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Pyoderma Flashcards

1
Q

Pyoderma is almost always….

A

Folliculitis

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2
Q

Top 3 causes of folliculitis

A

Pyoderma
Demodex
Ringworm

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3
Q

What species is bacterial folliculitis and furunculosis common?

A

Canine

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4
Q

What species is cellulitis and abscesses most common?

A

Feline

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5
Q

What is folliculitis?

A

Inflammation of hair follicle
Inflammation of superficial epidermis

Note: cats do not get true folliculitis

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6
Q

Why do pyodermas develop?

A

Usually secondary to an underlying disease process

Think: allergies or endocrine

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7
Q

Resident skin bacteria

A

Staphylococcus sp.
Micrococcus sp.
Streptococcus sp.
Acinetobacter sp.

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8
Q

Transient skin organisms

Gram (-)

A

E. coli
Proteus mirabilis
Pseudomonas sp.

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9
Q

Transient skin organisms

Gram (+)

A

Staph sp.
Corynebacterium sp.
Streptococcus sp.

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10
Q

Transient skin organisms

What do they do?

A

May colonize abnormal skin surfaces

Generally do not penetrate and cause infection directly

May become secondary invaders to Staph (already infected skin; especially deep infections)

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11
Q

Pathogenic coagulase positive Staphylococci

Types

A

Staph. pseudointermedius (most common)

Staph. schleiferi (second most common)

Rarely Staph. aureus

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12
Q

Pathogenic coagulase positive Staphylococci

Resistance

A

Penicillin

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13
Q

What is MRSP?

A

Methicillin-resistant Staph. pseudointermedius

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14
Q

Natural barrier to infection

Physical

A

Stratum corneum
Hair

Has normal flora

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15
Q

Natural barrier to infection

Physiologic

A

Skin cell turnover rate

Sebaceous gland/Sebum (has antimicrobial properties)

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16
Q

Natural barrier to infection

Immunologic

A

Langerhans’ cells (antigen presenting cells; helps prevent infection)
Lymphocytes
Sweat

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17
Q

What does pyoderma do to natural barrier functions?

A

Alters it:
Micro-environment of skin (skin folds)
Suppresses immune system (endocrine, steroids)

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18
Q

Pathogenic bacteria mechanism

A

Adhere to skin, colonize, and infect abnormal skin

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19
Q

Surface pyoderma

What is it?

A

Bacterial overgrowth

Skin erosions (surface irritation or trauma) with secondary adherence and colonization of abnormal skin surface by coagulase positive Staph

No inflammation

NOT folliculitis

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20
Q

Skin fold dermatitis

Pathophyisology

A

Surface pyoderma

Anatomical defects create warm moist environment for bacterial adherence and colonization

Accumulation of tears, sebum, urine

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21
Q

Skin fold dermatitis

Clinical Sings

A

Surface pyoderma

Erythema
Alopecia
Exudation within skinfolds
\+/- pruritic 
Odor
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22
Q

Skin fold dermatitis

Types

A

Surface pyoderma

Facial fold
Lip fold
Vulvar fold
Tail fold
Mammary fold 
Obesity fold
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23
Q

Skin fold dermatitis

Diagnosis

A

Surface pyoderma

History
PE
Scrape
Surface cytology (tape, cotton swab, impression) 
Response to treatment
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24
Q

Skin fold dermatitis

Treatment (broad)

A

Surface pyoderma

Goal: keep folds dry

If deep lesions present may have to use antibiotics

Do NOT use steroids

Usually: shampoos, wipes, sprays, mousse, ointment

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25
Skin fold dermatitis | Treatment: topical antibacteirals
Surface pyoderma Chlorhexidine Mupirocin ointment Benzyl peroxide
26
Skin fold dermatitis | Treatment: Antifungal
If cytology reveals yeast Combination products with antibacterials: MalaKet, MiconaHexTriz, etc.
27
Pyotraumatic dermatitis | What is it?
Surface pyoderma Hotspot Acute moist dermatitis
28
Pyotraumatic dermatitis Signalment Clinical Signs
Surface pyoderma ``` Thick coated, long haired Alopecia Erythema Exudation Ulceration Lesion well demarcated from normal skin Pruritus Pain ```
29
Pyotraumatic dermatitis | Pathophysiology
Surface pyoderma Self trauma Rule out underlying causes (fleas, allergies, ectoparasites)
30
Pyotraumatic dermatitis | DfDx
Demodex
31
Pyotraumatic dermatitis | Diagnosis
PE Skin scraping (rule out demodex) Cytology Response to treatment Note: lesions around face are usually deep lesions and not hotspots
32
Pyotraumatic dermatitis | Treatment (broad)
Treat underlying cause (ex. flea control) Clip and clean
33
Pyotraumatic dermatitis | Treatment: Antibacterials
Usually topical Only have to do systemic antibacterials for deep infections Chlorhexidine (spray, wipes, shampoo, mousse) Mupirocin ointment
34
Pyotraumatic dermatitis | Treatment: Antipruritics
Topical anesthesia (lidocaine, paramoxine) Oral steroid Cytopoint Apoquel
35
Superficial pyoderma | What is it?
Infection restricted to under the stratum corneum or within the ostia of the hair follicles
36
Impetigo | What is it?
Superficial pyoderma Puppy Pyoderma Infection just beneath stratum corneum of the non-haired areas (axillae and inguinal region)
37
Impetigo | Underlying causes
Superficial pyoderma Parasitism Viral infections Dirty environment Poor nutrition
38
Impetigo | Clinical Signs
Superficial pyoderma Papules, pustules, crusts, epidermal collarettes, crusted papules, hyperpigmented macules Pruritus variable Axillae and inguinal regions main affected areas
39
Impetigo | Signalment
Superficial pyoderma Less than 1 year of age
40
Impetigo | Diagnosis
Superficial pyoderma ``` History, PE Epidermal collarettes! Skin scraping (rule out demodicosis) Cytology; neutrophils with cocci Response to treatment (if it does not respond to treatment think underlying food allergies) ```
41
Impetigo | DfDx
Demodicosis | Dermatopytosis
42
Impetigo | Treatment
Can be a self-limiting disease Topical: chlorhexidine, mupirocin ointment Systemic anitbiotics for 3 weeks
43
Folliculitis (KNOW) | What is it?
Superficial bacterial folliculitis typically referred to as pyoderma Infection starts in ostia (enterance into hair follicle) and spreads outward under the stratum corneum
44
Folliculitis (KNOW) | Clinical Signs
Superficial pyoderma Papules, pustules, crust! Epidermal collarettes Patchy alopecia (mouth-eaten) +/- pruritus (irritation, usually secondary to underlying disease; allergies, ectoparasites)
45
Folliculitis (KNOW) | Cause
Superficial pyoderma Usually secondary to underlying disease process Think: allergies or endocrine
46
Papules and pustules think X until proven otherwise
Folliculitis
47
Folliculitis (KNOW) | Distribution of lesion
Superficial pyoderma VENTRUM (chest, abdomen) Axillae Inguinal region Focal, multifocal, or generalized Usually spares legs and head
48
Folliculitis (KNOW) | If pruritus rsolves with antibiotics than...
True folliculitis and steroids are contraindicated Do NOT give steroids until have a diagnosis
49
Folliculitis (KNOW) | Pathophysiology
Superficial pyoderma Something has altered the natural barrier to infection Frequently secondary to underlying cause (allergies or endocrine)
50
Folliculitis (KNOW) | Pruritic causes
Allergies (flea, food, atopy) Parasites (scabies, chyeletiellosis) Skin fold
51
Folliculitis (KNOW) | Nonpruritic causes
Parasites (demodex) | Endocrine (Hypothyroidism, Cushing's)
52
Folliculitis (KNOW) | Other causes
``` Chronic steroid administration Immune dysfunction Malnutrition Environmental factors Frequent bathing High-humidity Poor grooming ```
53
Folliculitis (KNOW) | DfDx
Must rule out: Demodicosis Dermatophytosis Others: Sterile folliculitis (eosinophilic folliculitis) Autoimmune (pemphigus foliaceus)
54
Folliculitis (KNOW) | Diagnosis
Pyoderma = clinical diagnosis History and PE Skin scrapings (rule out demodex) Cytology: neutrophils with or without cocci (taken from intact pustules, crust, epidermal collorette) Fungal culture; rule out dermatophytosis Response to treatment (should respond to antibacterials)
55
Folliculitis (KNOW) | Treatment: avoid
Do NOT used steroids (or combination products with steroids)
56
Folliculitis (KNOW) | Treatment: Focal
Topical: chlorhexidine or mupirocin 2-3 weeks Shampoos Medicated wipes Sprays Mousse
57
Folliculitis (KNOW) | Treatment: Multifocal
Topical | +/- systemic antibiotics
58
Folliculitis (KNOW) | Treatment: Generalized
Systemic antibiotics 1-2 weeks beyond clinical resolution! (3-4 weeks total) Avoid undertreatment; starting to see resistance
59
First Tier Class Antibiotics (KNOW) | When to use them
If no prior history of antibiotics used OR If previous empirical treatment was effective
60
Beta-lactam Antibiotics | Examples
First tier class antibiotics Cephalexin (1st generation); best choice Cefpodoxime (Simplicef) (3rd generation) Cefovecin (Convenia) (3rd generation) Amoxicillin with clavulante (Clavamox); high dose of 20 mg/kg q12 but should avoid using
61
Folliculitis | Reasons for treatment failure
``` Resistance Wrong diagnosis (demodex, dermatophytosis, autoimmune) Wrong antibiotic or wrong dose Too short of a course of antibiotics ``` Failure to identify underlying cause (allergy or endocrine)
62
Folliculitis (KNOW) | Culture?
Reconsider DfDx first When there is no response to first tier or empirical treatment Deep pyodermas Cytology reveals mixed infection (rods and cocci) Immunosuppression
63
Folliculitis (KNOW) | Culture interpretation
Make sure you have cultured staphylococcal organism, especially Staph. pseudintermedius or S. schleiferi Resistance to oxacillin = resistance to methicillin = resistance to beta-lactam antibiotics = MRSP/MRSS
64
``` Second tier class antibiotics When to use ```
ONLY use based off of C/S results
65
``` Second tier class antibiotics Examples ```
``` Fluoroquinolones Clindamycin TMS Doxycycline Rifampin Amikacin Chloramphenicol ``` If focal try topical; if getting worse give systemic treatment Must be on antibiotics for 3-4 weeks (must re-check)
66
``` Third tier class antibiotics When to use ```
Should not be used for ethical reasons! Reserved for humans and treatment of MRSA
67
``` Third tier class antibiotics Examples ```
Linezolid | Vancomycin
68
Mucocutaneous pyoderma | What is it?
Superficial pyoderma affecting the lips and perioral skin Usually staph infection
69
Mucocutaneous pyoderma | Clinical Signs
Swelling and erythema of lips, especially commissures Crusting and fissuring may follow Similar lesions may occur at nares, medial canthus, vulva, prepuce, anus Hypopigmentation may be seen Seen most commonly in GSD
70
Mucocutaneous pyoderma | Pathophyisology
Unknown! Does not originate from lip folds
71
Mucocutaneous pyoderma | DfDx
Demodicosis Autoimmune (discoid lupus erythematosus, pemphigus) Lip fold dermatitis
72
Mucocutaneous pyoderma | Diagnosis
PE Skin scraping Cytology; bacteria and if not than maybe Lupus Culture
73
Mucocutaneous pyoderma | Treatment
AVOID steroids Topical antibacterials: mupirocin, chlorhexidine Systemic antibiotics; 3-4 weeks Look for underlying disease; allergies or endocrine
74
Deep pyoderma | What is it?
Deep infections of deeper regions of the hair follicle, dermis, and subcutis Includes deep folliculitis/furunculosis and cellulitis Less common than superficial pyoderma; can occur in conjunction with
75
``` Deep pyoderma Diagnostic approach (broad) ```
ALWAYS CULTURE May be Staph or gram (-) bacteria (Pseudomonas)
76
Furunculosis | What is it?
Nodular dermatitis secondary to bacterial infection deep in a hair follicle (deep folliculitis) and subsequent rupture of that follicle (furunculosis) Rare in cats!
77
Furunculosis | Pathophysiology-Causes
Pyodermas are secondary to an underlying disease! Starts superficial than moves deeper ``` Allergies (flea, food, atopy) Endocrine (hypothyroidism, Cushing's) Ectoparasites Inappropriate use of corticosteroids Inappropriate antibiotic therapy Poor nutrition Foregin body Immune dysfunction ```
78
Furunculosis | Pathophysiology-What occurs
Hair follicle ruptures (furunculosis) and releases bacteria, hair, and follicular keratin into the dermis that insights a pyogranulomatous inflammatory reaction Bacteria present usually Staph. pseudintermedius Can also be: Proteus, Pseudomonas, E. coli
79
Furunculosis | Clinical Signs
``` Papules Nodules Hemorrhagic bullae or vesicles Draining lesions Cellulitis Lymphadenopathy Systemic illness ```
80
Furunculosis | DfDx
``` Demodicosis Fungal infections Foreign body Sterile Neoplasia ```
81
Furunculosis | Diagnosis
``` History and PE Skin scraping (rule out demodex) ``` Cytology: Pyogranulomatous inflammation +/- cocci with or without rods Culture and Sensitivity! need a sterile punch biopsy; collect with sterile instruments and put in a red top with saline Do NOT swab surface; not helpful
82
Furunculosis | Kinds
Canine acne Nasal pyoderma Interdigital pyoderma Hot spot pyoderma/pyotraumatic folliculitis/furunculosis
83
Furunculosis | Treatment
Based on C&S results: Systemic antibiotics: 6-12 weeks! 2 weeks past clinical remission Look for underlyin gcuase of pyoderma (allergies? endocrine?) Topical antibacterial shampoo (chlorhexidine)
84
Canine acne | Breeds
Furunculosis Doberman Great Dane English bulldogs Boxer
85
Canine acne | Location
Furunculosis Chin Muzzle
86
Canine acne | Cuase
Furunculosis Trauma? Genetics? Puberty?
87
Canine acne | Treatment
Furunculosis Topical or systemic antibiotics in more severe cases
88
Interdigital pyoderma
Furunculosis ``` Commonly seen in many disease processes: Allergic disease Parasitic disease (Demodex!) Infectious diseases (fungal) Endocrine diseases Sterile (rare) Foreign bodies (generally rare) ```
89
Interdigital pyoderma | Lesions
Furunculosis ``` Papules Nodules Vesicles Bullae Draining lesions ```
90
Hot spot pyoderma | AKA
Pyotraumatic folliculitis/furunculosis
91
Hot spot pyoderma | What causes this?
Scratching! Secondary allergies can be the underlying cause
92
What disorder is caused by dog biting at themselves?
Pyotraumatic dermatitis
93
Hot spot pyoderma | Lesions
Plaque-like alopecia "Satellite" papule lesions Look at ears Usually seen around face and neck

Dermatology (13 decks)

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