Patient with Greasy or Scaling Skin

Question 1

Ddx for scaling or greasy skin

Answer 1

malassezia
sebaceous adenitis
keratinization disorders including primary idiopathic seborrhea
pyoderma/bacterial overgrowth
demodicosis
dermatophytosis
Vitamin-A responsive dermatosis
endocrine skin disease
Cheyletiella
ichthyosis
cutaneous lymphoma
paraneoplasic disorders

Question 2

what are the classifications of seborrhea?

Answer 2

seborrhea sicca
seborria oleosa
seborrheic dermatitis

Question 3

what will often accompany oily and flaky hair

Answer 3

pruritus

odor

Question 4

The most important diagnostic tests for greasy and scaly skin

Answer 4

skin scrapings

cytology

Question 5

The three ddx for crusting that can cause scaling and greasy skin

Answer 5

pyoderma
demodicosis
dermatophytosis

Question 6

etiology of malassezia

Answer 6

malassezia pachydermatitis

Question 7

malassezia is symbiotic with …

Answer 7

staph

Question 8

what is malass results due to?

Answer 8

overproliferation of yeast on the skin –> just on the skin –> causes inflamm, hypersen rxn –> atopic signs

Question 9

Malass thrives when

Answer 9

high humidity
skin folds
greasy skin
staph overgrowth areas

Question 10

breeds predisposed to malass

Answer 10

shih tzus, lhasa apsos, basset hounds, devon rex cats

Question 11

Underlying disease that predisposes to malass

Answer 11

AD, pyo
seborrheic diseases
endocrine diseases

Question 12

clinical features of malass

Answer 12

can be gen or localized

pruritus

Question 13

locations of malass

Answer 13

feet, lip folds, nailbeds, ventral neck, and other folds

Question 14

Malass can often cause

Answer 14

otitis externa

Question 15

additional clinical features of generalized malass

Answer 15

erythematous
greasy
scaly
crusty

this is the corn chips one

Question 16

Dx of malass

Answer 16

cytology
tape technique
1 or more organisms there significant
NOT fungal cultures
biopsies are not sensitive, not specific

Question 17

Tx of malass

Answer 17

anti-fungal shampoos
systemic and topical is good. 
Ketoconazole for 7 days after cure
itraconazole
fluconazole
terbinfafine

Question 18

Warning when treating for malass

Answer 18

if lethargy or inappetance, stop therapy immediately

Some people will do pre-treatment tests

Question 19

Drugs that ketoconazole interacts with

Answer 19

ivermectin

cyclosporine

Question 20

GSA (granulomatous Sebaceous Adenitis) cause and effect

Answer 20

idiopathic and heritable

progressive destruction of the sebaceous glands and loss of sebum production –> derm findings

Question 21

Breeds targeted by GSA

Answer 21

Standard poodle
saoyed
akita

autosomal recessive thing

Question 22

CLinical signs of GSA

Answer 22

progressive areas of hair loss, poor hair coat, dry hair, excessive scaling, follicular plugging, casts
Mild Pruritus
pyoderam as a secondary

Question 23

DDx for GSA

Answer 23

endocrine disease like hypothyroidism

Question 24

Dx of GSA

Answer 24

characteristics inflammatory pattern
absence of sebaceous glands
skin biopsies

Question 25

Tx of GSA

Answer 25

aim for restore oil to the skin
FA supplementation
bath oil to wet skin 30 min before shampooing once per week
AD doses of cyclosporine
NOT steroids

Question 26

Keratinization disorders are called

Answer 26

primary seborrhea

Question 27

Keratinization dosirder of cocker spanial

Answer 27

primary idiopathic seborhhea - because of the 8 day renewal time, not 21

Question 28

Clinical signs of primary seborrhea

Answer 28

dull coat
excessive flaking
greasy malodorous skin
otitis externa
digital hyperkeratosis
brittle claws
Secondary malass and pyoderma sometimes

Question 29

Dx of primary seborrhea

Answer 29

not curable
shampoos and conditioners
Omega-3,6 FA
Synthetic retinoids - do the Schirmer tests when on this though

Question 30

Vitamin A-responsive dermatosis is characterized by…

Answer 30

marked follicular plugging

hyperkeratotic plaques

Question 31

Dx of Vit A responsive dermatosis

Answer 31

histopathology

response to vitamin A