Dermatology 2 Flashcards
1
Q
what are the 3 types of pyoderma ?
A
surface, superficial and deep
2
Q
which pyoderma effects the surface of the skin? what are some examples?
A
- surface pyoderma
- examples are: hot spot, intertrigo
3
Q
which pyoderma effect the epidermal layer and/or hair follicles ?
A
superficial pyoderma
4
Q
which pyoderma effects the dermal layer plus follicles? what are some examples?
A
- deep pyoderma
- exudation of blood or pus, crusting, odor, ulceration, fistula and swelling
5
Q
how do we diagnose pyoderma?
A
- clinical signs like pustules, papules, crusts, etc.
- cytology
- culture
6
Q
should we do cytology and culture on surface pyoderma?
A
cytology - yes, critical
culture - no, not really helpful, spend $ on something else
7
Q
should we do cytology and culture on superficial pyoderma?
A
yes and no
- cytology can be supportive
- culture can sometimes help
8
Q
should we do cytology and culture on deep pyoderma?
A
cytology - often negative
culture - yes, always culture!
9
Q
when should we absolutely do a bacterial culture for pyoderma?
A
- if less than 50% improvement or new lesions after 2 weeks of treatment
- residual lesions at 6 weeks
- intracellular rods on cytology
- history of MRSA
10
Q
what should we culture for pyoderma?
A
the pustules are best but can also culture under crusts or the epidermal collarettes
11
Q
what type of pyoderma do we use topical antibacterial agents to treat?
A
- surface pyoderma
- mild or localized pyoderma
- can be helpful for deep pyoderma
12
Q
what type of pyoderma do we use systemic antibiotics to treat?
A
- superficial pyoderma
- deep pyoderma
- rarely surface pyoderma
13
Q
true or false.
Topical therapy may eliminate the need for systemic antibiotics.
A
true
14
Q
true or false.
Topical antibacterial therapy is only helpful for certain types of pyoderma.
A
false, helpful in all pyodermas
15
Q
what are some examples of topical antibacterial agents ?
A
benzoyl peroxide, chlorhexidine, iodine, gentamycin, polymyxin b, bacitracin
- mupirocin and silver sulfadiazine
16
Q
which has follicular flushing capabilities, benzoyl peroxide or chlorhexidine ?
A
benzoyl peroxide
17
Q
would you use chlorhexidine or benzoyl peroxide for a pyoderma with oily seborrhea?
A
benzoyl peroxide, because it has a degreasing agent
18
Q
what type of bacteria is mupirocin effective against?
A
gram positive bacteria including MRSA
19
Q
what is silver sulfadiazine effective against?
A
several types of bacteria including psuedomonas
20
Q
what are the first tier systemic antibiotics we use for pyoderma?
A
- 1st generation cephalosporins (ex. cephalexin)
- amoxicillin/clavulanic acid
- clindamycin
21
Q
what are the second tier systemic antibiotics we use for pyoderma?
A
- empirically: sulfas, erythromycin, doxycycline
- based on c/s results: chloramphenicol, rifampin or amikacin
22
Q
what are the 3rd tier systemic antibiotics we use for pyoderma?
A
fluoroquinolones and THIRD generation cephalosporins
- based on results from a c/s
23
Q
when do we use 3rd tier systemic antibiotics for pyoderma?
A
as a LAST RESORT
24
Q
examples of a 3rd generation cephalosporin?
A
enrofloxacin, marbofloxacin, ciprofloxacin, cefovecin (convenia), cefpodoxime (simplicef)
25
how long should we treat superficial pyoderma for?
treat 3-4 weeks minimally and treat 1 week beyond resolution
26
how long should we treat deep pyoderma for?
treat 3-12 weeks and treat 2 weeks beyond resolution
27
what are some reasons for recurrent pyodermas?
- not treating appropriately
| - an underlying reason like immunosuppression, corticosteroid use, endocrine disease, or allergies
28
what type of pyoderma is an acute traumatic pyodermatitis (HOT SPOT)?
SURFACE pyoderma
29
what type of pyoderma is puppy pyoderma (IMPETIGO) ?
SUPERFICIAL pyoderma
30
what type of pyoderma is nasal folliculitis/furunculosis?
superficial AND deep pyoderma
31
what type of pyoderma is chin acne?
DEEP pyoderma
32
what type of pyoderma is a lick granuloma (acral lick dermatitis) ?
DEEP pyoderma
33
true or false.
| acute moist dermatitis is a lick granuloma.
false, it is a hot spot or pyotraumatic dermatitis
34
where do we commonly see hot spots ?
hip/thigh and ear
35
what is the cause of hot spots?
self induced trauma
36
do we treat pyotraumatic dermatitis with steroids?
we can, hot spots are an exception where we can use corticosteroids to break the itch cycle
37
what do you see with impetigo (puppy pyoderma)?
pustular rash in axillary or inguinal areas
38
how do we treat impetigo ?
its usually self-limiting, can use topical antibacterial shampoos and occasionally may need systemic antibiotics
39
what happens to cause nasal folliculitis and furunculosis?
the hair follicle has bacteria growing in it, usually staph
40
true or false.
| nasal folliculitis usually has an underlying cause
true but not always
41
what age do we commonly see chin acne in ?
young dogs < 1 year
42
what do we use to treat chin acne?
topical benzoyl peroxide in mild cases, can add systemic antibiotics if a severe case
43
what can cause a lick granuloma?
- primary factors can be: atopy, food allergy or trauma which causes them to start licking
- perpetuating factors that can keep the lick cycle going are: deep pyoderma, ruptured hair follicle, compulsive behavior
44
how can we treat lick granuloma ?
treat the underlying cause as well as stop what is keeping the lick cycle going - break the itch-lick cycle
45
where do we commonly see Malassezia dermatitis?
ears, lip folds, ventral neck, axilla, interdigital and perianal
*check the ears and folds*
46
is Malassezia frequently a primary invader of skin and ears?
no, SECONDARY invader
47
what are some clinical signs of Malassezia?
- pruritus
- malodor
- erythema
- greasy scaly plaques
- otitis externa
- paronychia - infection of nails
48
what clinical signs do we see with CHRONIC malassezia ?
lichenification, HYPERpigmentation and hyperkeratosis
49
how do we diagnose malassezia ?
- history of pruritus
- clinical signs (can look like allergic dermatitis)
- cytology - ESSENTIAL
50
how do we treat malassezia?
- anti-yeast shampoos: ketoconazole, miconazole, etc. (2-3x weekly)
- creams and lotions
- systemic ketoconazole or itraconazole
Also treat any underlying cause
51
do we prefer to treat malassezia topically or systemically?
always use topical if possible, reserve systemics for extensive infection or if topical isn't working
52
how does feline pruritus differ from canine pruritus?
- skin lesions are different
| - excoriation, lichenificiation and hyperpigmentation are rare
53
what is the first thing we should do when we see skin signs in a cat?
eliminate ringworm and fleas as ddx
54
what are the 3 forms of skin lesions we see with pruritus in cats?
1. bilaterally symmetrical hair loss with normal (non-inflammatory) skin
2. miliary dermatitis
3. eosinophilic granuloma complex
55
how can we determine whether feline symmetrical alopecia was self-induced or not?
a trichogram
56
what is a cause of self-induced feline symmetrical alopecia ?
psychogenic caused by anxiety or pruritic conditions
57
where do we usually see signs from psychogenic alopecia?
areas that are easiest to reach like medial thighs, ventral abdomen and medial forelegs
58
how can we tell if a cat has a flea allergy vs another pruritic condition?
will see caudo-dorsal alopecia but can have facial, limb and neck involvement. Will also have eosinophillic granuloma complex lesions too
59
how can we tell if a cat has atopy vs another pruritic condition?
will see barbering of the ventrum and medial front limbs
60
how can we tell if a cat has food allergies vs another pruritic condition?
will see persistent and year-round pruritus at any site on the body, especially face and head
61
what is responsible for feline scabies?
notoedres
62
what part of the body is affected with feline scabies?
pinna, face, neck, forelimbs then whole body
63
how do we treat feline scabies ?
lime sulfur dips or ivermectin injections
| can also use selamectin or moxidectin
64
what type of demodex affects cats?
demodex gatoi
65
what cause of pruritus in cats has a "salt and pepper" appearance?
fur mite - lynxacarus
66
how do we diagnose lynxacarus?
acetate tape or trichogram
67
true or false.
| Pyoderma is never seen in cats
false, it is RARELY seen in cats
68
what can be a cause of non self-induced alopecia in cats?
- endocrine disease
| - paraneoplastic syndromes
69
what can cause "skin fragility" in an alopecia cat ?
HYPER adrenocorticism
70
what can give a shiny appearance to the skin in an alopecia cat?
pancreatic neoplasia which causes a paraneoplastic syndrome
71
what clinical signs do we see in cats with miliary dermatitis?
crusted papules, erythema and secondary alopecia
72
what are the 3 presentations of eosinophilic granuloma complex?
1. indolent ulcers
2. eosinophilic plaque
3. collagenolytic/eosinophilic granuloma
73
how to we confirm the lesion is part of the eosinophilic complex?
cytology will show eosinophils, can biopsy and culture as well
74
what is the cornerstone of therapy with eosinophilic granuloma complex?
identifying and managing the underlying cause
75
do we treat eosinophilic granuloma complex in cats with topicals or systemic drugs?
- topicals not ideal because cats can lick off
- systemic glucocorticoids are main stay of tx
- can use antibiotics for secondary bacterial infections
76
if you have a dog with patchy, focal ("moth eaten") alopecia, what is likely the cause?
pyoderma or an infection
77
if you have a dog with diffuse, bilaterally symmetrical alopecia, what is the likely cause?
endocrine or follicular dysplasia
78
when evaluating a dog with alopecia, what are important things to know?
- age of onset and breed
| - pruritic vs non-pruritic
79
what is folliculitis and what are some causes ?
- inflammation of the follicle wall
| - demodex, dermatophytes and pyoderma
80
what is furunculosis?
rupture of deeply infected hair follicle within the dermis
81
what is injection site alopecia and how does an animal acquire it?
- hair loss at injection site or in a distant location
| - idiosyncratic immunological rxn with rabies and lepto vaccines
82
who is the reservoir for microsporum canis?
CATS NOT DOGS
83
what kind of animal is ringworm (dermatophtosis) more likely to effect?
young cats
84
what happens when a cat is exposed to ring worm that causes alopecia ?
invades anagen hairs/skin
85
how do we diagnose ringworm?
fungal culture (DTM culture) mostly but can use woods lamp too (not always accurate)
86
what is an important point to remember about the DTM culture for ringworm?
we have to watch it everyday because the color change happens at the same time there is growth
87
true or false.
| most healthy animals will self-cure if they have ringworm
true
88
if healthy animals can self cure, why do we treat them?
to minimize possibility of zoonosis and environmental contamination
89
what is the treatment for dermatophytosis?
- environmental decontamination
- topical treatments (lime sulfur dips, Rx shampoo)
- systemic drugs (itroconazole, ketoconazole, NOT fluconazole - can cross BBB)
90
how long do we treat for dermatophytosis?
we treat until there's 1 or more negative fungal cultures
| if using systemic treatment should treat until 2 negative cultures 1 month apart
91
what is the systemic drug of choice for ring worm?
itraconazole
92
what is the pathogenesis of demodex with juvenile onset?
- depressed T cell function
- decreased Th1 response
- mite-specific immuno-incompetence
93
what is the pathogenesis of demodex with adult onset?
immunosuppression (can be from drugs, concurrent disease, endocrine diseases or idiopathic)
94
how do we diagnose demodex?
- deep skin scrapes
- trichogram
- biopsy if indicated
95
true or false.
| most cases of generalized demodicosis that occur at 2-4 years of age were likely undiagnosed juvenile-onset demodicosis
true
96
do we usually treat localized demodex?
no, 90% usually resolves but if secondary pyoderma is present we treat that
97
true or false.
| we treat localized demodex with glucocorticoids.
FALSE DO NOT USE GLUCOCORTICOIDS
98
how do we treat generalized demodex ? what is the average duration of treatment?
usually daily ivermectin or weekly mitoban dips, average duration of treatment is about 3 months but can take 6 + months in some cases
*caution using ivermectin with collies - MDR gene mutation*
99
true of false.
| we never use glucocorticosteroids with generalized demodex.
True, NEVER use them
100
does spontaneous remission of generalized demodex happen in up to 70% of young dogs?
NO, up to 50% of cases
101
true or false.
| you should neuter a dog with generalized demodex.
true, neuter dog after infection is controlled
102
what is sebaceous adenitis?
inflammation and destruction of sebaceous glands, we don't know the cause
103
what are some important clinical signs of sebaceous adenitis?
- long coated dogs: follicular casts
| - short coated dogs: moth-eaten appearance
104
how do we diagnose sebaceous adenitis?
skin biopsy from the dorsal surfaces
105
how do we treat sebaceous adenitis ?
first choice - topical shampoos, topical sprays
| second choice - systemic drugs
106
when do we use second choice treatment for sebaceous adenitis?
when there is a biopsy or if first line treatment doesn't work
107
what breeds do we see familial dermatomyositis in?
collie and sheltie breeds
108
what is the time line of clinical signs with familial dermatomyositis?
- skin lesions at 2-6 months of age
| - muscle atrophy at 3-5 months of age
109
is alopecia of endocrine diseases pruritic?
NO
110
what causes calcinosis cutis?
hyperadreoncoricism
111
what is the most common underlying cause of demodicosis?
CUSHINGS DISEASE
112
what disease looks just like an endocrine disease but has normal endocrine tests?
- alopecia X
- pattern baldness
- recurrent flank alopecia
113
what is the difference between alopecia X and endocrine diseases ?
- hair loss starts earlier (around 3 years old)
| - no systemic signs
114
what breed has thinning hair coat on the ears ?
dachshund
115
how can we definitively diagnose color dilution alopecia?
biopsy hair for abnormal hairshafts and distorted hair follicles full of keratin and melanin
116
do we need a biopsy to confirm follicular dysplasia ?
yes
117
what is recurrent flank alopecia and where does it effect ?
- seasonal follicular dysplasia
- flank and mid-lateral thorax
- can be uni or bi-lateral
118
how long can alopecia persist with post clipping alopecia?
12-24 months
