Derm Flashcards
1
Q
How to sample wet/greasy skin for microbiology
A
Impression smear or indirect (with swab)
2
Q
How to sample dry skin for microbiology
A
stained acetate tape strip
3
Q
Staining protocol for
Impression smear
Acetate samples
Waxy ear smears
A
IS = ABC
AS = BC (no fixative)
WES: C (Only methylene blue)
4
Q
How to view cytology V parasites on microscope
A
Cytology = 4-100X with oil
Parasites = 4-10X
5
Q
Name the four cutaneous reactions patterns of cats
A
Head and neck pruritus (often fleas)
Self induced alopecia (Bilateral and symmetrical)
Eosinophilic granuloma complex (can be ulcerated)
Miliary dermatitis (on the dorsal)
6
Q
Common reasons to see the 4 reaction patterns
A
Common reasons are flea, food and environmental atopy.
7
Q
What is the importance of knowing if the purities or the lesions came first
A
Allergic disease = pruritus precedes lesions
Immunosuppression or endocrinopathies = no pruritus until secondary pyoderma lesions develops
8
Q
where are cats v dogs effeceted with Flea bite hypersensitivity
A
Dogs = Caudal half of the body (tail base, thighs, inguinal area) and dorsum
Cats = 4 rection patterns
9
Q
Common flea treatments
A
- Imidacloprid (A + L)
- Selamectin (A + L)
- Fipronil (A)
- Isoxazolines (A)
10
Q
Ease of treating fleas V lice
A
Fleas = can’t kill pupae and also have to treat part of lice cycle in enviroment
Live = easy as whole life is on host
11
Q
Distinctive signs of sarcoptic mange (Sarcoptes scabiei var. canis)
A
Intense pruritis
Papules and crusts especially on pinnal margins
80% show pinnal pedal reflex!!!!
12
Q
Difference in appearance of sarcoptes V Cheyletiella
A
S = round with 8 short legs (deep scrape)
C = hear shaped, 8 long legs, curved mouth parts (superirical scrape_
13
Q
Signs of Cheyletiellosis
A
- Pruritus and scale, esp dorsal trunk
14
Q
Signs and appearance of Otodectes
A
- Ear irritation, head shaking
- Excessive ear wax
- Occasional irritation of face, body
idk why they’re always in pairs and shaggin
15
Q
How to perform a deep skin scrape
A
Scrape into liquid paraffin and put a cover slip on
16
Q
Treatments for arachnids (mites)
A
Sarcoptes = isoxazolines (Sarolaner, afoxolaner, fluralaner) are licensed. Also selamectin, moxidectin can be used
Cheyletiella = nothing licensed but use the same as sarcoptes
.
Feline demodex = No licensed products
Canine demodex = isoxazolines
Otodectes = systemic isoxazolines, selemectin or moxidectin
17
Q
Products to treat the environment for fleas
A
Pymethrin and IGR
18
Q
4 presentations of surface pyoderma
A
- Intertrigo (skin fold)
- Acute moist dermatitis, pyotraumatic dermatitis (‘hot spots’)
- Bacterial overgrowth syndrome
- Mucocutaneous pyoderma
19
Q
Top differential fr patch alopecia
A
Pyoderma
also see pustules and pruritus
20
Q
what are hotspots
A
- Acute lesion from self-trauma
- Triggered by irritant (flea bite, classically)
- Very rapid development of bacterial overgrowth
21
Q
common bacteria implicated in surface pyoderma
A
Staphs - especially S. pseudintermedius
22
Q
Difference in surface V superficial pyoderma on cytology
A
- Surface = bacterial overgrowth, no inflamm
- Superficial = degenerative neutrophils, high numbers of cocci
23
Q
How does superficial pyoderma present
A
- Impetigo (often due to immunosupression or immaturity)
- Exfoliative superficial pyoderma (erythematous rings with central alopecia)
- Bacterial folliculitis
all = see patchy alopecia
Short coated = moth eaten, patchy
Heavy coated = thinning undercoat
24
Q
How to treat surface and superficial pyoderma
A
Topical ONLY (unless superficial really bad)
- CHEX washes (+ moisturiser)
- Steroids in surface, try avoid or only a short course in superficial as don’t want to dampen immune response
25
What factors predispose to malassezia
- Skin folds, pendulous lips, hairy feet) warm lipid-rich environment
- Underlying disease (allergies, endocrinopathies) Alter skin barrier - Breed – e.g. Bassets + Devon Rex cats with high normal mucosal populations
26
Treatment for malassezia pyoderma
- Miconazole/chlorhexidine
- Chlorhexidine shampoo or foam or wipes
- Drying so add moisturiser
27
Other considerations when treating surface, superficial and malassezia pyoderma
Both infections are secondary problems – need to address underlying disease for long term control
- Compromise of cutaneous defences, e.g.
§ Mechanical damage to skin
§ Defects in skin barrier function
§ Changes to innate/acquired immunity
- Increased microbial adherence (e.g. with canine atopic dermatitis (CAD)
- Changes to skin microclimate
28
What to parasiticides are topical and therefore not good for swimmers
Neanicitinoids (Imaclopramid (Advocate)) and Fiprinol
29
Names of isoxazalines and what they cane be used for and precaution
Fluranaler (Bravecto) Sarolaner (Stronghold) Afoxolaner
Literally everything: fleas, lice, ALL mites, ticks
care re seizures
30
Cautions to take if using macrocyclic lactones (selemectin, moxidectin) or Pyrethroids (On environment for fleas)
ML = can be toxic to collies
P = toxic to cats
31
Age of onset of CADs (e and F)
Environmental = 6 months to 1 year
food = any age but 1/3 under a year
32
Signs of CADs (E and F)
Clinically indistinguishable
- Pruritis
- Can present as pyoderma that responds to therapy
- Face, ears, ventral abdomen, perineum, Carpi/tarsi, feet
- Uncomplicated case: Erythema, Self-induced alopecia, excoriations, Primary papular eruption
- With chronicity: Lichenification, hyperpigmentation
33
Difference in lesions in CAD cases compared to sarcoptes and fleas
CAD = unaffected ear margins (sarcoptes), and unaffected dorsal region (fleas)
34
2 tests to identify environmental allergens for avoidance
Serological testing (Ensure CDD blockers used)
Intradermal skin testing to look for a reaction
35
How to diagnose food atopic dermatitis
Exclusion diet trial (for minimum of 8 weeks)
Hydrolysed, limited antigen (novel), or home cooked (novel)
Hydrolysed best BUT ensure fully hydrolysed and avoid chicken hydrolyse diets
- If pruritis resolves, rechallenge with old diet to confirm. Treatment = feed exclusion diet now.
36
Presentation of feline atopic dermatitis
- FASS, FFA and flea allergic dermatitis (FAD) can cause any/all cutaneous reaction patterns
37
What is FASS and FFA
Feline atopic skin syndrome (FASS)
- Inflammatory/pruritic skin syndrome, likely associated with IgE to environmental allergens
- Usually young adult – 6mo-5y onset
Feline food allergy (FFA)
- Can occur at any age (3mo+) but 30% cats <1yo
38
name the 4 drugs commonly used to control inflammation and pruritus
prenisalone (steroid)
Oclacitinib (Apoquel) (JAK inhibitor)
Lokivetmab (Cytopoint) (Pruritus only, IL-31 inhibitor)
Ciclopsorin (Atopica) (T-cell suppressor)
39
Pros and cons of prednisolone
Pros: Cheap, effective, easy, anti pruritic and anti-inflammatory
Cons: Lots of side effects, need lots of monitoring, immunosupression
40
Pros and cons of Oclacitinib
(Apoquel)
Pros: quick to act (24 hours), for allergic dermatitis ONLY
Cons: expensive. Can't use in dogs under 1 year, alongside preds or ciclosporin, causes immunosupression
41
Pros and cons of Lokivetmab
(Cytopoint)
Pros: Quick to act (24 hours), only monthly dosing, safe and more specific (acts on IL-31)
Cons: Not anti-inflammatory, expensive
42
What must be done before giving cats ciclosporin
How long does it take to work?
Supresses T cells so test for FeLV/FIV/toxoplasmosis
Slow (1-2 months)
oral dosing every 24 hours
43
Downside of using immunotherapy
Takes a year to take effect and have to use other treatments in this time
44
Cytological appearance of an ulcer
Macrophages present, blood cells too
full thickness wound to dermis
(erosion is only superficial)
45
Tx for herpes virus
Support; feeding tube, anti-virals
Systemic famciclovir in severe cases
Appetite stimulants e.g. mirtazapine
Calicli = add lysine too
46
What feline viruses can present with cutenaous ulcers? and where?
Herpes virus: lesions make a mask. eyelids, muzzle, nose
Calicli virus: ulcers on mucous membranes, lips and nose
47
Signlament and signs of feline cowpox
Signalment: Male hunting in late summer
Signs: Onset of a single crusted ulcerated lesion followed by smaller lesions (satellites)
signs start at head, sometimes for feet
48
Signs of feline plasma cell pododermatitis ad treatment
- Soft, swollen pads with scaling
- Ulceration centrally in some
Immune-modulation:
- Steroids, ciclosporin
- Doxycycline commonly used
49
What can cause vasculitis
infections (e.g. Leishmaniasis),
Food hypersensitivity
Insect bites
Neoplasia
Drugs (e.g. high dose itraconazole) and idiopathic
50
Signs of vasculitis
lesions depend on areas effected
Immune mediated damage to blood vessels so
- Purpura, erythematous to purpuric plaques, ulcers, non-healing wounds
51
Treatment for vasculitis
Preds + ciclosporin/chlorambucil to reduce adverse effects
+/- topical tacromilus
- Perfusion enhancing drugs (e.g. propentofylline)
52
Signs of vasculitis
Immune mediated damage to blood vessels so
- Purpura, erythematous to purpuric plaques, ulcers, non-healing wounds
53
Signalment and signs of canine cutaneous lupus
Signalment: 7 year old GSD
Signs: On nose
- Erythema, depigmentation, scaling
- erosions/ ulcerations, +/- crusting
- loss of cobblestone pattern
54
How to differentiate canine cutaneous lupus and mucocutaneous pyoderma
Give antibiotics
- Disease goes away = MP
- Disease remains = CL
can perform histology after antibiotics: subtle interface reaction (cell-rich lymphocytic interface dermatitis) see with lupus
55
Tx for canine cutaneous lupus V mucocutaneous pyoderma
CL: Topical
- ChlorHex wipe/spray/shampoo
- Topical steroid creams
- Maybe topical Tacrolimus (Ciclosporin like)
MP:
- Anti-staphylococcal antibioti
- Chlorhexidine washes for 3-4 weeks
- Steroids may reduce disease severity
56
Common signs of cutaneous epitheliotropic lymphoma as well as ulceration
Ulceration +
- Alopecia (effects hair follicles)
- Can vibe VERY pruritic
- oral lesions common, disease of OLDER DOGS
57
Common cause of Erythema multiforme and signs
And helpful diagnostic signs
Drug reactions
Erythematous macules or papules which may ulcerated
Rapidly acute onset helps diagnoses
58
What 2 drugs can be used to treat immune mediated disease
prednisalone
ciclosporin
59
what adjunctive immunosuppressants can help reduce the doses of preds and ciclo needed
- Azathioprine (dogs only)
- Chlorambucil (drug of choice in cats)
- Mycophenolate mofetil (good for pemphigus)
- Topical agents such as steroid sprays and creams and tacrolimus
60
Anti-pruritic/anti-inflammatory drug summary
Preds: AI and AP. Cheap, side effects
Oclacitinib (Apo): AI and AP. Allergies only. ££. Can't use with Ciclosporin, Preds, or under a year
Lokivetnab (cyto): AP. Monthly injection in dogs only. Very specific (IL-31) but spenny
Ciclosporin (Atop): Ai and AP. Slow effect, expensive, daily dosing. T cell suppression (test cats for viruses!)
61
top differential for patchy alopecia
Superficial pyoderma (esp bacterial folliculitis)
62
Which diseases cause follicular casts
Demodex
Dermatophytosis
Seborrhoea/ sebaceous adeninitis
63
What diseases cause comedones
HAC
demodex
64
Signs of dermatophytosis
Scale, alopecia, follicular casts
circular patches
Usually non-pruritic
65
treatment for dermatophytosis
Topical:
- Chlorhexidine* / miconazole shampoo (NOT CH alone)
- Enilconazole in dogs (not licensed in cats) every 4 days
Systemic:
- Necessary to achieve cure
- Itraconazole (cats & dogs), ketoconazole (dogs)
Also treat environment
66
Signs of demodex
Juvenile:
- Can be local or general
- Alopecia, comedones, follicular casts, scaling +/- secondary pyoderma
- Greasy and smelly
Adults:
- Often generalised with secondary pyoderma (Papules and pustules)
- Alopecia, comedones, erythema
67
Dx and Tx for demodex
Dx: deep skin scrapes into liquid paraffin (+ cover slip)
Tx: Treat any secondary pyoderma or underlying immune suppression in adults
- Licenced isoxazolines e.g. afoxolaner, flurolaner, sarolaner
- Imidacloprid/moxidectin (Advocate®): licensed, efficacy?
- Treat until 2-3 consecutive clear skin scrapes
68
Cutaneous signs of HAC
- Thin skin
- Bilateral, symmetrical alopecia (esp trunk)
- Comedones
- Scale
- Prominent blood vessels
- Calcinosis cutis
- Poor wound healing and secondary pyoderma
69
Cutaenous signs of Hypo T
- Hyperpigmentation
- Bilateral alopecia around areas of wear (trunk + pinnal)
- Scale and brittle hair
- Pruritis, especially if secondary pyoderma
- Tragic face + depressed demeanour
- Ceruminous otitis
70
What tumour can cause hyperoestrognism
Sertoli cell tumour in entire males
71
Signs of paraneoplastic alopecia
- Alopecia of ventrum and legs
- Skin shiny and translucent
- Pancreatic and bile duct carcinomas
- Older cats
72
3 common breed manifestations of pattern alopecia
- Yorkie: Dorsal nose, ears, legs
- Daxie: Pinnae
- Sighthouds; Bald thigh syndrome
73
Treatment for any deep infection
* Treat systemically for extended period to minimum 2 weeks post-resolution
* Antimicrobial choice usually based on culture
* +/- adjunctive topical therapy
* Avoid immunosuppressive drugs (e.g. corticosteroids)
* Consider underlying cause
74
Anal furunculosis signalment and Tx
GSD with Co-existing diseases include colitis, atopic skin and ear disease
- Clip, clean + antibiotics (Metronidazole or Cephalexin)
- Prednisolone or Ciclosporin for immuno suppression
- Can be surgically resected (remove anal sacs, close dead space)
75
Treatment for metatarsal fistulation
The big pad
- Requires long term management. Chronic condition.
- Topical anti-inflammatory like Tacrolimus or glucocorticoids
- NSAID for analgesia
- Treat secondary bacterial infections if present
76
Causes of Pansteatitis and signs
Innaproriate diet (Tuna)
Aka yellow fat disease
- Dull/greasy coat, sensitive skin
- Deep nodules that open as draining sinuses
77
What is deep pyoderma
Infection outside epidermis or hair follicle epithelium
Presents as
a. Furunculosis
b. Abscess
c. Cellulitis
78
what systemic antibiotics can be given for abscesses or cellulitis
Amoxicillin Clavunate
Lance and drain abscesses too
79
Different presentations of furunculosis (deep pyoderma)
furunculosis = - Extension of folliculitis (rupture of hair follicle wall) = microbes + free keratin in dermis = provokes a foreign-body reaction
- Chin: Acne
- Nasal: Effects dorsum
- Interdigital folliculitis/furunculosis
- Acral lick dermatitis/granuloma from self trauma
- Post-grooming folliculitis/furunculosis*
80
Cytological findings in furunculosis
- Pyogranulomatous reaction (macrophages, neutrophils +/- rbcs)
- Deep pyos = commonly staphs (still C&S)
81
Treatment for furnuculosis
- Long systemic antibiotic course (after C&S)
- Continue to 2 weeks post-resolution (min. 4 weeks)
- Topical chlorhexidine shampoos/foams also
82
why can inflammation persists are resolution of the pyoderma in furnuculosis
Keratin persists for a long time and continues the foreign body reaction
continue nti-inflammatory medication (corticosteroids/ ciclosporin/ tacrolimus)
83
How are cats infected with mycobacterial granulomas
Though open wounds (oppurtunistic)
Mycobacterium tuberculosis complex (MTBC)
euthanise
84
Signs of mycobacterial granulomas in cats
Cutaneous nodules +/- draining tracts
+/- systemic disease
85
stain for mycobacteria
Zeihl-Neelsen
86
common cause of scale?
Bacterial infection
scale = folliculitis = pustules = rupture and central hair loss = circle of scale moves from central area
87
Common scale treatments
* Sulphur (good for primary seborrhoea)
* Salicylic acid (often combined with sulphur)
* Selenium sulphide (old product that dies her pink!)
topical Hydrocortisone aceponate in caine ear margin sebborhoea
88
What can scale treatments be combined with
Moisterisers to stop water loss
use AFTER scale removeal
89
Breeds and signs of Zn respsonvei dermatitis
Huskies are geneitically prediposed
- Hard plaques of hyperkeratotic skin around areas that are abrased often (hocks, elbows).
- Marked scale and crusting
- Tx: supplement
90
Breed and signs of Ichthyosis
Golden retrievers
Large flakes of scale seen from a few weeks of life
Barrier function compromised so secondary infection common
91
Breed and signs and treatment of ear margin seborrhoea
Dachshunds
Follicular casts and plugs on ear margins alone
May rub and ulcerate
Tx: topical anti-seborrheic shampoos, topical steroid (hydrocortisone aceponate) but incurable
can surgically remove
92
Breed and signs of nasal parakeratosis
And important ddx
Labradors (usually between 6 months and 1 year)
Roughening od nasal skin and hyperkeratosis
Ddx: Discoid lupus erythematosus and mucocutaneous pyoderma. Biopsy or genetic test for this disease
93
Breed and treatment of footpad hyperkeratosis
Dogue de Bordeaux (in first few months of age)
Need to stand in propylene glycoll for 5 minutes a day
94
Signs of nasodigital hyperkeratosis
Older dog (senile change)
slow, bilateral, no ulcers or depigmentation
95
2 paraneoplastic conditions in cats
Alopecia (Biliary duct and pancreatic cancer)
Thymoma induced exfoliative dermatitis
96
Signs of Leishmaniasis
Dog has been abroad
scale
alopecia
non-pruritic
enlarged lymph nodes
can be exfoliate, ulcerative or nodular
97
Cytological signs of Leishmaniasis
Reactive lymph node with plasma cells and intracellular amastigotes
98
Treatment for Leishmaniasis
Allopurinol (if they have renal problems)
Monitor for side effects bcos there are loads!
Common combinations
- Meglumine antimoniate and Allopurinol
- Mltefosine and Allopurinol
99
Signs of canine pemphigus foliaceus
Superficial pustules (larger than pyoderma ones and erythematous)
Bilateral and symmetrical
100
Tx of pemphigsu
autoimmune diseaase abasing desmosomal proteins
preds +
Mycophenolate mofetil, or Chlorambucil, Ciclosporin, tacrolimus, Azathioprine,
101
Cytology of pemphigus
- Acantholytic keratinocytes (large ‘fried-egg’ cells, sometimes in rafts) + neutrophils
102
What is Canine juvenile sterile granulomatous dermatitis and lymphadenitis
Sterile granulomatous condition of the face, pinnae and LNs
Acute swelling
Lymphadenopathy
Sterile pustules
103
What disease cause superficial necrolytic dermatitis lesions
End stage liver disease
Pancreatic atrophy
104
What can sebaceous gland tumours look like
Warts x
105
Ddx for pigmented tumour in cats
Melanoma and basal cell tumour (more common)
106
Common cause of feline fibrosarcomas
Injection sites (intrascapular)
107
Signs of cutenaous lymphoma
Eryhemta, cruising, alopecia
nodules
pruritis and scale (generalised)
mucocutenaous junction may depigment
108
When to find common pathogens in ear disease
Fungal: Malassezia common and is followed by
=> Acute bacterial: Gram positive staphs, streps and Corynebacterium species
=> Chronic bacterial; Gram positive enterococcus, gram negative Pseudomonas, E.coli (Pseudomonas aeruginosa is end point often)
o Predisposing factors e.g. Hairy &/or pendulous ears, stenosis
o Perpetuating factors e.g. Ear canal hyperplasia, stenosis and scarring
109
Two good all purpose ear cleaning solutions
Cleanaural
epiotic
110
Good ear cleaner for purulent otitis
Otodine (TRIZChlor)
Antimicrobial but no ability to remove wax. Watery cleaner
111
Good ear cleaner for waxy otitis
Cerumaural & Otoact (Contain squalene)
No antimicrobial properties
112
Use of TRIZ EDTA
Pre-treatment and base for other treatments only
No antibiotic or anti-wax properties aone
113
use of TRIZ EDTA with added N-acetyl cysteine
disrupts biofilm
Pre-treat for 20mins => flush => follow with antibiotics
114
Treatment for Cocci +/- yeasts, minimal inflammation
Only ear cleaner
115
Treatment for Cocci +/- yeasts, consistent inflammation
Polypharmacy product with narrow spectrum ABs
116
Treatment for Rods +/- cocci + yeasts, significant inflammation
Polypharmacy product, systemic steroids (Antibiotic with good action on pus)
ADD SYSTEMIC STEROIDS FOR RODS
117
what ear treatments don't target Rods
ones with Florfenicol (neptra, osurnia)
118
what antibiotic is inhibited by pus
polymixin B (surolan)
119
name 3 ear cleaners that cover all types of bacteria
Eostatic
otomax
canaural
