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Y3 MOD Dermatology > Approach to alopecia > Flashcards

Approach to alopecia Flashcards

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1
Q

What is alopecia?

A

The loss or absence of hair

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2
Q

What are the two classifications of alopecia?

A

Spontaneous: no animal involvement, various causes

Self-induced: animal removes hair, pruritis, psychogenic

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3
Q

How can we be sure an alopecic animal is not pruritic at onset?

A
  • Cutaneous signs of pruritis: feel of the coat, saliva staining
  • Trichogram shows broken hair shafts in pruritic animals
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4
Q

Give some examples of conditions that cause symmetrical alopecia

A
  • Alopecia X
  • Follicular dysplasia
  • Canine recurrent flank alopecia
  • Hyperadrenocorticism
  • Hypothyroidism
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5
Q

Contagious alopecia would be due to?

A

Dermatophytosis

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6
Q

What are some examples of causes of alopecia in older dogs?

A
  • Hypothyroidism
  • Hyperadrenocorticism
  • Neoplasia (e.g. epitheliotropic lymphoma
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7
Q

What are some different characteristics of alopecia that should be used to help with diagnosis?

A
  • Partial/complete
  • Regular vs irregular patches
  • Asymmetrical vs symmetrical
  • Focal/multifocal vs generalised
  • Erythema, hyperpigmentation, scaling, comedones, skin atrophy
  • Spontaneous vs self induced
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8
Q

What are some inflammatory causes of alopecia?

A
  • Infectious agents e.g. Dermatophytosis
  • Parasitic e.g. Demodicosis
  • Immune mediated
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9
Q

What are some non-inflammatory causes of alopecia?

A
  • Hair follicle arrest

- Hair synthesis defetcs

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10
Q

Name some examples of hair follicle arrest conditions

A
  • Endocrinopathies
  • Alopecia X
  • Paraneoplastic alopecia
  • Cyclical flank alopecia
  • injection alopecia
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11
Q

Name some examples of hair synthesis defect conditions

A
  • Congenital alopecia
  • Follicular dysplasia
  • Pattern alopecia
  • Sebaceous adenitis
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12
Q

What is the most common cause of spontaneous infectious alopecia in dogs and cats?

A

Bacterial folliculitis

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13
Q

Name the bacteria which causes bacterial folliculitis

A

Staphylococcus pseudintermedius

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14
Q

How does bacterial folliculitis present?

A

Focal to multifocal patches of alopecia

+/- pustules, crusts

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15
Q

Most causes of ringworm are in…?

A

young or immunocompromised animals

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16
Q

What will be observed in the examination of an animal with ringworm?

A
  • Often mild disease with scale and associated alopecia
  • Multifocal patches often circular
  • typical size 4-6 cm
  • +/- hyperpigmentation
  • Follicular casts
  • Mostly non-pruritic
  • Often the head, ears and chin
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17
Q

Give some examples of methods use to diagnose ringworm?

A
  • Wood’s lamp examination
  • Trichography
  • In house dermatophyte test medium
  • External lab fungal culture (gold standard)
  • Mackenzie toothbrush sampling
  • Biopsy
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18
Q

Describe a wood’s lamp examination for ringworm

A
  • Warm for 5-10 mins, expose hair for 3-5 mins

- Apple green fluorescence of hair

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19
Q

What will be seen on a Trichogram if ringworm is present?

A

Arthrospores (soap bubbles) surrounding hair shaft, hyphae within hair

20
Q

Describe a Mackenzie toothbrush sample for ringworm

A
  • Use a cheap new toothbrush with nylon bristles
  • Brush the affected areas on the animal until some hair and scale connected.
  • Submit the whole toothbrush (with or without the handle removed) to the lab or inoculate onto fungal culture medium
21
Q

Which special stain is used for fungal hypahe?

A

Silver stains

22
Q

Even though ring worm may spontaneously resolve, why should it be treated?

A

Due to zoonotic risk and to reduce environmental contamination

23
Q

Describe treatment options for ringworm

A
  • Clipping
  • Topical treatment with chlorhexidine or a lime sulphur dip
  • Environmental decontamination: isolate animal, destroy bedding, daily vacuuming and disinfection
24
Q

Which systemic treatments can be used to treat ringworm?

A
  • Itraconazole: effective in dogs and cats

- Ketoconazole: licensed in dogs

25
Q

How can ringworm treatment success be monitored?

A
  • Monitor fungal culture every 2 weeks ideally using toothbrush technique
  • Start when obvious reduction in clinical lesions
  • Require two negative cultures 2 weeks apart
26
Q

Nodular Dermatophytosis affects which cat breed?

A

Persian

27
Q

Nodular dermatophytosis is also known by which name?

A

Pseudomycetoma

28
Q

Describe the features of Pseudomycetoma

A
  • Subcutaneous form of dermatophytosis
  • Usually accompanied by typical dermatophyte signs unless treated
  • 3-6 months of daily treatment
29
Q

What is a parasitic cause of spontaneous alopecia?

A

Demodex/Demodicosis

30
Q

Name the 3 long bodied Demodex spp seen in dogs and cats

A
  • Demodex canis (dog)
  • Demodex injai (dog)
  • Demodex cati (cat)
31
Q

Name the short bodied Demodex spp seen in cats

A

Demodex gatoi

32
Q

What are the two clinical syndromes of canine demodicosis?

A

Juvenile onset

Adult onset

33
Q

Describe the features of juvenile onset canine demodicosis

A
  • Immature immune system
  • Localised (<6 patches of alopecia)
  • Generalised (includes body region – feet, head)
  • Mild cases spontaneously resolve
34
Q

What are the clinical signs of juvenile onset canine demodicosis?

A
  • Alopecia
  • Scaling
  • Blue-grey hyperpigmentation
  • Comedones
  • Follicular casts
  • +/- Secondary bacterial infection
35
Q

How is juvenile onset canine demodicosis diagnosed?

A

Clinical appearance:
- Multifocal alopecia with follicular castings
- Comedone formation
- Secondary bacterial infection, often associated with peripheral lymphadenopathy
- Malodour
- Greasiness
Positive skin scrapings, hair plucks or biopsy

36
Q

Follicular casts are common in which 3 conditions?

A

Demodicosis
Dermatophytosis
Sebaceous adenitis

37
Q

Skin scrapings must always be done if what are seen?

A

Comedones

38
Q

Describe the features of adult onset canine demodicosis

A
  • Immunosuppressive disease
  • Idiopathic
  • Often generalised
  • Require aggressive treatment
39
Q

What are the clinical signs of adult onset canine demodicosis?

A
  • Papules, pustules, draining sinus tracts, enlarged lymph nodes, +/-pyrexia
  • Pruritic or painful
40
Q

Give some examples of underlying disease which may contribute to adult onset canine demodicosis?

A
  • Hyperadrenocorticism
  • Hypothyroidism
  • Diabetes mellitus
  • Systemic neoplasia
  • Immunosuppressive therapy
  • FIV / FeLV
41
Q

Describe some treatment methods for canine demodicosis

A
  • Clip long haired animals, bathe to remove debris
  • Treat any secondary bacterial pyoderma
  • Treat ANY underlying immunosuppression
  • Anti-mite treatments e.g. amitraz
  • Treat until 2-3 consecutive negative skin scrapes taken every 4 weeks
  • Spey dogs with generalised juvenile onset demodicosis
42
Q

Name some examples of immune mediated spontaneous alopecia

A
  • Alopecia areata
  • Dermatomyositis
  • Sebaceous adenitis
43
Q

What are some indications for taking a skin biopsy?

A
  • Nodules and plaques and any suspected neoplastic lesion
  • Vesicular lesions
  • Ulcerative disease processes or unresolving ulcers
  • Lesions failing to respond to rational therapy
  • Unusual, severe or widespread disease
  • Alopecic diseases (rule out parasitic, endocrine and infectious causes)
44
Q

How do you select the right lesion to biopsy?

A
  • Primary lesions where possible
  • Intact epidermis
  • Take enough samples to represent disease process, ideally >3 (5-6)
45
Q

Where would you take skin biopsy’s from an animal with suspected non-inflammatory alopecia

A

e.g. 4 biopsies from the middle of the non-inflamed alopecia, 1 from the edge and 1 from an apparently normal part of the skin

46
Q

Where would you take skin biopsy’s from an animal with suspected inflammatory alopecia

A

3 biopsies from the expanding edge of the lesion, 2 from the middle of the alopecia and 1 from an apparently normal part of the skin

Y3 MOD Dermatology (12 decks)

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