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535 Cards in this Set
- Front
- Back
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A genetically predisposed inflammatory and pruritic skin dz with characterisitic clinical features associated with IgE antibodies most commonly against environmental allergens" =
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Canine atopic dermatitis
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What are 5 key words to remember about canine atopic dermatitis?
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Environmental, contact, IgE, itchy, immunotherapy
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What are common allergens causing CAD?
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Mites (dust, food storage), pollens etc, human & cat dander (amazing), mold
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True or false. Antihistamines is the best treatment of CAD because the allergic response is a result of histamine releaase.
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False. Antihistamines can be used in conjunction with other therapies but histamine always plays a small role in CAD, there are a million other things going on causing the allergic response too.
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True or false. IgE is an antibody formed by a dog in response to an antigen.
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True
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IgE attaches to the ______ receptor on _______ and ________.
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Fc receptors on mast cells and basophils.
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House dust mites are the most common allergen involved in CAD. Whats the primary route by which the mites "attack" the dog?
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Contact aka percutaneous aka through the skin
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True or false. Purebreds are genetically predisposed to CAD except poodles (and mutts of course).
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True
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If given a case where a dog is affected with CAD, which of the following ages would NOT be likely? (choose two)
8 weeks 1-2 years 5 years 8 years |
8 weeks and 8 years is unlikely...almost all CAD dogs start around 1-2 years and rarely before 6 months or after 8 years
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Wyat three locations are you going to see the itchy, erythematous lesions of CAD?
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Face, ventral body, and feet (facial, ventral, pedal)
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True or false. CAD dogs are definitely going to show otitis interna at one point or another.
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False. They are going to show otitis externa
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What is the classic presentation of otitis externa in a CAD dog?
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Gunk on th inner ear flap and the vertical canal but a CLEAN HORIZONTAL canal.
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Whats th most common bacteria and the most common fungal infection that occurs secondary to CAD?
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Staph and Malassezia
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True or false. CAD is staph pyodrma waiting to happen.
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True
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True or false. CAD is flea allergy dermatitis waiting to happen.
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True
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True or false. CAD has a definitive diagnoatic test.
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False. CAD is diagnosed by exclusion.
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Which is more accurate for diagnosis of CAD--intradermal skin tests or serology tests?
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Neither, they have the same sensotivity and specificity
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Foe which test does the dog have to be taken off antihistamines and corticosteroids prior to testing? Intradermal or serological testing for CAD?
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Intradermal. Serology is ok on antihistamines and low doses of CCS
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What IS the serological test were runjing for CAD and what are we looking for?
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An ELISA and were looking for allergen-specific IgE's
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True or false. A positive skin test or serological test justifies a diagnosis of atopic dermatitis.
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False. Positive tests merely support your diagnosis. Diagnosis of CAD is based primarily on CS and exclusion of other diseases.
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Immunotherapy aka hyposensitization aka desensitization is the cornerstone approach to treating CAD. What exactly are we doing?
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Giving allergy shots (aka allergen shots) to upregulate T regulatory cells.
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What are the two possible side effects of immunotherapy for treatment of CAD?
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Anaphylaxis and increased pruritis.
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True or false. Random hypersensitization with a standard mixture of allergens is generally effective.
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False thats pretty ineffective, you have to ID and treat with the specific allergens the dogs allergic to!
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You have been treating a Westie with a history of CAD with allergy shots. He was doing a lot better but has recently relapsed. What are ypu going to do with the shots?
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Decrease the dose and increase the frequency!
You can add in cyclosporine and lo dose CCS too. |
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True or false. You can change your pets living conditiona to improve CAD.
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True. Get rid of your cat, clean up the stale foos thats everywhere, maybe evem throw some Knockout on him to kill the dust mites.
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True pr false. Do not use long-acting injectable CCS on CAD dogs.
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True
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True pr falde. Topical therapy is ineffective in the battle against CAD.
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False. Helloooo the reason theyre getting CAD is cause the allergens are touching them.
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True or false. Because histamine only plays one part in CAD, antihistamines are useless.
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False. They help 1 in 4 dogs so tgive them in conjunction with other therapy to decrease the itch.
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True pr false. Being itchy all the time is comfortable.
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False
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What is the purpose of ceramides in treatment of CAD? ________ ________
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Barrier function
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What does "barrier function" even mean in the treatment of CAD?
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It means the ceramides create a barrier between the dog and the environment so the allergens cant get on the skin
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Why are essential fatty acids like linoleic and linolenic acid recommended for treatment of CAD?
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Anti inflammatory function...they result in different prostaglandins and leukotrienes being made
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Is shampoo therapy recommended for treatment of CAD?
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Definitely. We want to wash them to get allergens off them. We can use antibacterial or antifungal shampoos depending on 2ndary infection. We can use oatmeal baths for the itch or CCS-containing shampoos for their topical anti-inflammatory effects etc. Also, you can use shampoos with ceramide in them. Recall what ceramides are for.
(i think shampoos rock) |
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What is th cornerstone approach for treatment fo CAD?
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Immunotherapy
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What is THE most common allergen associated with CAD?
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House dust mites
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Crusty papules are steong evidence for a staph pyoderma. Truw or false.
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True!
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True or false. Contact allergy (a ddx for CAD) is ALWAYS a macular or papular eruption that is restricted to hairless areas.
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True
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When presented with a dog that has the classical signs of CAD but no allergen-specific IgE what do you call it?
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Canine Atopic-like Dermatitis
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How long does you CAD patient have to be off antihistamines and CCS prior to intradermal allergy testing?
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10 days off antihistamines. For every month hes been treated with CCS, he has to be off them for that many weeks (so if treated for 3 months, take him off them for 3 weeks prior to testing)
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If a CAD dog is always scratching and rubbing itself, what chronic skin changes would you expect to see develop over time?
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Seborrhea, hair loss, generalized erythema, hyperpigmentation, and lichenification.
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What are four important parasitic diseases that you need to rule out before diagnosing a dog as having CAD?
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Scabies, cheyletiella, trombone something or other, and flea allergy.
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True or false. There is a correlation between the presence of allergen-specific IgE and the presence of allergen in th environment.
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True
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What kind of drug is Atopica?
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A friggin expensive one called cyclosporine...
Commonly given (orally) to dogs with CAD...if the owner isnt poor |
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Does cyclosporine aka Atopica inhibit intradermal testing for CAD?
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Nope, their skin will still undergo the inflammatory changes if an allergen theyre sensitive to aka allergic to is injected intradermally. You just have to take them off antihitamines and CCS for it.
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What are the two ways to detect allergen-specific IgE serologically?
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Using an enzyme-labelled anti-IgE.
Using the cloned alpha-chain of the mast cell receptor for IgE (the Fc receptor that is!) |
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True or false. The primary and secondary diseases caused by CAD require life-long therapy in most cases.
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Yes. CAD is basially a nonstop pain in the ass, even with excellent treatment.
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What CAD therapy causes upregulation of the T-reg cells?
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Immunotherapy
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Altho immunotherapy is the best Treatmen for CaD, when is it NOT indicated?
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In an older animal and in dogs whose allergies have a short season.
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What are th two types of immunotherapy preparations available to treat CAD?
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Aqueous extracts and alum precipitated (thr latter not avail in the US)
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Can CAD spontaneously improve without trearment?
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Yes, remember 20% of placebo dogs did.
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When are you more likely to see relapse when treating a CAD dog via immunotherapy?
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When the intervals between shots is increased--aka when the owner starts skipping shots
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If you are treating a CAD dog with immunotherapy and her pruritis gets worse what shpuld you do?
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Treat with CCS and lower the dose of Ag. (versus an anaphylactic reaction in which you wouldnt give the shot ever again)
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If a patient has not shown improvement after _________ months of immunotherapy, he should be reassessed or given lower doses more frequently.
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9
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If a dog is allergic to human dander (haaaa) where should he NOT be ?
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In beauty parlors..haha, and the bedrooms.
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What is AFR?
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Adverse food reactions aka food allergy
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AFR can occur thru what two types of reactions?
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Immunological rxns = hypersensitivity or non-immunological rxns = food intoleranc, altho most are prob true allergy (immunologic)
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What three immune responses are involved in AFR?
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IgE, IgG, and CMI
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If ypu have a dog with GI and derm signs what should you suspect?
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AFR
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What is more common, CAD or AFR?
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CAD is more common
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What three breeds are predisposed to AFR?
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GSD
Pugs Rhodesians |
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Chronic GI dz manifested by vomiting and diarrhea are associated with which derm dz in dogs?
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AFR
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Boz farts nonstop and has gross skin. What might he suffer from?
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AFR
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What would you see on histopath of intestines if a dog has AFR?
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Eosinophilic gastroenteritis and/or lymphocytic/plasmacytic enteritis
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True or false. Pruritis is a common manifestation of serm conditions but is not usually seen in the case of AFR.
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False! Pruritis is almost always seen
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When does a dpg start presenting with derm signs in the case of AFR, and what lesions do you see?
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Theyre usually young, about half will start showing signs of AFR before theyre one.
Primary eruptions are papuled and sometimes you might see wheals. |
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True or false. Distribution of skin lesions is not diagnostic for AFR but perianal involvement is suggestive.
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True
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You see otitis externa with both CAD and AFR. When does it involve the horizontal canal?
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AFR. Remember CAD usu has a clean horizontal ear canal.
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What infection is quite common secondary to AFR?
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Generalized staph pyoderma, which relapses Very quickly after antibiotic therapy ceases
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If a dog is diagnosed with CAD but has perennial signs, what other disease should you suspect?
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AFR is seen perennially (throughout the year) and perianally (around the anus) haa
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True or false. Coexistence of a pruritic skin disease and signs of GI disease, however mild, may be suggestive of AFR.
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True
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AFR dogs have higher serological levels of which antibodies? Which one is easier to test for?
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IgE and IgG
IgE is easier to test for serologically |
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What are intradermal skin tests more reliable for, CAD or AFR?
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CAD. For AFR your best bet is serology.
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What is the only way to confirm the diagnosis of AFR?
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Hypoallergenic diet trial FOLLOWED BY PROVOCATION ie refeeding the original diet 6-8 weeks later
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When does relapse occur after feeding the original diet to AFR dogs following a 6-8 week trial period?
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Within hours to 14 days.
2-14 days according to powerpoints...whatever, just remember it may take up to 2 weeks |
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If you had an AFR dog and you fed him rabbit diet for 2 mos and he was doing great, why would you go and feed him the diet that made him miserable in the first place?!
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Because a bunch of dogs will get over their allergy and you dont want to waste money feeding them a hypoallergenic diet if they no longer require it.
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What is the BEST diet to feed for food trial?
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Homemade diet containing a single novel protein source
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True or false. Homemade diets containing a single novel protein source are thideal diet for food trials and maintenance of an AFR dog.
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False. Theyre ideal for trial but not for maintenance because theyre not a balanced diet.
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What are the two types of commercially available food for AFR dogs?
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Those containing a single novel protein source or hydrolyzed diets (in which the protein antigens are broken down into such small pieces the body no longer recognizes them as the allergen that they actually are)
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When should you use anti inflammatories for AFR?
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You can give CCS during the firat two weeks of food trial to help control the animals symptoms amd discomfort. After that, only use if dietary control isnt working for them.
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ACD = ______
what species do ypu see it in? |
Allergic contact dermatitis
Very very rarely seen in cats |
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ACD can be due to contact with _____ or ______.
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Irritants or allergens. There is a lot of overlap tho
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Langerhan cells are involved with _______ presentation,and a cell-mediated Type _____ hypersensitivity is involved in ACD.
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Langerhans cells are involved with antigen presentation, and a cell-mediated Type IV hypersensitivity results.
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Is ACD a cokmon disease in dogs?
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No
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He showed us a pic of an ACD dog who had an extremely obvious line of dermarcation between diseased and healthy skin. What point was he illustrating?
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That ACD leaions only affect HAIRLESS skin. (the healthy skin was where they had shaved the fur off)
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True or false. There is always a maculopapular primary eruption with Atopic Dermatitis, but usually only secondary signs seen with Allergic Contact Dermatitis.
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False, other way around. There usually isnt a primary eruption associated with atopic dermatitis, but there is always a maculopapular primary eruption with Contact Dermatitis.
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Which two diseases do you see a GENERALIZED pyoderma?
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Atopic Dermatitis & Adverse Food Reaction = generalized pyoderma (vs ACD which is restricted to the involved (hairless skin) area only)
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If a collie and a pug are both allergic to plastic, theyre going to show maculopapular eruptions where?
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Collie...nose
Pug...practically its whole face Contact dermatitis...think about how they put their face in it to eat |
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What does skin look like when there is chronic irritation from swlf trauma?
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Black and leathery....hyperpigmentation and lichenification
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If you suspect contact dermatitis and recommend keeping the dog in th hospital for week to see if he shows improvement, what other dz can NOT be ruled out?
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CAD. there are no house dust mites in your hospital so his improvement supports CAD or ACD as thr dx.
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If removing a dog from the contact allergen causing his dermatitis is impossible, what therapy is implicated?
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Oral or topical CCS
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What is hymenoptera hypersensitivity to? What happens to the dog?
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Wasps and shit...they can get a fatal anaphylactic reaction when stung
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What antibody mediates. Hymenoptwra hypersensitvity?
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IgE
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True or false. Cats respond dermatologically in several distinct patterns, which makes diagnosis of their disease easier than in dogs.
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False. They have a limited number of skin reactions so you can never be sure whats causing it just by looking at the disteibution of the lesions.
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Miliary dermatitis produces what lesions?
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Crusty papules
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True or false. Pemphigus vulgaris is the primary rule out for miliary dermatitis.
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False. Pemphigus foliaceous is a rule out for miliary dermatitis.
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If a cat has miliary dermatitis and fleas, what do you suspect is causing it?
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Flea allergy until proven otherwise. Treat the fleas and see if she gets better
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What are two rule outs for miliary dermatitis in the cat that are diseases we discussed in the first two lectures?
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Atopic dermatitis and food allergy
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If you have ruled out all parasitic and allergic causes of miliary dermatitis, what would you call the dz and how would you treat?
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Idiopathic miliary dermatitis.
Treat with CCS injections every two weeks OR with megasteol acetate, but this has serious side effects |
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What are 7 side effects of using megastrol acetate in cats?
I know its a lot but theyre not hard to remember. We learned half od them in therio |
PUPD, DM, Adrenocortical suppression
Uterine and mammary shit Personality changes |
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Altho NOT definitive for this dz, where would ypu most likely see crusting lesions with self-excoriation as a result of feline food allergy?
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Around the head and neck
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What are the three diseases that make up Feline Eosinophilic Granuloma Complex?
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Eosinophilic plaques and Linear granulomas (aka collagenolytic granuloma), and eosinophilic/indolent ulcers
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How would you describe an eosinophilic plaque, besides gross?
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Well-demarcated, raised, oozing and ulcerated plaques
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Where do eosin plaques like to occur on cats?
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Abdomen and medial thighs (we learned this in path too)
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True or false. Eosin plaques are gross to look at, but they do not usually bother the cat.
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False. Theyre super itchy!
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Why are mast cell tumors a differwntial for eosin plaques?
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Maybe cause of all the eosinophils I guess
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What are the three forms of linear granulomas?
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1. Linear lesions of hair loss on the posterior aspect of hindlimb(s)
2. Nodular, verrucous lesions in the mouth 3. Swelling on the chin 3. |
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True or false. Linear granulomas in the mouth and chin could be cancer or acne....but the linear form is so characteristic there are no other differentials.
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True
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Which type of eosinophilic granuloma is more responsive to CCS--plaques or the linear granulomas?
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Plaques are more responsive to CCS
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Eosinophilic ulcers aka indolent ulcers are usually located on the upper lip.
True or false: Like the other diseases in eosinophilic granuloma complex, tissue and periperal eosinophilia are expected features. |
False. Eosinophilia is not a feature of insolent ulcers.
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True or false. Indolent ulcers are associated with flea allergy.
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Random but true
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True or false. There is no autoimmune component of indolent ulcers.
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False. There is a possibility of autoimmune component.
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A cat presents with sparsely haired flanks and ventral abdomen. You find no evidence of fleas when youre doing your PE and note that the hair cpvering these regions is short and stubbly. What is your diagnosis and how do you confirm?
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Its overgrooming. Pluck the hairs and examine the end. They should be nice and pointy under the microscope but if the cats licking itself to death theyll have shorn-off tips.
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True or false. Hair loss in cats is common.
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False! Much mich much more common for dogs to have hair loss.
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What is the cardinal sign of feline atopic dermatitis?
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Theyre very very pruritic
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What might a cat with atopic dermatitis suffer concomitantly from?
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Asthma!
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Do dogs with atopic dermatitis have concomitant asthma?
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No pnly cats. Dogs dont get asthma!
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Will a cat with Barbered alopecia be itchy?
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No
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Of the diseases making up eosinophilic granloma complex, which one does he specifically state as being very itchy?
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The plaques are itchy...not so sure that the other ones are
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Teuw or false. Both canine and feline atopic dermatitis have a genetic component.
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False. Feline atopic dermatitis has no known genetic componwnt.
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How might you demonstrate allergen-specific IgE in a cat with suspected atopic dermatitis?
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Intradermal skin testing or in vitro tests using antifeline IgE (or the Fc receptors alpha chain) which would both cross-react with the allergen.
Intradermal test is not as good in the cat as the in vitro testing. |
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What is the most effective antihistamine to give a cat, eg if shes got atopic dermatitis?
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Chlorphenarimine which is what IIIIIII take!!
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What CS might a cat with atopic dermatitis show?
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Self-induced hair loss (prob from being so itchy)
Miliary dermatitis (crusty papules) Eosinophilic plaques and maybe some other esosin shit |
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What are your three different therapies for the atopic cat?
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Hyposensitization aka allergy shots
CCS Chlorphenaramine (antihistamine) |
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Trye or false. Were all abput using hyposensitization therapy for dogs with CAD, but for somw reason we dont utilize this therapy much in cats.
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True. Nobody cares about cats. Meow I love them.
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Whe did we say lesions associated with food allergy are most likely to be seen on cats?
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Head and neck...in 33% of cases
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Which virus does my feline patient have? Her nailbeds are so inflamed some of her nails are falling out.
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FeLV
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Remember that pic of feline cowpox virus and it looked like half th cats face had been burned off? Well that shit apparently spontaneously regresses. True or false.
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True
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What derm conditions might you expect in an FIV positive cat aka Jim Bob?
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Recurrent otitis externa
Demodecosis (dont worry its not zoonotic) Gingivostomatitis (yep, he has no teeth) Recurrent abscesses (ew) |
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What skin conditioms might you expect in a leukemia positive cat?
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Recurrent abscesses (like FIV)
Cellulitis Recurrent paronychia |
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What is paronychia?
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Inflammation of the nailbeds...seen in leukemia positive cats
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What virus causes "paw and moth disease?"
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Calici!
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A herpesvirus usually starts as a respiratory tract infection...if not treated or the patient is immunosuppressed, what could it progress to?
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Inflamed plaques and ulcerations by the nares.
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Ulcerated plaques from herpes and eosinophilic granulomas both resemble each other and show eosinophilia on histopath. What test would you perform to distinguish between the two?
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PCR
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We know that calici can cause oral lesions, eg stomatitis and ulcers on the tongue and hard palate...what other skin condition may accompany these signs?
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Ulcerated carpal pads! Called paw and mouth disease
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What is the treatment for calici?
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Supportive care only, there is no treatment
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Which feline virus is zoonotic?
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Fel cowpox virus
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Whats the definition of pyoderma and what bacteria causes it?
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Staphylococcus causing pus within the skin
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Is normal skin colonized by staph?
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No. Staph might live around the asshole and nose and some of those little freak bugs may crawl around ON the skin but they do not live there.
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What are the three NORMAL things to find colonizing the skin?
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Micrococci
Corynebacteria Clostridium perfringens |
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What is the major pathogen causing pyoderma?
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Staph pseudintermedius
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True or false. Abnormal skin is susceptible to colonization by Staph pseudintermedius.
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True. Abnormal skin being the key word
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What are three factors preventing development of a staph pyoderma?
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Physical barrier (ie normal skin desquamates, shedding all the bad bacteria off it)
Sebum (oil) contains antibacterial factors (antibodies)normal colonies of bacteria...if theyre living on the skin like they should be, theres no place for the pathogenic bacteria to move in. |
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What response by the dog is responsible for the CS of pyoderma?
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The hosts inflammatory response
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True or false. 99% of pyodermas are primary in caue.
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False. Most, if not all, cases of pyoderma are secondary to something.
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What is the most useful way to classify pyoderma: as primary or secondary, according to site, or according to the depth within th skin?
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According to its depth bcause thats how youre gonna decide how to treat.
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What are the three types of pyodermas classified as "surface pyoderma?"
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BOG
Pyotraumatic dermatitis (hot spots vs acute moist dermatitis) Fold pyodermas |
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What are the three types of "superficial pyodermas?"
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Impetigo (puppy acne)
Mucocutaneous pyoderma Folliculitis |
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What are the three types of "deep dermatitis?"
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Perifolliculitis
Furrunculisis Cellulitis |
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What is THE most common type of pyoderma?
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Folliculitis
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What does BOG stand for?
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Bacterial overgrowth, which is one of the surface pyodermas.
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What are the two types of pyotraumatic ddermatitis?
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Hot spots vs acute moist dermatitis
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What predisposes to hot spots?
What predisposes to acute moist dermatitis? |
Itch-scratch-itch cycle --> hot spot.
Underlying perforating folliculitis |
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Name some fold pyodermas youll see in dogs
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Lip fold
Facial fold Vulval fold Tail fold Body fold haha |
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Where do Impetigo infections occur?
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Juuuust inder the stratum corneum (so theyre considered superficial pyodermas)
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What is an edematous, spongiotic dermatitis absolutely classical for?
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ACD
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Diagnosis is difficult, as there is a short pustular phase...what disease am I?
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Folliculitis
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With pyotraumatic folliculitis careful palpation of the periphery of thlesion will reveal...
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Early folliculitis lesions palpable as discrete intradermal thickenings
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Which have readily visible pustules--impetigo or folliculitis?
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Impetigo
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Where is a common site to see impetigo in puppies?
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Hairless skin like their little belly and around their vulva
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Whats the only breed ypu really see mucocutaneous pyoderma in?
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GSD...usually around their lips theyll have swolle, erythematous lesions with crusting
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Is folliculitis visible as a pustule or a papule?
What IS a papule vs a pustule? |
Papules...their pustular phase is super short so you prob wont see any.
Papule = small, palpable, erythematous circular eleavtion of the skin Pustule = small, circumscribed elevation containing pus aka a pimple |
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Where does folliculitis like to occur on the body?
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Trunk and ventral abdomen
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What is groin pyoderma in young dogs?
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Folliculitis around the groin
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What does a dog with "short-haired dog syndrome" look like?
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Moth-eaten
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If a dog presents with spreading, erythematous lesions with circular "EPIDERMAL COLLARETTES" hen alopecia, crusting, and maybe some hyperpigmentation....what disease do you suspect?
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A folliculitis
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Where does folliculitis originate?
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Within th hair follicle
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Where do you incise the uterus to perform equine c-section?
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On the greater curvature of the uterus, wherever the hindlimbs are.
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Why is the diagnosis of folliculitis confirmed by response to antibiotics, vs CS?
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Because the pustular phase is so short (dog will usually present already crusted over), the dx is often made retrospectively by response to ABx therapy.
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What is the FIRST treatment for an acral lick granuloma?
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Antibiotics! They always have a secondary infection
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Which infection is deeper and more progressive--perifolliculitis or folliculitis?
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Perifolliculitis.
Folliculitis may spread to become a perifolliculitis. Folliculitis is superficial. Perifolliculitis is deep. |
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What are the three deep pyodermas?
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Perifolliculitis
Furrunculosis Cellulitis |
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Which deep pyoderma is the result of rupture of the hair shaft?
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Furrunculosis
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Rin Tin Tin comes into your practice with a very specific type of cellulitis. How would you describe thr lesions?
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"punched out lesions"....rin tin tin got punched out by the bad guys.
They call it GSD Pyoderma. Easy enough. |
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You suspect a doggie has folliculitis and do a cytology to be sure (because youre aa cytology wizard of course).
What findings would support your dx of folliculitis? |
Lotssssss of neutrophils and intracellular cocci
(staphyloCOCCUS) |
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Whats th major pathogen in pyoderma?
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Staph pseudintermedius
It is coagulase positive. |
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Sometimes youll see some other staphs on cutaneous microbiology.
There are three of them. What are their names. |
HAS
Hyicus Aureus Schleiferi |
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Which staph schleiferi is coagulase positive?
Which one is more susceptible? |
S.s coagulans is coagulase positive.
S.s schleiferi is more suspectible C = C S = S |
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A dog comes in covered with papules and crusts on his ventral abdomen. He is a little itchy.
You suspect superficial pyoderma, more specifically, a folliculitis. What do you do if you are in an area where MRSP is common? |
Antibiotic sensitivity testing without sterilizing the superficial skin wi alcohol!
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When do you normally run ABx sensitivity tests on a dog with pyoderma?
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If you have a supf pyoderma on an animal in an area with MRSP cases.
If you have an animal with a deep pyoderma. Sterilize the skin with alcohol first! Were sticking a needle down deep for the bacterial sample so we want the dustracting surface bacteria excluded from the sample. |
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True or false. Biopsy is often performed to confirm a diagnosis of pyoderma.
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No. Usually unnecessary.
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What is the best way to make a definitive diagnosis of pyoderma?
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Antibiotic responsiveness aka a response to the appropriate antibiotic.
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What medication DONT you give an animal youre treating for pyoderma?
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CCS. give em thr antibiotic alone or youll confuse the response. And God knows this shit is confusing enough.
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Omg i just got to thr management of pyoderma. I was hoping we were finally done with it.
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Fail.
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How do you treat BOG?
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Topical and shampoo therapy
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How do you treat Pyotraumatic folliculitis, depending on whether or not there is an underlying folliculitis?
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No folliculitis? Take care of the annoying problem thats making them lick (full anal glands, otitis, fleas), put some antiseptic on their lesions, and give them a short course of CCS if you want to break the itch cycle.
If theres an underlying folliculitis, THEN you can give the parenteral ABx in addition to the CCS. |
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Whats th only cure for fold pyodermas?
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Same as above....clip th hair, clean the lesion, give some steroids for comfort level...but the only way to cure it is by fixing thr anatomical defect
Anatomical defects include being a sharpei. Think about it. Theres your fold pyoderma. |
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True or false. Superficial pyodermas are treated with ABx for 15+ days and deep pyodermas for 30+ days.
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True! Or ten days pst cure for the deeps.
So supf is half a month, deep is a month. $$$$ bet the owner wishes she had a chihuahua |
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When choosing antibiotics to treat an animal with pyoderma, what organism are we targeting?
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Staph pseudintermedius. Its the major player in pyoderma.
The gram negs will usually disappear once the staph is taken care of. |
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True or false. If antibiotic sensitivity results show that a pathogen is resistant to Erythromycin, a good bet is to use Clindamycin.
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Wrong wrong wrong! If its resistant to erythromycin, itll be resistant to clindamycin too!
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Trimethoprim-sulfas and other sulofonamides have what major side effects?
Boardddddd question. |
Arthropathy in dobies
KCS Cutaneous rxns Systemic rxns |
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Which class of antibiotics is "excellent" for the tteatment of pyodermas. Aka whats the AB your doc has you make up when a dog has an infected hotspot?
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Cephalosporins
Cephalexin (keflex) Cephadroxyl Cefpodoxime (simplicef) |
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True or false. Dr Halliwell doesnt like Cefovecin (convenia).
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True
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Why doesnt Dr Halliwell like Cefovecin?
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Isk i wasnt quite following. Just dont use it as an answer choice.
Its an injection of AB that lasts for two weeks! Great for owner compliance, we use it in feral cats all the time. (bad doctors?). ;) |
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True or false. Fluoroquinolones are NOT a 1st choice antibiotic for pyoderma UNLESS there is a very significant gram neg involvement.
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True
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True or fslse. Enrofloxacin (baytril) is an appropriate choice in a pup with pyoderma.
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No! Dont use your fluoroquinolones for pyodermas!
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Truw or false. Fluoroquinolones are excellent against gram negs like E. Coli
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True. Thats why we use it for UTIs so much (it also establishes a good concentration in the urine). Throwing in a little non-derm but thsts ok...we all hate derm anyway
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When should you use penicillin, ampicillin, amoxi, or tetras for treatment of pyodermas?
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If indicated by sensitivity testing.
Aka you will prob not be giving these to your pyoderma dogs. |
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Which four antibiotics are NOT effective in S. Pseudintermedius infections and should NOT be used unless indicated by sensitivity testing?
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TAPA
tetras Amoxi Penicillin Ampicillin |
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Shampoos are amazing for treatment of pyodermas. Its topical medication!
What are the advantage of chlorhex shampoos over benozyl peroxide or ethyl lactate? |
Chlorhex takes ONE min to kill the bugs.
Benozyl and Ethyl lactate take 10 min of contact time to work (they work by adjusting the skins pH to levels that arent conducive to bacterial life) |
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Your client is whining on the phone after using the prescribed soak you sent her home with to treat her white froo froo dog's perifolliculitis (deep pyoderma). Why is she complaining?
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Probably because the povidone iodine she had to soak her dog in turned her brown. Haa
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Which gene makes Staph resistant to beta-lactam antibiotics?
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mecA gene
This gene will induce the formation of an altered penicillin binding protein (PBP2a) which doesnt allow penicillins (beta lactam antibiotics) to bind to it. Aka resistant bug! |
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True or false. Theres a mecA gene , a clindamycin-inducible resistance gene, and a rifampin resistance gene (three resistance genes)
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True!
And in Michigan, the home of my fareesy pants, there has been vancomycin resistance as well! |
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Why are bugs taking over the world?
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Because we are giving out inappropriate antibiotics like candy. "the greatest risk factor for AB resistance is AB usage"
I have a sore throat someone give me some antibiotics i cant get sick. |
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True or false. MRSP is no more pathogenic than MRSA.
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true
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Who is the main reservoir for MRSA? Where do dogs get MRSA from?
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People. People.
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Who is the main reservoir for MRSP? Where do people get MRSP from?
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Dogs dogs
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Whats the deal with carriers of MRSP?
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We can be a carrier. The dog can be a carrier. We can onfect our pstients. Im sure a carrier dog ca infect people and dogs.
We dont treate to eliminate the carrier state tho. Often it self-cures. |
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Which three drugs are usually chosen from for treatment of mrsp?
vroom vroom |
CAR
chloramphenicol Amikacin Rifampin/keflex in combo |
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True or false. Ensure that you give attention to underlying causes of MRSP--if you can control these, th staph should resolve.
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True. THIS IS ABSOLUTELY CRITICAL.
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What three drugs will you never use for MRSP, not because they suck, but because they are the big guns we save for humans with MRSA?
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Vancomycin
Linezolid Quinipristin/dalfoprisitin |
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What six things predispose to current pyoderma?
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FIBS HH.
Food allergy Immunocompromised Barrier impairment Surface colonization Hypersensitization to Staph Hypothyroidism |
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What skin parasite should you repeatedly search for in the case of recurrent pyoderma, particularly pododermatitis?
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Demodex.
Bx may be required if the scrapes keep coming back neg. |
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What do you have to do in cases of idiopathic recurrent pyoderma?
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Do antibiotic sensitivity tests all the time (in vitro)... You know, send it to the lab. Dont just keep giving the dog random ABx or assume that itll remain sensitive to one thats worked in the past.
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If you hsve a dog with recurrent idiopsthic pyoderma, which of the following treatment plans is LEAST ideal?
1. Normal dose ABx every day for life. 2. Month on, month off 3. WET aka WeekEnd Therapy (give on sat and sun) 4. Continual low dose therapy |
Continual low dose therapy is th least desirbale choice. You want to kill th bug, not hit it with baby levels of antibiotics and allow bigger better mutants to replace the originsl ones!
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Whats the most common agent isolated from cat abscesses?
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Pasteurella multocida
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What are the four manifestations of Mycobacterial infections?
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1. Tuberculosis mycobacteria
2. Feline leprosy 3. Opportunistic mycobacterial granulomas 4. Canine leprosy |
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Tuberculosis mycobacteria cause _______ skin dz in dogs and cats.
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Nodular
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A cat presents with nodular, granulomatous lesions around her head and ears.
What agent causes leprosy? How do you advise treating this cat? |
Mycobacter leprimurium
Surgically excise |
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True or false. Mycobacter leprimurium is easy to culture if you think your feline patient has leprosy.
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False. This bacteria isnt easy to culture.
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Which of the following is FALSE regarding opportunistic mycobacterial granulomas?
1. Occur mostly in cats 2. They can only survive on devitalized tissue (not healthy skin). 3. Infection leads to abscesses |
3 is false. Opportunistic mycobacterial granulomas occur secondary to abscesses or other infections.
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True or false. Leprosy causes nodular, granulomatous lesions around head and neck of both dogs and cats.
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True
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Dermatophytosis is a fungal infection caused by the following species: Microsporum, _________, or Epidermopyton.
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Microsporum, Trichophyton, or Epidermopyton.
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True or false. Dermatophytosis and Dermatomycosis are synonyms for each other.
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False. Dermatophytosis is caused by Microsporum, Trichophyton, or Epidermopyton.
Dermatomycosis is also an infection of the skin, hair, or nail, but its caused by other species. |
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Dermatophytosis and Dermatomycosis are fungal infections of which tissues?
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Hair, skin, or nail
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Dermatophytes are either anthropophylic, zoophilic, or geophilic.
Based on their names, which primarily affects animals? Humans? Which is a normal inhabitant of the soil? |
Anthro = human
Zoo = animal Geo = soil |
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Which drmatophyte most commonly affects dogs? Cats?
Microsporum gypseum Trichophyton mentagrophytes microsporum canis Trichophyton erinacei |
Microsporum accounts for 65% of canine dermatophytoses and 95% in cats
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True or false. Microsporum canis likes to infect the owners too.
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True. M canis is zoonotic
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True or false. The dermatophytes dont exhibit asymptomatic carriers.
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False. Asymptomatic carrier situations occur in all species.
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True or false. The fungus only invades the telogen phase of the hair cycle.
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False. Only anagen hairs are invaded. Once the hair enters the telogen phase, the fungus is eliminated.
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Whats the anagen and telogen phases of hair growth again?
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Anagen is growth. Telogen is resting or quiescent stage
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Dermatophytosis usually self-cures in about 2-3 months via (cell mediated immunity or a humoral response?).
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Cell mediated immunity (not antibodies)
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In some species of dermatophytes, there is no hair invasion--the fungus stays in the stratum corneum.
Give an example |
Microsporum persicolor
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True or false. Only 50% of M canis infections fluoresce under a Woods lamp.
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True. Only half will fluoresce (=false negatives). And sometimes youl have dander and bits of cloth that will fluoresce (= false positives)
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What offers the most reliable diagnosis of dermatophytosis?
Woods lamp, microscopic examination, or fungal culture, or biopsy? |
Fungal culture, tho biopsy is reliable as well
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What does microscopic examination of dermatophytic hairs reveal?
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"sick hairs". Hairs plucked from the periphery of the lesion will be partially digested by fungal keratinases. These hairs are most likely positive for arthrospores.
In addition, you might find hyphae or arthrospores. |
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Whats the common name for dermatophytosis?
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Ringworm
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What is a kerion?
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A well-demarcated circular proliferative lesion, which is an enhanced inflammatory response that kills th dermatophyte.
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Will cultures of a kerion be positive for the fungus?
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Peobably not, this inflammatory response usually kills the organism.
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If a cat has dermatophytosis and 3 months later theres no evidence that shes clearing the infection, what should you suspect?
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Immunosuppressive disease
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Why do you suspect immunosuppressive disease in a cat that hasnt cleared her dermatophytosis in 60-90 days?
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Because they usually self-cure due to cell mediated immunity.
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This antifungal should be given with a fatty meal and should NOT be given to pregnant animals.
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Griseofulvin!
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What is an important side effect to be aware of when giving cats high dises of griseofulvin?
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Bine marrow suppression
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True or false. In cats, CS of dermatophytosis = broken hairs leading to focal alopexia with slight erythema.
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True. Sometimes, more inflamed lesions are seen with some crusting, but normally youll see broken hairs around a focal aa of hairless red skin.
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What the Mackenzie brush technique for?
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Use a new (sterile) toothbrush and vigoeously brish over a suspected area of dermatophytosis to send it out for culture.
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How long should an animal with dermatophytosis be treated with oral antifungals (eg griseofulvin or itraconazole)?
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At least four months aka 12 weeks
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Malassezia pachydermatitis is a natural inhabitant of skin and ears. When does it become a peoblem?
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Secondary to skin conditions--especially if allergic in origin and in seborrheic disorders. It also proliferates with ear infections.
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Which three areas are good spots to find Malazpssezia?
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Folds, lichenified areas, and any greasy areas
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How do you determine if theres a Malassezia overgrowth?
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Tape strip then stain with Diff Quik....there shouldnt be more than 1-2 Malassezia organisms per oil immersion field
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True or false. Malassezia overgrowth will inevitably recur unless attention is given to the underlying cause.
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Teue
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What are the two subcutaneous mycoses? (weve learned about them in medicine and LAS)
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Sporotrichiosis and Pythiosis
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Sporothrix gains access via puncture wounds then causes what kind of lesion?
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Draining lesions
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Sporothrix schenkii is what shape?
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Cigar
Shnookie smokes cigars |
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How can we treat Sporothrix?
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KI, ketoconazole, or itraconazole
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True or false. You walk into an exam room and theres a dog with icky draining lesions. Why do you put on gloves before touching him?
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In case its Sporothrix (which is highly zoonotic)
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Pythiosis is from the water. What kind of lesons will it cause on the limbs?
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Proliferative draining granulomas
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When you perform biopsy on a suspected Pythiosis patient, what stage are you looking for?
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Hyphae..."dx is confirmed by biopsy when hyphae are readily demonstrable."
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How do you treat pythiosis?
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Early diagnosis and surgical excision +/- amphotericin B
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What are the four systemic mycoses?
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Blasto, cryptococcosis, coccidiomycosis, and histoplasmosis.
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Which systemic mycosis is seen in the San Joaquin Valley?
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Coccidiodomycosis
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A dog has draining sinuses and a cough. What do you expect to see on cytology or biopsy?
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BBB...or "thick walled, budding, yeast-like fungus"
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What is the most common deep mycosis in cats, and likes to cause subq swellings which ulcerate with granulomatous proliferation.
What does the organism look like on cytology or biopsy? |
Pleomorphic round to elliptical yeast-like organism with a largr clear mucinous capsule!
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Hiw are we going to treat our patientswith systemic mycoses like blasto and crypto?
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Itraconazole!
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There arw three organisms that case demodicosis in dogs. Ist them in size order (smallest to biggest)
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D. Cornei
D. Canis (commonest) D. Injai (rare) |
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How does D injai infection present?
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Dorsal seborrhea
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Demoex isnt usually pruritic. Which organism lives in the stratum corneum and may cause the dog to be very itchy?
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D cornei (corneum....cornei)
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True or false. Demodex mites can survive off the host.
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False.
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What are the four stages of the demodex life cycle?
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Egg, larvae, nymphs, and adults
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Briefly describe what Demodex eggs, larvae, and nymphs look like.
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Diamond-shaped eggs
3-legged larvae 4-legged nymphs Adults.. |
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True or false. All cases of generalized demodicosis start as localized.
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True
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Whats the dz called when the feet are the site of demodex?
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Demodex pododermatitis
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When demodex only causes hair loss without secondary infection, whats it called?
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Squamous demodicosis
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When there is an obvious Staph intermedius infection scondary to demodicosis, what do you call it?
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Pustular demodicosis
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What age qualifies as "juvenile onset" of demodicosis?
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8 weeks to 15 months
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True or false. Adult onset of demodicosis is usually secondary to an underlying dz such as hypothyroidism, Cushings or LSA.
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True
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What are the two theories explaining the development of demodicosis?
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Immunological or the local environment theory.
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Animals with demodicosis have impaired ____ cell function as assessed by lymphocyte blastogenesis.
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They have impaired T cell function
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True or false. There is evidence that immunosuppression is not seen in the squamous form of demodicosis, only when there is secondary pyoderma.
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True--this is evidence against the immunosuppressive theory
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True or false. Many intact female dogs will relapse with demodicosis when they come out of heat.
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False--theyll develop the dosease when they go into estrus, yhen self cure after.
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True or false. It seems likely that th development of demodicosis is multifactorial, and that no single factor can explain all cases.
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True
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What are the sites of predilection for demodex?
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Face and forelimbs
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Is secondary bacterial infection common with localized demodex?
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True
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Following generalized demodex, pustules may develop as a result of folliculitis, furrunculosis or ________.
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Cellulitis
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What kind of discharge is common from demodex pododermatitis?
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Serosanguinous
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What are the four ways to diagnose demodex?
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Examine the exudate
Hair plucking Skin scraping Biopsy |
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Where do demodex mites live?
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In the hair follicles
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What should you do before the skin scrapw qhen looking for demodex mites?
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Squeeze the skin first in order to force the mites higher up in the hair follicle.
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What medication should ypu never give to a dog with demodicosis?
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CCS--because of the possibility of immunosuppression as a factor in development of the disease.
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Spontaneous cure of localized demodicosis is expected within what time period?
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3-6 weeks
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Which drug is not safe to use in Collies or Sheepdogs?
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Ivermectin
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Which medication claims to be effective against demodex but has the sucky side effect of inducing a pemphigus-like drug eruption?
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PromerisDuo
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Collies have a mutation of which gene, making them sensitive to Ivermectin?
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Multi-drug resistance gene (MDR1)
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PIMMA are five medications used to treat Demodex. What are they?
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PromerisDuo
Ivermectin Milbemycin Moxidectin Amitraz |
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Which topical medication contains moxidectin and has been used off label for treatment of Demodex by Dr Paterson?
Whats the drug called in the the UK? |
AdvantageMulti here
Advocate in the UK |
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Which soaks are recommended in the treatment of demodicosis?
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Benzoyl peroxide shampoos or povidone iodine soaks (for deeper pyodermas)
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What are the three types of deep pyodermas?
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Perifolliculitis
Furrunculosis Cellulitis |
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Why should bitches with demodicosis be spayed?
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Its hereditary and relapse may occur with estrus.
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True or false. If an underlying cause of adult-onset demodicosis cannot be found, prognosis is poor.
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True
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Which is more pruritic in the cat--Demodex cati or Demodex gatoi?
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Demodex gatoi
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The life cycle of Sarcoptes scabei takes place entirely on the host, and is completed in around _____ (time period).
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3 weeks
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Where does Sarcoptes scabei complete its life cycle?
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On the host
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Which event results in the intense pruritis characteristic of Sarcoptic scabei?
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After copulation, the female mite burrows into the epidermis = itchy!!
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Sarcoptes scabei causes a highly pruritic papular eruption in humans, which self-cures after the pet is treated.
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True!
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What is THE most pruritic disease we will see?
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Scabiesssss
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Where does Sarcoptes scabei complete its life cycle?
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On the host
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What is the primary eruption seen with scabies?
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Papules
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Which event results in the intense pruritis characteristic of Sarcoptic scabei?
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After copulation, the female mite burrows into the epidermis = itchy!!
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What is the pinnal scratch reflex?
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You rub the ear on itself and it makes the dog scratch. This is almost always seen with scabies.
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Sarcoptes scabei causes a highly pruritic papular eruption in humans, which self-cures after the pet is treated.
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True!
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What three sites does scabies occur?
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Ear pinna
Elbows Ventral chest |
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What is THE most pruritic disease we will see?
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Scabiesssss
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Where does Sarcoptes scabei complete its life cycle?
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On the host
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What question MUST you ask the owner when you have a derm disease, especially when you suspect scabies?
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Are any people in the house itchy?
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What is the primary eruption seen with scabies?
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Papules
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What is the pinnal/pedal reflex?
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The same as the pinnal scratch reflex--when you rub the ear the dog scratches with his hindlimb.
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Which event results in the intense pruritis characteristic of Sarcoptic scabei?
|
After copulation, the female mite burrows into the epidermis = itchy!!
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What is the pinnal scratch reflex?
|
You rub the ear on itself and it makes the dog scratch. This is almost always seen with scabies.
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Sarcoptes scabei causes a highly pruritic papular eruption in humans, which self-cures after the pet is treated.
|
True!
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Is scabies responsive to CCS?
|
Only half of dogs will respond.
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What three sites does scabies occur?
|
Ear pinna
Elbows Ventral chest |
|
|
What is THE most pruritic disease we will see?
|
Scabiesssss
|
|
|
What question MUST you ask the owner when you have a derm disease, especially when you suspect scabies?
|
Are any people in the house itchy?
|
|
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What is the primary eruption seen with scabies?
|
Papules
|
|
|
What is the pinnal/pedal reflex?
|
The same as the pinnal scratch reflex--when you rub the ear the dog scratches with his hindlimb.
|
|
|
What is the pinnal scratch reflex?
|
You rub the ear on itself and it makes the dog scratch. This is almost always seen with scabies.
|
|
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When a dog has scabies (THE itchiest dog disease we'll see), what is her usual response to CCS?
|
about 50% reduction in pruritis.
|
|
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Is scabies responsive to CCS?
|
Only half of dogs will respond.
|
|
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Allergies & scabies cause an itchy dog. Which do you think responds better to CCS?
|
allergies! There is usually a 100% response to CCS, whereas with scabies, the itch improves by about 50%
|
|
|
Where does Sarcoptes scabei complete its life cycle?
|
On the host
|
|
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To find Demodex, what kind of skin scrape do we do?
What do we have to see in order to determine we've performed the scrape at the proper level? |
deep (they live down in the follicles therefore in the dermis)
blood-- capillaries live in the dermis, so once you see blood you know you've scraped to the appropriate level |
|
|
What three sites does scabies occur?
|
Ear pinna
Elbows Ventral chest |
|
|
What kind of skin scape will you perform to find Sarcoptes MITES?
|
superficial
|
|
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Which event results in the intense pruritis characteristic of Sarcoptic scabei?
|
After copulation, the female mite burrows into the epidermis = itchy!!
|
|
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What kind of skin scrape will you perform to find Sarcoptes eggs & mites?
|
deep for the eggs & mites
|
|
|
What question MUST you ask the owner when you have a derm disease, especially when you suspect scabies?
|
Are any people in the house itchy?
|
|
|
True or False. You almost never get false negative skin scrapes for Sarcoptes.
|
False! Only about 50% of Scabies patients will yield a positive skin scrape!
= lots of false negatives |
|
|
What is the pinnal/pedal reflex?
|
The same as the pinnal scratch reflex--when you rub the ear the dog scratches with his hindlimb.
|
|
|
In Europe, there is a blood test for Sarcoptes Ag-specific IgE.
Is this a reliable test? |
yes! but it's not available in the US cause we suck?
|
|
|
Sarcoptes scabei causes a highly pruritic papular eruption in humans, which self-cures after the pet is treated.
|
True!
|
|
|
If you have an itchy puppy with a papular rash on her ears & chest, an itchy owner with a papular rash, and negative skin scrapes but you still strongly suspect Scabies, what are you going to do?
|
put the pup on a scabecide, and if she gets better you will make a retrospective diagnosis.
|
|
|
What is THE most pruritic disease we will see?
|
Scabiesssss
|
|
|
When a dog has scabies (THE itchiest dog disease we'll see), what is her usual response to CCS?
|
about 50% reduction in pruritis.
|
|
|
True or False. Advantage Multi has proven effective in the treatment of both Demodex & Scabies.
|
True
|
|
|
What is the primary eruption seen with scabies?
|
Papules
|
|
|
Allergies & scabies cause an itchy dog. Which do you think responds better to CCS?
|
allergies! There is usually a 100% response to CCS, whereas with scabies, the itch improves by about 50%
|
|
|
What are two topical flea medications we have available in the States which have proven effective in the treatment of Scabies?
|
Advantage Multi & Revolution
|
|
|
What is the pinnal scratch reflex?
|
You rub the ear on itself and it makes the dog scratch. This is almost always seen with scabies.
|
|
|
To find Demodex, what kind of skin scrape do we do?
What do we have to see in order to determine we've performed the scrape at the proper level? |
deep (they live down in the follicles therefore in the dermis)
blood-- capillaries live in the dermis, so once you see blood you know you've scraped to the appropriate level |
|
|
What three sites does scabies occur?
|
Ear pinna
Elbows Ventral chest |
|
|
When a dog has scabies (THE itchiest dog disease we'll see), what is her usual response to CCS?
|
about 50% reduction in pruritis.
|
|
|
What kind of skin scape will you perform to find Sarcoptes MITES?
|
superficial
|
|
|
What question MUST you ask the owner when you have a derm disease, especially when you suspect scabies?
|
Are any people in the house itchy?
|
|
|
What kind of skin scrape will you perform to find Sarcoptes eggs & mites?
|
deep for the eggs & mites
|
|
|
Allergies & scabies cause an itchy dog. Which do you think responds better to CCS?
|
allergies! There is usually a 100% response to CCS, whereas with scabies, the itch improves by about 50%
|
|
|
What is the pinnal/pedal reflex?
|
The same as the pinnal scratch reflex--when you rub the ear the dog scratches with his hindlimb.
|
|
|
True or False. You almost never get false negative skin scrapes for Sarcoptes.
|
False! Only about 50% of Scabies patients will yield a positive skin scrape!
= lots of false negatives |
|
|
In Europe, there is a blood test for Sarcoptes Ag-specific IgE.
Is this a reliable test? |
yes! but it's not available in the US cause we suck?
|
|
|
What kind of skin scape will you perform to find Sarcoptes MITES?
|
superficial
|
|
|
What kind of skin scrape will you perform to find Sarcoptes eggs & mites?
|
deep for the eggs & mites
|
|
|
If you have an itchy puppy with a papular rash on her ears & chest, an itchy owner with a papular rash, and negative skin scrapes but you still strongly suspect Scabies, what are you going to do?
|
put the pup on a scabecide, and if she gets better you will make a retrospective diagnosis.
|
|
|
True or False. Advantage Multi has proven effective in the treatment of both Demodex & Scabies.
|
True
|
|
|
True or False. You almost never get false negative skin scrapes for Sarcoptes.
|
False! Only about 50% of Scabies patients will yield a positive skin scrape!
= lots of false negatives |
|
|
What are two topical flea medications we have available in the States which have proven effective in the treatment of Scabies?
|
Advantage Multi & Revolution
|
|
|
If you have an itchy puppy with a papular rash on her ears & chest, an itchy owner with a papular rash, and negative skin scrapes but you still strongly suspect Scabies, what are you going to do?
|
put the pup on a scabecide, and if she gets better you will make a retrospective diagnosis.
|
|
|
True or False. Advantage Multi has proven effective in the treatment of both Demodex & Scabies.
|
True
|
|
|
What are two topical flea medications we have available in the States which have proven effective in the treatment of Scabies?
|
Advantage Multi & Revolution
|
|
|
What is the active ingredient in Advantage Multi, which has proven effective against Scabies & Demodex?
|
Moxidectin
|
|
|
Which two treatments are virtually 100% effective against Scabies and only available from a vet?
|
Ivermectin & Milbemycin
|
|
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True or false. Lime sulphur dips are appropriate for both Demodex and Scabies.
|
False? I only see it listed under Scabies.
|
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|
Although sarcoptes can occasionally affect cats, the usual cause of feline scabies is _____________.
|
Notoedres cati
|
|
|
What is the active ingredient in Advantage Multi, which has proven effective against Scabies & Demodex?
|
Moxidectin
|
|
|
Is feline sarcoptes (Notoedres cati) zoonotic?
|
yes! very itchy people from Notoedres cati!!!!
|
|
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CS of sarcoptes is localized to the head and neck of cats. What kind of lesions will you see?
|
scaling & crusting--and you'll see evidence of self trauma from all the intense scratching they're doing w/ those sharp claws
|
|
|
Which two treatments are virtually 100% effective against Scabies and only available from a vet?
|
Ivermectin & Milbemycin
|
|
|
True or false. Lime sulphur dips are appropriate for both Demodex and Scabies.
|
False? I only see it listed under Scabies.
|
|
|
Why would rabbits have really itchy ears with a crusty exudate?
|
Psoroptes cuniculi aka Psoroptic Mange
|
|
|
Although sarcoptes can occasionally affect cats, the usual cause of feline scabies is _____________.
|
Notoedres cati
|
|
|
What kind of eruption do humans get after being exposed to Cheyletiella?
|
highly pruritic papular eruption
|
|
|
Is feline sarcoptes (Notoedres cati) zoonotic?
|
yes! very itchy people from Notoedres cati!!!!
|
|
|
CS of sarcoptes is localized to the head and neck of cats. What kind of lesions will you see?
|
scaling & crusting--and you'll see evidence of self trauma from all the intense scratching they're doing w/ those sharp claws
|
|
|
Can Cheyletiella mites survive in the environment?
|
yes, for up to a week off the host
|
|
|
Why would rabbits have really itchy ears with a crusty exudate?
|
Psoroptes cuniculi aka Psoroptic Mange
|
|
|
What kind of eruption do humans get after being exposed to Cheyletiella?
|
highly pruritic papular eruption
|
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|
You suspect Cheyletiella infestation on a dog that has "walking dandruff."
What kind of skin scrape could you perform to confirm? |
very superficial
|
|
|
Can Cheyletiella mites survive in the environment?
|
yes, for up to a week off the host
|
|
|
Are dogs likely to be asymptomatic carriers for Cheyletiella?
|
No they usually show signs of intense pruritis aka are not asymptomatic when they are infested w/ Cheyletiella
|
|
|
Is a dog or cat more likely to be an asymptomatic carrier for Cheyletiella?
|
cat
|
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True or False. Cheyletiella can cause a cat to be more oily than normal w/ varying degrees of pruritis.
|
True. "Can induce merely a seborrhoea-like condition w/ varying degrees of pruritis."
|
|
|
How can you diganose Cheyletiella with a microscope?
|
very superficial skin scrapings or scotch tape prep*
|
|
|
Which is more sensitive--very superficial skin scrape or scotch tape prep for Cheyletiella?
|
Scotch tape prep is more sensitive for Cheyletiella
|
|
|
True or False. Cheyletiella is pretty easy to treat w/ most topical parasiticides EXCEPT imidocloprid.
|
true. just dont' use imidocloprid
|
|
|
Which life stage of Trombicular (Chiggers) is parasitic?
|
larvae (6-legged L)...the adults live on veg
|
|
|
True or False. Both Cheyletiella & Chiggers are resistant to imidocloprid.
|
True--dont' bother treating the Ch's w/ imidocloprid.
|
|
|
Why is Trombicula known as "berry bugs?"
|
because the larvae are seen as bright orange dots walking around on the feet & ears
|
|
|
Which life stage of ticks can cause an intense pruritis?
|
L1's aka "seed ticks" can cause signficiant pruritis.
|
|
|
Why is it important to remove the mouthparts when removing a tick?
|
mouthparts cause a granulomatous reaction when left behind
|
|
|
Which species of fleas is the LEAST host-specific (aka infests the greatest number of hosts)
|
Ctenocephalides felis
|
|
|
Some animals are allergic to fleas & go crazy when they have 1 or 2 on them.
Other animals have non-allergic responses to fleas, whihc include |
anemia & transmission of organisms (Dipylidium, Yersinia, Dipetolonema, Bartonella hensalae)
|
|
|
true or false. It seems likely that animals that suffer from dermatitis due to flea infestation are, in fact, allergic to the bites of the fleas.
|
true
|
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|
What do we call the dermatologic disease in dogs and cats that are allergic to flea bites?
|
flea allergy dermatitis (FAD)
|
|
|
What is the major allergen associated w/ flea bites?
|
Ctef1 is the major allergen, recognized in most animals w/ FAD
|
|
|
Can spontaneous desensitization to flea allergy occur as an animal ages?
|
yes
|
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|
Who is more likely to get FAD--a kitten raised in a barn, or a kitten bred & raised in a house?
|
Animals that aren't exposed to fleas early in life are MORE likely to get FAD. So the barn cat is less likely to be bothered by fleas, and the pampered cat is more likely to develop FAD if she ever came across any.
|
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|
True or false. Atopic dogs are predisposed to developing FAD.
|
true
|
|
|
What's the major allergen associated w/ FAD?
|
Ctef1
|
|
|
How are we ever going to remember the major allergen associated w/ FAD?
|
Ctef1 = CTEnocephalides Felis
|
|
|
Which is more likely to lead to immunological tolerance, and which is more likely to lead to the development of FAD?
nonstop exposure to fleas intermittent exposure to fleas |
nonstop exposure to fleas --> immunological tolerance
intermittent exposure --> allergy |
|
|
There's a lot of shit going on that causes cats & dogs to go crazy when they've got FAD... what are the 3 immunological processes occuring?
|
"I Don't Care"
Immediate hypersensitivity (IgE) Delayed, CMI hypersensCutaneous basophil hypersens |
|
|
What is the PRIMARY lesion that occurs after a flea bite in an animal w/ FAD? (it only lasts a couple days before it gets all crusted over)
|
papules
|
|
|
Where do FAD lesions occur on the dog?
|
lower back, thighs, umbilicus
|
|
|
Secondary bacterial folliculitis can occur in a dog w/ FAD. What started all this?
|
flea bite --> papule --> itch
|
|
|
True or false. In cats w/ FAD, the primary lesion is a papule like in dogs.
|
True. papule papule papule
|
|
|
True or false. Miliary dermatitis can occur secondary to FAD.
|
true!
|
|
|
There are 5 things that must be going on in order to confirm FAD.
|
1. there's gotta be fleas or flea dirt on the animal
2. compatible CS (aka papules as the primary lesion) 3. demonstration of hypersensitivity (IDT or serological tests to flea antigen) 4. Response to appropriate parasiticides 5. R/O concomitant dz (eg atopic dermatitis) |
|
|
True or false. You should use organophosphates to rid your feline patient of fleas.
|
false. please don't.
|
|
|
Of the following, which is SAFE to use on cats (to treat fleas):
organophosphates permethrin (a pyrethrin) fipronil imidocloprid |
fipronil and imidocloprid are safe to use on cats (they are frontline & advantage)
organophosphates & permethrin are NOT safe to use on cats |
|
|
Selemectin is a broad-spectrum parasiticide which kills fleas, ticks, & mites (scabies, ear mites)
|
True.... Revolution kills some ticks I guess
|
|
|
What is the problem with using ProMerisDuo aka metaflumizone?
|
drug eruptions
|
|
|
True or false. Hyposensitization is the hallmark of treatment of FAD.
|
false--hyposensitization w/ the currently available products have NOT worked in dogs or cats
|
|
|
You have a FAD patient ripping herself to shreds. She is miserable. What are you going to treat her with?
|
1. topical flea product
2. short course CCS to stop the itch 3. Antihistamines & Essential FAs if the owner is willing to buy anything that could possibly help (go w/ the first two I'd say) |
|
|
What is "louse infestation" called?
|
pediculosis
|
|
|
Anaplura & Mallophaga...which is biting & which is sucking
|
Ana sucks
-phaga bites |
|
|
FAD and Pediculosis (louse infestation) leads to itchy cats with secondary miliary dermatitis, but the primary lesions are different. What are they?
|
FAD in cats (and dogs) = papules
Pediculosis = crusts |
|
|
What is myiasis?
What animal will likely be affected? |
Fly larvae (maggots)
Animals with urine scald or feces ,atted into their coats... Those with open wounds that are outside, etc |
|
|
SEBORRHEA AND OTHER DISORDERS OF KERATINIZATION
|
SEBORRHEA AND OTHER DISORDERS OF KERATINIZATION
|
|
|
Epidermal cell kinetics: How long does it take from cell division in the basal cell layer to desquamation?
|
21 days =). Aka three weeks
|
|
|
Desquamation is hen an invisible corneocyte is shed from what layer of the skin?
|
The stratum corneum
|
|
|
What are some chemicals that affect keratinization? (there are five)
|
1. Copper
2. Vitamin A 3. Estrogens 4. CCS 5. Zinc |
|
|
The "epidermal barrier" is formed by keratinocyte plasma membraneS and epidermal lipids--if formed incorrectly, what could occur?
|
The epidermis can dry out
|
|
|
What are the five evemts in tge process of keratinization?
|
1. Keratinization
2. Development of the epidermal barrier 3. Cell death 4. Dehydration 5. Desquamation |
|
|
During "dehydration," the cells of the Stratum corneum have to lose 50-80% of their fluid, and will consist of over 80% ______
|
Keratin
|
|
|
What is the definition? Of seborrhea?
|
The formation of visible scale
|
|
|
There is a more dtailed definition of Seborrhea, which is:
|
A generalized scaling disorder that may be accompanied by excessively dry or excessively oily skin.
|
|
|
What are two consequences of scale aka seborrhea?
|
Change in bacterial flora and increased numbers of Malassezia
|
|
|
What do you think increased Malassezia makes the cskin feel like?
|
Greasy...or it could be greasy skin allows more Malassezia to grow there....either way they go hand in hand
|
|
|
Seborrhea can occur secondary to AIME. What are these four conditions?
|
Allergy
Inflammatory skin dz Mycotic infections Ectoparasites |
|
|
How should you treat secondary seborrhea?
|
By treating the primary problem (allergy, inflammatory, mycoses, ectoparasites)
|
|
|
There is a genetic condition in huskeys and Akitas that cause scaling of the skin. This disease is considered zinc responsive.
What does this tell us about zinc? |
Its required for normal keratinization.
|
|
|
BICs are predisposed to what seborrheic condition?
(Bassets, Irish setters, Cockers) |
Primary idiopathic seborrhea
|
|
|
What is Ichthyosis?
|
Fish skin dz! = tightly adhered scales
Seen in small terriers (Westies, Yorkies, JRT) |
|
|
Sebaceous adnitis is an inflammatory dz of th sebaceous glands that can lead to:
|
Total destruction of th glands --> severe scaling and hair loss
|
|
|
What happens to poodles with sebaceous adenitis?
|
Their ugly fur loses its crimp
|
|
|
True or false. Idiopathic seborrhea is almost always generalized.
|
True
|
|
|
Is idiopathic seborrhea common?
|
No
|
|
|
Whens the only time you shpuld make a diagnosis of idiopathic seborrhea?
|
When all other possible causes have been eliminated
(even in susceptible breeds aka BICs, you dontake th dx of idiopathic seborrhea til youve ruled out everything else!) |
|
|
When treating sebprrhea, you must never forget how important th epidermal barrier is.
Therefore, you should use: |
Oils with surfactants
Humectamts Essential FAs Ceramides |
|
|
Is idiopathic seborrhea cureable?
|
Idiopathic seborrhea is not curable, it is only controllable.
|
|
|
True or false. Autoimmune diseases are common and therefpre very important.
|
False--they are life-long diseases that require life-long treatment and therefore theyre important to understand
|
|
|
What are the two main types of autoimmune diseases?
|
Autoimmune rxns against the skin
Systemic autoimmune diseases which damage the skin via an "innocent bystamder" rxn |
|
|
What are the autoimmune skin diseaes?
|
The pemphigus group
|
|
|
What is the main autoantigen in Pemphigus foliaceus?
|
Desmocolin
|
|
|
Whats your systemic autoimmune disease that can result in skin disease as one of its many components?
|
Systemic Lupus Erythematous
|
|
|
What cell can you find on cytology that is classic for pemphigus?
|
Large, round, darkly staining ACANTHOlytic cells
|
|
|
There are three main types of presentations of autoimmune diseases:
1. Pemphigus foliacepus (supf pustules) 2. Pemphigus vulgaris (ulcerative) 3. Lupus (scaling and crusting) |
What are the three main presentations of autoimmune skin diseases?
Please tell me you didnt forget them already! |
|
|
In cats with pemphigus foliaceous, there is a refractory paronychia. What does that mean?
|
Infection of th claw bed
|
|
|
In general, what lesions do you want to biopsy? Primary or secondary?
|
Primary--biopsies of old, secondarily infected lesions are a waste of time.
|
|
|
Direct immunofluorescence and immunohistochemistry are tests that look for what?
|
Deposition of immunoglobulins
|
|
|
What disease do you perform an ANA, or antinuclear antibody test for?
|
SLE aka systemic lupus erythematous
|
|
|
Which autoimmune disease results in pustules and crusts on the nose, ears, and footpads?
|
Pemphigus foliaceous
|
|
|
True or false. Pustules that start on the face and spread to the body are likely pyoderma, not pemphigus foliaceous.
|
False. If it starts on the nose and spreads from there, its probably pemphigus foliaceous and NOT pyoderma.
|
|
|
Can an aimal with PF become systemically ill?
|
Yes--she can get pyrexia and a leukocytosis.
|
|
|
Which autoimmune diseases are exacerbated by sunlight?
|
The scalers and crusters--SLE, DLE, PE
|
|
|
Like PF, lesions start on the nose and spread from there in DLE and PE.
What else happens to the nose in DLE and PE? |
Depigmentation of the nose--remember you only really see that with Aspergillosis or Lupus.
|
|
|
True or false. In DLE and PE there is no systemic disease, but there can be in SLE.
|
True
|
|
|
A dog with hemolytic anemia, immune mediated thrombocytopenia, and glomerulonephritis presents with crusty footpads.
What dosease does he have? |
SLE
|
|
|
Truw or false. The ulcerative autoimmune diseases have classical CS and from a clinical standpoint its not necessary to differentiate between them.
|
True--PV, BP, EBA are all going to be treated the same
|
|
|
Do the ulcerative autoimmune diseases have an acute or chronic onset?
|
Acute
|
|
|
True or false. All the autoimmune diseases can affect th footpads.
|
False? I dont think DLE or PE have footpad involvement.
|
|
|
The mucocutaneous junctions and oral mucosa are preferentially affected in which Autoimmune disease?
|
the ulcerative ones--PV, BP, EBA
|
|
|
What are the three ulcerative autoimmune diseases called?
|
Pemohigus vulgaris
Bullous pemphigoid Epidermolysis bullosa acquista |
|
|
True or false. Animals with ulcerative autoimmune disease are almos alway febrile and systemically very ill.
|
True
|
|
|
What are three important histopath features of SLE and DLE?
|
1. Superficial dermal lymphoid infiltrate
2. Pigmentary incontinence (pigment falla down into the dermis) 3. Degeneration of the epidermal basal cells |
|
|
Hats th histological differnce between PE and PF?
|
There is none--there will be subcorneal, intraepidermal pustules, with acantholytic cells and neutrophils.
|
|
|
What are acantholytic cells classic for?
|
Pemphigus foliaceous
|
|
|
True or false. SLE lesions are symmetrical.
|
True
|
|
|
What hereditary condition can GSHPs get that causes scaling and crusting that start on their face?
|
Herditary Lupoid Dermatitis
|
|
|
What is th goal of therapy in treating the autoimmune diseases?
|
Control the abnormal immune response
Reduce the resultant inflammatory rsponse Life long therapy is required |
|
|
Ouchie which disease affects primarily the scrotum and hocks and (not surpirsingly) can cause an abnormal gait?
|
Lupoid Dermatosis in GSHPs....if your balls had weird skin disease youd walk weird too
|
|
|
Azathioprine can have what devastating side effect?
|
Bone marrow suppression (weve learned this several times--know this)
|
|
|
What is azathioprine used for?
|
Its immunosuppressive effects, so its used to tteat autoimmune diseases
|
|
|
Cyclophosphamide can be used in conjunction with CCA to treat autoimmune diseases. What is a potential sid effect of cyclophosphamide?
|
Sterile cystitis--weve learned this before--know it
|
|
|
True or false. Tetras and niacinamidenaee effective in the treatment of discoid lupus.
|
True, but only for DLE
|
|
|
CCS with chlorambucil or cyclophosphamide or azathioprine are all possible treatments for autoimmune disease.
|
True
|
|
|
There are a lot of side effects to the drugs that are required for life-long therapy of autoimmune disease. What do we always have to keep in mind when treating these diseases?
|
We have to be sure the tteatment isnt worse than the disease.
|
|
|
Why do drug eruptions occur--aka why does the animal have an allergic reaction to the drug?
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Drugs act as haptens, which mean when they combine with host proteins, they are seen as antigens.
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Whats the most commin drug eruption you will see?
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Urticaria (hives)/ angioedema
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Vesiculobullous is a drug eruption that mimics....
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PV, PF, and BP.
Always take a careful drug history in all cases of suspected autoimmune diseaes! |
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True or floss. Toxic epidermal necrolysis is a "no big deal" kind of drug eruption.
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Ummmm FALSE. It will kill half of them so that is a big deal
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How do you diagnose drug reactions?
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Largely based on circumstantial evidence...a history of recebt drug administration, coupled with compatible CS
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True or false. Like AFR, you should confirm diagnosis of drug reaction by challenging the dog with the same medication again.
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No way. Never! They could go into anaphylactic shock next time....
Animals with penicillin reactions eg, there will always be a big note in th chart so that the animal is never given it again. |
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How do ypu treat a drug reaction?
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First off, stop giving him th drug. Second, offer supportive treatment for whatever he has going on, including CCS when there is acute inflammation.
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Morbilliforme, or exanthemous drug eruptions are characterized by what CS?
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Maculopapular eruptions (localized pr generalized)
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What other disease is manifested by maculopapular eruptions?
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Allergic contact dermatitis, but that is only on hairless skin.
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Erythema multiforme has what *characteristic* lesion?
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Target or bulls eye lesions
These may ulcerate before crusting over |
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What do you see on histopath of a erythema multiforme lesion?
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Necrotic basal cells in the epidermis
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True or false. Toxic epidermal necrosis can result from drug reactions or internal malignancies.
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True.
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What disease causes full thickness necrosis of the epidermis?
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Toxic eoidermal necrosis
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Why does the deposition of immune complex in vessel walls result in damage to the vessel?
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Because the immune complexes attract neutrophils, which bring about an inflammatory reaction that damages the vessel wall
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Which affects a large portion of skin, and which affects small focal areas of the extremities
Vasculitis Toxic epidermal necrosis |
Toxic epidermal necrosis is as bad as it sounds--it affects large areas of the skin
Vasculitis causes necrosis of small focal areas of the extremities like the ears and footpads. |
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Skin tumors account for 50% of all tumors.
What test is your best bet for diagnosis of the tumor? |
Biopsy... Cytology is good for MCT and lymphomas but nit very diagnostic for most other tumors.
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Whats a skin tumor thats common in YOUNG animals?
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Histiocytoma.
We learned that in clin path too. Papillomas (warts) |
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90% of perianal tumors affect what signalment?
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Intact male dogs
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SCC is more common in dogs and cats that are what color?
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White. We know this
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Is MCT more likely to be malignant in dog or cat?
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Dog
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What dog breed is predisposed to histiocytosis?
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Bernese mountain dogs
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What skin tumor are boxers predisposed to?
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MCT
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Basal cell tumors--who gets them dogs or cats?
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Cats! Solitary firm nodules on a cat = basal cell tumor (or something else who knows)
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Is ulceration common with SCC?
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Yes
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Whats the most common type of Follicular Epithelial Tumor?
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Sebaceous cysts
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Bella th Schnauzer has many intradermal swellings that ooze yellowish brownish waxy stuff when squeezed.
What is it and should you keep squeezing them? |
Sebaceous cyst aka follicular epithelial tumor. Stop squeezing it, its just gonna keep filling up anyway. Besides, if you keep opening it up it can get infected.
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Hepatoid glands are perianal glands whixh are modified sebaceous glands.
Are tumors of these glands usually benign or malignant? |
Benign! And remember, 90% of them occur in intact male dogs.
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Perianal gland tumors are reaponsive to esteogen therapy.
Do we treat dogs with estrogen therapy? |
Ni, too many side effects. Thefore we will castrate!
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Anal sac apocrine gland carcinomas--uni or bilateral?
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Unilateral!
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Do fibrosarcomas like to mets?
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No
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If you vaccinate a cat and a swelling persists for four months, what are you going to do?
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Surgically excise so it doesnt turn into a post vaccinal sarcoma and require leg amputation ..... (and who are we kidding, old school vets dont vaccinate in the leg so amputation wouldnt even be am option...)
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Lipomas can be subcutaneous or...
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Or intracutaneous
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When would we recommend removing a lipoma?
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If its interfering with movement or function.
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True or false. Dieting could make an obese dogs lipoma shrink.
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True. Cool!
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Hemangiopericytoma occurs where on the dog?
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Limbs
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So what are your round cell tumors?
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Histiocytoma
(cutaneous histiocytosis) MCT Lymphoma Malignant melanoma Melanocytoma |
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Whats a tumor of the Langerhans cell called?
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Histiocytoma
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Are histiocytomas benign or malignant?
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Benign, and thank goodness because these are in your younger patients.
They usually spontaneously resolve within two months. |
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Is a cutaneous histiocytosis a tumor?
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No, but it looks like one.
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What is cutaneous histiocytosis a proliferation of?
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Normal dendritic cells (its non-neoplastic)
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Cutaneous histiocytosis is responsive to what drug?
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CCS
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True or false. Wide margins are important when excising a MCT.
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True
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When handling a MCT, diphenhydramine should be given prior to the surgery to protect against histamine release, excessive handling is contraindicated (to prevent release of large amounta of histamine), and wide surgical margins are required.
Why dont you want massive histamine release to occur? |
Histamine can cause urticaria (hives), gastric ulceration, or anaphylaxis. (bad)
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Which has an acute onset--epitheliotropic or nin-epitheliotropic lymphoma?
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Non = acute
Epitheliotropic = gradual, insidious onset |
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You see a pigmented lesion in a dogs mouth that you suspect is a malignant melanoma.
What other locations would you check for melanomas? |
Mouth
Nailbeds Limbs = malignant melanoma |
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Wide surgical excision is indicated for malignant and benign mekanomas.
Where do you usualoy find tumors? |
Head
Trunk Paws = benign melanomas |
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Where do malignant vs benign melanomas occur?
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Malignant = mouth, nailbeds, limbs
Benign = head, trunk, paws |
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What is "epithelial migration" in regard to the ear?
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The normal cleaning mechanism that pushes shtuff out of the horizontal ear canal.
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What does the horizontal ear canal end in?
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Tympanic membrane
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What two nervous structures pass thru the middle ear?
Thereforw, what can otitis media result in? |
Facial nerve and sympathetic chain
Facial paralysis or Horners |
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The middle ear sits within the air-filled ________ cavity in the ______ temporal bone.
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The middle ear sits in the air-filled tympanic cavity in the petrous temporal bone.
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Wyat are the two portions of the inner ear?
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Vestibular and cochlear
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