derm CAD

Question 1

question

Answer 1

answer

Question 2

a dog comes in with lesions on the mouth, crotch, legs, and feet, and arm pits. The owner says this happens every year around the spring. The lesions show erythema and alopecia. The owner says shes not concerned as the dog is not itchy…. A) you suspect atopic dermatitis so you need to rule out ectopic parasites , B) you can rule out atopic dermatitis so you start working up other causes c) its a food allergy so start a diet trial d) its an environmental allergy so you start on steroids

Answer 2

B - if the animal is not pruritic it is not atopic dermatitis

Question 3

lesions on the rump and some dots on the neck and crotch - what is your 1st differential

Answer 3

flea allergy

Question 4

lesions on the ears hind hock and the elbow

Answer 4

scabies

Question 5

what is the distribution of demodex

Answer 5

focal lesions all over the body

Question 6

you see lichenification in the cubital fold of the dog (front of the elbow)

Answer 6

predilectation site of atopic dermatitis

Question 7

Cad is a ____ and ____ disease (2 broad side effects), that involves immunoglobulin __ directed most commonly against ____ allergens but sometimes associated with ___ allergens.

Answer 7

inflammatory and pruritic disease, IgE , usualy against environmental but sometimes assocaited with food allergies

Question 8

what are 5 components that make up the pathogenesis of CAD

Answer 8

genetics, environment, immune system dysfunction, sesnitization to allergens, skin barrier dysfunction, aleration in microbial populations

Question 9

you have many clients with puppies from the same breeder and they all have signs of CAD. What do you want to discuss with the owners / breeder

Answer 9

there is a genetic component of CAD that increases if both parents have the genes that predispose…. This can affect the inflamm cytokines and skin structural . So they should not breed these animals anymore.

Question 10

what are some risk factors of CAD

Answer 10

urban environment, male, neutered, allowed on upholstered furniture, receiving flea control, exposure to smoke, being raised in a shed as a puppy, adopted at 8-12 weeks, living in a county with a veterinary dermatologist, regular bathing, chocolate labs vs. other color labs

Question 11

what are some protective factors associated with CAD

Answer 11

Potential Protective factors: rural, walking in woodlands, fields or beaches, non-commercial diet, raw diet, living with other animals

Question 12

an owner has a dog you have diagnosed with atopic dermatitis - you’ve ruled out food allergy and explain that environmental allergies are the most common cause. What is the most common cause of environmental allergies for CAD dogs?

Answer 12

dust mites

Question 13

dust mites is a common cause of CAD. How can an owner help reduce this exposure a) keep a cleaner house b) don’t let the dog roll in dirt c) improve the skin barrier with nutrition and bathing d) use a mite preventative medication

Answer 13

c) improve the skin barrier

Question 14

what are 2 primary and 2 secondary skin lesions for CAD

Answer 14

priamry - erythema and papules … secondary - excoriation, alopecia, lichenification, moist dermatitis, 2ndary infection

Question 15

you dx CAD and the owner says the c/s arent so bad and they don’t want to treat … what do you tell them

Answer 15

this disease is progressive and will likely get worse with time

Question 16

what are the 3 important steps to dx CAD

Answer 16

1. rule out other diseases 2. detailed history and c/s 3. demonstrate an IgE component

Question 17

what are 3 ways we can rule out other causes when working up a case of CAD

Answer 17

1. skin scraping or treat for ectoparasites (demodex) 2. cytology (pyoderma) 3. food trials (food allergy)

Question 18

a dog presents with lesions that make you suspicious of CAD. You take a history: …… Dog lives indoors, is 6 years old, has never had a yeast infection, has lesions on the front feet and pinnae but not on the ear margins or dorsolumbar region… which of these are NOT part of the criteria for ruling in CAD (favrot’s criteria)

Answer 18

AGE = <3years old is more common for CAD, also recurrent yeast infections is more common for CAD (doesn’t mean the dog doesn’t have it ..)

Question 19

how do you identify a component of IgE with CAD

Answer 19

intradermal skin testing or serum IgE testing

Question 20

t/f the only way to dx CAD is to do intradermal / serum testing so all owners should do it if they have a dog that presents with potential CAD?

Answer 20

FALSE … only do allergy testing if the owner wants to consider allergen specific immunotherapy … otherwise there is no point because it doesn’t change how we treat the disease

Question 21

what are 4 ways we can offer to a client to treat CAD

Answer 21

1. treat with anti-pruritics and anti-inflammatories 2. allergen specific immunotherapy 3. topical therapy 4. identify and prevent flares

Question 22

when / why would you prescribe oclacitinib (apoquel)

Answer 22

fast acting for acute flares but less helpful for otitis and pododermatitis. Its relatively safe. No increased risk of neoplasia. Cannot use in animals younger than 12 months

Question 23

what is the MOA of oclacitinib?

Answer 23

inhibits the cytokines involved with CAD (janus kinase inhibitor)

Question 24

pros and cons of lokivetmab (cytopoint)

Answer 24

monoclonal antibody against IL - 31. fast acting (useful for flares), it lasts 4-8 weeks but needs an injection, no drug interactions if they are on other drugs, minimal immune suppression

Question 25

what is the MOA of lokivetmab

Answer 25

monoclonal antibody against IL-31

Question 26

which drug is : slow acting calcineurin inhibitor starts dose 5 mg/kg and decrease to EOD or less frequent, not useful for acute flares.

Answer 26

modified cyclosporine (atopica)

Question 27

when / why would you prescribe oclacitinib (apoquel)

Answer 27

acute flares in animals >12months

Question 28

what are 4 examples of corticosteroids

Answer 28

prednisone - dog, prednisilone - cat, methlypredisolon (medrol) - 1.2x more potent, dexamethasone - 10x more potent

Question 29

what is the dose and most common steroid used for allergies ?

Answer 29

0.5 mg/kg pred for pruritis and taper down to lowest effective dose …… If you have inflamm otic / pedal conditions = 1mg/kg

Question 30

you have a large dog with otic inflammationg and pruritis what dose would you use …. A) 0.5 mg/kg and taper predisone B) 1 - 1.5 mg/kg but likely higher in larger dogs c) 1mg/kg but likely lower dose because doses are often lower in larger dogs d) don’t use pred for otic inflammation

Answer 30

C 1mg/kg for otic inflammation and taper down - esp. in larger dogs they often require lower doses

Question 31

name 5 side effects of pred

Answer 31

PU/PD, polyphagia, muscle atrophy, weight gain, panting, sterioid hepatopathy, iatrogen cushings, GI ulceration, lipidemia, vomiting /diarrhea, immune suppression, hypercoagulability

Question 32

what are some indications for oral corticosteroids

Answer 32

when other tx don’t work, acute allergic rxns, ear stenosis and severe pododermatitis (essentially ear and foot signs treat better with pred)

Question 33

t/f topical steroids are stronger than oral because they metabolize to weaker steroids once they enter circulation

Answer 33

true

Question 34

what are two kinds of topical steroids

Answer 34

(soft steroids: hydrocortisone aceponate, mometason) and topical tacrolimus (its similar to corticosteroids but smaller so good for topical use)

Question 35

aside from the common antipuritics and topical steroids what are some other options for medical treatment of CAD

Answer 35

antihistamines, vitamin E, fish oils, pentoxifylline, palmitoylethanolamide, dietary modifications (derm diets)

Question 36

what is the only “TREATMENT” that can decrease disease progression of CAD?

Answer 36

allergen spcific immunotherapy (ASIT)

Question 37

how does allergen specific therapy work?

Answer 37

first you do a intradermal skin test to see what the specific allergen is promotes a Th1 response that induces T-cell anergy … increases IgG that competes with IgE …. You give low doses of the allergens identified to induce tolerance desensitization

Question 38

how long does ASIT take to work?

Answer 38

3-9 months (12-18 to see full benefits)… 60 - 80% improvement NOT CURE

Question 39

which of the 4 anti-pruritics is not used for flares

Answer 39

NOT cyclosporine

Question 40

what are some common causes of flares or what can we do to reduce flares?

Answer 40

food allergens, ectoparasites, seasonal allergies, medication ingredients, infection (yeast or staph)

Question 41

what are some chronic treatments of CAD?

Answer 41

oclacitinib, lokivetmab, cyclosporine (combinational therapy possible). Topic treatment (shampoos and ear meds), antifungals / parasitics …. Consider ASIT

Question 42

what would you do to find out if there is a food allergy cause of CAD?

Answer 42

diet trials ?

Question 43

how long do food trials take?

Answer 43

8 weeks

Question 44

t/f you don’t use anti-pruritics during a food trial because it messes up your results

Answer 44

you can use anti-pruritcs at the beginning of the trial (oclacitinib ideally) and stop 1-2 weeks before you challenge the diet

Question 45

you do a food trial and notice the animal’s c/s have improved…. What are 6 reasons for this improvement

Answer 45

1. seasonal 2. placebo, 3. nutraceutical ingrediates, 4. infection has resolved, 5. strict flea control, 6. true food allergy