heal |
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Where are lesions more typically located with dermatomycosis
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head
ears extremities but may be generalized |
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How do trichophyton species typically present as?
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pustular eruptions
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What are Pseudomycetomas?
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deep dermal or subcutaneous infections by dermatophytes. Present as nodules and draining lesions that histologically are pyogranulomatous to granulomatous panniculitis
M. Canis is the causative organism in the cat Surgical excision of the lesion and systemic antifungal therapy is recommended. |
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What are some examples of diseases that should be on your differential for a patient with dermatomycosis?
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scaling such as familial seborrhea, superficial pyoderma, demodicosis, hypothyroidism, bacterial hypersensitivity
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How can you make a diagnosis of dermatomycosis?
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Scrapings for culture
Clinical appearance Woods light exam Trichogram Fungal culture Skin biopsy |
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What species of dematophyte is the only one that fluorescence with a wood lamp
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M. Canis
and it will only fluoresces 25-50% of the time |
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There are round circular lesions and epidermal collarettes on a patient 90% of the time they will be what?
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Staph NOT dermatophytes
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What is the definitive test for dermatophytes?
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Fungal culture
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What do you look for on a trichogram to diagnose dermatophytosis?
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Rotten logs!
Hairs if affected will look like they are dissolving / a rotten log. |
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What should you have your microscope set on to see dermatophytes?
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Lower the condensor and close the diaphragm
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T/F an alcohol rinse can be used on areas for fungal culture to cut down on contaminants
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True
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What should you use to sample for dermatophyte infection (ie type of hairs)
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Broken hairs
crusts scales and or individual hairs that fluoresce under the wood's light |
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What is the Mackenzie Brush technique
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used to id carrier animals.
Employs a sterile toothbrush to comb the hair coat of the animal The bristles of the brush are then embedded or shaken over agar for culture |
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What is the standard fungal culture media
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Sabouraud's dextrose agar
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You have a patient that you suspect has a dermatophyte infection (M. Canis). You pull hairs for a fungal culture and 7 days later the culture has turned pink. is this diagnostic for M. Canis
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NO
The diagnosis of a pathogenic organism should not be based solely on the color change of Dermatophyte test medium! |
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Why do fungus change the color of test medium when they grow
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utilize the protein in the agar as a growth substrate, producing alkaline by-products which cause a color change from amber to red
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T/F if a color change occurs with a fungal culture then the sample is a pathogenic fungi?
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FALSE
some pathogenic species will not cause a color change and some non pathogenic fungi will cause a color change |
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T/F non pathogenic fungi will cause a red color change if incubated for extended periods of time
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True
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how long should fungal cultures be kept
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For 4 weeks! oy!
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What are some treatment options to decontaminate a patient with a dermatophyte infection
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Topical disinfectants 2% lime sulfur
Miconazole-chlorhexidine shampoo Should clip areas affect and may need to clip full body if generalized infection |
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T/f topical treatment is appropriate for multi-focal dermatophytosis infections but not generalized?
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FALSE
topical therapy is not recommended as the sole treatment for multi-focal or generalized dermatophytosis |
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What are some examples of topical therapy used for spot treatment of dermatophytosis infections
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Chlorhexidine ointment
1% miconazole lotion (conofite) Chlotrimazole ointments and lotions Enilconazole Malaseb shampoo - JON recommends |
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What are some systemic therapy options for dermatophytosis?
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Griseofulvin
Azoles Lufenuron Terbinafine |
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What are some points to remember about Griseofulvin (trx from dermatophytes)
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Griseofulvin - need to get through human medicine - 1x dosing, give with fatty meal - available in ultrafine, microsized form which reduces the does by half - teratogenic!, leukopenia more likely in FIV + cats
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What are the types of azoles available to use for treatment of dermatophytes?
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Ketoconazole
Itraconazole Fluconazole |
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T/F Azoles are fungistatic
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True
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What is currently the drug of choice for treatment of cats with dermatophytosis
What will most likely become the drug of choice for dogs and cats in the future? why? |
Itraconazole - mix 1 capsule with small amount of butter and spread into a line then freeze - can then break off the proper amount and cats love it!
Terbinfine (Lamisil) - is fungicidal - very few side effects |
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Which of the following drugs is not recommened for use as treatment with dermatophytosis infections and why?
a. Ketoconazole b. Lufenuron c. Terbinafine d. Griseofulvin |
B- Lufenuron
Is a chitin inhibitor that interferes with chitin development in hyphae/spores Not recommended due to the side effects - hemorrhagic diarrhea, vomiting and sudden death see pg. 44 of the notes to review the fungal drugs |
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T/F Griseofulvin is only available as a human product for treatment of dermatophytosis
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True
- no vet products |
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You have a client with a dog with dermatophytosis and you just started it on ketoconazole, will the owner need to do anything further than administer medication?
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YES -
Clean/launder bedding and carpets Vacuum every where - dispose of vacuum bag change furnace or airfilters in the home on a weekly basis Use topical disinfectants in appropriate areas goal - to reduce the burden of infective agents in the house - virtually impossible to sterilize the environment or remove all spores and hyphae |
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What would you recommended to catteries or kennels that have a dermatophyte infection or want to prevent it from occuring
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- survey all new animals before entering with a fungal culture
- separate infected animals immediately (wear protective clothing when working with infected animals) - clean and decontaminate environment - Consider treating all animals with Lufenuron monthly as a preventative - Environmental sprays |
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What is Onychomycosis
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A fungal infection of the claw - is rare
Usually part of a generalized infection Diagnosis by removing part or all of the claw and culture Requires long term therapy (months) |
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What are the public health considerations of dermatomycosis
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Is infectious
contagious Zoonotic! *Vets are obligated to explain to pet owners the possible ramifications of exposure to humans* |
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What are some examples of intermediate mycoses
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Sporotrichosis - cutaneous nodules, draining ulcerative tracts - trx sodium iodide - ZOONOTIC!!!
Phaehyphomycosis - SC nodules, granulomatous lesions and draining tracts - sx removal, amphotericin B Candidiasis- thick white opaque plaques on mucous membranes or mucocutaneous junctions - often secondary pathogens |
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What are some examples of deep mycoses
how do they present |
Histoplasmosis
Blastomycosis Cryptococcosis Coccidiodomycosis Generally present as ulcers, crusted ulcers, SC nodules, and or as draining tracts |
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What is Mallassezia pachydermatis
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non-obligatory, lipophilic, budding yeast considered part of the normal flora of the skin and external ear canal
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When do Malassezia become pathologic?
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Almost always secondary conditions (perpetuating factors of pruritus)
Primary factors - atopy, other allergic skin diseases, endocrine imbalances, systemic illness, immunodeficiency syndromes, glucocorticoid usage, nutritional deficiencies |
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What are some predisposing factors to Malassezia infections
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breed
presence of seborrheic dermatitis increased temperature increased humidity immunodeficiency conditions |
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What is the pathogenesis of Malassezia infections
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Activation of the alternate pathway of complement
Production of enzymes and toxins that induce inflammation hypersensitivity reactions synergistic actions with Staph pseudointermedius |
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What breeds are most common for Malassezia infections
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Chinese Shar-pei
Basset hound American cocker spaniel boxer Dachshund Labrador retriever |
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what areas should you look for on an animal for Malassezia?
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interdigital (top and bottom of foot)
Ventral neck Perivulvar Axillary Lip fold KNOW THESE! |
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What is a key factor of Malassezia infections?
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SEVERE PROGRESSIVE INTENSE PRURITIS!
hx of licking feet, rubbing face, generalized pruritus that initally respond to glucocortocoid therapy but then less and less |
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You suspect a patient has Malassezia what clinical signs/physcial findings should you find?
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Intense pruritus, scratching and biting in the exam room
Lesions begin as erythema and scaling then progress to alopecia, lichenification, and hyperpigmentation The skin and hair coat are generally greasy and malodorous Otitis externa is generally seen Peripheral LN are enlarged and prominent |
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How do you diagnose a Malassezia infection
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Identify the proper factor (reason for the infection!)
Hx, PE, Derm data base, allergy tests, tests for endocrine, routine hematology, Id organism on the skin Impression smears - scale of 1-4 (a grade 4 = 1 or more yeast found per microscopic field) |
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What will a skin biospy show with Malassezia infections
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hyperplastic dermatitis with orthokeratotic hyperkeratosis, superficial perivascular dermatitis with varying degrees of crusts
Special stains will help to demonstrate the organisms in the stratum corneum |
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what are the key steps in treatment of a malassezia infection
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Control concurrent bacterial dermatitis
Treat the yeast infection Identify and control the primary dz |
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T/F With Malassezia dermatitis - shampoos may be used as the sole treatment or in conjunction with systemic therapy
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True!
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What are some examples of appropriate shampoos for treatment of Malassezia
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Selenium disulfide (Selsun blue)
Miconazole (Malaseb) Salicylic acid ketoconazole (Nizoral AD) |
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You just diagnosed a patient with Malassezia and are sending home some Malaseb shampoo - what are your instructions to the owner
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Bathe 3x weekly for three weeks, then twice weekly for 2-3 weeks then weekly
For maintenance continue bathing as needed until the primary disease is identified and controlled |
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When will shampoos for Malassezia be effective as the sole treatment?
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May be effective as the sole treatment of malassezia dermatitis IF the condition is mild or moderate and IF the owners are conscientious in the application of the shampoo
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Besides shampoos what are some other topical forms of therapy used for Malassezia infections
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Sprays - 1% miconazole
conditioners/lotions Wipes/pads |
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What are some systemic antifungals used for Malassezia infections
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Ketoconazole - for 30 days
*adverse effects - may increase liver enzymes* and cause anorexia in cats Cats rec - Itraconazole |
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When would systemic treatment for malassezia be appropriate
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The owner can't bathe or manage the patient topically
Severe infection Cutaneous and otic infections |
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You diagnosed a patient with Malassezia when should they come back for a recheck and what should you perform at the recheck
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30 days
repeat impressions or scrapes look for primary disease condition (atopy) |
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What are some common examples of primary diseaes processes that lead to Malassezia
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atopy
hypothyroidism adverse reactions to food other endocrine imbalances flea allergy debilitating systemic diseases |
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T/F Once Malassezia problems start they tend to always have it, therapy should never be completely discontinued
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True
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The majority of pyodermas involve what type of bacteria and what are they
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Coagulase positive bacteria
Staphylococcus pseudointermedius S. aureus, S. schelferi, Proteus, Pseudomonas, E. coli, strep |
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What are some predisposing factors for bacterial infections of the skin
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Signalment - some breeds have IgA deficiency
Behavior - swimming Anatomic factors - skin folds, hair coat type Environmental factors - temperature, humidity, frequent swimming by the pet |
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What is the pathogenesis of bacterial skin diseases
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Increased adherence of bacteria leads to increased inflammation leads to change in microclimate of the skin leads to change in permeability
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What are the primary factors associated with bacterial infections
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Allergies (atopy) - MOST COMMON
Ectoparasites Scaling disorders / disorders of cornification Immunodeficiencies, demodicosis, endocrinopathies (hypothyroidism) Skin trauma or maceration |
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What are the clinical features of pyoderma (ie. the patient in front of you with pyoderma looks like what)
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papules
pustules epidermal collarettes erythema scale/crusts patchy alopecia draining (fistulous) tracts (classical for furunculosis) Pruritus is usually mild to moderate Patchy alopecia (moth eaten look) |
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What are the differential diagnosis for pustules
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pyoderma
autoimmune skin diseases Dermatophytosis eosinophilic dermatitis steril pyogranulomatous dermatitis panniculitis |
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What are the rule outs for folliculitis
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Demodicosis
pyoderma Dermatophytosis |
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How do you make a diagnosis of pyoderma
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Hx
Dermatological data base cytology culture and sensitivity testing routine blood work Endocrinology panels if needed skin biopsy if needed |
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What is in the dermatolgic data base
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scrapings
trichogram impression smears for yeast fungal evaluation |
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With a case of pyoderma - where should samples for cytology be collected from
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Intact lesions such as pustules when possible -- avoid prepping the area!
Place material on a glass slide, spread smoothly, stain |
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What are some appropriate topical antibacterial therapies for pyodermas
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Benzoyl peroxide - gel or shampoo, 2.5% solution - higher concentrations may cause severe cutaneous irritation
Mupriocin ointment Povidine-iodine - bactericidal, messy Chlorhexidine |
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Why is benzoyl peroxide good for pyodermas
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bactericidal for up to 48hrs after application
follicular flushing action keratolytic, astringent, degreasing, a debriding action, promotes wound healing. |
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What is the #1 topical antibacterial application used with pyodermas
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Benzoyl peroxide (BPO)
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What are some shampoo options for treatment of pyodermas
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BPO
chlorhexidine (4%) povidone-iodine Ethyl lactact |
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T/F shampoos be used as sole therapy for mild or superficial pyodermas
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True
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What are the keys to use of shampoos with pyodermas
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MUST HAVE CONTACT TIME OF 10MINUTES!
use neutral temperature to slightly cool water (reduces pruritus) Bathe every 2-3 days for sole treatment, every 7-10days for adjunctive therapy, every 7-14 days for long term use. |
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What is the phrase you should remember with lesions in dermatology and moisture
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If the lesion is moist dry it, if the lesion is dry moisten it
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what are some common astringents
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Domboro's solution
TAN-SAL |
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Do you want bactericidal or bacteristatic for pyodermas
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CIDAL
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What are some poor choices of antibiotics for skin infections
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penicillin
ampicillin sulfas tetracyclines |
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What some highly effective antibiotics for pyodermas
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cephalexin/cefadroxil/cefpodoxime, some fluroquinolones, amoxicilllin + clavulinic acid, penicillinase resistant synthetic pencillins (cloxacillin)
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What are the characteristics for the ideal antibiotic for pyodermas
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low cost
narrow spectrum of activity few adverse effects penetrates skin active in the presence of inflammatory cells concentrates in macrophages avoid complications effective orally infrequent administration |
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How long should pyodermas be treated?
surface, superficial, deep |
Surface pyoderma - 5-21 days
superficial pyoderma (folliculitis) 21-30 days deep pyodermas (furunculosis) 1-6 months |
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How is hydrotherapy beneficial to pyoderma cases
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Includes the use of whirl pools, ultrasonic tubes, or active bathing systems
helps to remove surface debris, alleviate discomfort, increased cutaneous blood flow Especially helpful in deep pyodermas |
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How do you determine how aggressive your therapy needs to be with pyodermas?
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increasing depth of the infection generally indicates a more aggressive condition and requires more aggressive therapy
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What are the 3 rules to remember for treatment with acute moist dermatitis
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clip
clean dry |
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What is the most common organism of acute moist dermatitis
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Staphylococcus pseudintermedius
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What are the clinical features of a hot spot
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Intense pruritis (focal at the lesion)
lesions develop VERY quickly (with in hours) focal areas of edema, erythema, alopecia (self induced), crusts, ulcers Hair is often matted down at the lesion |
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What are the other terms used interchangeably with acute moist dermatitis
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hot spots
pyotraumatic dermatitis |
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How long should a hot spot be treated with antibiotics
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7-10-21 days - depends on severity
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What is the treatment for a hot spot
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clip, clean, dry
antibiotics short term glucocorticoids (7-10days of oral pred) topical application of an antibacterial steroid combination |
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What is Canine Acne
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essentially folliculitis
affects immature dogs most often and reported most common in short haired breeds factors may include undeveloped immune system, nutritional status, other heath issues Lesions range from a few papular eruptions and pustules to severe, progressive folliculitis and furunculosis |
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Can dogs get scarring from canine acne?
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YES
pemanent alopecia and scarring accompanies furunculosis |
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What is the therapy for canine acne
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Mild cases often regress at sexual maturity
topical antibacterial therapy may be sufficient for mild cases daily cleaning of affected area with iodine or chlorhexidine shampoos, wiping areas daily with acetic acid/boric acid wipes systemic ABS (7-30+days) ID and correct predisposing factors |
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Why are skin folds great places for pyodermas
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warm
dark moist environment |
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Where is skin fold dermatitis usually found
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lip folds (spaniels)
facial folds (brachycephalic breeds) vulvar folds (obese, spayed females), corkscrew tails (brachycephalics) |
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What is the therapy for skin fold dermatitis
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dry the skin
Topical astringents are often helpful Topical antibiotics systemic antibacterials may be needed |
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What is impetigo - superficial pustular pyoderma
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Puppy pyodmera
often secondary to improper sanitation, poor diet, coincidental disease states, parasitism Generallly culture a staphylococcus or strep species seen in dogs <9mth Subcorneal pustular formation which rupture forming honey colored crusts |
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Where are lesions from impetigo usually found
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ventrum: abdomen, groin, medial aspects of thighs
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What is the therapy for puppy pyoderma
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topical antibacterials such as BPO or good cleansers
systemic ABS for 7-14 days or as needed |
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What are the main causes of folliculitis
KNOW THIS |
Demodicosis
Dermatophytosis staphylococcal infections |
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What is the pathogenesis of folliculitis (superficial bacterial dermatitis)
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inflammatory reaction of the hair follicle leads to accumulation of inflammatory cells, edema in the perifollicular area, resulting in formation of a papule
can progress to destruction and rupture of the hair follicle (furunculosis- deep pyoderma) Atopy and hypothyroidism are the two most common predisposing diseases |
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What breeds are predisposed to folliculitis
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shorthaired breeds - doberman pinscher, great dane, dachshund, dalmation, english bull dogs
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What is the progression of lesions in superficial bacterial dermatitis (folliculitis)
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papules to pustules to epidermal collarettes
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What is the treatment for folliculitis
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Abs 21-30 days
topical antibacterial shampoos ID and control predisposing factors antiseborrheic shampoos to reduce crusts and pruritis |
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What is a key finding with furunculosis
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Follicular rupture extends the infection and releases highly irritating keratin into the dermis.
SINUS or DRAINING tracts develop to extrude the keratinized debris |
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What other signs besides draining tracts are seen with furunculosis
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pruritis
alopecia |
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A patient has nasal pyoderma what are your other rule outs
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demodicosis
dermatophytosis drug reactions autoimmune dz |
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Who gets pressure point pyoderma
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Lg and giant breed dogs
see on stifles, hocks, elbows and sternum May be pitted or raised, exudative and contain draining tracts |
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What is the therapy for deep pyodermas (furunculosis)
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ABs for 1-6mths
Hydrotherapy helps to clear up lesions and reduce pain surgical debridement and lancing of the lesions may be helpful in some cases Topical antibacterials are generally of little value unless there are very focal lesions |
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What is the causative agent generally of Interdigital pyoderma
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S. pseudointermedius
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What does interdigital pyoderma look like
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purulent, exudative, draining tracts of feet with moderate to severe swelling
painful one foot or all feet involved |
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What is the therapy for interdigital pyoderma
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Long term ab therapy
whirlpools surgical debridement and removal of fistulous tracts Id and manage primary disease Surgical removal of webbing |
