Dermatology - General Principles Of Dermatological Treatment Flashcards
What do we expect generally from dermatological cases
- Occurence: approx. 20% of a small animal practice
- Many cases are chronic (relapse, secundary problems)
- A systematic approach is needed
List the major points to approaching dermatological patients
history + general examination + dermatological examination ➡️ suspected/tentative diagnosis, list of differentials ➡️ laboratory and other diagnostic tests
➡️ preliminary therapy ➡️ final (etiological) diagnosis
➡️ treatment ➡️ new diagnosis ? ➡️ improvement ➡️
managing the problem
Why do we often find a “new diagnosis” in dermatology?
Cant see what primary problem is before we treat the secundary problems - they all look the same after a while!!
Important to go step by step in dermatology
What are important specific questions to ask during the history/signalment?
- When did the problem start?
- Pruritus or alopecia ? (1/2. alopecia)
- Housing? Travel? (Leishm. In mideterranian, sarcoptes in northern europe)
- Food/diet? GI signs? Food allergy common! Many wrongly advertised hypoallergenic/sensitive foods.
- Flea control? Cat esp - may not find flea not feces due to grooming. Even indoor cats!!
- Other animals (humans) affected? Zoonotic skin disease - ring worm - eryth circle, contact with other animals..
What are important non-specific questions to ask during the history/signalment?
- Appetite ?
- Thirst, urination (i.e. PD/PU)?
- Exercise intolerance? Cushing - panting..?
- Reproductive status and problems? Sex hormone dermatosis, oestrus cycle problem (longer, not able to become pregnant, abcent cycle) –> early sign of hypothyroidism!! Very chronic case if see skin issues
Primary skin vs systematic secundary skin problem!
Endocrinopathies -> skin diseases (cushings incr appatite and weigh, hypothyroidism - not incr appatite but incr wight)
What do we look for during the physical examination of a dermatological patients?
Primary skin vs systematic secundary skin problem!
Endocrinopathies -> skin diseases,
How do we perform a dermatological examination
•Check for ectoparasites
•Localization of the lesions:
local-diffuse, symmetry
•Description of the skin lesions!!
Primary vs secundary skin lesions - differentials of them!!
Eg. Symmetric, rat tail: endocrinopathies (hypothyroidism)
•Characteristics of the hair and skin
Name the possible topical therapies we can use in dermatology
• antibacterial (ear drops mostly, rarly ointments, never shampoo! Resistnace) • antimycotic: We prefer topical bc very hepatotoxic! (Not itraconazol tho) we try systemic if topical doesnt work (emulsion, shampoo) • antiseptic • antiectoparasitic Topical rehydration: • rehydrating, emollient • keratoplastic • keratolytic • supporters of epidermal barrier
Name the possible systemic therapies we can use in dermatology
• antibacterial drugs (Bacterial pyoderma is most common disease since it can be secundry to all skin diseases! We give systemic usually)
• antimycotic (prefer topical)
• antiectoparasitic /antiendoparasitic drugs (We like systemic! Admin topically but work syst too)Dilofilaria, must exclude others before treatment, can kill the animal if start wrong treatment?
• antiallergic drugs
• vitamins(rare maybe akita sinc)/ EFA ((Important!! Good in skin problem, 5-10% antiinfalmm effect. Reduction of other therapies., SE!!)
• immunmodulators/ cytostatics (Cyclosporins, azathiprine, immune mediated, neoplastic skin diseases)
• hormones (Only thyroxine! (Cortisol)
Not in sex hormone dep dermatosis. No testost or oestrogen - may cause bm suppression.. SE!!)
Therapy of juvenile localised demodicosis
All animals have demodex - this is a immunosuppression caused problem!
Spontaneous healing (up to 90%)
No need for acaricid therapy, if small amount of mites, but follow-up in every
two weeks!
If many mites:
- shampooing with follicular flushing effect: benzoyl-peroxid
- REGISTERED: spot on: Advocate spot on (moxidectin) in every 4 to 2 weeks
Therapy of generalized demodicosis
Intense therapy + IMMUNSTIMULATION!
NOT REGISTERED BY NOW:
Flushing with amitraz 250-600 ppm in every 7-14 days (0.025- 0.06%) (125 g/l amitraz: Taktic)
(For large animals mostly, but use for small, dilute 50%)
- to do before: hair clipping
- shampooing with benzoyl-
peroxid (clearing from crusts and debris/ do not use together with spot ons !!!)
Skin scrape every 2w - ratio of adult living vs dead how many eggs - to control effectivity. Pyoderma as secundary esp in generalized demodicosis - benzoyl-peroxid is used - follicular flushing effect good!! Also can suggest owner this in localized instead of just waiting for recovery)
Unregistered therapy of generalized demodicosis
PO - not registered - ivermectin, doramectin - milbemycin - moxidectin --> suggested to reach upper dose in an increasing dosing for safety. SC - not registered - ivermectin, NEVER collie/sheltie (Combo of topical and systemic treatment) PO - registered - never in epilepsy/seizure patients!! - fluralaner (Demodex, Sarcoptes, Otodectes) - afoxolaner (Dem., Sarc.) Only one met in the kidney not liver - give to liver patients, and vice versa for kidney patients! - sarolaner (Dem., Sarc.,Otod.) - lotilaner (demodicosis)
How do we use antibiotics in the treatment of pyoderma
(Pyoderma = bacterial pyoderma)
🔺empirical treatment
- we treat without all information what we think is best.
- we only do this at first pyoderma, First generation cephalosporins that we dont need to do any lab;
Cefalexin (high dose, no success we need culturing)
Cefadroxil
(Clindamycin, Lincomycin , Sulfadimethoxine)
🔺 based on resistance - culturing
- amox-clav (broad spectrum, eg bite wound in mouth)
- cefovecin (no gut flora influence! Narrow spectrum but staph)
- only after culture, sensitivity test: Enrofloxacin, Norfloxacin, Marbofloxacin, Pradofloxacin, Ciprofloxacin
What are our options for treating dermatophytosis?
Antifungal therapy!
🔺 Topically: Imaverol solution, Malaseb shampoo AUV
🔺 Systematically:
- itraconazole: Microsporum, Candida, Malassezia,
Aspergillus, Leishmania, Trypanosoma
(Solution, capsule (must give with food)) SID on 1st and 3rd week. Fewe SE (liver non-teratogenic)
- terbinafin: Trichophyton-nailbed-inflammation dogs (more SE liver but better penetration of keratinized tissue)
- fluconazol: fungal meningitis and oral candida (otherwise wouldnt use (except cns signs?))
Atopic dermatitis - what should we know about this disease
Congenital, autoimmune disease, pruritic inflammatory disease driven by igE ab targeting many possible allergens. Commonly eg. Food allergy, flea allergy, but also environmental causes etc.!
Therapy importance: Chronic disease, pruritis control
