Dermatology Flashcards
Define bulla.
Localised collection of fluid greater than 1cm in diameter and larger than a vesicle
Define erythema.
A diffuse or localised redness of the skin which disappears with diascopy
Define macule.
A flat circumscribed skin discolouration less than 1cm in diameter without surface elevation or depression
Define nodule.
Circumscribed solid elevation greater than 1cm usually extending into the dermis, large nodules may be referred to as masses
Define papule.
A small solid elevation of the skin up to 1cm in diameter, feels solid and is due to the infiltration of inflammatory cells, fluid or foreign material (calcium), with oedema and epidermal hyperplasia
Define patch.
A localised flat change in skin pigmentation larger than 1cm in diameter (big macule)
Define plaque.
A flat topped elevation of the skin greater than 0.5cm formed by a coalition of papules, flatter than a nodule
Define pustule.
A small circumscribed elevation of the epidermis filled with purulent material
Define vesicle.
Small circumscribed elevation of the epidermis filled with a clear fluid less than 1cm in diameter
Define wheal.
A sharply circumscribed raised lesion consisting of oedema, usually appears and disappears within minutes to hours
Why may skin be red?
Can be caused by erythema/blood in blood vessels or haemorrhage/blood outside of blood vessels
How can the cause of skin redness be differentiated?
- Place a glass slide over the area of redness
- Erythema will blanch because the blood vessels compress
- Haemorrhage will not
What is a secondary lesion?
Secondary lesions may be created by scratching, chewing or other trauma to the skin, as a result of infections or may evolve from regressing primary lesions.
Define comedone.
Dilated hair follicle filled with cornified cells and sebaceous material
Define crust.
Dried exudate, cells, pus and scale adherent to the surface
Define epidermal collarette.
A circular lesion with a marginal rim of scale
Define excoriation/erosion.
Superficial damage to the epidermis
Define fissure.
Linear cleavage into the epidermis
Define hyperkeratosis.
Increase in thickness of the cornified layer of the skin
Define lichenification.
Thickening of the skin (as a whole, not just cornified layer) resulting in a cobblestone appearance
Define scale.
Accumulation of loose fragments of the cornified layer of the skin
Define scar.
Fibrous replacement tissue formed when there has been trauma
Define ulcer/ulceration.
Full thickness loss of the epidermis, exposing the dermis.
Is hypo/hyperpigmentation primary or secondary lesions?
Secondary
Name 5 dermatological diagnostic tests.
Acetate tape
Skin scrapings
Cytology
Flea comb
Trichogram
What can acetate tape diagnose?
Malassezia, bacteria, inflammatory cells
What can deep and superficial skin scrapings diagnose?
Deep – demodex mites
Superficial – cheyletiella, sarcoptes, chorioptes, psoroptes
What can a trichogram diagnose?
- Demodex mites
- Anagen, telogen
- Mite and lice eggs
- Evidence of pruritus
- Dermatophytosis
- Hair shaft abnormalities
What is ASIT?
Allergen specific immunotherapy
What are some considerations for ASIT?
- Only use allergen test with highly compliant owners who understand limitations of the test and ASIT
- Need to correlate with history – patient old enough to have IgE response/12 months, owner cost
What is allergen testing?
Inject histamine for positive control and saline for negative control and then inject a number of allergens. Not diagnostic but something we can use to formulate immunotherapy
How is allergen specific IgE serology (ASIS) testing for dogs done?
- Capture of IgE antibody by the Fc
- Receptor normally binds IgE to a mast cell in vivo
- Binding is highly specific for the IgE antibody
- ELISA that measures serum IgE using a panel of monoclonal antibodies specific for dog IgE
- Antigens coated on the ELISA plate
Describe the results of allergen testing for dogs.
- Only a guide to the amount of IgE – calculated from positive and negative controls – arbitrary antibody units
- Poorly validated
- Merely measure the serum antibody
- Positive results do not unequivocally indicate clinically significant allergic reaction to that allergen
Describe the results of serology allergen testing.
- They are not diagnostic tests
- They are widely misused and misunderstood
What diagnoses are serological tests available for?
- Malassezia
- Staphylococcus
- Food serology not recommended for ‘food allergy’
What are the diagnostic dermatological methods using tissues?
- Culture – bacterial, fungal, mycobacteria, susceptibility testing
- PCR
- Dermatopathology
What is the itch-scratch cycle?
The mechanical effect of scratching temporarily abolishes the sensation of pruritis. Pruritis recurs intensified by the damaging effects of self-trauma.
Name 3 possible allergic skin diseases.
- Atopic dermatitis
- Food allergy
- Flea/insect bite hypersensitivity
What is canine atopic dermatitis?
A genetically inherited clinical syndrome that encompasses a diversity of mechanisms and can have a variety of triggers. Multifactorial and complex inflammatory syndrome, typically associated with antigen-specific IgE antibodies to environmental allergens.
What are the primary lesions of canine atopic dermatitis?
Erythema
Papules
What are the clinical signs of canine atopic dermatitis?
Pruritus
Associated with self-trauma and secondary bacterial and Malassezia infections:
- Alopecia
- Erythema
- Excoriation
- Lichenification
- Hyperpigmentation
What are the published diagnostic criteria for canine atopic dermatitis?
- Onset of signs under 3yo
- Dogs that live mostly indoors
- Pruritus is glucocorticoid responsive
- Pruritus is the major/only sign (skin lesions can develop later)
What are the affected regions of canine atopic dermatitis?
- The front feet and concave aspects of the pinnae are affected
- The ear margins are not affected (think scabies)
- The dorso-lumbar area is not affected (more consistent with flea allergy)
What are the licensed medications for canine atopic dermatitis?
Glucocorticoids
Ciclosporin
Oclacitinib (Apoquel)
Lokivetmab (Cytopoint)
What is an unlicensed medication for canine atopic dermatitis?
Antihistamines
How is canine atopic dermatitis treated?
- Topical therapy – antimicrobial, soothing, glucocorticoids, steroid
- Shampoos – malaseb is antimicrobial, allermyl is soothing
- Essential fatty acids – supplements, diets and topicals
What are the possible adverse reactions to ASIT?
Pruritis
Vomiting
Urticaria
Angioedema
Anaphylaxis
What is CAFR?
Cutaneous adverse food reaction - relevance of food-specific IgE and IgG
How is CAFR diagnosed?
- Do not use serology tests to make a diagnosis or suggest the constituents of a diet trial
- Diagnosis by elimination of signs following a restricted protein and carbohydrate diet
- Duration at least 6-12 weeks
- Rechallenge/provocation with the original diet
What are the common triggers of CAFR in cats and in dogs?
Dogs = beef, dairy, chicken, wheat
Cats = beef, fish, chicken
When is insect bite hypersensitivity in horses common?
- Common, April to October
- Usually over 2 years old at onset
Where is insect bite hypersensitivity common?
Mane
Tail
Lateral neck
Tail to croup – ventral midline
What are the clinical signs of insect bite hypersensitivity?
Pruritis causing rubbing
Biting
Stamping
Agitation
Alopecia
Crusting and erosions – lichenification and hyperpigmentation
How is insect bite hypersensitivity treated?
- Avoidance – manage pasture grazing and housing, stable at high risk periods, such as at dusk and dawn
- Protective fly wear
- Application of licensed permethrin or cypermethrin based emulsion
- Antihistamines
- Glucocorticoids
- Allergen specific immunotherapy does not appear effective
What are the other causes of pruritus in horses?
- Atopic disease
- Insect bit hypersensitivity due to other insects
- Mites – chorioptes typically on distal limbs
- Pediculosis
- Oxyurasis – perineum
- Onchocerciasis
- Post clipping
- Contact reactions
When is ovine culicoides hypersensitivity common/
- Seasonal recurrence
- Particularly severe September to October
What are the clinical signs of ovine culicoides hypersensitivity?
- Foot stamping, dropping to the ground and sternal recumbency
- Non-wool areas of the body are usually affected
What is surface pyoderma?
- Infection is confined to the interfollicular epidermal layers of the skin
- Pyotraumatic dermatitis ‘hot spots’
- Intertrigo ‘skin fold dermatitis’
What are the clinical signs of surface pyoderma?
- Erythema, erosion, serosanguineous to purulent exudate
- Often very uncomfortable – pruritic and painful
- Matted fur
How is pyogranulomatous dermatitis diagnosed?
Cytology of exudate
Find underlying cause – may vary with location: otitis externa for facial lesions, fleas for caudal dorsum lesions
How is pyogranulomatous dermatitis treated?
Topical antimicrobial therapy and oral/topical steroids
What are the clinical signs of superficial pyoderma?
- Intraepidermal pustules (primary) easily disrupted by grooming, scratching or bathing
- Lesions and sometimes the pruritus are antibiotics responsive
What are the common underlying disorders of superficial pyoderma?
Ectoparasitism
Allergy
Endocrinopathies
Describe the lesions of superficial pyoderma.
- Primary lesions may be transient and secondary lesions may predominate – crusting, erosion
- Peripheral spread produces an annular lesion with a peeling epidermal collarette
What are the clinical signs of deep pyoderma?
Swelling/nodules
Draining tracts
Crusting
Ulceration
Often painful
How is deep pyoderma diagnosed?
Cytology and culture of draining fluid may not be representative – biopsy for deep material
Why is topical therapy the treatment of choice for pyoderma?
- Removes scale, crust and exudate
- Reduced the number of bacteria
- Promotes drainage of deeper lesions
- Can reduce pain and pruritis
When are antibacterial agents used in pyoderma?
Only if really needed. Severity, temperament, deep pyoderma. Only for superficial pyoderma if there is no way we can manage things without other therapy.
Name the narrow spectrum bacteriostatic antibiotic used for pyoderma.
Clindamycin
Name the 3 broad spectrum bacteriocidal drugs used in pyoderma.
Trimethoprim/sulphonamides
Clavulanic acid and amoxicillin
Cefalexin
What is dermatophilus?
Dermatophilus congolensis - zoonotic
What are the clinical signs of dermatophilus?
Distribution of matted hair
Crusts and erosions
Fissuring
Pain
Lameness
What are the differentials of dermatophilus?
- Dermatophytosis, bacterial folliculitis (staph)
- Photosensitisation
How is dermatophilus diagnosed?
- Smears from under side of crusts
- Dermatophilosis preparation from crusts – saline maceration
- Demonstration of branching fam positive filamentous bacteria with internal compartments, ‘tram track’ appearance
- Culture
What are the predisposing factors of dermatophilus?
Excessive moisture
Biting insects
Abrasive pasture
Excessive brushing
How is dermatophilus treated?
- Clean affected area with topical antibacterial agents, such as chlorhexidine
- Some may benefit from a 3-5 day course of penicillin/streptomycin
What are malassezia?
- Opportunistic yeast pathogen
- Normally resident in the external ear canal, the chin, perioral and interdigital areas
- Lipid dependent yeasts
What are the predisposing factors of malassezia?
- Alterations in skin microclimate – sebum production, moisture
- Allergic and bacterial skin disease
What are the clinical signs of malassezia?
Pruritus
Erythema
Scale
Hyperpigmentation
Greasiness
Malodour
How is malassezia diagnosed?
- Impression smears with a dry swab or direct slide contact
- Acetate tape strip preparations
- Culture
- Serology – not recommended
How is malassezia treated?
Topical therapy with twice weekly bathing with shampoo products
Why may otitis externa be a sign of malassezia infection?
The ceruminous glands provide a lipid-rich medium for the organisms to survive, they are commensals in this environment
How can otitis externa due to malassezia infection be treated?
In some cases topical or oral steroids will help to control the glandular hyperplasia and cerumen production within the ear canal and starve the yeast
What are the primary lesions of atopic dermatitis?
Erythema, papules and pruritus
Which of these cutaneous microbial infections are zoonotic?
Dermatophytosis
Dermatophilosis
What are the 4 main manifestations/clinical syndromes of pruritic/allergic dermatitis in cats?
- Self-induced alopecia/hypotrichiosis (SIAH)
- Miliary dermatitis/popular dermatitis
- Head and neck pruritus
- Eosinophilic granuloma complex
Describe head and neck pruritus.
- Self-trauma leads to excoriation, erosion and ulceration
- Blepharitis
- Can be ulcerative with wounds caused by scratching
What is miliary dermatitis?
Crusted papules commonly seen with flea bite hypersensitivity, food allergy and feline atopic skin syndrome
What are the differential diagnoses of miliary dermatitis?
- Allergic skin disease
- Ectoparasites
- Dermatophytosis and rarely bacterial folliculitis
- Pemphigus foliaceus
What does eosinophilic granuloma complex include?
- Eosinophilic ulcer
- Eosinophilic plaque
- Eosinophilic/linear granuloma
Describe the lesions of eosinophilic plaques.
Pruritic, raised, often ulcerated
Where are eosinophilic plaques located?
Found anywhere on the body, often ventral abdomen and medial thighs
What can eosinophilic plaques be seen concurrently with?
Miliary dermatitis
Eosinophilic granuloma of the chin
How is the underlying cause of eosinophilic plaques investigated?
- Look for evidence of fleas
- Flea treatment trial
- Elimination diet trial
- Feline atopic skin syndrome
Describe the lesions of eosinophilic (/rodent/idolent) ulcers.
- Distinct well-demarcated
- At philtrum of upper lip or adjacent to upper canine tooth
- Large lesions – may cause facial distortion
- Pain and/or pruritus are rare
How are eosinophilic ulcers diagnosed?
Consider biopsy to rule out neoplasia and bacterial/fungal infections for chronic lesions
How are eosinophilic ulcers treated?
- Small single lesions, leave the cat intreated if they are not bothered by them
- Manifestation of allergic skin disease, treat underlying cause
Describe eosinophilic/linear granuloma lesions.
- May or may not be pruritic
- Linear form often seen on caudal thigh
- Proliferative lesions in mouth
- Poorly defined chin swelling/fat chin
- Erosion/ulceration common
What may be associated with eosinophilic/linear granulomas?
- Can see concurrently with cutaneous eosinophilic granulomas and plaques
- Oral cavity disease may be associated with halitosis, anorexia and hypersalivation
How are eosinophilic/linear granulomas treated?
Oral cavity lesion – surgical debulking
Glucocorticoids, ciclosporin, topical therapy – does topical stimulate more overgrooming by trying to get medication off
What may CAFR be concurrent with?
Flea bite hypersensitivity or feline atopic skin syndrome
What are the possible non-cutaneous signs of CAFR?
Vomiting
Diarrhoea
Respiratory signs
Conjunctivitis
Hyperactive behaviour
How is CAFR diagnosed?
Elimination of signs following an elimination diet trail. Re-challenge – re-introduce the original diet in its entirely, clinical signs recur within 7 days
What are the problems of diet trials?
- Potential problems with palatability
- Cats can access other sources of food, such as hunting
- Difficult to evaluate a food trials in a cat allowed outdoors
What are the treatment options of pruritus in cats?
- Essential fatty acids – to protect the skin barrier
- Antihistamines
- Oclacitinib
- Allergen specific immunotherapy
What is the dosage of glucocorticoids in cats?
Intial dose 1-2mg/kg/day of prednisolone – higher than in dogs