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Dermatology > Pyoderma > Flashcards

Pyoderma Flashcards

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1
Q

How common are folliculitis/furunculosis in dogs vs cats?

A
  • Common in dogs

- True folliculitis and furunculosis are uncommon in cats

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2
Q

What causes folliculitis and furunculosis in dogs?

A
  • Usually secondary to underlying disease like allergies or endocrine
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3
Q

What causes cellulitis and abscesses most commonly in cats?

A
  • Bite wounds
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4
Q

Name 4 normal residents of the skin

A
  • Staphylococcus sp (coagulase negative and positive)
  • Micrococcus sp
  • Streptococcus sp
  • Acinetobacter sp
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5
Q

Transient flora - what do they do?

A
  • Colonize abnormal skin
  • Generally do not penetrate and cause infection
  • Often secondary to Staph infected skin
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6
Q

Examples of gram neg transient organisms?

A
  • E. coli
  • Proteus mirabilis
  • Pseudomonas
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7
Q

Examples of gram pos transient organisms?

A
  • Staph sp (coagulase positive and negative)
  • Corynebacterium sp
  • Streptococcus
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8
Q

Which type of Staph are we most concerned about with skin infections?***

A
  1. Staph pseudintermedius**
  2. Staph. schleiferi (coagulase positive)*
  3. Rarely Staph aureus (think horses and humans)
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9
Q

What should you think if you culture Staph aureus from a skin sample of a dog?

A
  • THINK contamination
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10
Q

Normal resistance mechanism of Staph and implications for antibiotic choice

A
  • Beta-lactamase positive

- Any of the -cillins are ineffective

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11
Q

How long does it take for cells from the stratum basal to turnover and go the stratum corneum again?

A
  • 21 days to turn over
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12
Q

How do keratinocytes help with infection prevention?

A
  • Very tightly packed together

- Langerhans are the surveillance cells to prevent infection

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13
Q

MRSP

A
  • Methicillin-resistance Staph pseudintermedius

- Growing concern in dogs and cats

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14
Q

Skin’s physical barrier to infection

A
  • Stratum corneum, hair
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15
Q

Skin’s physiologic barrier to infection

A
  • Skin cell turnover rate, sebum
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16
Q

Immunologic barriers to infection in skin

A
  • Langerhans’ cells
  • Lymphocytes, etc.
  • Sweat
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17
Q

Bacterial barriers to infection in skin

A
  • Normal bacterial flora
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18
Q

What three types of disease process can happen that predispose to pyodermas?

A
  1. Alteration of barrier function (e.g. allergies)
  2. Alters microenvironment of the skin
  3. SUppresses the immune system
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19
Q

How do pathogenic bacteria invade?

A
  • Adhere to skin, colonize, then infect abnormal skin
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20
Q

What layer is below the dermis?

A
  • Panniculus
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21
Q

What is surface pyoderma?

A
  • SKin erosions with secondary adherence and colonization of abnormal skin surface by coagulase positive staph
  • NOT folliculitis
  • Surface irritation
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22
Q

Is surface colonization folliculitis?

A
  • No
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23
Q

Pathophysiology of skin fold dermatitis

A
  • Anatomical defects create warm moist environment for bacterial adherence and colonization
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24
Q

Clinical signs of skin fold dermatitis

A
  • Erythema, alopecia, exudation within skin folds
  • May be pruritic
  • Have offense odor
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25
Q

Types of skin fold dermatitis

A
  • Facial fold
  • Lip fold
  • Vulvar fold
  • Tail fold
  • Mammary fold
  • Obesity fold
  • Body fold
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26
Q

Differentials for skin fold dermatitis?

A
  • Malassezia

- Is it surface colonization or deeper? Did pruritus come first? What is colonizing the surface?

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27
Q

Diagnosis of skin fold dermatitis?

A
  • History
  • PE
  • Scrape
  • Surface cytology (“tape”, cotton swab, or impression)
  • response to treatment
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28
Q

How do you treat skin fold dermatitis?

A
  • many can be managed medically with shampoos, wipes, sprays, mousse, ointment
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29
Q

Products to use for skin fold dermatitis

A
  • Topical abx such as chlorhexidine, mupirocin ointment, benzoyl peroxide
  • Topical antifungal if cytology reveals yeast
  • Antifungal/antibacterial combination products
  • DO NOT use combo produtcs with steroids!
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30
Q

Appearance of malassezia?

A
  • Little bowling balls
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31
Q

Other treatments for skin fold dermatitis

A
  • Weight reduction if obese (vulvar fold, mammary fold)
  • Keep fold dry!
  • May need systemic antibiotics (deeper infection implied!)
  • Surgery
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32
Q

What is a true hotspot?

A
  • Pyotraumatic dermatitis
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33
Q

SIgnalment of pyotraumatic dermatitis or hospots

A
  • Thick coated, long haired breeds
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34
Q

Clinical signs of pyotraumatic dermatitis

A
  • Alopecia, erythema, exudation, ulceration
  • Lesion is well demarcated from normal skin
  • Pruritus and pain
  • SUmmer months on caudal dorsal back (think flea allergy)
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35
Q

Pathophysiology of pyotraumatic dermatitis

A
  • Self trauma

- Rule out underlying causes - why is the dog scratching?

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36
Q

What should you be considering with pyotraumatic dermatitis as a idfferential?

A
  • Fleas #1
  • Allergies
  • Other ectoparasites (e.g. demodex)
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37
Q

2 questions you must answer to diagnose pyotraumatic dermatosis

A
  • Is this a surface colonization or deeper infection? (lesions around the face are usually deep lesions, not true hotspots)
  • If surface, is it colonized by a bacteria or yeast?
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38
Q

Diagnosis of pyotraumatic dermatitis

A
  • PE
  • SKin scraping (r/o demodicosis)
  • Cytology
  • response to treatment
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39
Q

Treatment of pyotraumatic dermatitis

A
  • Treat underlying cause for pruritus (e.g. flea control!)
  • Clip and clean
  • TOpical antibiotics
  • Astringents
  • Antipruritus
  • True surface colonization does not require systemic antibiotics, but most are no true surface infections
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40
Q

Abx to use for pyotraumatic dermatitis?

A
  • Chlorhexidine (spray, wipes, shampoo, mousse)

- Mupirocin ointment

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41
Q

Antipruritics to use for pyotraumatic dermatitis

A
  • Topical anesthetics (lidocaine, pramoxine)
  • Oral steroids
  • Cytopoint
  • APoquel
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42
Q

Definition of superficial pyoderma

A
  • Infection restricted to under the stratum corneum or within the ostia of the hair follicles
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43
Q

What is impetigo?

A
  • Puppy pyoderma
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44
Q

Where is the infection (in the dermis and distribution) with impetigo?

A
  • Just beneath the stratum corneum of the non-haired areas

- AXILLAE and inguinal region

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45
Q

Underlying causes for impetigo

A
  • Parasitism
  • Viral infections
  • Dirty environment
  • Poor nutrition
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46
Q

Are dogs with impetigo usually pruritic?

A
  • Not usually
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47
Q

Lesions in dogs with impetigo

A
  • Papules
  • Pustules
  • Crusts
  • Epidermal colarettes
  • Crusted papules
  • Hyperpigmented macules
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48
Q

Distribution of lesions with impetigo

A
  • Axilla and inguinal region
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49
Q

Age of dogs with impetigo

A
  • <1 year of age
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50
Q

What should you think if impetigo recurs?

A
  • Food allergies

- It’s not normally recurring

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51
Q

Diagnosis of impetigo

A
  • Hx, physical exam
  • Scrapings to rule out demodicosis
  • Cytology shows neutrophils with bacterial cocci
  • Response to tx
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52
Q

Dfdx for impetigo

A
  • Demodicosis and dermatophytosis
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53
Q

Treatment for impetigo

A
  • Can be self limiting
  • Topical (chlorhexidine or mupirocin ointment)
  • Systemic antibiotics
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54
Q

What is folliculitis/

A
  • Superficial bacterial folliculitis

- This is often referred to as pyoderma

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55
Q

Where does folliculitis start?

A
  • Ostia of a hair follicle and spread outward under the stratum corneum
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56
Q

Ostia

A

= Entrance of the hair follicle

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57
Q

Clinical signs of folliculitis

A
  • Papules, pustules, crust, epidermal collarettes, patchy alopecia (“moth-eaten” especially in short coated breeds which can be mistaken for hives
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58
Q

Distribution of folliculitis lesions

A
  • VENTRUM!**
  • Ventral chest
  • Axillae
  • Ventral abdomen
  • Inguinal region
    Can be dorsum and trunk
    Usually spares legs and head
59
Q

Pruritus with folliculitis

A
  • Variable
  • Not to the point where he would use steroids usually
  • May be hypersensitivity to a component of bacteria
  • May be irritating
  • May have concurrent or underlying allergy
  • May have ectoparasites
60
Q

Should you always use steroids with pruritic folliculitis?

A
  • No

- Steroids would be contraindicated if pruritus resolves with antibiotics

61
Q

Pathophysiology of bacterial folliculitis

A
  • Something has altered the natural barrier to infection; frequently secondary to underlying cause (often allergies and endocrine)
62
Q

Pruritic causes of bacterial folliculitis

A
  • Allergies (flea, food atopy)

- Parasites (scabies, cheyletiellosis)

63
Q

Non-pruritic causes of bacterial folliculitis

A
  • Parasites (demodex)

- Endocrine (hypothyroidism, Cushing’s)

64
Q

Other possible causes of non-pruritic bacterial folliculitis

A
  • Chronic steroid administration
  • Immune dysfunction
  • Malnutrition
  • Environmental factors
  • Frequent bathing
  • Hihg-humidity
  • Poor grooming
65
Q

Differentials for bacterial folliculitis (MAJOR and other)

A
  • Major: Demodicosis or dermatophytosis

- Sterile folliculitis or autoimmune (pemphigus foliaceus)

66
Q

Diagnosis of bacterial folliculitis?

A
  • History and PE (CLINICAL DX)
  • Skin scrapings to r/o demodex
  • Cytology shows neutrophils with or without bacterial cocci
  • Fungal culture (dermatophytosis is uncommon but never wrong to fungal culture)
  • Response to tx
  • Bacterial culture if resistance is suspected
67
Q

What should you think with papules, pustules, and crusts on the ventrum?

A

Pyoderma

68
Q

Skin biopsy for follicultiis?

A
  • SHouldn’t be necessary for diagnosis of superficial pyoderma
69
Q

What is superficial folliculitis (epidermal collarettes) often misdiagnosed as?

A
  • Dermatophytosis
70
Q

Distribution of superficial bacterial folliculitis?

A
  • Focal
  • Multifocal
  • Generalized
71
Q

Cytology sample for superficial bacterial pyoderma

A
  • Intact pustules
  • Crust
  • Epidermal collarettes
72
Q

What is the definition of pyoderma on cytology?

A
  • Neutrophils (with bacteria is ideal
73
Q

Should you use steroids for superficial bacterial pyoderma?

A
  • DO NOT USE
74
Q

Treatment for superficial bacterial pyoderma (focal)?

A
  • Focal - topical (chlorhexidine or mupirocin) until infeciton/lesions resolve (e.g. 2 weeks)
75
Q

Treatment for superficial bacterial pyoderma (multifocal)?

A
  • Topical +/- systemic antibiotics
76
Q

Treatment for superficial bacterial pyoderma (generalized)?

A
  • Systemic antibiotics +/- topical
77
Q

How long to treat with systemic antibiotics for superficial bacterial pyoderma

A
  • 1-2 weeks beyond clinical resolution
  • usually 30 days/3-4 weeks total
  • D o not undertreat or underdose
78
Q

Do the different % of chlorhexidine matter for skin stuff?

A
  • not as much
79
Q

What are the first tier class antibiotics?

A
  • Beta lactams
  • Cephalexin
  • Cefpodoxime
  • Cefovecin (Convenia)
  • Amoxicillin with clavulanate - he doesn’t use this
80
Q

Topical types

A
  • Shampoos
  • Medicated wipes
  • Sprays
  • Mousse
  • Leave on conditioners
81
Q

How to decide which type of topical to use?

A
  • Think about your patient
82
Q

Signs of steroids on the skin?

A
  • Milia
  • Comedomes
  • Dermal atrophy
83
Q

Cephalexin activity

A
  • Good against staph (gram pos) and little activity against gram-neg
84
Q

Side effects of cephalexin

A
  • GI upset
85
Q

Cefpodoxime spectrum of activity

A
  • Same as cephalosporin but more exposure against gram neg
86
Q

Cefpodoxime side effects relative to cephalexin

A
  • Fewer GI side effects
87
Q

Convenia or cefovecin - how administered? how long does it last?

A
  • Administered SQ

- 10-14 days and repeat in 2 weeks

88
Q

Clavamox - why shouldn’t you use it?

A
  • many failures seen in his experience due to standard dosage usage (e.g. 13-14 mg/kg)
89
Q

What dose of Clavamox should you use if you decide to go against his advise and use it?

A
  • 20 mg/kg every 12 hours
90
Q

Reasons for treatment failure of superficial bacterial folliculitis?

A
  • Development of bacterial resistance
  • wrong diagnosis (Demodex, dermatophytosis, autoimmune)
  • Wrong antibiotic/wrong dose/too short of a course
  • failure to ID and address underlying cause
91
Q

Underlying causes of superficial bacterial folliculitis

A
  • ALlergies and endocrine!
92
Q

When should you culture for superficial bacterial folliculitis?

A
  • No response to first tier or empirical treatment (if they still have active lesions after 28 days of the 1st line treatment)
  • Deep pyodermas
  • Cytology reveals mixed infection (rods and cocci)
  • Immune suppression
93
Q

How to culture for superficial bacterial folliculitis?

A
  1. Wear gloves
  2. Prick pustule or papule with 25g needle and dab with culturette
  3. Lift up crust or scale from the collarette with 25g needle and rub culturette under crust or around the rim of the collarette (abrading the keratin)
  4. Culture a draining tract (clean off surface first with chlorhexidine and rinse with sterile water, then express material from the tract and place on culturette)
  5. Take sterile tissue biopsy (deep pyoderma) - gently prep surface with chlorhexidine and rinse with sterile water, place tissue in red top tube with 1 cc saline and send to lab
94
Q

Resistance mechanisms for Staph

A
  • beta lactamase
  • Expression of BlaZ gene
  • Acquisition of mecA gene on SCC mec (penicillin binding protein 2)
95
Q

How to interpret culture results for superficial bacterial folliculitis?

A
  • Make sure you have cultured a staphylococcal organism, especially Staph pseudintermedius or S schleiferi
  • Resistance to oxacillin = resistance to methicillin = resistance to beta-lactam antibiotics = MRSP?MRSS
96
Q

Second tier class antibiotics - when to use?

A
  • Only based on culture and sensitivity
97
Q

When can you use first tier antibiotics?

A
  • No prior history of antibiotics used OR if previous empirical treatment was effective
98
Q

Examples of second tier antibiotics

A
  • Fluoroquinolones
  • Clindamycin
  • TMS
  • Doxycycline
  • Rifampin
  • AMikacin
  • Chloramphenicol
99
Q

How to decide which second tier abx to use?

A
  • C&S

- Then side effects, and then the cost

100
Q

Third tier antibiotics - when to use?

A
  • Should not be used for ethical reasons

- Reserved for humans tx of MRSA

101
Q

Examples of third tier class antibiotics

A
  • Linezolid

- vancomycin

102
Q

Prognosis for superficial bacterial folliculitis

A

Depends on ability to find and correct the underlying problem of allergies and endocrine

103
Q

How long can MRSP carry it?

A
  • Anywhere up to a year

- MRSP pyoderma best to reculture if they develop another

104
Q

Prevention of MRSP

A
  • Hand hygiene
  • Wearing gloves
  • Disinfection of surfaces
  • BSAVA guidelines (isolation and barrier protection)
105
Q

What is mucocutaneous pyoderma?

A
  • Superficial pyoderma affecting the lips and perioral skin
106
Q

What usually causes mucocutaneous pyoderma?

A
  • Staph infection
107
Q

Clinical signs of mucocutaneous pyoderma

A
  • Swelling and erythema of lips, especially commissures
  • Crusting and fissuring may follow
  • Similar lesions may occur at nares, medial canthus, vulva, prepuce, or anus
  • Hypopigmentation can be seen
108
Q

Who gets mucocutaneous pyoderma?

A
  • Tends to be German Shepehrds
109
Q

Pathophysiology of mucocutaneous pyoderma?

A
  • unknown

- Doesn’t originate in lip folds

110
Q

Primary differentials of mucocutaneous pyoderma?

A
  • Demodicosis**
  • Autoimmune (discoid lupus erythematosus, pemphigus)
  • Lip fold dermatitis
111
Q

How can you differentiate mucocutaneous pyoderma secondary to bacteria or autoimmune disease like discoid lupud erythematosus with a secondary infection?

A
  • If you biopsy them in an active state, a pathologist can’t differentiate
  • Often have to differentiate based on clinical response to tx
  • If you prescribe antibiotics and it goes away, think mucocutaneous pyoderma
  • If it doesn’t think DLE
112
Q

Diagnosis of mucocutaneous pyoderma

A
  • PE
  • Skin scraping
  • Cytology
  • Culture
  • May be biopsy (better off to treat first and biopsy if disease remains after infection is cleared)
113
Q

Treatment of mucocutaneous pyoderma

A
  • Topical antibacterials (without steroids) - mupirocin or chlorhexidine
  • Systemic antibiotics for 3-4 weeks; 1 week past clinical remission
  • Look for underlying cause like allergies or endocrine!
114
Q

What are deep pyodermas?

A
  • Deep infections of deeper regions of the hair follicle, dermis, and subcutis
  • Includes deep folliculitis/furunculosis and cellulitis
  • Less common than superficial pyodermas
115
Q

What hsould you always do to diagnose deep pyodermas?

A
  • ALWAYS CULTURE

- May be staph or gram neg bacteria like Pseudomonas

116
Q

Furunculosis

A
  • Nodular dermatitis secondary to a bacterial infection deep in a hair follicle and subsequent rupture of the follicle (furunculosis)
117
Q

Difference between folliculitis and furunculosis?

A
  • Basically the same, but hair follicle ruptures with furunculosis
118
Q

Pathophysiology of furunculosis

A
  • remember that pyodermas are secondary to some underlying disease***
  • When the hair follicle ruptures, it releases bacteria, hair, and follicular keratin into the dermis that incites a pyogranulomatous inflammatory reaction
119
Q

Underlying causes of furunculosis

A
  • Basic categories are allergies, ectoparasites, endocrine!
  • Allergies (flea, food, atopy)
  • Endocrine (hypothyroidism, Cushing’s disease)
  • Ectoparasites
  • Inappropriate corticosteroids
  • Inappropriate antibiotic therapy
  • Poor nutrition
  • FB
  • Immune dysfunction
120
Q

What are bacteria usually with furunculosis?

A
  • Often Staph pseudintermedius

- Can also have Proteus, Pseudomonas, and E. coli

121
Q

CLinical signs of furunculosis

A
  • Papules
  • Nodules
  • Hemorrhagic bullae or vesicles
  • Draining lesions
  • Cellulitis
  • Lymphadenopathy
  • Systemic illness
122
Q

Differentials for furunculosis

A
  • Demodicosis
  • Fungal infections
  • FB
  • Sterile
  • Neoplasia
123
Q

Dx of furunculosis

A
  • Hx and PE
  • Skin scrapings to rule out demodicosis
  • Cytology
  • C&S (IMPORTANT IN ALL DEEP PYODERMA)
124
Q

Cytology of furunculosis

A
  • Pyogranulomatous inflammation

- +/- bacterial cocci +/- rods (if mixed)

125
Q

C&S for furunculosis

A
  • Important in all
126
Q

Sample type for C&S for furunculosis

A
  • Preferably via tissue bx

- Don’t simply swab the surface

127
Q

Canine acne - who gets?

A
  • Short coated breeds (Doberman, Great Dane, English Bulldogs, Boxer)
128
Q

Where do dogs get acne?

A
  • Chin and muzzle
129
Q

Cause of canine acne

A
  • Trauma? Genetics? Puberty?
130
Q

How to prevent canine acne

A
  • avoid or minimize trauma
131
Q

Treatment for canine acne

A
  • Topical or systemic antibiotics in more severe cases
132
Q

Nasal pyoderma - where?

A
  • Bridge of the nose
133
Q

Nasal pyoderma - onset speed?

A
  • Sudden
134
Q

Nasal pyoderma - who gets?

A
  • Dolicocephalic breeds
135
Q

Etiology of Nasal pyoderma

A
  • Trauma? Rooting?
136
Q

Differentials for Nasal pyoderma

A
  • Pyoderma, demodex, dermatophytosis (WITH A CRUST)
  • Insect hypersensitivity
  • AUtoimmune (pemphigus foliaceus or erythematosus)
137
Q

Interdigital pyoderma - what causes?

A

Many diseases!

  • Allergy
  • Parasite (Demodex)
  • Infectious disease (fungal)
  • Endocrine disease
  • Sterile (rare)
  • FB (rare)
138
Q

Lesions for interdigital pyoderma

A
  • Papules, nodules, vesicles, bullae, draining lesions
139
Q

Who gets interdigital pyoderma?

A
  • Short coated breeds
140
Q

Hot spot pyoderma or pyotraumatic folliculitis/furunculosis - what’s the difference from pyotraumatic dermatitis?

A
  • Dermatitis created by mouth

- Hot spot pyoderma caused by scratching

141
Q

Lesions of Hot spot pyoderma or pyotraumatic folliculitis/furunculosis

A
  • Areas of plaque-like alopecia with “satellite” papule lesions
142
Q

Where are Hot spot pyoderma or pyotraumatic folliculitis/furunculosis lesions distributed?

A
  • Face and neck
  • Be a detective and check the ears
  • SEcondary allergies can cause these too
143
Q

Treatment for furunculosis - what and for how long?

A
  • Systemic antibiotics based on culture and sensitivity for 6-12 weeks or 2 weeks past clinical remission
  • Look for an underlying cause of pyoderma
  • Adjunctive therapy includes topical antibacterial shampoo (chlorhexidine)

Dermatology (15 decks)

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