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Specialty Medicine (Ophthalmology, Oncology, Dermatology) > Derm > Flashcards

Derm Flashcards

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Dermatology Board Prep flashcards
1
Q

What are the components of eosinophilic granuloma complex?

A

Indolent (rodent) ulcer, eosinophilic plaque, eosinophilic granuloma

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2
Q

Feline atopic syndrome (FAS) includes….

A

allergic dz of the skin, GI tract, resp. tract and includes allergic dermatitis assoc. with environmental allergens, food allergy, and asthma that may be associated with IgE antibodies

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3
Q

Feline atopic skin syndrome (FASS) is an allergic skin disease associated with what?

A

Environmental allergens

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4
Q

Feline atopic skin syndrome is caused by….

A

Inflammatory and pruritic skin syndrome, assoc with IgE antibodies to environmental allergens, food allergy or flea allergy can mimic or contribute to this syndrome

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5
Q

Feline atopic syndrome CS/characteristics:

A

Miliary dermatitis, self inflicted alopecia/hypotrichosis, head and neck pruritus and eosinophilic granuloma complex

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6
Q

Feline atopic skin syndrome (FASS) genetic?

A

we are unsure, few cases reported but not enough evidence
will have increased numbers of antigen- presenting cells and T lymphocytes in the skin with lesions, also has increased mast cells

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7
Q

Feline atopic syndrome clinical signs?

A

Typically young age of onset, 75% start between 6 months old and 2-3 years old
Pruritus is the most common and consistent CS and usually on face/neck
Non- cutaneous signs are: chronic sneezing/coughing, conjunctivitis, asthma like symptoms

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8
Q

What are some bacterial agents in dogs and cats secondary to derm issues???

A

Bacterial- staphlyococcus pseudintermedius
Malassezia dermatitis- M. pachydermatis (the most common reason for this is allergies)

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9
Q

What demodex in cats causes itching?

A

Demodex gatoi

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10
Q

What are some ddx for itchy cats?

A

Food hypersens., flea allergy (FAD), parasitic infestations (Demodex gatoi, Otodectes, Cheyletiela, Notoedres), dermatophytosis, behavioral/psychogenic alopecia
*diagnosis of exclusion is biopsy**

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11
Q

Atopica for cats

A

Cyclosporine oral solution, calcineurin inhibitor which inhibits IL-2 formation (inhibition of T-cell immunity) suppresses cytokine production, mast cell degranulation and histamine release, prostaglandin release, and mast cell and eosinophil production
used in cats when there is poor response to steroids or steroids are not indicated, or has comorbidities like DM, dont use in immunosuppressed cats like if they have FeLV/FIV, avoid with hx of neoplasia, and avoid with cats with Toxoplasmosis and can cause GI SE and tastes bad

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12
Q

Can use Apoquel in cats off label with more frequent dosing. DO NOT use cytopoint in cats bc its CANINE monoclonal antibody against IL-31 and will cause anaphylaxis and serum sickness in cats. T/F

A

True!!!!

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13
Q

Food hypersens is what types of hypersens?

A

Types 1, 3, and 4 hypersensitivities

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14
Q

What are the most common feline food allergens identified?
What breeds are predisposed? What are some CS of feline food allergy hypersensitivity???

A

Beef, dairy, fish

Siamese breeds predisposed, face ears and neck is typically distribution of lesions, recurrent and non-seasonal otitis externa, GI disease, overgrooming, miliary dermatitis

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15
Q

___ weeks MIN for ruling out food allergy with diet

A

8 weeks

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16
Q

Demodex gatoi

A

found superficially, affected cats are pruritic, inhabits the stratum corneum, contagious!!!!! traumatic alopecia usually over the lateral thorax, ventral abdomen and extremities
can do fecal or skin scrape to diagnose, some cats may be asymp. carriers of it

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17
Q

Demodex gatoi tx

A

Lime sulfur dips- weekly, advantage multi every 1-2 weeks for 8 weeks, can do Bravecto instead

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18
Q

Feline scabies

A

Notoedres cati, can infect cats, dogs, foxes, and rabbits
Contagious and zoonotic
Causes severe pruritus, alopecia, crusting, lichenification, and excoriations

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19
Q

Tx options for cats with feline scabies

A

Lime sulfur dips weekly for 6-8 weeks, Ivermectin SQ every 14 days, Revolution every 14-30 days, Advantage Multi every 14-30 days, TX ALL CATS IN THE HOUSEHOLD AND CONSIDER ALSO TX ANY DOGS WITHIN THE HOUSEHOLD IF THEY CUDDLE/ASSOCIATE

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20
Q

Cheyletiellosis

A

Live superficially in the keratin layer, move in epidermal debris, attach to the epidermis to feed, and lifecycle is about 24 days
Variably pruritic
CONTAGIOUS AND ZOONOTICCCC
Diagnosis is superficial skin scrapings, fecal exam, or tape prep

Tx is revolution, frontline, ivermec or lime sulfur dips

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21
Q

How to spell itching patient

A

PRURITUS

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22
Q

Some causes of pruritus:

A

Allergic dermatitis- flea, food, environmental
Parasites
Infectious causes- bacterial, yeast

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23
Q

Essential fatty acids (EFAs) information

A

cannot be generated by dogs/cats so must be supplied in diet, incorporated to cell membrane, competitive inhibition with arachidonic acid, results in less inflammatory products or anti-inflammatory activity

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24
Q

What are some examples of EFAs?

A

omega 3’s- EPA, DHA, flaxseed oils
Omega 6’s- evening primrose oil, sunflower oil, safflower oil

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25
Q

what is the MOA of EFA’s?

A

compete with AA for cyclooxygenase and lipoxygenase and modifies PG and LT production to less inflamm. versions, good for coat and arthritis only SE are mild diarrhea (not common) and can lead to weight gain but also not very common

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26
Q

Antihistamines for derm

A

MOA- Type 1 histamine receptor antagonists, 1st generation also can sedate, and usually not effective with dermatitis in dogs, 2nd generation is non sedating (Claritin, Zyrtec), also may not work
can calm down flares but will not tx atopic dermatitis

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27
Q

What drug is Temaril P?

A

Trimeprazine 5mg/prednisolone 2mg so anti-histamine and steroid

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28
Q

Glucocorticoids MOA-

A

Blocks phospholipase A2 and prevents the arachidonic acid (AA) pathway to delay the synthesis of histamine
avoid with bacterial pyoderma

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29
Q

avoid using injectable glucocorticoids in patients with what disease?

A

Diabetes mellitus

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30
Q

does injectable glucocorticoids have more or less SE than oral?

A

Injectable has more SE

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31
Q

Apoquel (Oclacitinib) MOA-

A

Janus kinase inhibitor to inhibit signaling of cytokines important in allergies by inhibiting the activation of the JAK-STAT pathway

32
Q

How are cytokines implicated in allergic skin disease?

A

Cytokines are implicated in allergic skin disease and bind to their receptor on the cell membrane and activate the JAK STAT pathway

33
Q

how do we avoid inhibiting cytokines that are involved and healthy in normal hematopoiesis?

A

BID vs SID dosing intervals with a broad margin of safety
this is why we taper to SID dosing after the loading dose

34
Q

Atopica aka Cyclosporin

A

MOA- calcineurin inhibitor, inhibits IL-2 formation which means inhibitor T cell immunity, impairs T helper and cytotoxic T cell function, suppresses cytokine production, inhibits mast cell degranulation and histamine release, prostaglandin release, and mast cell and eosinophil production

35
Q

___ has slow onset and is therefore poorly suited for acute pruritus and lesions

A

Atopica aka cyclosporin

36
Q

What are some SE of Atopica aka Cyclosporin?

A

GI upset, lethargy, abn behavior, papilloma growths, gingival hyperplasia/oral papillomatosis, secondary infections of the skin and urinary tract, hypertrichosis

37
Q

Cytopoint

A

Lokivetmab- canine monoclonal antibody against IL-31 DO NOT USE IN CATS
no age limit unlike Apoquel which you cannot use in young p
Duration of effect is 4-6 weeks, can be given as often as every 4 weeks, works within 24 hrs, and safe

38
Q

What are the most common SE for cytopoint?

A

Lethargy and vomiting

39
Q

Can you use Cytopoint and Apoquel with other drugs?

A

Yes, you can even use them together

40
Q

Does cytopoint affect the dog kidney and liver at all?

A

No, eliminated via normal protein degradation pathways as a natural antibody so does not involve the kidneys or liver

41
Q

What is the difference between autoimmune and immune-mediated?

A

Autoimmune- failure of immune system to tolerate itself, immune response to normal body structures/functions

Immune-mediated- antigen is foreign to the body, usually foreign proteins involved, stimulate immune reaction resulting in host tissue damage

42
Q

what are some autoimmune skin diseases?

A

Pemphigus complex, discoid lupus erythematosus (DLE)

43
Q

What are some example of immune-mediated skin diseases?

A

Cutaneous adverse drug reaction, erythema multiforme, toxic epidermal necrolysis

44
Q

Pemphigus complex hallmark of disease is what?

A

Acantholysis which is the breakdown of epidermal intercellular adhesions with separated keratinocytes

45
Q

What is the most common autoimmune skin disease of dogs?

A

Canine pemphigus foliaceus
occurs in middle to older aged dogs, chows and Akitas are overrepresented
Can be idiopathic, drug induced, or rxn to IV light in some cases

46
Q

CS of Pemphigus foliaceus

A

pustules, papular dermatitis, crusts on head, face, ears, footpads, usually within 1-2 weeks onset or can be insidious over 1-2+ months, pruritus is variable
Can have systemic signs of illness

47
Q

What are some CS of feline pemphigus foliaceus

A

age of onset is young to super old, focal crusting is most common on head, face, ears, and footpads (like in dogs), also may have it on their nail beds and teats regions

48
Q

What is ddx of pemphigus foliaceus

A

Cytology of pustules showing acantholytic cells, confirm with histopathology of the pustule itself DO NOT scrub first

49
Q

Tx of pemphigus foliaceus

A

Corticosteroids orally, recheck in 1-2 weeks
DOGS only- Azathioprine- goal is to alternate dosing of azathioprine and prednisone EOD if the pred alone does not help or if steroids are causing some serious SE

50
Q

Azathioprine MOA and potential SE

A

synthetic modification of 6-mercaptopurine so antagonizes purine metabolism

Excreted in the liver, can cause myelosuppression, GI distress, hepatotoxicity, and/or pancreatitis

51
Q

What are alllll of the tx options for pemphigus foliaceus

A

*Corticosteroids
*Azathioprine
*Chlorambucil
*Cyclosporin
*Mycophenolate mofetil
*Abx

52
Q

What is Pemphigus erythematosus?

A

Crossover between PF and DLE and usually only facial lesions with some erosions and ulcers of the nasal planum, depigmentation

53
Q

Diagnosis of PE?

A

Histopathology of the intragranular and subcorneal pustules showing lichenoid interface dermatitis

54
Q

What is the most severe form of pemphigus?

A

Pemphigus vulgaris

55
Q

Pemphigus vulgaris ddx-

A

Will have vesiculobullous lesions with erosions and ulcers within the oral and mucocutaneous regions usually
Nikolsky sign— means there will be lack of epidermal cohesion, nail beds may be sloughing, and may have p that is systemically ill
diagnosed via histopathology showing basal cells in tombstone arrangement

56
Q

What is the tx of Pemphigus vulgaris???

A

Immunosuppression, prognosis is poor

57
Q

Discoid lupus erythematosus aka cutaneous LE

A

benign disease without any systemic signs, initial sign is depigmentation of the nose and loss of nose normal texture, may also have erythema and scaling within the nose
can also be within the ears, distal limbs, footpads, and perianal region

58
Q

Discoid lupus erythematosus aka cutaneous LE is rare in cats; what is the prognosis in dogs?

A

Prognosis is good

59
Q

Tx options for Discoid lupus erythematosus aka cutaneous LE?

A

Avoidance of direct sunlight, Vit E, essential FA, Tacrolimus in eyes, niacinamide, abx, immunomodulation and may need immunosuppressives in severe cases as an initial treatment

60
Q

Systemic lupus erythematosus

A

multisystemic disease, autoimmune, insidious onset unless hematologic signs, skin lesions in about 50% of cases, ulcerative symmetric mucocutaneous lesions, joint involvement with anemia and thrombocytopenia, low or high WBCs, glomerulonephritis, ulcerative stomatitis, pericarditis, neuro signs, fever, lymphadenopathy, etc.

61
Q

Diagnosis of SLE:

A

3 or more signs of it and + ANA with PA (antinuclear antibody testing with positive titer in face of other CS (at least 3)), also cutaneous histopathology

62
Q

tx of SLE

A

Glucocorticoids are mainstay therapy, also Azathioprine, chlorambucil, cyclosporine

63
Q

Focal vasculitis at rabies vaccination site

A

Seen in poodles and terriers; regions of alopecia, pigmentation and erythema and sometimes scaling where the RV was administered and usually shows up 2-8 months post vaccination

64
Q

What is atopic dermatitis?

A

A genetically predisposed inflammatory and pruritic allergic skin disease with characteristic clinical features associated with IgE most commonly directed against environmental allergen; can be exacerbated by food hypersens. as well

65
Q

Pathogenesis of atopic dermatitis

A

multifactorial- resulting from interaction between host and enviro., genetics, barrier function issues, immuno alterations, classic involvement of OgE formation and then re-exposure to allergens, allergens processed in skin by antigen presenting cells (APC’s)

66
Q

APCs and presentation of allergens to the immune system

A

APCs- antigen presenting cells- initial exposure is no CS “sensitization” and re-exposure is what results in the CS

67
Q

what are some derm meds used as topical therapies available for restoration of the barrier function?

A

Ceramides, topical FA’s, Ophytrium (in Douxo PYO which also has chlorhexidine in it)

68
Q

atopic dermatitis age affected mostly in dogs and most common CS

A

most common in dogs 4 months- 7 years old; most common CS are feet, face, ventrum, and extremity pruritus, may also have hyperhidrosis, papular dermatitis, salivary staining, acral pruritic nodules/lick granulomas; may also have otitis, conjunctivitis, rhinorrhea, urticaria, and sneezing and GI disturbances

69
Q

Atopic dermatitis TX

A

Steroids, antimicrobials for secondary bacterial infections (Staphylococcus pseudintermedius) and yeast infections (Malaseezia pachydermatis)

70
Q

when should allergy testing be recommended?

A

Duration of CS of skin issues more than 3-4 months, recurrent otitis and/or recurrent infections, owner wants to

71
Q

what is the MOA of essential fatty acids (EFA’s)?

A

Modifies leukotriene and prostaglandin synthesis, inhibits arachidonic acid (AA) metabolism by the metabolic byproducts of FA metabolism
Synergistic with anti-histamines and steroids and may even help decrease the steroid dose “steroid sparing effect”
need 9-12 weeks of use to tell if they are working

72
Q

what to do when Apoquel and/or Cytopoint stop working?

A

Evaluate for cutaneous infection and treat it if its present, check for ongoing allergen exposures (fleas, allergy to food, etc.), check for other ectoparasites (like Scabies), allergy testing and allergen specific immunotherapy

73
Q

sensitization to food allergens may occur via ____ route

A

epicutaneous

where the barrier of the skin is disrupted and may promote sensitization and prevent tolerance of GI exposure of the protein

74
Q

Food hypersensitivity/allergy is type ___ hypersensitivities

A

Type I, III, IV

75
Q

Duration of a food trial needs to be how long?

A

10-12 weeks long

but should have a positive response by 6 weeks

Specialty Medicine (Ophthalmology, Oncology, Dermatology) (4 decks)

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