Dermatology Flashcards

1
Q

Atopic Dermatitis

A
  • allergic (inappropriate) reaction to environmental allergens
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2
Q

Atopic Dermatitis (Causes)

A
  • allergens gain access to body by resp. or percutaneous route
  • hypersensitivity via IgE antibodies
  • loss of barrier function
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3
Q

Atopic Dermatitis (Loss of Barrier Function)

A
  • abnormal lipid layer in stratum conreum
  • decreased epidermal filaggrin
    Allows for:
  • allergen penetration
  • staph spp. and malassezial “stick to the stratum corneum
  • water loss
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4
Q

Atopic Dermatitis (Signalment and Clinical Signs)

A

Dogs:

  • Age 1-7 years,
  • no sex predilection
  • pruritis, erythema, rarely small papules, feet face axilla ears conjunctiva (front end disease)

Cats:

  • no age or sex predilection
  • facial head neck pruritis, miliary dermatitis (fleas most common cause), eosinophilic granuloma complex, self-induced alopecia
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5
Q

Atopic Dermatitis (Secondary Infections)

A
  • Dogs > Cats

- Staph and Malassezia infections

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6
Q

Atopic Dermatitis (Diagnosis)

A
  • History - seasonal, <7 years old
  • Clinical Signs - pruritis, feet face axilla ears
  • Rule Outs - food allergy, ectoparasites
    Classic (seasonal, typical lesions), Semi-classic (non-seasonal or non-typical lesions), and Not classics (rule outs fail)
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7
Q

Atopic Dermatitis (Hyposensitization)

A
  • intradermal testing (IDT)

- serologic testing

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8
Q

Common Allergens for Atopic Dermatitis

A
  • house dust mites

- house dust

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9
Q

Pyoderma

A
  • pus producing bacterial infection of the skin
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10
Q

Pyoderma ( Reasons for increased frequency)

A
  • canine stratum corneum is less effective barrier to prevent bacterial infection
  • lack of ostial plug in entrance of canine hair follicle
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11
Q

Top 3 canine skin pathogens

A
  1. Staph pseudintermedius (most common)
  2. Staph schleiferi (uncommon in dogs, > in cats)
  3. Staph aureus (uncommon in dogs and cats)
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12
Q

T/F: all staph species can develop methicillin resistance

A

T

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13
Q

Predisposing Factors for Pyoderma

A
  • pruritis -> self-trauma
  • environment
  • dec immune function
  • endocrinopathy
  • infectious dz
  • inflammatory dz
  • hair follicle dz
  • cornification disorders
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14
Q

Diagnosis of Pyoderma

A
  • inflammatory skin disease
  • evidence of bacterial invasion/ proliferation
  • response to antimicrobial therapy
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15
Q

Acute Moist Dermatitis

A
  • Surface Pyoderma
  • ‘hot spot’, pyotraumatic dermatitis
  • caudal manifestations usually flea allergy dermatitis
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16
Q

Intertrigo (skin fold pyoderma)

A
  • Surface Pyoderma
  • moist areas created w/in skin folds
  • either breed related or obesity
  • common d/t change in temp, pH, humidity, and frictional microtrauma
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17
Q

Mucocutaneous pyoderma

A
  • Surface Pyoderma
  • often around lips and peri-oral
  • occurs around muco-cutaneous jxns
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18
Q

Impetigo

A
  • Superficial Pyoderma
  • non-follicular pustules
  • often less haired areas
  • > puppies and immunocompromised
  • inguinal regions
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19
Q

Superficial folliculitis

A
  • Superficial Pyoderma
  • follicular pustules –> collarette
  • circular hair loss, scale
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20
Q

Deep folliculitis and furunculosis

A
  • Deep pyoderma
  • pyotraumatic derm on the head/ neck
  • any hemorrhage evidence means that it’s deep
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21
Q

Cellulitis

A
  • deep pyoderma

- bacterial infection of skin and deeper tracts

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22
Q

Feline Pyoderma

A
  • same species as dogs

- can present w/ miliary dermatitis (pinpoint rash), papules, scale, and collarettes

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23
Q

When to do culture and sensitivity testing

A
  • <50% reduction in lesions w/in 2wks of abx therapy
  • new lesions still develop 2 wks or > after starting abx therapy
  • cocci after 6 wks, rods on cytology
  • Sample intact pustules*
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24
Q

Tier 1, 2, 3 abx

A

Tier 1 - no risk factors for antimicrobial drug resistance are present
Tier 2 - post culture and sensitivity
Tier 3 - never use

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25
Q

Treatment of Pyoderma

A
  • surface and superficial can get topical alone (chlorhexidine)(treat for 7 days post-clinical cure)
  • Abx (start with tier 1)
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26
Q

T/F: previous abx therapy elevates the risk of mrsa to about 1/3

A

T

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27
Q

Most important flea species

A
  • Ctenocephalides felis (Most common in all of small animal)

- Ctenocephalides canis

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28
Q

Flea Life Cycle

A
  • Egg
  • Larva (feed on organic matter, flea feces, dried blood)
  • Pupa (adult emerges in response to CO2, warmth, vibrations)
  • Adult
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29
Q

Flea Allergy Dermatitis

A
  • hypersensititivyt to flea saliva
  • most common type of allergy in both dogs and cats
    Canine FAD:
  • caudal half disease
  • any breed, season, age
    Feline FAD:
  • miliary dermatitis anywhere on the body (esp head and neck)
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30
Q

Diagnosis of Fleas

A
  • history
  • flea comb
  • location of itch (particularly for dogs)
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31
Q

Fleas (treatment)

A
  • you can either go oral or topical formulations
  • topical formulations require the animal to not be swimming all that much or washed a lot
  • oral has faster time to kill
32
Q

2 types of treatments for fleas

A
  1. Insect growth regulators
    - -> juvenile hormone analog
    - -> chitin synthesis inhibitors
  2. Adulticides
33
Q

Fleas (topical products)

A
  • most topical shave about the same speed of kill

- avoid pyrethroid/ pyrethrin products in felids d/t neuro toxicity

34
Q

Revolution Plus

A
  • Selametin + Sarolaner
  • selamectin activtes glutamate gated chloride channels
  • must be over 8 weeks of age
35
Q

Frontline

A
  • Fipronil
  • Binds GABA receptors and blocks transfer of chloride
  • do not use in rabbits or hedgehogs
36
Q

Advantage-multi

A
  • imidacloprid w/ moxidectin
  • binds post synaptic nicotinic receptor - blocks impulse transmission
  • useful in canine and feline demodeicosis
  • don’t use in birds - maxidectin is ok but imidacloprid is toxic
37
Q

Bravecto

A
  • Fluralaner
  • oral or topical
  • well tolerated for cats
  • avoid in dogs w/ seizure history
38
Q

Oral Products

A
  • quicker to kill than topicals
  • often easier to administer
  • should be given with a meal
39
Q

Isoxazolines

A
  • oral product
  • inhibits GABA gated chloride channels
  • CNS signs have been reported anecdotally
  • Nexgard, Simpirica, Credelio, Fluralaner,
40
Q

Nexgard

A
  • Afoxolaner
  • oral chewable
  • useful against fleas and ticks (also off label demodex and sarcoptes)
  • given via soy protein
  • avoid in animals w/ seizure history
41
Q

Simparica

A
  • Sarolaner
  • good for fleas and ticks (also off label for demodex and sarcoptes)
  • avoid in animals w/ seizures
  • Revolution plus contains Selamectin + Sarolaner
42
Q

Capstar

A
  • nitenpyram
  • kills adults fleas, 100% w/in 6 hrs
  • can be given orally every 23-72 hours
43
Q

Environmental Treatment

A
  • vacuum and throw away bag

- do not steam clean carpets

44
Q

Hyposensitization treatment for Atopic Dermatitis

A
  • 70% of dogs that improve do so w/in 4-6 months
  • Injections q48hr x 1 month, then once weekly
  • Oral b.i.d. continually
  • cats = dogs
45
Q

Atopic Dermatitis (Rx)

A

Systemic:
- corticosteroids, antihistamines, psychotropic agents, EFAs, cyclosporine, oclacitinib, lokivetmab

Topicals:
- steroids, barrier aids

46
Q

AD (Corticosteroids)

A
  • pred/ prednisolone/ methylprednisolone
47
Q

AD (Antihistamines)

A
Dogs = Cetirizine, diphen, dyroxyzine, chlorpheniramine
Cats = Chlorpheniramine
48
Q

AD (EFAs)

A
  • Omega 3
  • Omega 6
  • steroid-sparing, but may take > 3 months
49
Q

AD (Cyclosporine)

A
  • inhibits T cell activation
  • Atopica
  • ok to test for allergies while receiving
  • ok to hyposensitize while receiving
    Side Effects: Anorexia, vomiting (store in freezer to avoid), diarrhea, papillomas, pyoderma, hypertrichosis, gingival enlargement
50
Q

How to avoid vomiting w/ cyclosporine

A
  • keep in freezer
  • give with food
  • pair with cerenia
51
Q

AD (oclacitinib)

A
  • Apoquel
  • JAK stat 1 inhibitor
  • mediator of IL 31
  • only approved in dogs
52
Q

AD (Lokivetmab)

A
  • Cytopoint
  • antibody targeting IL31
  • not useful in cats
53
Q

malassezia pachydermatitis (dogs)

A
  • yeast organism, normal inhabitant of skin
  • waxy brown exudate: skin or proximal claws, erythema interdigitally or under tail
  • usually secondary to AD or food allergy
54
Q

malassezia pachydermatitis (cats)

A
  • sometimes associated w/ AD

- generalized - look for systemic disease

55
Q

malassezia pachydermatitis (Diagnosis)

A
  • by cytology via acetate tape preparation or skin scrapings
56
Q

Anti-Yeats Rx: Systemic

A
  • Terbinafine

- Ketoconazole (not in cats, and not w/ ivermectin)

57
Q

Advantages of Topical Therapies

A
  • can be sole or adjunctive treatments for numerous skin conditions
  • relatively cheap compared to oral medications
  • direct delivery of a specific ingredient to the skin surface
58
Q

Downsides of Topical Therapies

A
  • may be time-consuming
  • risk of topical reactions
  • risk of systemic absorption
59
Q

Agent vs Excipient

A

Agent: active ingredients
Excipient: inactive ingredients. often include the vehicle (primary excipient used to carry the agent)

60
Q

Shampoos

A
  • minimum contact time of 10 minutes

- use veterinary products - canine skin is more basic

61
Q

Conditioners

A
  • contain cationic surfactants –> bind to damaged, negatively charged hair shafts
62
Q

Rinses/ Dips

A
  • concentrated solutions or powders mixed with water- do not rinse off afterwards
63
Q

Wipes

A
  • easy to use

- can only cover small surface areas

64
Q

Mousses

A
  • basically a foam formulation-
  • do not rinse off after use
  • can contain alcohol - sting
65
Q

Keratolytic vs Keratoplastic

A

Lytic - remove excess scale
Plastic - reduces scale production
avg epidermal turnover rate is 21 days

66
Q

Moisterizing Agents

A
  • Emoolients - lipid based to improve skin barrier function

- Humectants - non-oily hydrscopic agents to attract water

67
Q

Chlorhexidine

A
  • positively-charged bisbiguanide compound –> binds to negatively-charged bacterial cell walls
  • antifungal at 3% concentration or greater
68
Q

Benzoyl Peroxide

A
  • antibacterial, kertolytic, degreasing follicular flushing
  • human concentrations are too strong and will damage the skin (only use 2.5-5%)
  • indications: superficial pyoderma, comedones, +/- demodicosis
69
Q

Ethyl Lactate

A
  • antibacterial, astringent, cooling

- breaks down to lactic acid and ethanol

70
Q

Sodium Hypochlorite

A
  • bactericidal, fungicidal, sporicidal, and virucidal

- dilute to 1:10-20 with water and spot-test

71
Q

Mupirocin

A
  • topical antibiotic
  • mostly gram-positive activity
  • excellent for resistant Staph pyoderma
72
Q

Silver Sulfadiazine (SSD)

A
  • extensive broad spectrum activity - very useful for pseudomonas aeruginosa
73
Q

Imidazoles

A
  • antifungals
  • interfere with the production of ergosterol
  • Indications: dermatophytosis, malassezia dermatitis
74
Q

Lime Sulfur

A
  • antifungal, antiparasitics, keratolytic, keratoplastic, anti-pruritic
  • Indications: dermatophytosis and most ectoparasites
    • does not treat demodex or fleas **
  • will stain every surface yellow-green
75
Q

Tris-EDTA

A
  • antibacterial, antifungal, anti-biofilm

- very good for ear cleaning since it is non-ototoxic

76
Q

Tacrolimus

A
  • inhibition of calcineurin –> inhibition of T-cell proliferation/ activation
  • expensive
77
Q

Trifexis

A
  • milbemycin/ spinosab
  • kills heartworm, fleas, intestinal worms
  • > 8 wks of age
  • don’t give with ivermectin