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Dermatology > Lecture: Demodicosis > Flashcards

Lecture: Demodicosis Flashcards

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Dermatology Board Prep flashcards
1
Q

pathogenesis Demodex

A
  • Deficient cell mediated immune response
  • Genetics, autosomal recessive
  • Immunosuppression
  • Bacterial folliculitis
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2
Q

Any dog (animal I think) positive for demodex needs to be

A

on an antibiotic

(something about staph receptor on demodex…blah blah blah)

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3
Q

Demodex and contagiousness

A

Not contagious

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4
Q

Demodex

CS

A
  • Papules/pustules, erythema
  • Alopecia
  • Scaling, crusting
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5
Q

common places for demodex

A

face and feet

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6
Q

Comedones

A
  • follicular plugging (blackheads)
  • comedeones on feet, MUST SCRAPE
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7
Q

DDX for comedones

A
  • endocrine dz
  • demodex
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8
Q

Grey patchy skin from far away

A
  • thick folliculitis
  • think comedones
  • scrape for demodex
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9
Q

Demodex lives inside

A

hair follicle

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10
Q

Demodex DX

A
  • Pinch, scrape in direction of hair, till blood
  • pluck the hair (not as sensitive as a scrape)
  • Biopsy where comedones are
    • shar pei
    • scar tissue (hot spots)
    • pododermatitis
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11
Q

juvenile demodex

A

genetically inherited dz….?!?!

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12
Q

Adult demodex indicates

A

an underlying disease

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13
Q

If demodex on deep scraping is diagnosed

A
  1. Is it generalized?
    • scrape 5 places total
  2. If it’s not generalized, will it become generalized?
    • don’t treat, wait and see (if a breeding animal)
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14
Q

Localized Demodicosis - Prognosis

A
  • 90 % of localized juvenile demodecosis will spontanously clear up
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15
Q

Generalized demodicosis in breeding animals…

A

These animals should not have puppies

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16
Q

TX localized juvenile demodicosis

A
  • Antibiotics
    • topical benzoyl peroxide gel/shampoo
    • systemic if needed
  • De-worming, good diet, HW, TLC

*do not use steroids, or anti-mite therapy

17
Q

Localized demodicosis

A
  • monitor course of disease
    • recheck in 2-4 weeks
    • deep scrape skin same 5 spots
      • if mite counts decrease: lesion resolving, recheck q 4 weeks until negative
      • if mite counts inc: may be progressing to generalized
18
Q

Generalized Demodicosis

A
  • 5 localized lesions or more
  • involvement of an entire body region (ie: head)
  • Involves 2 or more feet
19
Q

rate of clearance of gen juvenile onset demodicosis

A

50% of self clearance rate with an antibiotic

50% need anti-mite prescription

5% need lifelong treatment

20
Q

Adult onset generalized demodex

A

may precurse cushings, or other endocrine/metabolic dz

underlying immunosuppression…. (steroid misuse)

21
Q

Pododemodicosis

A
  • very painful
22
Q

Generalized Demodicosis

TX

A
  1. Miticide
  2. Antibiotics
    • treat secondary bacterial infections
    • until neg 1st scrape
  3. Benzoyl Peroxide shampoo (2.5%)
    • Follicular flushing
23
Q

Generalized Demodicosis

RX to kill mites

A
  1. Amitraz = Mitaban
  2. Ivermectin = Ivomec
  3. Milbemycin = Interceptor (not available right now)
24
Q

Amitraz

A
  • Topical
  • only FDA approved tx
  • MOI, alpha-2 adrenergic agonist, inhibits prostaglandin synthesis
  • there are side-effects and it is labor intensive
  • 6-9 weeks no response is a failure
25
Q

Amitraz (mitoban) pitfalls

A
  • toy breeds and toxicity
  • Sick, old patients
  • extensive ulcerations
26
Q

Amitraz

side effects

A
  • Sedation/dull mentation
  • reversals
    • yohimbine
    • antipamezole
  • avoid use in owners with
    • asthma
    • diabetes (or animals with diabetes)
    • owner taking MOA: Parkinson’s disease
27
Q

Amitraz failure

A
  • No improvement after 6-9 months
  • untreated staph infection
28
Q

Ivermectin (Ivomectin)

A
  • off label
  • Dose:
    • 400-600 microgram (0.4-0.6 milligrams)
    • HW prevention dose is 6 micrograms
    • 1% ivermectin is 10mg/mL
    • toxic dose for collies/shelties is 100 micrograms ( 0.1 mg)
  • build up to final dose
  • monitor patient, educate patients
    • look for pupils and glazed look
29
Q

Ivermectin: white feet

A

dont treat

30
Q

Moxidectin

A
  • Advantage multi
  • weekly or every other week
31
Q

Bravecto (flurolaner)

A
  • 1 pill (lasts 12 weeks) eliminates 100% mites by day 56
  • Safe for the white feets
32
Q

Generalized Demodicosis

TX monitoring plan

A
  • deep skin scrape
    • 5 sites
    • always include muzzle and feet
  • record mites
  • re-scrape same sites q 4 weeks
  • treat until 3 consecutive negative skin scrapes

Dermatology (22 decks)

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