04 - General Assessment of the Dermatology Patient (Cont)

Question 1

(History of the Disease)

(6. Is the Animal Preritic/Itchy?)
1. This is the most important question to ask

How severe do you think the pruritus is? Determining the level of pruritus is important in the development of an adequate treatment plan. These are different questions you can ask to help you gauge the level of the pet’s itching. How many times the animal scratches during the day? Does the animal wakes up at night to scratch? Does the animal lick, chew, scratch and/or rub? A dog that licks likely has a mild pruritus; on the other hand, a dog that chews scratches and/or rubs has a moderate to severe pruritus level. On a scale of 0 to 10 how itchy do you think your pet is?

Question 2

(History of the Disease)

(Is the Animal Pruritic/Itchy?)

Determining if the patient’s condition is pruritic or not will help you formulate an appropriate list of possible diseases for that patient. Below I will provide a list of diseases that are: “typically pruritic”, “variably pruritic”, or “non-pruritic”

Question 3

(History of the Disease)

(Is the Animal Pruritic/Itchy?)

1-7. Which seven are typically or always pruritic?

Answer 3

1. atopic dermatitis
2. food allergy
3. flea bite allergy
4. sarcoptic mange
5. notoedric mange
6. feline demodicosis caused by the surface mite (demodex gatol)
7. Canine demodicosis caused by the surface mite (demodex cornei)

Question 4

(History of the Disease)

(Is the Animal Pruritic/Itchy?)

1-6. Which six are variably pruritic?

Answer 4

1. cheyletiellosis
2. malassezia dermatitis
3. superficial pyoderma
4. feline dermatophytosis
5. autoimmune disorders (e.g. pemphigus foliaceus)
6. epitheliotropic T-cell lymphoma or cutaneous T-cell lymphoma

Question 5

(History of the Disease)

(Is the Animal Pruritic/Itchy?)

1-7. Which seven are non-pruritic?

Answer 5

1. hypothyroidism
2. cushing’s disease
3. alopecia X
4. sex hormone imbalances
5. follicular dysplasia
6. canine demodicosis and feline dimidicosis caused by the follicular mite (Demodex canis and Demodex cati). These can, however, become pruritic if secondary skin infections develop
7. canine dermatophytosis

Question 6

(History of the Disease)

(7. How Does Pruritis correlate with the lesions?)

(This is also a very important question and if the owner can answer it accurately, it can help you formulate a sensible list of differential diagnosis)

A. Which came first? Itching or alopecia or skin rash (pustules, papules, crusts, and epidermal collarettes)?

1. If itching came first, pursue what?
2. If alopecia came first pursue what?
3. If skin rash came first pursue what?

Answer 6

1. allergic or parasitic causes
2. endocrinopathies or demodicosis
3. bacterial, endocrinopathies (underlying cause) and sterile pustualar diseases (eg pemphigus faliaceous)

Question 7

(History of the Disease)

8. Be sure to ask if the animal is licking feet or legs. You may see salivary staining, a copper penny discoloration of the feet. This can be a sign of pruritus (atopy, food allergy) yet the owner may not recognize leg licking as a pruritic sign. The copper penny discoloration of the hair coat can also be a sign of Malassezia over-growth so, look for it! Licking may also be a sign of pain (orthopedic, deep infections, foreign body). Other clinical manifestation of pruritus are chewing, scratching, and rubbing.

Question 8

(History)

(Response to Previous Treatment)

This is of extreme importance in attempting to shorten or define the list of differential diagnoses. Previous therapy information is only helpful when it has been used at appropriated dosages for proper duration of time

(Examples)

1. If a very pruritic dog does not respond to high anti-inlammatory doses of glucocorticoids be high highly suspicious of what?
2. If a disease becomes worse with glucocorticoids, consider what?
3. If a dog with superficial pyoderma is not responding to an empirical antibiotic theryap choice it will be prudent to do what?
4. IF the skin disease starts after the administration of a drug and resolves after withdrawal, consider what?

Answer 8

1. sarcoptic mange because allergic dogs typically respond to glucocorticoid therapy
2. parasitic (eg demodicosis, sacroptic mange) or infectiious causes (blastomycosis, dermatophytosis)
3. chage the antibiotic based on culture and susceptibilit results
4. skin/drug reaction

Question 9

(PHYSICAL EXAMINATION)

read red box on p24

Question 10

(PHYSICAL EXAMINATION)

(3. Collation of the Clinical Findings)

Necessary step to forumulate a reasonable list of differential diagnosis

1. Key factors in the diagnosis include what three things?

Answer 10

1. degree of pruritis

distribution of pruritis

nature and distribution of any lesion

Question 11

(PHYSICAL EXAMINATION)

4. Types of Skin Lesions: Primary and Secondary Lesions

A. The skin only has a few ways to react and in animals, the primary lesions are often quite short in duration.

B. Primary lesions arrive de novo in the skin and often are a reflection of the underlying etiology. They are not always present at the time of the examination and especially in chronic cases.

C. Secondary lesions usually evolve from primary lesions (often develop late in the disease process) and the recognition of these lesions and the time sequence which allowed them to occur play an important role in allowing the clinician to formulate a differential diagnosis. Secondary lesions may be created by the patient or external factors i.e. trauma, medications.

D. Some lesions are a combination of both primary and secondary lesions.

Question 12

(PHYSICAL EXAMINATION)

4. Types of Skin Lesions: Primary and Secondary Lesions

she says not to worry much about knowing difference between primary and secondary