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Dermatology > Nodular and Draining Dermatoses > Flashcards

Nodular and Draining Dermatoses Flashcards

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Dermatology Board Prep 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
Q

Histiocytoma (KNOW)

What is it?

A

Langerhan’s cell origin
Benign
Tumor vs reactive hyperplasia

Common in young dogs

Rare in cats

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26
Q

Histiocytoma (KNOW)

Clinical Appearance

A 
Rapid growing 
Dome-shaped
Alopecic
0.5-1.5 cm
May ulcerate
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27
Q

Histiocytoma (KNOW)

Clinical behavior

A

Spontaneous regression

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28
Q

Histiocytoma (KNOW)

Diagnosis

A

Signalment (young dog)
Clinical appearance

Cytology:
Round cells!
Histiocytes with mitoses
Lymphocytes in regressing lesions

Histopathology, do C/S at same time

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29
Q

Round Cell tumor

DfDx

A 
Lymphoma
Mast cell 
TVT
Plasmacytoma
Histiocytoma
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30
Q

Histiocytoma (KNOW)

Treatment

A 
Ignore
Surgical Excision (esp. if ulcerative and bleeding)
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31
Q

Cutaneous Histiocytosis

What is it?

A

Nodular disease of dogs

Nodules occur in dermis or subcutaneous fat of face, neck, back, trunk
Can occur in nasal mucosa

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32
Q

Cutaneous HIstiocytosis

Treatment

A

Immunosuppression: prednisone or dexamethasone

Doxycycline/niacinamide

Cyclosporine

Long term treatment usually needed

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33
Q

Melanocytoma (KNOW)
What is it
Dogs? Cats?

A

Benign neoplasms from melanocytes
Concern when it involves nailbed or oral cavity

Common in dogs; higher in pigmented breeds

Rare in cats

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34
Q

Melanocytoma (KNOW)

Location

A

Trunk
Head (eyelids, muzzle)
Extremities (between digits)

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35
Q

Melanocytoma (KNOW)

Clinical Appearance

A 
Solitary
Circumscribed
Alopecic
Non-ulcerated
Dome-shaped
Blue-black to dark brown
36
Q

Melanocytoma (KNOW)

Clinical Behavior

A

Most are benign

Can’t always predict based on histopathology

37
Q

Melanocytoma (KNOW)

Diagnosis

A

Cytology

Histopathology

38
Q

Melanocytoma (KNOW)

Treatment

A

Surgical removal with clean margins!

39
Q

Trichoblastoma (KNOW)

Background

A

Basal cell tumor

Primitive hair germ epithelium

Common in dogs and cats
(most common pigmented tumor of cats)

40
Q

Trichoblastoma (KNOW)

Location

A

Dog:
Head and Neck

Cat:
Cranial half of trunk (eyes even)

41
Q

Trichoblastoma (KNOW)

Clinical appearance and behavior

A 
Solitary
Dome-shaped
Firm
1-2 cm
Alopecic
Ulcerated 
Melanotic

Benign

42
Q

Trichoblastoma (KNOW)

Treatment

A 
Observe 
Surgical excision (curative)
43
Q

Sebaceous Gland Tumors (KNOW)
Species
4 Types

A

Dogs; Poodles and Cocker Spaniels

Nodular sebaceous hyperplasia (most common)
Sebaceous adenoma (common)
Sebaceous epithelioma (common) 
Sebaceous adenocarcinoma (rare but aggressive)
44
Q

Sebaceous Gland Tumors (KNOW)

Most common

A

Nodular sebaceous hyperplasia

45
Q

Sebaceous Gland Tumors (KNOW)

Location

A

Trunk
Limbs
Eyelids
Head

46
Q

Sebaceous Gland Tumors (KNOW)

Clinical Appearance

A

Wart-like or cauliflower-like
Pinkish or orangish
May be melanotic or ulcerated

47
Q

Sebaceous Gland Tumors (KNOW)

Clinical Behavior

A

Benign

New adenomas or hyperplasias will develop

Adenocarcinoma and epithelioma rarely metastasize (but if they do they are aggressive)

48
Q

Sebaceous Gland Tumors (KNOW)

Sequela

A

Could get secondary infection due to production of sebum; address with topical treatment

Can cause pruritus

Do cytology

49
Q

Sebaceous Gland Tumors (KNOW)

Diagnosis

A

Clinical appearance
Cytology
Histopathology

50
Q

Sebaceous Gland Tumors (KNOW)

Treatment

A

Observe

Surgical excision

51
Q

What is an acrochordon?

A

Skin tag!

Not bothering patient (or client) than leave be

CO2 laser though can take them off if client wants

52
Q

Sterile Nodules

Background

A

Many syndromes fit into this category

Most are probably immune-mediated

53
Q

Sterile Nodules

Pathogenesis

A

Unkown

54
Q 
Sterile Nodules
Sterile Causes (KNOW)
A

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
Q

Sterile Nodules

Treatment (KNOW)

A

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
Q

Sterile Nodules

Differentials

A

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
Q

Canine Eosinophilic Furunculosis (KNOW)
Causes
Location

A

Arthropod or insect bite most likely (ex. mosquito)

Sudden onset

Characteristically on bridge of nose

58
Q

Canine Eosinophilic Furunculosis (KNOW)

Treatment

A

Steroid responsive

Recurrence is rare

59
Q 
Juvenile Cellulitis (KNOW)
Age
A

Pustular to nodular disease of young puppies

12-18 weeks old

Can occationally occur in adults

60
Q 
Juvenile Cellulitis (KNOW)
Breeds
A

Dachshunds
Goldens
Pointers

61
Q 
Juvenile Cellulitis (KNOW)
Causes
A

Occasionally seen after vaccination

62
Q 
Juvenile Cellulitis (KNOW)
Clinical Signs
A

Face and head (especially muzzle, periocular)

Ears, anus, prepuce may be affected

Lymphadenopathy; specifically submandibular

Sterile abscess at site of vaccination

63
Q 
Juvenile Cellulitis (KNOW)
Lesions
A

Pustules
Crusting
Erythema
SQ nodules

64
Q 
Juvenile Cellulitis (KNOW)
Treatment
A

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
Q 
Juvenile Cellulitis (KNOW)
Diagnosis
A

Signalment
Clinical Signs

Biopsy

66
Q

Sterile Nodular Panniculitis (KNOW)

What is it?

A

Solitary or multiple subcutaneous nodules that ulcerate and discharge an oily, bloody exudate

Lesions occur anywhere

67
Q

Sterile Nodular Panniculitis (KNOW)

Clinical Signs

A 
Dogs may be systemically ill
Anorexia
Lethargy
Fever
Ulcerations on body

Pancreatitis can trigger this syndrome

ALP could be elevated

68
Q

Sterile Nodular Panniculitis (KNOW)

Treatment

A

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
Q 
Granulomatous Dermatoses (KNOW)
What is it?
A

Periadnexal multinodular granulomatous dermatosis (sterile pyogranuloma/granuloma syndrome)

“Sterile histiocytic disease”

70
Q

Periadnexal Multinodular Granulomatous Dermatitis (KNOW)

Lesions

A

Pyogranuloma/granuloma syndrome

Multiple nodules of the head, pinnae, paws

Specific histopathological pattern

71
Q

Periadnexal Multinodular Granulomatous Dermatitis (KNOW)

Treatment

A

Usually steroid responsive (immunosuppressive)

+/-cyclosporine; doxycycline/niacinamide

Long term treatment needed

72
Q

Follicular cyst/Epidermal inclusion cyst (KNOW)

Characteristics

A

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
Q

Follicular cyst/Epidermal inclusion cyst (KNOW)

Diagnosis

A

Biopsy

74
Q

Follicular cyst/Epidermal inclusion cyst (KNOW)

Treatment

A

Surgical excision
Retinoids/Vitamin A
Sudden occurrence of many nodules (R/O endocrine)

75
Q

Epidermal Inclusion Cyst

Characteristics

A

Cyst has a lining => must remove lining to rid body of it

76
Q

Intracutaneous Cornifying Epithelioma

A

A type of Follicular cyst

Found in German Shepherds and Keeshounds

Usually multiple and can be quite large

77
Q

Apocrine Cyst

A

Fluid filled cyst

Ruptures and deflates; will continue to fill up over and over

78
Q 
Perianal fistulas (KNOW)
AKA
A

Anal furunculosis

79
Q 
Perianal fistulas (KNOW)
Characteristics
A

Draining lesions around anus:
Shallow blind-ended sinuses
NOT associated with anal sacs

Very painful

Unknown etiology; most likely immune-mediated

80
Q 
Perianal fistulas (KNOW)
Breed
A

German Shepherds

Irish Setters

81
Q 
Perianal fistulas (KNOW)
Diagnosis
A

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
Q 
Perianal fistulas (KNOW)
Treatment
A 
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
Q

Focal metatarsal fistulas

Breed

A 
GSD
But also:
Weimaraner 
Greyhound
Doberman
84
Q

Focal metatarsal fistulas

Clinical signs

A

Asymptomatic to lame

85
Q

Focal metatarsal fistulas

Treatment

A 
Immunosuppression 
Steroids
Tacrolimus
Cyclosporine
Doxycycline/niacinamide

Dermatology (13 decks)

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