Management of pruritis Flashcards
What differentials are suspected with pruritic skin disease?
- Parasites
- Infection
- Allergy
- Misc
Pruritic skin disease may not be overtly distinguishable.
Outline three clinical presentations which may lead you to suspect pruritis.
- Trichogram - fractured hair shaft
- Overgrooming
- Hairballs
- Hair stuck between teeth
Describe the classification of skin infection by depth of infection.
- Surface - an overgrowth of bacteria rather than true infection
- Superficial folliculitis - affects epidermis and follicles
- Deep folliculitis and furunculosis - affects epi, follicles and dermis (may affect subcut tissues)
Which bacterial species may be suspected with infectious skin disease?
(x1 +x3)
- Staph. pseudointermedius
- Staph. aureus
- Staph. schleiferi
- Staph. hyicus
- Gram -ve - rare, deep infections
Which fungal species may be suspected with infectious skin disease?
Malassezia
A dog is presented to you with pruritic skin disease affecting ears, neck, groin, peritoneum and feet.
The dog is presented with excessive licking of feet and trunkal pruritis.
Which differentials may you suspect, how could you treat?
Malassezia
Antiseptic shampoo (prevent SBI), topical azoles, systemic antifungals in severe cases.
Surface overgrowth of bacteria may be presented as…
- Hot spots - pyotraumatic dermatitis
- Skin fold pyoderma
- Bacterial overgrowth syndrom - progresses to deep infection
Describe this lesion
The skin at the base of the ear shows marked erythema and alopecia, there is also a focally irregular area of ulceration.
Focally extensive acute severe ulcerative pyotraumatic dermatitis
Underlying disease of which types can lead to deep pyoderma?
Foreign bod
Demodecosis
Immunosupression
Trauma
Allergy
Self trauma
Pressure sores
Deep pyoderma may be expected with what signs at clinical presentation?
- Haemorrhagic bullae
- Crusts
- Haemopurulent discharge
- Heat, oedema and erythema
- Furuncules, nodules, plaques
- Ulcers
- Sinus tracts
What is a epidermal collarette?
A ring of erythema with a rim of scale/ flaking
What is a papule?
A small round solid bump found on the skin
Define superficial folliculitis.
Pyogenic skin disease caused by increased bacterial adherence, multiplication, production of virulence factors & invasion into follicles and epidermis
Genetically predisposed inflammation/ pruritic allergic skin. Usually associated with IgE adn environmental allergens.
Canine atopic dermatitis
Outline the pathogenesis of canine atopic dermatitis.
Multifactorial:
- Defective cutaneous barrier
- Flare factors - bacterial/ parasitic
- Hypersensitivity/ allergy - food etc
Which diagnostic tests are implimented when investigating a case of CAD?
Serum IgE
Intradermal skin tests
Clinical signs - seasonal/ non-seasonal pruritis
Young dogs
What are Favrots criteria for CAD?
- Under 3y/o
- Living mostly indoors
- Steroid responsive pruritis
- Front feet and ear pinnae affected (non-marginal)
- Dorso-lumbar area not affected
Outline a potential management program for a dog suffering from cAD.
- Improve barrier function - nutritional and topical treatments
- Decrease flare factors - ectoparasite treatment, antiseptics (bacterial infection)
- Allergen vaccines - 60-70% success
- Anti-inflammatory drugs - eg steroids, apoquel
How can barrier function be improved in cAD?
- EFA diets - decreased water loss and improves coat
- Topical emollients - transient decrease in pruritis
- Allermyl - antimicrovial (piroctone, monosacc), anti-inflamm and anti-ox (vit E, linoleic acid)
What is the MOA of Oclacitinib?
Where is its use contraindicated?
JAK inhibitor - decreases interleukins (JAK1), decreased haematopoiesis (JAK2)
Contraindicated - <12mo, <3kg BW, breeding, neoplasia, immunosupressed
How long would you need to wait to see a full response to ciclosporin in a patient?
What adverse effects may be seen?
4-8 weeks
Adverse effects - Increase hair (anagen), increased tear production, gum hyperplasia
Name three drugs which interfere with ciclosporins mechanism of action.
- Inhibit metabolism - azole, steroids
- Increased metabolism - rifampin, phenobarb
- Other - omeprazole, tramadol, ivermectin
What adverse effects may be expected with use of systemic glucocorticoids?
PUPD
Polyphagia
Panting
Behavioural changes
Chronic - hyperadrenocorticism, calcinosis cutis
