Approach to pruritus, feline reaction patterns Flashcards

1
Q

What is the clinical presentation pruritus in dogs and cats?

A
  • Scratching, chewing
  • Licking feet (dogs)
  • Feather-plucking (birds)
    *Overgrooming (=‘self-induced alopecia’) (cats)
    • Also –> tufts of hair in house, vomiting furballs, hair in faeces
    • One of the four feline reaction patterns
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2
Q

What are the four cutaneous reaction patterns in cats?

A
  1. Self-induced alopecia (SIA)
  2. Face, head and neck pruritus (FHN)
  3. Miliary dermatitis (MD)
  4. Eosinophilic granuloma complex (EGC)

often more than one pattern present

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3
Q

What are the key features of Self-induced alopecia (SIA) in cats?
what is a DD for this?

A

Bilaterally symmetrical alopecia in areas that cat can reach with tongue

  • Hair often stubbly
  • Damaged distal tips on trichograms
  • Often not recognised by owner
  • +/- tufts of hair in house, vomiting furballs, hair in faeces

d/d spontaneous loss – may also be symmetrical
* Much less common
* Hair often easily epilated

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4
Q

What are the key aspects of Face, Head and neck pruritus?

A

extreme self trauma to the head, cat will scrate until ulcerated
1/3 of cases are caused by flea allergic disease

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5
Q

What are the key features of miliary dermatis in cats?

A

Papulocrustous lesions (feels lumpy), especially on dorsum
- most common cause is flea allergy

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6
Q

What are the key features of eosinophilic granuloma complex in cats?

A

A. Eosinophilig granuloma
- Well-demarcated, solid, raised, yellow to pink plaques/nodules
- +/- eroded or ulcerated surface
- +/- crust
- Any site but especially caudal thighs (linear), oral cavity, lips

B. Eosinophilic plaque
- Raised, flat-topped erythematous plaques
- Usually ulcerated/eroded and pruritic
- Usually ventral abdomen/caudal thigh
- Secondary bacterial infection common

C. Indolent ulcer (‘rodent ulcer’)
- Erosive/ulcerated lesion on mucocutaneous junction of upper lips
- Unilateral/bilateral
- Rarely painful or pruritic

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7
Q

What are the three most common causes of feline reaction patterns?

A
  • FAD – flea allergic dermatitis
  • FFA – feline food allergy
  • FASS – feline atopic skin syndrome
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8
Q

What are the differnetials of millary dermatitis?

A

Most likely to be FAD, FFA, FASS
* Dermatophytosis
* Pyoderma
* Cheyletiella, Neotrombicula, Otodectes
* (Pemphigus foliaceus)

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9
Q

What are the differntials of eosinophilic granuloma complex in cats?

A

Most likely to be FAD, FFA, FASS
* Cowpox
* Mycobacterial infections
* Neoplasia (cut lymphoma, MCT, SCC)
* Deep bacterial infections
* Fungal disease
* Respiratory viruses
* Insect bite HS

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10
Q

What are the differntials of face head and neck pruritus in cats?

A

Most likely to be FAD, FFA, FASS
* D cati,
* Otodectes
* Insect bite HS

  • Dermatophytosis
  • Malassezia dermatitis
  • Respiratory viruses
  • Bacterial pyoderma
  • Pemphigus foliaceus
  • Skin neoplasia (MCT, SCC, cut lymphoma)
  • Drug reactions (methimazole)
  • Idiopathic facial dermatitis (Persians)
  • FOPS (esp Burmese)
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11
Q

What are the differntials of Self-induced alopecia in cats?

A

Most likely to be FAD, FFA, FASS
* **D gatoi **
* Dermatophytosis
* Malassezia dermatitis
* Feline paraneoplastic alopecia
* Psychogenic alopecia
* FLUTD/pain/neuralgia

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12
Q

What is the age of onset of the following?
* Demodicosis
* Other ectoparasites
* Environmental AD
* Food induced AD
* Endocrinopathies (secondary infection –> pruritus)
* Neoplasia

A
  • Demodicosis - Young (< 1yo) and old - immunocompromise
  • Other ectoparasites - Any age
  • Environmental AD - 6mo- 3 year
  • Food induced AD - any age but 30-50% < 1yo
  • Endocrinopathies (secondary infection → pruritus) - Middle-aged-older
  • Neoplasia - Older
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13
Q

In what species is sarcoptic mange more common in?

A

dog

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14
Q

What is the breed desposition for demodicosis and Canine AD?

A

Demodicosis - Staffordshire bull terrier, Shar pei . Canine AD - Terriers, Labradors, French bulldogs

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15
Q

What is your top dd for a Dog with dull coat, lethargy and bradycardia?

A

hypothyroidism

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16
Q

What is your top dd for a
Dog with diffuse thinning of coat, PUPD, polyphagia?

A

hyperadrenocorticism

17
Q

Why may endocrinopathies present as pruritus?

A

Secondary microbial infection due to immunocompromise

18
Q

What are the dd for pustules?

A
  • Usually - superficial pyoderma (staphylococcal folliculitis)
  • Uncommonly - demodicosis, dermatophytosis, pemphigus foliaceus (PF)
  • Rarely – other sterile pustular diseases
19
Q

What are the dd for epidermal collarettes, crusts?

A

Usually - superficial pyoderma
Occasionally - PF

20
Q

What is the to dd for a dog with Lesions affecting caudal and dorsal regions in dog?

A

FAD top d/d!

21
Q

What is the first step when dealing with a pruritic dog?

A

Eliminate ectoparasites and microbial dysbiosis/infections

  • Investigate parasites: Confirmed or suspected –>Treat as appropriate (don’t believe a negative test –> thorough treatment trial if not on good (ideally isoxazoline) regime already)
  • cytology: for microbial dysbiosis/infection - treat if confirmed
22
Q

After elimination of ectoparasites and infection what does it mean in pruritis resolves fully?

A

implies non-pruritic underlying cause

  • e.g. immunosuppressive disease: including endocrinopathy –> investigate as appropriate
  • or ectoparasites, if not previously on good ectoparasite control –> continue ectoparasite control
23
Q

After elimination of ectoparasites and infection what does it mean in pruritis remains?

A

implies other pruritic underlying disease
usually atopic dermatitis (environmental or food-induced)

24
Q

How do you Distinguish between environmental and food-induced AD ?

A

Exclusion diet trial
* Exclusion diet needs to be fed for 8 weeks minimum

Environmental atopic dermatitis (FASS* in cat) diagnosed by exclusion

25
Q

How can you use of prednisolone or oclacitinib to shorten time to diagnosis of food allergy?

A

Treat for initial 2-3 week, then stop to observe response
* pruritus recurs –> resume prednisolone/oclacitinib –> repeat cycles of treatment/observation to end of trial
* no pruritus for 2 weeks –> rechallenge with old diet)