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SS - Exam 3 > Papules, Pustules, Crust - Derm > Flashcards

Papules, Pustules, Crust - Derm Flashcards

1
Q

Flea bite hypersensitivity

A

Flea allergy dermatitis - papule lesion
Pruritus, erythema, excoriation, self induced alopecia are often seen w crusted papules

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2
Q

Sarcoptic mange

A

Scabies - papule lesion
Intense pruritus, exocoriation, crusts, self induced alopecia are often see w papules

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3
Q

Miliary dermatitis

A

Crusted papular dermatitis - papule lesion
Not a disease but cutaneous reaction pattern common w hypersensitivity in cats

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4
Q

Pustule vs crust

A

Pustule - small circumscribed elevation filled w pus
Crust - cellular debris, dried exudate/blood - left over dried up pustule, vesicle or bulla

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5
Q

Infectious pustule or crust

A

Bacterial**
Superficial pyoderma

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6
Q

autoimmune pustule or crust

A

Pemphigus foliaceus*

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7
Q

Sterile pustule or crust

A

Subcorneal pustular dermatosis - fire ant sting

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8
Q

Papule conditions

A

Flea bite hypersensitivity
Sarcoptic mange
Miliary dermatitis

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9
Q

Superficial pyoderma

A

Bacterial folliculitis, impetigo, exfoliative superficial pyoderma - all caused by staph Pseudintermedius (common) or schliferi (emerging)

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10
Q

Bacterial folliculitis

A

Extremely common in dogs, rare in cats
Affects follicles
Abdomen, groin, medial thighs, axillary - pruritus can be variable

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11
Q

Bacterial folliculitis lesion

A

Erythematous papules —>
Pustules —>
Crusts

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12
Q

Bacterial folliculitis in short coated dogs

A

EXTREMELY common
Skin lesions: Spontaneous alopecia, multi focal - will not expand or coalesce
Found on trunk & extremities
Pruritus is variable, can be mistaken as Dermatophytosis

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13
Q

Bacterial impetigo - pyoderma

A

Puppy pyoderma
Caused by strains of staph that produce exfoliative toxins - common in abdomen
Lesions: pustules, collarettes

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14
Q

exfoliative superficial pyoderma

A

Superficial spreading pyoderma - bacterial exfoliative toxins separate stratum corneum
Lesions:
Large readily expanding collarettes
Peripheral erythema
Hyperpigmented center of chronic lesion
PUSTULES ARE RARE, pruritus varies

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15
Q

Cytology for superficial pyoderma
Bacterial folliculitis

A

Bacterial folliculitis - sample from intact pustules & beneath the crust
Finding - degenerate neutrophils w intracellular bac

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16
Q

Cytology of bacterial folliculitis of short coat breeds

A

Cytology doesn’t yield degenerative neutrophils or bacteria - not reliable

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17
Q

Cytology for bacterial impetigo

A

Sample from intact pustules, edge of epidermal collarette
Findings - degenerate neutrophils w intracellular cocci, free floating epidermal cells due to separation of stratum corneum

18
Q

Cytology of exfoliative superficial pyoderma

A

Sample from edge of epidermal collarette
Findings - similar bacteria to impetigo but presence is scarce

19
Q

Treatment of superficial pyoderma a

A

Depends on location
Localized: topical antibacterials - chlorhexidine, benzoyl peroxide, dilute bleach, mupirocin, gentamicin, erythromycin
Oral/systemic antibiotics - cephalosporins, clindamycin, tetracyclines, sulfonamides, floroquinalones, rifampin, chorlamphenicol

20
Q

Localized /topical antibiotics

A

Chlorhexidine (2-4%)
Benzoyl peroxide
Dilute bleach (1:100)
Mupirocin
Gentamicin
Erythromycin

21
Q

Oral /systemic antibiotics

A

Cephalosporins
Clindamycin
Tetracyclines
Sulfonamides
Fluoroquinolones
Rifampin
Chloramphenicol

22
Q

XX systemic antibiotics

A

Bacteria might not be suspectible
Staph = beta lactam, XX for penicillin, amoxicillin, ampicillin
Cephalosporins and potentiated amoxicillin are b lactamase resistant

23
Q

Duration of treatment

A

At least 3 weeks, 1 week beyond clinical resolution
Floroquinalones - reserve for resistant infections
Combo therapy is ideal method

24
Q

Treatment approach

A

Superficial pyoderma —> recurs after successful treatment —>investigate underlying causes
- allergic, parasitic, endocrine, chronic steroid use
- no cause = idiopathic recurrent pyoderma

25
Q

TX for idiopathic recurrent pyoderma

A
  1. Frequent and proactive use of topical antibacterial shampoos and/or solutions
  2. Immunotherapy with bacterial extracts (i.e. Staphage lysate) – not available now
  3. Intermittent systemic antibiotic treatment – controversial treatment
26
Q

Antibiotic resistant pyoderma

A

Lack of response + new lesions, spreading of old lesions, increased exudation
**time to perform a susceptibility test

27
Q

MSRP

A

Methicillin resistance staph Pseudointermedius
Resistant to ALL beta lactamase resistance antibiotics

28
Q

MDR

A

Multi drug resistant bacteria
Resistant to 3 or more classes of antibiotics

29
Q

MSPR is not the same as MRSA

A

MRSA - methicillin resistant staph aureus
Normal flora in humans/horses NOT dogs = can be zoonotic pyodermas

30
Q

Pemphigus foliaceus

A

Most common autoimmune skin disease in cats and dogs (horses)
Autoantibodies target desmosomes in superificial epidermis

31
Q

Breeds predisposed to pemphigus foliaceus

A

Dogs - GSD, chows, akitas - could be any
Cats - any breed

32
Q

Pathogenesis of pemphigus foliaceus

A

Autoantibodies
Neutrophils
Pustule + acantholytic keratinocytes

Erosion —> crust

33
Q

progression of pemphigus foliaceus lesion

A

Pustules in irregular shape —> erosion—> crust, most common lesion at presentation

34
Q

distribution of skin lesions in pemphigus foliaceus

A

Facial** bilaterally symmetrical
Nasal planum, nose bridge, periorbital, pinnae (convex or concave)
Feet
Generalized form

35
Q

DX for pemphigus foliaceus

A

Cytology
Bacterial culture
Biopsy

36
Q

Cytology findings for pemphigus foliaceus

A

nondegenerate neutrophils with acantholytic keratinocytes, no bacteria

37
Q

Findings for bactieral culture for pemphigus foliaceus

A

to rule out superficial pyoderma (take samples from intact pustules)

38
Q

Biopsy findings for pemphigus foliaceus

A

often diagnostic if appropriate samples taken (best = intact pustule, second best = lesion with crust, must include crust!)

39
Q

Treating canine pemphigus foliaceus

A

Oral glucocorticoids - prednisolone /prednisone
If not improvement add Azathioprine - ADR: hepatotoxicity, Myelosuppression monitor
Can add cyclosporine

40
Q

failed treatment of pemphigus foliaceus (+3months)

A

Time to refer to a dermatoplog

41
Q

Treating feline pemphigus foliaceus

A

Oral glucocorticoids - prednisolone
Cats do NOT tolerate azathioprine - due to Myelosuppression
Failed +3 m poor prognosis

SS - Exam 3 (28 decks)

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