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SA DX & TX II > Exam 2 - Folliculitis > Flashcards

Exam 2 - Folliculitis Flashcards

1
Q

for deep pyoderma, what are the 3 categories of differentials you’re considering?

A

infectious - bacterial (common, staph & pseudomonas), fungal, protozoal, & viral

inflammatory - hypersensitivity, foreign bodies, reactive histiocytes, nodular panniculitis, sweet’s syndrome, & sterile eosinophilic dermatitis (weil’s syndrome)

neoplastic - follicular tumors, sebaceous gland tumors, cutaneous lymphoma, mast cell

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2
Q

what treatment recommendations are used for deep pyoderma?

A

adjunct topical therapy to decrease exudate

systemic abx - based off of C/S for a minimum of 6-8 weeks at least 2 weeks past clinical resolution of signs

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3
Q

what are the guidelines for topical therapy for an animal with MRSA/MRSP?

A

frequent bathing - every 24-48 hours (can resolve superficial pyoderma with bathing alone) but needs owner dedication

spray/leave on formulations - ability to decrease bathing & frequency & gives residual activity

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4
Q

what are some recommendations made for the owner’s health who’s pet has MRSA/MRSP?

A

keep any draining wounds covered, don’t let the animal lick your face or wounds, no sharing beds/towels/linens, & hold off on pet therapy/social activities

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5
Q

what recommendations are made for an owner managing a pet with MRSA/MRSP?

A

minimize contact with young/immunocompromised people, good hand hygiene, finish ALL ABX, rechecks are important, regularly pick up their stool/change their litter box, & wear gloves when applying topical treatment

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6
Q

what is the mechanism of methicillin-resistant staph aureus/pseudintermedius?

A

mecA gene - altered drug affinity for penicillin-binding protein 2a which leads to the resistance conferred to all b-lactam & cephalosporin abx

carried on a staphylococcal chromosome cassette (SCCmec)

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7
Q

what abx is MRSA unaffected by?

A

all beta lactam abx!!!!

penicillins, cephalosporins, carbapenems, methicillin (replaced by oxacillin)

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8
Q

what is folliculitis?

A

inflammation of hair follicles

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9
Q

what is the pathogenesis of furunculosis?

A

deep bacterial folliculitis that has follicular rupture (furunculosis) resulting in deep infection of the surrounding soft tissue & a foreign body response (pyogranuloma) to free keratin that has escaped the follicle (nidus for continued infection)

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10
Q

what is the primary pathogen involved in folliculitis/furunculosis?

A

s. pseudintermedius

other staph spp., pseudomonas, proteus, & e. coli

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11
Q

T/F: folliculitis/furunculosis infection tend to be secondary to other underlying disease

A

true

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12
Q

what is the most common underlying disease you should think of when an animal presents to you with folliculitis/furunculosis?

A

DEMODICOSIS

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13
Q

what are some recognized clinical forms of folliculitis & furunculosis?

A

nasal pyoderma

muzzle pyoderma

pedal folliculitis & furunculosis

callus/pressure point pyoderma

GSD pyoderma

post-grooming folliculitis & furunculosis

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14
Q

what is another name for muzzle pyoderma?

A

canine acne

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15
Q

when do we see nasal pyoderma occur? where on the nose are lesions seen?

A

secondary to trauma or insect bites

bridge of the nose - doesn’t affect the nasal planum

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16
Q

where are lesions of canine acne seen? what animals?

A

rostral chin & muzzle

young dogs, short-coated breeds with stout hair (boxers, dobermans, english bulldog, mastiff, great dane)

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17
Q

pyotraumatic folliculitis resembles what surface pyoderma?

A

hot spot

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18
Q

what dog breeds are most commonly affected by pyotraumatic folliculitis? where are lesions seen?

A

goldens & st bernards

cheek & neck

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19
Q

what do lesions of pyotraumatic folliculitis look like?

A

circumscribed erythematous plaques with surface oozing & excoriation, peripheral erythematous macules/plaques, or epidermal collarettes

recurrence is common

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20
Q

T/F: pedal folliculitis & furunculosis is a common & frustrating skin disease that affects single/multiple paws on any haired surface with short-coated breeds with ‘stout’ hair may be over-represented (dachshund, english bulldog, boxer, mastiff, bullmastiff)

A

true

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21
Q

what clinical signs may be seen alongside pedal folliculitis & furunculosis?

A

may see hemorrhagic interdigital bulla/cysts

local lymphadenomegaly & pain manifests as lameness

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22
Q

what is the problem with using antibiotics for treating pedal folliculitis/furunculosis?

A

scarring from the disease prohibits the penetration of antibiotics & also tissue drainage

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23
Q

where do lesions of GSD pyoderma start?

A

haunches & ventral abdomen

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24
Q

what lesions are seen in GSD pyoderma?

A

stinky, painful

erythematous papules/pustules, furuncles, ulcers, draining tracts, severe devitalized necrotic skin, surface oozing severely adhered crusts forming ‘plates of armor,’ celluitis, scarring, & hyperpigmentation

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25
Q

how is GSD pyoderma diagnosed?

A

skin cultures!!!!!!!! clip & clean these dogs under heavy sedation/general anesthesia after diagnostic samples are taken

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26
Q

why does callus/pressure point pyoderma occur?

A

repeated trauma to calluses over bony prominences - especially on the elbow, hock, sternum, tuberosities of the pelvis, stifle, lateral digits - common to see comodones observed within the callus

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27
Q

what animals are commonly affected by callus/pressure point pyoderma?

A

large breed & giant breed dogs

also, sternum of dachshunds

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28
Q

T/F: GSD pyoderma is specific to middle-aged GSDs & their crosses & they typically have underlying diseases such as demodicosis, allergic skin disease, & endocrinopathies

A

true

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29
Q

what is the pathogenesis of post-grooming furunculosis?

A

associated with recent bathing/grooming against the direction of hair growth which traumatically causes hair to penetrate through follicular epithelium (shampoo and/or grooming instruments may be contaminated)

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30
Q

what lesions are seen with post-grooming furunculosis?

A

painful erythematous pustules, hemorrhagic bullae, nodules, & draining tracts along the dorsal back

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31
Q

what is your major differential to consider for deep pyoderma?

A

demodicosis

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32
Q

how is folliculitis/furunculosis diagnosed?

A

history, clinical signs, & exclude differentials

cytology - suppurative to pyogranulomatous inflammation with cocci or mixed infection

culture - ALWAYS CULTURE DEEP PYODERMA

skin scrapes - rule out demodicosis

biopsy - suppurative to pyogranulomatous nodular to diffuse dermatitis with folliculitis & furunculosis

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33
Q

what treatment is recommended for folliculitis/furunculosis?

A

topical therapy - avoid products containing alcohol

systemic abx - based off of c/s, for 6-8 weeks, & avoid concurrent use of glucocorticoids

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34
Q

what is cellulitis? what is the pathogenesis of it?

A

deep & rapidly spreading bacterial infection that is poorly demarcated & dissects through tissue planes of the dermis & subcutis

evolves from deep bacterial folliculitis & furunculosis in dogs or puncture (including bites) wounds in dogs & cats

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35
Q

what lesions are seen with cellulitis?

A

edematous boggy & gelatinous deep plaques with oozing from devitalized tissue

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36
Q

what should you always look for in an animal with cellulitis?

A

demodicosis

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37
Q

what differentials should be considered for an animal with cellulitis?

A

subcutaneous & deep mycosis, sterile nodular panniculitis, & neoplasia

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38
Q

how is cellulitis diagnosed?

A

skin culture - aspiration or deep tissue biopsy!!!!

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39
Q

what treatment is indicated for cellulitis from a cat-bite or dog-fight?

A

appropriate to empirically treat!!!!

lance it

clean with an antiseptic solution & rinse it well

+/- systemic abx for 14-21 days if poorly drained

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40
Q

what therapy is indicated for treating cellulitis?

A

topical therapy - bathing & whirlpool therapy

systemic abx based off of c/s for 8+ weeks

potential need for sx debridement

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41
Q

what is the pathogenesis of acral lick dermatitis?

A

results from chronic licking due to pruritus, pain, and/or psychological/behavioral disorders (boredom, attention seeking, confinement, loneliness, separation anxiety)

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42
Q

what animals are commonly affected by acral lick granulomas?

A

males often more affected

medium to large/giant breeds with shorter coats (dobermans, great dane, labs, goldens, GSD, weimaraner)

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43
Q

T/F: acral lick granulomas are always infected regardless of what the skin surface looks like

A

true

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44
Q

what are some underlying primary causes of acral lick granulomas?

A

allergic skin disease, demodicosis, infection (bacterial/fungal), trauma, foreign body, musculoskeletal disease, neuropathy, hypothyroidism, & psychological disorders/stress

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45
Q

what is the common lesion distribution seen in acral lick granulomas?

A

usually unilateral bony prominences with cranial/dorsal carpus as the most common site

metacarpus, tarsus, & metatarsal regions

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46
Q

what lesions are seen with acral lick granulomas?

A

firm, thick, alopecia, erosive to ulcerative, well-delineated plaque with a hyperpigmented periphery

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47
Q

what are some differentials you should consider for a patient with an acral lick granuloma?

A

folliculitis, callus, infectious granuloma, & neoplasia

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48
Q

what diagnostic test is recommended for all acral lick granulomas? how is it performed?

what others are recommended?

A

culture!!!!! tissue culture & aseptic biopsy - remove the epidermis & submit the dermis

history, rads if very swollen, & any other diagnostics needed to identify the underlying cause

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49
Q

T/F: acral lick granulomas are rarely a primary behavior disorder

A

true

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50
Q

when is it okay to use topical therapy for acral lick granulomas?

A

only if it doesn’t re-enforce the animal’s behavior to lick

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51
Q

what therapy is recommended for treating acral lick dermatitis?

A

identify & treat primary underlying cause

treat secondary deep pyoderma with antibiotics selected based off of culture & sensitivity (6-8 weeks)

provide options for more normal behavior - behavior modification, leash walks, behavioral pharmacology

barrier therapy

topical therapy as long as it doesn’t re-enforce the behavior

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52
Q

what lesion is pictured here?

A

acral lick granuloma

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53
Q

what are the main causes of folliculitis in the dog & cat?

A

superficial bacterial pyoderma - most common in dogs

demodicosis

dermatophytosis - most common in cats

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54
Q

can folliculitis occur on non-haired epithelium?

A

no

55
Q

what is the major difference between juvenile onset demodicosis & adult onset demodicosis?

A

juvenile - doesn’t require treatment

adult - treatment is necessary

56
Q

what is the general presentation of juvenile-onset demodicosis?

A

localized problem - 1-5 areas of patchy alopecia that is limited to one body region that is often associated with stress & may self-resolve within 4-8 weeks

57
Q

what is the general presentation of adult-onset demodicosis?

A

generalized problem - more than 5 areas of patchy alopecia with 2+ regions or feet affected with short coated breeds being predisposed

58
Q

T/F: in an animal with adult-onset demodicosis, you should consider the possibility of a genetic defect causing the problem or mites

A

true

59
Q

adult-onset demodicosis is ALWAYS _________ & secondary to what?

A

generalized

secondary to an underlying disease process such as immunosuppression, neoplasia, endocrinopathy, or medications

60
Q

lesion distribution shown here is characteristic of what skin condition? what is the common lesion distribution?

A

demodicosis

haired skin, perioral/periocular, head, & paws are all very common

61
Q

how is demodicosis diagnosed?

A

easy to find on skin scraping if you’re scraping deep enough in multiple spots

minimum of scraping 4-6 spots, record areas sampled, & record mite numbers in different life stages & whether they are alive or dead

62
Q

T/F: there is no juvenile onset demodicosis in cats

A

true

63
Q

lesion distribution shown here is characteristic of what skin condition? what is the agent that causes it?

A

demodicosis in cats

demodex gatoi & demodex cati

64
Q

what is the agent pictured? is it contagious?

A

demodex gatoi - YES CONTAGIOUS

65
Q

demodex injai is a problem for what dogs? what does it cause?

A

WHWT, fox terriers

dorsal topline seborrheic dermatitis & occasionally intense facial pruritus

66
Q

how is canine demodicosis classified?

A

based on the age of onset, extent of disease, & pathogenesis

67
Q

what is the pathogenesis of juvenile-onset demodicosis?

A

aberration in host immune system (cell-mediated immunity)

associated with genetics/breeds, poor nutrition, & stress of varying causes

68
Q

what is the pathogenesis of adult-onset demodicosis?

A

alteration in host immune system due to disease (allergic skin disease, hyperadrenocorticism, hypothyroidism, diabetes, neoplasia) or immunomodulatory therapies

mites proliferate in hair & cause folliculitis

69
Q

what is the most difficult form of demodicosis to treat?

A

pododemodicosis

70
Q

T/F: dogs with allergic skin disease have higher odds of having demodicosis than dogs without allergies

A

true

71
Q

why is selective breeding necessary in regards to treating demodicosis?

A

selective breeding works to eliminate generalized juvenile-onset demodicosis from the canine population - do not breed sire, dam, or affected puppies

72
Q

what are your main differentials for canine demodicosis?

A

bacterial folliculitis/superficial pyoderma

dermatophytosis

allergic skin disease

73
Q

what diagnostics are needed apart from skin scrapes for adult-onset demodicosis?

A

CBC, chemistry, UA, fecal, heartworm testing, & MRD1/ABCB1-1 testing

74
Q

why avoid miticidal therapy in juvenile-onset cases of demodicosis?

A

they have the potential for self cure & it poses an unnecessary risk

75
Q

when are systemic antibiotics indicated for treating juvenile-onset demodicosis? what other treatments are used? how do you recheck?

A

if the animal also has superficial pyoderma, use for 3-4 weeks

topical therapy

recheck in 2-4 weeks to monitor resolution or progression

76
Q

T/F: it is okay to use glucocorticoids in cases of juvenile-onset demodicosis

A

false - avoid using them

77
Q

what is the goal of managing a patient with generalized demodicosis?

A

at least 2 consecutive negative skin scrapes obtained 4 weeks apart

78
Q

what is a negative skin scrape in regards to demodicosis?

A

no mites of any developmental stage including dead mites or mite fragments

79
Q

what is considered to be a complete disease cure in regards to generalized demodicosis?

A

no relapse of demodicosis for 1 year after drug discontinuation

80
Q

T/F: administration of isoxazolines is not a valid reason to exclude demodicosis as a cause of alopecia & you still need to do a skin scrape to exclude it

A

true

81
Q

why do we see treatment failure in cases of demodicosis?

A

failure due to:

-can’t control concurrent pyoderma
-failure to select appropriate therapy/failure to administer it at the correct dose/frequency/duration
-fail to identify/treat predisposing factors & conditions
-failure to monitor patient & adjust therapy accordingly
-failure to avoid the use of glucocorticoids & oclacitnib

RARELY EVER DUE TO RESISTANT MITES

82
Q

all feline skin disease with alopecia as a feature should be considered suspect for what disease until proven otherwise?

A

dermatophytosis

83
Q

what must be done for a DTM culture?

A

keep it at 25-30 C at >30% humidity

MONITOR DAILY FOR 21 DAYS

84
Q

if you have an animal test positive in DTM for microsporum, what do you do next?

A

do a PCR!!!!!!!!

if it is positive - you have a diagnosis

if it is negative - pursue a culture

85
Q

if you have an animal you suspect has trichophyton, what do you do next?

A

DTM - if negative, look at other differentials

if positive, do a culture

86
Q

what are the biggest differences between dogs & cats in regards to dermatophytosis?

A

cats produce a large number of infective spores & distribute the spores over their entire body & shed numerous spores into their environment

87
Q

what environmental decontamination is needed for a cat with dermatophytosis?

A

minimize stirring up spores with sweeping/dusting - swiffer clothes or damp moth

disinfection followed by 1:1 dilution bleach

confinement of infected cat

88
Q

what adverse effect is associated with griseofulvin for treating dermatophytosis in cats?

A

bone marrow suppression

89
Q

what adverse effect is associated with ketoconazole for treating dermatophytosis in cats?

A

hepatotoxicity - not well tolerated

90
Q

what topical adjunct therapies are used for cats with dermatophytosis?

A

lime sulfur 3% solution & miconazole nitrate 2%/chlorhexidine gluconate 2%

used 1-2 times weekly

91
Q

what systemic treatments are used for treating cats with dermatophytosis?

A

itraconazole 25mg/cat or 5-10mg/kg & terbinafine 30-40mg/kg

once daily for 30 days, then week on & then week off until cured

92
Q

what is the benefit of using itraconazole or terbinafine for a cat with dermatophytosis?

A

it accumulates in the hair shaft & the medication persists for several weeks following discontinuation of treatment

ability to pulse dose patient

93
Q

a cat with dermatophytosis will be ‘better’ before being cured - why?

A

there is a clinical cure prior to a mycological cure with average time to mycological cure of 6-8 weeks

cats are still potentially infective until mycological cure is reached

94
Q

what treatment monitoring recommendations are made for cats with dermatophytosis?

A

continue treatment until you get 2-3 negative cultures

culture every 1-2 weeks

remember - 3 weeks needed to finalize cure

95
Q

what lesions are associated with demodicosis?

A

spontaneous alopecia that is partial to complete & focal to diffuse

erythema, hyperpigmentation, scaling, lichenification, erosions, ulcers

96
Q

what is pododemodicosis?

A

disease that specifically affects the paws causing pedal pruritus, pain, erythema, scaling, crusting, alopecia, hyperpigmentation, lichenification, pustules, hemorrhagic bulla, & draining tracts

possible fever & lymphadenopathy

97
Q

what are some risk factors for dermatophytosis?

A

immunosuppression, over-crowding, environmental factors, age, genetics, poor grooming, trauma, & inflammation

98
Q

what dermatophytes do not fluoresce?

A

microsporum gypseum & trichophyton mentagrophytes

99
Q

what dermatophyte species fluoresces? is it zoophilic or geophilic?

A

microsporum canis

zoophilic

100
Q

what dermatophyte species are zoophilic? which ones are geophilic?

A

zoophilic - microsporum canis & trichophyton mentagrophytes

geophilic - microsporum gypseum

101
Q

how long do you have to treat an animal with generalized demodicosis?

A

must treat until you have 2-3 consecutive negative skin scrapes that are 2-4 weeks apart and are taken from the same site every time - absolutely no mites of any stage alive or dead should be seen

102
Q

what products are used for treating demodex cati?

A

advantage multi

bravecto

revolution plus

103
Q

what products are used for treating demodex gatoi?

A

advantage multi

bravecto

revolution plus

lime sulfur

104
Q

what is the general mainstay therapy for treating generalized demodicosis?

A

nexguard/simparica/credelio every 3-4 weeks

bravecto every 2-3 months

105
Q

T/F: in dogs, superficial alopecia doesn’t mean ringworm & is often over diagnosed

A

true

106
Q

what dog breeds appear to be predisposed to dermatophytosis?

A

jack russell terriers & yorkies

107
Q

what do you think this cat has?

A

dermatophytosis

108
Q

is demodicosis a pruritic disease?

A

typically mild if present & often suggests concurrent bacterial folliculitis/pyoderma

109
Q

what is the recommended therapy for treating generalized demodicosis?

A

bathe 1-2 times weekly

control for secondary pyoderma - b lactam abx

select miticidal therapy - bravecto, simparica, nexguard, credelio

perform 4-6 skin scrapes at the same site every 4 weeks

avoid spinosad use in dogs receiving extra label high doses of ivermectin, avermectins, or milbemycin

110
Q

what is the mean duration of treatment for juvenile generalized demodicosis?

A

4.5 months

111
Q

what is the mean duration of treatment for adult generalized demodicosis?

A

6 months

112
Q

what was once the only approved treatment for canine demodicosis in the USA?

A

amitraz - MOA inhibitor & a2 agonist

113
Q

what ingredients are in advantage multi that treat demodicosis?

A

imidocloprid + moxidectin

114
Q

what ingredients are in bravecto that treat demodicosis?

A

isoxazolines - new standard of care for treating demodicosis, GABA gated chloride channel antagonist

115
Q

what is dermatophytosis?

A

infection of keratinized structures such as the stratum corenum, air shaft, horn, claw, or nail in animals & man with fungi of the genera microsporum, trichophyton, & epidermophyton

116
Q

T/F: dermatophytosis is 3x more present in FIV+ cats

A

true

117
Q

what is the most common infectious skin disease of cats?

A

dermatophytosis

118
Q

how do dogs get microsporum gypseum?

A

dogs digging & sticking their nose in soil

119
Q

if a dog is positive for dermatophytosis, what should you search for?

A

infected asymptomatic cat at home

120
Q

__________ is one of the few feline skin diseases that causes hyperpigmentation

A

dermatophytosis

121
Q

T/F: if it looks like ringworm in the dog, it’s probably staph

A

true

122
Q

what is the gold standard for diagnosing dermatophytosis?

A

DTM culture

123
Q

T/F: topical spot therapy is successful for treating dermatophytosis

A

false - rarely if ever successful, you use it as adjunct therapy

124
Q

how are lime sulfur dips used for treating dermatophytosis?

A

used 2x weekly - very effective, but stains porcelain/fabrics/jewelry

often used for 4-6 weeks

125
Q

when should you start with topical therapy for an animal you suspect has dermatophytosis?

A

animal you have a high index of suspicion pending fungal culture

use on asymptomatic pets in the household pending fungal culture

young puppies/kittens

126
Q

T/F: using topical body treatment in cats with dermatophytosis is rarely successful

A

true - use as adjunctive therapy

127
Q

T/F: do not use systemic therapy in kittens/puppies until they are 8-12 weeks old unless the only other option is euthanasia

A

true

128
Q

how long is therapy used for nodular dermatophytosis?

A

treated for 3-4 weeks beyond clinical remission & may require surgical removal

129
Q

systemic therapy for dermatophytosis is often administered for how long?

A

6-12 weeks

130
Q

why not use griseofulvin in FIV+ cats?

A

it causes severe neutropenia

131
Q

what fungal agent do you suspect?

A

microsporum canis - 50% fluoresce

132
Q

what fungal agent is pictured here?

A

microsporum canis

133
Q

what fungal agent is pictured here?

A

microsporum gypseum

134
Q

what fungal agent is pictured here?

A

trichophyton

SA DX & TX II (62 decks)

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