Framework of dermatology consultation

Question 1

Dermatological history - key questions

Answer 1

• True age of onset: check no prior history of skin disease, unrecognised by owner e.g foot licking, otitis. It’s important to detail the manifestations of pruritus for owner
• Evidence of contagion or zoonosis
  Ectoparasiticidal regime – detail – include in-contacts

Distribution of lesions/pruritus
Did pruritus start before or after onset of lesions?

Other questions, e.g.
- Progression: change/spread of lesions, seasonality
- Lifestyle: kennelled/indoors, contact with others
- Diet
- Travel abroad

Question 2

General health history

Answer 2

• underlying systemic dz, e.g. PUPD in hyperadrenocorticism
• systemic disease that may affect diagnostic or treatment plan e.g. concurrent cardiac failure
  Drug history, ?cutaneous drug reaction/ intolerance, ? iatrogenic effects

Question 3

Main causes of dermatological dz

Answer 3

• METABOLIC: includes endocrine
• NEOPLASTIC: skin is most common site for canine neoplasms
• INFLAMMATORY
• IMMUNE-MEDIATED: including hypersensitivities, auto-immune
• INFECTIOUS: parasitic, bacterial, fungal, viral, protozoal
• TRAUMATIC

Question 4

Main presentations of dermatological disease

Answer 4

• Pruritus
• Ulcerative disease
• Non-pruritic alopecia
• Draining sinuses
• Scaling disease
• Ear disease
• Cutaneous masses
• Crusting
• Claw disease

Many conditions may have >1 presentation, e.g. a deep pyoderma can present as a nodule +/- sinus +/- ulcer +/- crust +/- plaque

Question 5

Primary lesions

Answer 5

• e.g. papules, pustules, follicular casts
• Look for these - important diagnostically as ddx often limited
• Often transient

Question 6

Secondary lesions

Answer 6

• e.g. crusts
• Result from primary lesion or external factor
• May be useful diagnostically

Question 7

Lesion configuration

Answer 7

• Single
• Multiple
• Grouped
• Multifocal
• Linear
• Annular
• Coalescing
• Diffuse

Question 8

Lesion distribution

Answer 8

• Bilaterally symmetrical: ‘inside-out’
• Asymmetric, irregular distribution: ‘outside-in’

Question 9

Common diseases in dogs

Answer 9

• Ectoparasites*
• Infections
  – Staphylococci*
  – Malassezia*
  – Dermatophytes
  – Viral/protozoal
• Allergic*
• Neoplastic*
• Endocrine

Question 10

Common diseases in cats

Answer 10

• Ectoparasites*
• Infections
  – Dermatophytes*
  – Viral
  – Staphylococci
  – Malassezia
• Allergic*
• Neoplastic

Question 11

Initial approach to many presentations

Answer 11

• rule out ectoparasites + rule out microbial infections
• e.g. for pruritus, papules, pustules, scale, crusting, alopecia