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67 Cards in this Set
- Front
- Back
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Clinical Signs of Pruritis
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Scratching,
Chewing, Nibbling Licking Rubbing, Rolling Head Shaking |
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DDx for Pruritis
Ectoparasites |
Ecto:
Flea Allergy Derm Sarcoptic Mange Harvest Mite (Trombicula) Insect Bite Hypersensitivity Otodectes Cyanotis (Lice, Demodecosis) |
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DDx for Pruritis:
Infectious agents |
Staph Pyoderma
Malasezia derm (dermatophytosis= more alopecia than pruritis) |
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DDx Pruritis:
Allergies |
Atopic Dermatitis
Food Allergy Contact Dermatitis |
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Most important Flea Spp
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Ctenocephalides Felis
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Dx of Flea Bite hypersensitivity?
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Observe Fleas
Flea Dirt (flea comb, moistned paper) Distribution pattern: base of tail up back, neck, inguinal region Response to Tx |
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Flea Tx principals
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1) prevent animal getting bitten
2) Provide short term symptomatic Tx if pruritis is severe long acting flea control product (patient and in contact animals) Tx environment: long lastin life cycle inhibitor Prednisolone |
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Flea control products
1) animals 2) environment |
1)
Frontline: Fipronil Advocate, Advantage: Imidocloprid Stronghold: Selamectin Lufeneron: Chitin synthesis inhibitor (interrupts embryogenesis, hatching, moulting) 2) Insect Juvenile hormone: Methoprene, Fenoxycarb, Pyriproxifen |
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Tx Lice
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Cats: Fipronil & Selamectin
Dogs: Imidocloprid |
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Sarcoptic Mange: Life cycle
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All on host: obligate parasite
spread via direct contact with infested dog/ fox Some dogs may be asymptomatic carriers |
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Sarcoptic mange: Dx
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Pruritis: intense
papular dermatitis: pinna, elbows, hocks, ventral abdomen Multiple Skin scrapings (but often nothing found) Trial Tx |
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Sarcoptic Mange: Tx
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Stronghold: Selamectin
Advocate: Moxidectin Amitraz dips: IF Tx FAILS All dogs in house should be treated Prednisolone: break the itch scratch cycle |
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Cheyletiellosis: Dx
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Severe dorsal and truncal SCALING
Mild Pruritis microscopic ID of mites or eggs in coat brushings, scrapings, tape impressions |
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Cheyletiellosis: Tx
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None are Licensed
Fipronil: Frontline Selamectin: Stronghold Moxidectin: Advocate or Weekly bathing (6weeks) with pyrethroid |
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Ear Mites: Otodectes cyanotis: Dx
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Dry, Brownish, waxy exudate in ear canal
Pruritis of ears/ pinnae, head shaking, scratching |
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Ear Mites (Otodectes Cyanotis): Tx
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Stronghold: Selamectin
Advocate: Moxidectin Ear drops drown mites Tx all animals in house for at least 2 life cycles |
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Trombicula autumnalis:
Dx |
Clusters of orange larvae visible: Henry's pocket of pinnae, pre auricular region, interdigital spaces, eyelids, ventrum
Hypersensitivity= pruritis |
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Trombicula Tx
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Fipronil= reccomended
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Superficial Pyoderma:
Bacteria? |
Staphylococcus Intermedius
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Staph Pyoderma: Underlying conditions/ predisposing causes
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Parasitic skin dz
Allergic skin dz Greasy skin conditions Hormonal skin conditions: HypoT, cushings Cutaneous immunodeficiencies Poor grooming/ wetting |
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Staph pyoderma: Lesions
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papules
pustules epidermal collarettes |
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Staph pyoderma: Dx
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Lesions
Cytology: Acetate strip of ruptured pustule or pus from deeper lesion Degenerate neutrophils, intracellular cocci |
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Staph pyoderma: Tx
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Combination of Systemic and topical Therapy
ABC (clindamycin, cephalexin) & Chlorhexidine |
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First Line ABC for staph pyoderma
2nd line: when to use? |
Clindamycin
Cephalexin Lincomycin Amoxy Clav Trimethoprim Sulphonomide 2nd line= enrofloxacin (baytril), marbofloxacin (marbocyl): use for mixed infections (G-ve including resistant organisms) |
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Mallasezia:
Lesion appearance Lesion Distribution |
Erythema, yellow/ grey Waxy scale, feels greasy, rancid odour
Ears, mussle, feet, anus, body folds, medial thighs, perineum |
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Mallasezia:
Diagnosis |
Lesions
Cytology (tape strip, ear swab MUST BE HEAT FIXED): Russian doll yeast cells |
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Mallasezia : Tx
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Topical Tx is the mainstay
Malaseb= Chlorhexidine / Miconazole (3x a week until responded, then dec to 2x and 1x weekly) Systemic Tx if not responding: Ketoconazole (can cause malaise, occasioinal hepatotoxicity, malaise) must moitor liver enzymes repeat tape strips to monitor improvement |
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Atopic Dermatitis Definition
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genetically predisposed inflammatory and pruritic allergic skin disease with carachteristic clinical features assosciated with IgE antibodies to environmental allergens
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Atopic Dermatitis: common age range
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6 months ---- 3 years
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Atopic Dermatitis: Clinical signs
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Pruritis: common distribution pattern
Face, eyes, ears, feet, axilla erythema & papules --- staph infection, malassezia, self induced alopecia, seborrhoea, otitis externa --- Lichenification, Hyperpigmentation |
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Atopic Dermatitis: Dx
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Typical History
Typical clin signs (lesion / distribution) Rule out other pruritic dermatoses allergy tests (intradermal and blood allergen specific IgE) |
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Atopic Dermatitis: Tx
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Allergen Avoidance
Allergen specific immunotherapy Glucocorticoids Antihistamines Essential Fatty Acids Cyclosporine Chinese Herbs Topical Therapy |
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Use of Glucocorticoids in Atopy Tx
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Effective and cheap but have side effects... PREDNISOLONE
Long term use = minimum effective dose at alternative day therapy best for: seasonal atopy lasting 3months or less, adjunctive to other drugs, short term to break itch scratch cycle 0.5mg/kg/day divided into 2 doses 12hr apart (5-7 d until response seen) then daily dose once daily (3-5 d) then every 48 hrs, then decrease dose to lowest dose capable of controling the disease |
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Antihistamines
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effective in 20% of cases
(must try at least 3 diff drugs for a week each to assess efficacy) Piriton: Chlorpheniramine Nytol: Diphenhydramine Atarax: Hydroxyzine Keep diary and note level of pruritis each week, if drowsiness is noted stop |
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Fatty Acids
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work synergistically with antihistamines
admin @ 2-4x the reccomended dose for 6-8 weeks |
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Cyclosporine
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Licensed: as good as pred and dec side effects
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Chinese Herbs
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Phytopica
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Food Allergy Dx
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Intra dermal tests and IgE unreliable
Diet Trial: at least 6 weeks if positive response: challenge to assess situation |
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Feline Cutaneous Reaction Patterns (x4)
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miliary dermatitis
feline symmetrical alopecia eosinophilic granuloma complex head and neck pruritis |
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Clinical features: Miliary Dermatitis
1. carachteristic lesions 2. Distribution 3. Common Cause |
1. small scabs,(miliary papulocrustous lesions)
2. Dorsum (but can be anywhere) 3. Flea bite hypersensitivity |
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Feline Symmetrical alopecia
1. pattern 2.inflammed? 3. distibution 4. common causes (x3) |
1. bilateraly symmetrical alopecia
2. No 3. ventral abdomen, lateral abdomen, caudal hindlimbs. 4. Fleas, other hypersensitivities, psychogenic forms (nervous licking) |
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How would you destinguish wether hair is falling out or being licked out?
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Perform a TRICHOGRAM... look at the hairs under a microscope
if fallen out looks normal, if self induced hair appears fractured |
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Eosinophilic granuloma complexes
Comprises which 3 conditions? |
Indolent ulcer
Eosinophilic Plaque Eosinophilic Granuloma |
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Indolent Ulcer
1. Lesion appearance 2. Lesion Distribution 3. Pruritic? |
1. well demarcated, alopecic, reddish-brown ulcer with raised borders
2. unilateral/bilateral on upper lips, or oral cavity, rarely seen on skin 3. not usually pruritic |
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Eosinophilic Plaque
1. Lesion appearance 2. Lesion Distribution 3. Pruritic? 4. Cytology |
1. well demarcated, alopecic, raised plaques, witha moist red surface which may be eroded or ulcerated
2. Ventral abdomen, thorax, medial aspect of hindlimbs 3.Yes they are pruritic 4.Large #'s eosinophils seen on cytology |
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Eosinophilic (linear) Granuloma
1. Lesion appearance 2. Lesion Distribution 3. Pruritic? 4. Systemic? |
1. well defined, firm, raised, yellow-pink, linear lesions.
2. Caudal aspect of hindlimbs / oral cavity 3. May be pruritic 4. Circulating eosinophilia, local lymphadenopathy |
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Head and Neck Pruritis
1. Signs |
1. alopecia, excoriations, scratching around head and neck
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Management of Feline cutaneous reaction patterns
1. which presentations would benefit from an initial course of corticosteroids? 2. How long 3. If alopecic what must be ruled out before glucorticoids administered? Bacteria |
1. Eosinophilic Plaque, Eosinophilic (linear) granuloma, head and neck pruritis
2. 5-14 days, taper, then stop. Stopped to asses response to specific tx e.g. flea control. 3. Dermatophytosis via culture. 4. Antibiotics |
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Hot Spot: Acute Moist Dermatitis
1.Clinical Signs 2. Location 3. Causes |
Pruritic, well circumscribed, red, exudative erosion
2. Rump, neck, face 3. Spontaneous, fleas, anal sacculitis, otitis externa, atopy, food intolerance, staph pyoderma |
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Hot Spot: Acute Moist Dermatitis
4. Tx |
1. Determine underlying cause (also check anal sac)
2. clip matted fur from lesion and check for pyoderma in surrounding skin. 3.Chlorhexidine-- clean lesion 4. Glucocorticoids, break itch, scratch cycle. (3-5 @ 1mg/kg days, then reduce dose 0.5mg/kg) 5. Topical application of ABC/ Glucocorticoid cream to provide local antipruritic effect 5. |
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Acral Lick Dermatitis
1. Clinical Signs |
1. Well circumscribed, alopecic, ulcerated plaque on distal limb
usually caused by self trauma |
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Acral Lick Dermatitis
2. Possible Causes |
1. Mainifestation of Skin Dz
2. Mainifestation of Neuromuscular Disorder 3. Behavioral / psychological - anxiety, boredom, separation, OCD |
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Acral Lick Dermatitis
3. Treatment |
Permanent cure often not possible
1. Try ID underlying cause and initiate specific Tx 2. Mechanical barrier, Elibethan collar, bandage, sock. 3. Pyoderma -- ABC's (Cephalexin for up to 8 weeks) 4. Washed Daily with Benzoyl Peroxide Shampoo 5.Topical Glucocorticoids 6. Sublesional inj, depo-medrone (methyl prednisolone acetate) 7. Behavioral Modification 8. Sx, Laser therapy, radiation, cryosurgery, acupunture |
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3P's of Otitis?
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Predisposing factors
Primary Causes Perpetuating Factors |
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Otitis: Predisposing Factors
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Pendulous Pinnae
Congenitaly narrow ear canals Hairy ear canals excessive wax production Swimming |
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Otitis: Primary Causes
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Foreign Bodies
Ear Mites (Otodectes) Atopy Food Allergy Ear Canal polyps / tumors Adverse reaction to ear meds Hypo T Seborrhoeis conditions Ceruminous gland hyperplasia Otic demodicosis |
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Otitis: Perpetuating Causes
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Resistant Bacteria (Pseudomonas)
Progressive narrowing of ear canals Ear Canal Fibrosis Ear Canal Calcification Bulla Osteomyelitis |
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Otoscopic Exam: What are you looking for?
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Fb's/ Ear Mites
condition of Vert/ Horiz canal Appearance & integrity of tympanic membrane Carachterize type of exudate |
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Otitis: Cytology
1. When? 2. What can see |
1.EVERY TIME!!!
2. Cocci, Rods, Malassezia 3. If Rods present must do culture and sensitivity 4. Monitor Progress |
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Otitis: Would you treat Systemically?
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Only if evidence of Otitis Media i.e ruptured ear drum
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Topical Ear Therapy
CANAURAL ABC/anti YEAST/ anti INFLAM |
Framycetin & Fusidic Acid
Nystatin Prednisolone |
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Topical Ear Therapy
SUROLAN ABC/anti YEAST/ anti INFLAM |
Polymixin B
Miconazole Prednisolone |
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Topical Ear Therapy
OTOMAX ABC/anti YEAST/ anti INFLAM |
Gentamycin
Clotrimazole Betamethasone |
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Topical Ear Therapy
AURIZON ABC/anti YEAST/ anti INFLAM |
Marbofloxacin
Clotrimazole Dexamethasone |
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Pseudomonas Otitis TX
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Should do Culture and Sensitivity
SAY WOULD CONSIDER REFFERING AS PSEUDOMONAS INDICATES POOR CASE MANAGEMENT Gentamycin drops: Otomax Polymixin B drops: Surolan Fluroquinolones: Aurizon or Baytril inj Ticarcillin: extended spectrum penicillin Vinegar&water mix Silver Sulfadiazine cream &water |
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Dermatophytosis
Dx |
Trichogram: fractured hairs
Fungal Culture Woods Lamp (not all spp/strains flouresce) |
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Dermatophytosis
Tx |
Systemic:
Itraconazole Grizeofulvin (not preg animal or FIV +ve animal) Topical Malaseb Shampoo: miconazole & chlorhexidine Environment: Clean, Burn, Vircon |
