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Dermatology > Pruritic Patient > Flashcards

Pruritic Patient Flashcards

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Dermatology Board Prep flashcards
1
Q

Definition of pruritus

A

unpleasant sensation in the skin that produces the desire to scratch

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2
Q

Scratching provides temporary relief but can lead to what?

A

skin damage and release of further inflammatory mediators

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3
Q

While dogs are often obvious about being itchy, cats may only show what?

A

excessive grooming (licking) – can lead to hair loss

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4
Q

If more than one condition is present, pruritus can be additive. True or false?

A

true

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5
Q

what are the major categories of pruritus (PAIN)

A 
P = parasites
A= allergic disease
I = infections and immune mediated
N = neurogenic and neoplastic diseases
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6
Q

What are the 8 major differential diagnoses for pruritus

A
  1. sarcoptic mange
  2. flea exposure +/- hypersensitivity
  3. pediculosis (lice)
  4. cheyletiella
  5. atopic dermatitis
  6. cutaneous food adverse reaction
  7. other external or internal parasites
  8. Malassezia dermatitis
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7
Q

which mite causes sarcoptic mange

A

sarcoptes scabei (burrowing)

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8
Q

3 characteristics of sarcoptic mange

A

contagious, zoonotic, intense pruritus

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9
Q

what reflex is present in 75-90% of sarcoptic mange cases

A

positive pinnal-pedal reflex

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10
Q

although the skin can often appear normal in sarcoptic mange cases, what type of lesions are very common

A

scaly erythematous papules

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11
Q

what pattern of distribution is seen with sarcoptic mange

A

ventral abdomen and thorax, feet, face, elbows and ear margins

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12
Q

which locations of infection are unique to sarcoptic mange (not seen in other allergic diseases)

A

elbows and ear margins

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13
Q

how is a definitive diagnosis of sarcoptic mange achieved

A

by finding mites or eggs on skin scrapings

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14
Q

why are at least 5 skin scrapings from pruritic areas necessary for diagnosing sarcoptes

A

difficult to find the mites, they may only be seen in 20% of cases… so even one mite or egg is diagnostic

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15
Q

what is often considered the most sensitive diagnostic test for sarcoptes

A

therapeutic trial

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16
Q

what are two treatments for sarcoptes

A

selamectin (revolution) or imidacloprid/moxidectin

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17
Q

true or false: other dogs in the home should be treated even if they don’t show clinical signs

A

true

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18
Q

how long can sarcoptes survive in the environment

A

6 days – may need to consider environment cleaning

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19
Q

which type of flea is most common to infest both cats and dogs worldwide

A

ctenocephalides felis

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20
Q

life cycle of the flea

A

adult life on the host, lays eggs eggs fall off and finish life cycle in the environment (3 larval stages and 1 pupal stage)

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21
Q

what two factors are required for flea development in environment

A

mild ambient temperatures and moderate humidity

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22
Q

which tapeworm is the flea an intermediate host for

A

dipylidium caninum

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23
Q

what can the flea act as a vector for

A

Bartonella sp., rickettsia sp. and hemoplasma

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24
Q

distribution of flea induced pruritus

A

lumbar inguinal and tail areas and thighs

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25
Q

clinical signs of flea infestation depend on what

A

whether animal is fleabite hypersensitive or not

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26
Q

clinical signs of a flea bite hypersensitive dog

A

severe pruritis in dorsocaudal area

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27
Q

clinical signs of a flea bite hypersensitive cat can manifest as pruritus and what 3 other signs

A

miliary dermatits, symmetrical self-induced alopecia and lesions of eosinophilic granuloma complex

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28
Q

diagnosis of flea infestation is made by

A

parting the hair or using a flea comb to observe fleas; may also observe flea dirt

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29
Q

how is “black peppery debris” confirmed to be flea feces

A

turns red when wet (dried blood)

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30
Q

topical insecticides for the treatment of adult fleas

A

selamectin and imidacloprid

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31
Q

oral insecticides for treatment of adult fleas

A

fluralaner (bravecto) and spinosad (comfortis)

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32
Q

what is in some canine products that is toxic to cats

A

permethrins

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33
Q

what products can be used to help eliminate fleas from the home more rapidly

A

insect development inhibitors (IDI) and insect growth regulators (IGR)

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34
Q

what do insect development inhibitors do

A

prevent normal development – prevents eggs from becoming viable

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35
Q

what do insect growth regulators do

A

mimic insect juvenile hormone (keep form developing into adult)

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36
Q

example of an oral IDI

A

lufenuron (Program)

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37
Q

example of an IGR

A

pyriproxifen (Advantage 2)

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38
Q

what does pediculosis refer to

A

lice infestation

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39
Q

life cycle of lice

A

14-21 d life cycle; only survive a few days off the host

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40
Q

anoplura refers to what kind of lice

A

sucking lice

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41
Q

mallophaga refers to what kind of lice

A

biting lice

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42
Q

linognathus setosus infests what animal

A

sucking louse of dogs

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43
Q

trichodectes canis infests what animal

A

biting louse of dogs

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44
Q

felicola subrostratuas infests what animal

A

biting louse of cats

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45
Q

distribution of lice

A

concentrate around body openings and ears… but can be found anywhere

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46
Q

what type of anti-parasiticide are lice very sensitive to

A

topical flea control products

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47
Q

how are lice diagnosed

A

by finding nits on hair shafts (cemented on) or by seeing the lice

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48
Q

what two methods are useful for finding nits

A

trichograms and clear tape preparations

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49
Q

treatment of lice

A

topical flea control product, repeat in 3-4 weeks, wash bedding and treat in contact animals

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50
Q

which animals do cheyletiella mites infest

A

dogs, cats, rabbits, people (ZOONOTIC)

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51
Q

where do cheyletiella mites live

A

surface keratin of the epidermis

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52
Q

how do you differentiate cheyletiella eggs from lice nits

A

cheyletiella eggs are LOOSELY attached to hairs

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53
Q

life cycle of cheyletiella

A

21 days; females live greater than 10 days off host

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54
Q

distribution of cheyletiella

A

dorsal trunk most commonly

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55
Q

which mite is a major problem in catteries

A

cheyletiella

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56
Q

diagnosis of cheyletiella

A

skin scrapings, clear tape impressions and flea combs in the highly scaly animal; fecal exam in a less scaly animal

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57
Q

which animal can it be difficult to diagnose cheyletiella in?

A

the over-grooming cat

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58
Q

treatment of cheyletiella

A

selamectin or imidacloprid+moxidectin

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59
Q

definition of atopic dermatitis

A

genetically predisposed inflammatory and pruritic allergic skin disease which characteristic clinical features associated with IgE antibodies most commonly directed against environmental allergens

60
Q

which four factors are involved in the pathogenesis of atopic dermatitis

A
  1. genetic factors
  2. barrier function
  3. immunologic factors
  4. allergens
61
Q

how do genetic factors play a role in atopic dermatitis

A

predisposition is inherited and likely polygenic

62
Q

how does barrier function play a role in atopic dermatitis

A

defective epidermal barrier

63
Q

how do immunologic factors play a role in atopic dermatitis

A

circulating allergen specific IgE leading to degranulation of mast cells in skin; Langerhans’ cells; T cells

64
Q

type 2 T helper cells are thought to do what in atopic dermatitis

A

drive the reaction against inappropriate harmless substances

65
Q

type 1 T helper cells are thought to contribute to what part of atopic dermatitis

A

persistent inflammation

66
Q

how are allergens likely absorbed in atopic dermatitis

A

through epidermal contact and absorption

67
Q

typical onset of canine atopic dermatitis

A

between 6 months and 3 years of age

68
Q

most consistent sign of canine atopic dermatitis

A

pruritus

69
Q

what areas of the body are typically affected by atopic dermatitis

A

face, feet and ventrum; ears are often inflamed.

70
Q

3 components to diagnose atopic dermatitis are:

A
  1. ruling out other skin conditions
  2. detailed interpretation of historical and clinical features (Favrot’s criteria)
  3. assessment of skin reactivity by intradermal testing or detection of IgE by allergen specific IgE testing
71
Q

Minimum data base to rule out other skin diseases in a pruritic patient

A

ectoparasite exam (flea exam, deep and superficial skin scraping, trichogram, clear tape preps treatment trial), skin cytology, +/- fungal culture

72
Q

8 components of Favrot’s criteria for canine atopic dermatitis

A
  1. age of onset
73
Q

how many components of Favrot’s criteria should be met to be “diagnostic” of atopic dermatitis

A

5 out of 8

74
Q

can Favrot’s criteria differentiate food induced and nonfood induced atopic dermatitis

A

no

75
Q

Criteria for feline nonflea-induced hypersensitivty dermatitis

A
  1. presence of at least 2 body sites affected
  2. presence of at least 2 of: symmetrical alopecia, miliary dermatitis, eosinophilic dermatitis, head and neck erosions/ulcerations
  3. presence of symmetrical alopecia
  4. presence of any lesions on lips
  5. presence of erosions or ulceration on chin or neck
  6. absence of lesions on the rump
  7. absence of nonsymmetrical alopecia on rump or tail
  8. absence of nodules or tumors
76
Q

allergy tests do not truly identify a patient as having AD, but instead identify

A

offending allergens for avoidance or immunotherapy

77
Q

true or false: allergy tests are useful for identifying food allergens

A

false

78
Q

two types of allergy tests

A

intradermal allergy testing and serum IgE testing

79
Q

which allergy test is considered gold standard

A

intradermal allergy test

80
Q

what does the intradermal allergy test detect

A

cell-bound allergen specific IgE in the skin

81
Q

what does serum IgE test for

A

allergen specific IgE levels in the blood

82
Q

advantages of serum IgE

A

convenience and widespread availability… different labs may have different results though

83
Q

are there drug withdrawals for serum IgE

A

no. some labs recommend withdrawal of corticosteroids though

84
Q

drug withdrawals for intradermal allergen testing

A

withdraw oral, topic and long acting injectable corticosteroids; also withdraw oral antihistamines

85
Q

two primary reasons for using allergy tests

A

to identify allergens that can be avoided and to allow for formulation for allergen-specific immunotherapy (ASIT)

86
Q

5 components of treating AD

A
  1. treat pruritus and inflammation
  2. treat and prevent secondary infections
  3. modify immune response (ASIT)
  4. improve permeability barrier
  5. eliminate or avoid allergens
87
Q

what four types of drugs are used to treat inflammation and pruritus in AD

A

corticosteroids, oclacitinib, antihistamines and calcineurin inhibitors

88
Q

how quickly do corticosteroids work against pruritus in AD

A

very rapidly

89
Q

3 common corticosteroids used

A

prednisone, prednisolone and methylprednisolone

90
Q

what are side effects of corticosteroids related to

A

dose

91
Q

what are 3 common side effects of corticosteroids

A

PU/PD/PP

92
Q

what are some differences regarding treating cats with corticosteroids

A

cats require higher dosages, prednisolone rather than prednisone and some may respond better to dexamethasone

93
Q

are long acting injectable corticosteroids useful in treating AD

A

no (rare exceptions)

94
Q

what risks are associated with long acting injectable corticosteroids

A

diabetes, UTI and in cat, life threatening cardiac effects

95
Q

example of a calcineurin inhibitor

A

cyclosporine (atopica)

96
Q

how quickly does cyclosporine work on pruritus

A

slower acting; may require a month

97
Q

when would you rather use a corticosteroid than cyclosporine

A

in acute flareups

98
Q

when would you rather use cyclosporine than a corticosteroid

A

when you need more chronic use

99
Q

most common adverse effects of cyclosporine

A

vomiting and diarrhea

100
Q

what is associated with chronic use of cyclosporine

A

gingivial hyperplasia

101
Q

what should you test cats for prior to using cyclosporine

A

FIV and FeLV

102
Q

what is topical tacrolimus

A

a calcineurin inhibitor

103
Q

what is oclacitinib (apoquel)

A

a janus kinase inhibitor (JAK)

104
Q

what is oclacitinib used for

A

treatment or control of pruritus associated with allergic dermatitis and control/treatment of AD in dogs 12 months of age or older

105
Q

benefit of oclacitinib

A

rapid antipruritic effect

106
Q

what is long term oclacitinib associated with

A

development of UTI, vomiting, otitis, pyoderma and diarrhea…. but in 5-10% of dogs so pretty rare

107
Q

where do antihistamines work

A

for treatment of mild skin lesions or in combination with corticosteroids

108
Q

which two antihistamines work

A

hydroxyzine and cetirizine

109
Q

vanectyl-P contains what

A

trimeprazine and prednisolone

110
Q

how does shampooing help atopic dogs

A

removing allergens, physically soothing skin, and reducing secondary infections

111
Q

what infections are commonly seen with AD

A

skin and ear infections

112
Q

what do some AD dogs develop a hypersensitivity to

A

malassezia or staphylococcus

113
Q

what can be useful for patients presenting with pruritus and recurring infections

A

antimicrobial shampoo

114
Q

types of antimicrobial topical products

A

chlorhexidine shampoo, benzoyl peroxide shampoo, mupirocin, fucidic acid

115
Q

antifungal shampoos

A

micoconazole, ketoconazole, enilconazole

116
Q

what is allergen-specific immunotherapy (ASIT)

A

practice of administering gradually increasing quantities of an allergen extract to an allergic subject to ameliorate the signs associated with subsequent exposure to causative allergen

117
Q

how can ASIT be administered

A

subcutaneous injection or oral

118
Q

when is improvement expected with ASIT

A

in 6-9 months… may take a year

119
Q

why should ASIT be given for life?

A

permanent remissions are uncommon

120
Q

side effects of ASIT

A

rare but most common is increased pruritus

121
Q

benefit of ASIT

A

only treatment that has the potential to bring about a cure or long-term remission

122
Q

methods to improve the permeability barrier

A

essential fatty acids and topical lipid formulations

123
Q

how does omega-3 FA work

A

directing fatty acid metabolism towards the production of less inflammatory eicosanoids

124
Q

how does omega-6 work (linoleic acid)

A

important for epidermal lipid barrier

125
Q

two benefits of EFA

A

direct FA metabolism towards less inflammatory eicosanoids and improve epidermal lipid barrier function

126
Q

methods to eliminate/avoid allergens

A

washing bedding weekly, remove wool, frequent bathing/rinsing

127
Q

most common allergen for dogs with AD

A

house dust mite allergen

128
Q

definition of adverse food reactions

A

repeatable adverse reactions to specific dietary components that respond to exclusion of causative agent

129
Q

difference between food allergy and food intolerance

A

food allergy is immune mediated

130
Q

GI signs seen with food allergies

A

diarrhea, vomiting, flatulence, increased number of stools per day

131
Q

most common distribution of food allergy pruritus

A

perianal region and ears

132
Q

diagnosis of food AD

A

very strict hypoallergenic diet trial lasting a minimum of 8 weeks

133
Q

most common allergens for dogs with food induced AD

A

beef, dairy and wheat

134
Q

most common allergens for cats with food induced AD

A

beef dairy and fish

135
Q

how do hydrolyzed protein diets work

A

proteins are smaller than the typical size required by the immune system to mount an IgE-triggered reaction

136
Q

most common location of malassezia

A

face and feet

137
Q

diagnosis of malassezia

A

skin surface cytology

138
Q

what should you think of first with pinnal-pedal reflex

A

sarcoptes

139
Q

what should you think of first with lesions on ear margins, elbows and hocks

A

sarcoptes

140
Q

what should you think of first with perianal pruritus

A

adverse food reaction/food induced AD

141
Q

what should you think of first with GI signs and pruritus –

A

food induced AD

142
Q

what should you think of first with “Below the Belt” pruritus

A

flea allergy dermatitis

143
Q

what should you think of first with blepharitis, conjunctivitis, sneezing and reverse sneezing

A

atopic dermatitis

144
Q

what should you think of first with pruritus of the dorsal trunk and scaling

A

cheyletiella

145
Q

what should you think of first with brown discoloration of skin (especially in the interdigital region)

A

malassezia

Dermatology (10 decks)

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