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Nodular and Draining Dermatoses Flashcards

1
Q

Skin Nodules

What are they?

A

Circumscribed solid elevations

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2
Q

Skin Nodules

Causes (KNOW)

A

Infectious
Neoplastic
Sterile

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3
Q

Location of nodules

A

Single or multiple

Epidermis
Dermis
Dermis adnexal = next to hair follicle
Subcutaneous tissue

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4
Q 
Skin Nodule
History questions (KNOW)
A

When did you first notice it?

Any changes since then?

Growing?

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5
Q

Skin Nodules

When to worry? (KNOW)

A 
Poor margins
Depth
Systemic signs
Manipulation alters lesion 
Location on body

Cytological findings reveal:
Mitoses
Hemorrhage

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6
Q

Skin Nodules

Observations (KNOW)

A 
Location
Pigmentation
Alopecic or haired
Ulceration?
Margins?
Signalment
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7
Q

Skin Nodules

Basic Diagnositcs

A
  1. FNA/cytology
    2+3. Culture from biopsy (bacterial, fungal, mycobacterial)
  2. Histopathology
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8
Q

Bacterial Causes

A

Staphylococcus:
Furunculosis
Botryomycosis

Nocardia/Actinomycosis

Myobacteria

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9
Q

Canine Leproid Granuloma

A

Mycobacteria

Does not grow using standard methods (Culture)

Lesions restricted to head/pinnae

Boxers

Diagnosis: acid fast organisms on histopathology or cytology

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10
Q

Acral Lick Dermatitis (KNOW)

What is it?

A

Raised ulcerated firm mass over the distal extremity

Secondary to chronic licking

Increased incidence in large breed dogs

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11
Q

Acral Lick Dermatitis

2 Rules

A
  1. Always infected

2. Secondary to something

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12
Q

Acral Lick Dermatitis (KNOW)

Inciting Causes

A 
Allergies (esp. thoracic limbs) 
Infection
Prior Surgery
Foreign Body
Arthritis (pain so licks)
Previous Trauma
Neoplasia
Behavioral
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13
Q

Acral Lick Dermatitis (KNOW)

Diagnosis

A

Scrape (looking for demodex)
Cytology and Biopsy (can cause more irrtation)
Culture
Radiography

Look for underlying cause

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14
Q

Acral Lick Dermatitis (KNOW)

Treatment

A

Treat underlying infection with 4-6 weeks of systemic antibiotics (empirical at first but must do C/S to get more targeted therapy)

+/- behavioral modification to break licking cycle

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15
Q

Skin Nodule

Fungal Causes

A 
Dermatophyte
Saprophytic fungi
Pythium/Lagenidium
Sporotrichosis
Blastomycosis
Histoplasmosis
Cryptococcosis
Coccidiomycosis
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16
Q

Pythiosis/Lagenidiosis/Paralagenidiosis

A

Not true fungi

Saprophytic infection

Organisms found in decaying wood and vegetable matter

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17
Q

Pythiosis/Lagenidiosis

Diagnosis

A

Cytology:
Pyogranulomatous (macrophages, neutrophils) with eosinophils
Hyphae hard to see

Biopsy:
Silver stain required for Pythium

Culture
Serology, PCR, IH

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18
Q

Pythiosis/Lagenidiosis

Treatment

A

Very difficult
Wide surgical excision

Systemic therapy:
Itraconzazole +/- terbinafine
<25% response
Agriculture fungicides

Immunotherapy with anti-pythium vaccine

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19
Q

Histoplasmosis

Skin lesions

A

Papular to nodular growths often located at the mucocutaneous junctions

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20
Q

Cryptococcosis

Classic Clinical Sign

A

Bulging of head and bridge of nose

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21
Q

Viral Warts (KNOW)
Kind
Age
Location

A

Common

Papilloma virus
Young dogs
Around oral mucosa

Older dog? Think potential immune suppression

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22
Q 
Viral Warts (KNOW)
Treatment
A

Regress on own
Azithromycin
Laser surgery

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23
Q 
Viral Warts (KNOW)
Pathogenesis
A

Trauma to skin and virus enters

Virus makes way to basal cell layer where replication occurs

Epidermal cells replicate and move to surface taking virus with it; making a wart on the surface with a stalk under surface

Macrophages will eventually destroy it

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24
Q 
Viral Wart (KNOW)
Importance of removal
A

Need to remove the stalk or will continue to grow back

Need a CO2 laser or very deep margins

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25
Histiocytoma (KNOW) | What is it?
Langerhan's cell origin Benign Tumor vs reactive hyperplasia Common in young dogs Rare in cats
26
Histiocytoma (KNOW) | Clinical Appearance
``` Rapid growing Dome-shaped Alopecic 0.5-1.5 cm May ulcerate ```
27
Histiocytoma (KNOW) | Clinical behavior
Spontaneous regression
28
Histiocytoma (KNOW) | Diagnosis
Signalment (young dog) Clinical appearance Cytology: Round cells! Histiocytes with mitoses Lymphocytes in regressing lesions Histopathology, do C/S at same time
29
Round Cell tumor | DfDx
``` Lymphoma Mast cell TVT Plasmacytoma Histiocytoma ```
30
Histiocytoma (KNOW) | Treatment
``` Ignore Surgical Excision (esp. if ulcerative and bleeding) ```
31
Cutaneous Histiocytosis | What is it?
Nodular disease of dogs Nodules occur in dermis or subcutaneous fat of face, neck, back, trunk Can occur in nasal mucosa
32
Cutaneous HIstiocytosis | Treatment
Immunosuppression: prednisone or dexamethasone Doxycycline/niacinamide Cyclosporine Long term treatment usually needed
33
Melanocytoma (KNOW) What is it Dogs? Cats?
Benign neoplasms from melanocytes Concern when it involves nailbed or oral cavity Common in dogs; higher in pigmented breeds Rare in cats
34
Melanocytoma (KNOW) | Location
Trunk Head (eyelids, muzzle) Extremities (between digits)
35
Melanocytoma (KNOW) | Clinical Appearance
``` Solitary Circumscribed Alopecic Non-ulcerated Dome-shaped Blue-black to dark brown ```
36
Melanocytoma (KNOW) | Clinical Behavior
Most are benign Can't always predict based on histopathology
37
Melanocytoma (KNOW) | Diagnosis
Cytology | Histopathology
38
Melanocytoma (KNOW) | Treatment
Surgical removal with clean margins!
39
Trichoblastoma (KNOW) | Background
Basal cell tumor Primitive hair germ epithelium Common in dogs and cats (most common pigmented tumor of cats)
40
Trichoblastoma (KNOW) | Location
Dog: Head and Neck Cat: Cranial half of trunk (eyes even)
41
Trichoblastoma (KNOW) | Clinical appearance and behavior
``` Solitary Dome-shaped Firm 1-2 cm Alopecic Ulcerated Melanotic ``` Benign
42
Trichoblastoma (KNOW) | Treatment
``` Observe Surgical excision (curative) ```
43
Sebaceous Gland Tumors (KNOW) Species 4 Types
Dogs; Poodles and Cocker Spaniels ``` Nodular sebaceous hyperplasia (most common) Sebaceous adenoma (common) Sebaceous epithelioma (common) Sebaceous adenocarcinoma (rare but aggressive) ```
44
Sebaceous Gland Tumors (KNOW) | Most common
Nodular sebaceous hyperplasia
45
Sebaceous Gland Tumors (KNOW) | Location
Trunk Limbs Eyelids Head
46
Sebaceous Gland Tumors (KNOW) | Clinical Appearance
Wart-like or cauliflower-like Pinkish or orangish May be melanotic or ulcerated
47
Sebaceous Gland Tumors (KNOW) | Clinical Behavior
Benign New adenomas or hyperplasias will develop Adenocarcinoma and epithelioma rarely metastasize (but if they do they are aggressive)
48
Sebaceous Gland Tumors (KNOW) | Sequela
Could get secondary infection due to production of sebum; address with topical treatment Can cause pruritus Do cytology
49
Sebaceous Gland Tumors (KNOW) | Diagnosis
Clinical appearance Cytology Histopathology
50
Sebaceous Gland Tumors (KNOW) | Treatment
Observe | Surgical excision
51
What is an acrochordon?
Skin tag! Not bothering patient (or client) than leave be CO2 laser though can take them off if client wants
52
Sterile Nodules | Background
Many syndromes fit into this category Most are probably immune-mediated
53
Sterile Nodules | Pathogenesis
Unkown
54
``` Sterile Nodules Sterile Causes (KNOW) ```
Diagnosis of exclusion Must rule out infection via FNA, biopsy, C/S Pyogranulomatous (macrophages and neutrophils) inflammation: Infectious in origin until proven otherwise but in this case do not any organisms
55
Sterile Nodules | Treatment (KNOW)
Long duration therapy: Doxycycline/niacinamide Immunosuppressive steroids (prednisone or dexamethasone) Cyclosporine Once in remission, slow taper over several months Stops improving? Repeat cytology +/- biopsy and cultures
56
Sterile Nodules | Differentials
Eosinophilic furunculosis Juvenile cellulitis Sterile nodular panniculitis (concerning; can present in many different ways) Sterile pyogranuloma/pyogranuloma syndrome Follicular cysts Perianal fistulas Metatarsal fistuals
57
Canine Eosinophilic Furunculosis (KNOW) Causes Location
Arthropod or insect bite most likely (ex. mosquito) Sudden onset Characteristically on bridge of nose
58
Canine Eosinophilic Furunculosis (KNOW) | Treatment
Steroid responsive Recurrence is rare
59
``` Juvenile Cellulitis (KNOW) Age ```
Pustular to nodular disease of young puppies 12-18 weeks old Can occationally occur in adults
60
``` Juvenile Cellulitis (KNOW) Breeds ```
Dachshunds Goldens Pointers
61
``` Juvenile Cellulitis (KNOW) Causes ```
Occasionally seen after vaccination
62
``` Juvenile Cellulitis (KNOW) Clinical Signs ```
Face and head (especially muzzle, periocular) Ears, anus, prepuce may be affected Lymphadenopathy; specifically submandibular Sterile abscess at site of vaccination
63
``` Juvenile Cellulitis (KNOW) Lesions ```
Pustules Crusting Erythema SQ nodules
64
``` Juvenile Cellulitis (KNOW) Treatment ```
Immunosuppression (important to rule out demodex and ring worm) Doxycycline/niacinamide Cyclosporine Slowly taper off meds once in remission Treat any secondary infections as well
65
``` Juvenile Cellulitis (KNOW) Diagnosis ```
Signalment Clinical Signs Biopsy
66
Sterile Nodular Panniculitis (KNOW) | What is it?
Solitary or multiple subcutaneous nodules that ulcerate and discharge an oily, bloody exudate Lesions occur anywhere
67
Sterile Nodular Panniculitis (KNOW) | Clinical Signs
``` Dogs may be systemically ill Anorexia Lethargy Fever Ulcerations on body ``` Pancreatitis can trigger this syndrome ALP could be elevated
68
Sterile Nodular Panniculitis (KNOW) | Treatment
Immunosuppression (careful if the dog is systemically ill; must treat that first) - also should biopsy and do C/S prior to this to rule out other diseases Doxycycline/niacinamide Cyclosporine Vitamin E Sometimes can taper off all meds once in remission
69
``` Granulomatous Dermatoses (KNOW) What is it? ```
Periadnexal multinodular granulomatous dermatosis (sterile pyogranuloma/granuloma syndrome) "Sterile histiocytic disease"
70
Periadnexal Multinodular Granulomatous Dermatitis (KNOW) | Lesions
Pyogranuloma/granuloma syndrome Multiple nodules of the head, pinnae, paws Specific histopathological pattern
71
Periadnexal Multinodular Granulomatous Dermatitis (KNOW) | Treatment
Usually steroid responsive (immunosuppressive) +/-cyclosporine; doxycycline/niacinamide Long term treatment needed
72
Follicular cyst/Epidermal inclusion cyst (KNOW) | Characteristics
Dermal nodules sometimes with pore, has a lining Thick material within; brown/gray toothpaste Can create inflammatory reaction if ruptured into dermis Can become secondarily infected
73
Follicular cyst/Epidermal inclusion cyst (KNOW) | Diagnosis
Biopsy
74
Follicular cyst/Epidermal inclusion cyst (KNOW) | Treatment
Surgical excision Retinoids/Vitamin A Sudden occurrence of many nodules (R/O endocrine)
75
Epidermal Inclusion Cyst | Characteristics
Cyst has a lining => must remove lining to rid body of it
76
Intracutaneous Cornifying Epithelioma
A type of Follicular cyst Found in German Shepherds and Keeshounds Usually multiple and can be quite large
77
Apocrine Cyst
Fluid filled cyst Ruptures and deflates; will continue to fill up over and over
78
``` Perianal fistulas (KNOW) AKA ```
Anal furunculosis
79
``` Perianal fistulas (KNOW) Characteristics ```
Draining lesions around anus: Shallow blind-ended sinuses NOT associated with anal sacs Very painful Unknown etiology; most likely immune-mediated
80
``` Perianal fistulas (KNOW) Breed ```
German Shepherds | Irish Setters
81
``` Perianal fistulas (KNOW) Diagnosis ```
Clinical signs Cytology (most likely has secondary infections) +/- biopsy (not recommended because so painful and hard to suture) Rectal examination: Check for anal sac involvement
82
``` Perianal fistulas (KNOW) Treatment ```
``` Cyclosporine (+/- ketoconazole) - most helpful Tacrolimus (can be placed topically) Prednisone Food trial (allergies potentially) Antibiotics ``` Life long control required Surgery only for refractory cases
83
Focal metatarsal fistulas | Breed
``` GSD But also: Weimaraner Greyhound Doberman ```
84
Focal metatarsal fistulas | Clinical signs
Asymptomatic to lame
85
Focal metatarsal fistulas | Treatment
``` Immunosuppression Steroids Tacrolimus Cyclosporine Doxycycline/niacinamide ```

Dermatology (13 decks)

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