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Y3 MOD Dermatology > The approach to pruritus > Flashcards

The approach to pruritus Flashcards

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1
Q

What is pruritis?

A

Unpleasant sensation that elicits the desire or reflex to: scratch, Rub, Lick, Chew, Rolling

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2
Q

How do dogs show signs of pruritis?

A
  • Scratch
  • Rub
  • Nibble
  • Lick (often not perceived as pruritus by owners)
  • Temperament changes
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3
Q

How do cats show signs of pruritis?

A
  • Often secretive and not noticed by owners
  • Alopecia due to overgrooming
  • Hair plucking resulting in vomiting hairballs and hair in faeces
  • Tufts around the house
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4
Q

What is primary pruritis?

A
  • Itch is principal initial sign

- Other lesions such as alopecia, excoriations and secondary infection follow

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5
Q

What is secondary pruritis?

A
  • Lesions such as pustules, nodules, scale or crusts precede the onset of pruritus
  • 2˚ ~ most commonly due to superficial bacterial pyoderma or Malassezia
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6
Q

What are some manifestation of pruritis in dogs?

A
  • Recurrent pyoderma
  • Recurrent otitis
  • Scale, dryness and grease -> smell
  • Alopecia
  • Behaviour changes
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7
Q

What are some manifestation of pruritis in cats?

A

Reaction patterns

  • Alopecia
  • Head and neck pruritis
  • Eosinophilic granuloma complex
  • Behaviour changes
  • Self trauma
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8
Q

Why is interpretation of skin disease due to primary pruritus is complicated by secondary skin lesions?

A
  • Due to trauma
  • Due to secondary infection
  • So many skin diseases end up looking similar
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9
Q

How can pruritis be identified during the clinical exam?

A

Direct observation:
- Whilst taking history, let the dog free in the room if appropriate
- Owners may bring itch charts and videos
Look for secondary signs:
- Broken hair
- Saliva staining

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10
Q

Which two laboratory tests can be useful in identifying pruritis?

A
  • Trichography

- Cytology

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11
Q

Hair plucks (trichography) allow examination of the…?

A
  • State of growth e.g. anagen and telogen
  • Structure of the melanosomes
  • Pathological changes
  • Attached/associated organisms and parasites
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12
Q

Which pathological changes to the hair may be seen using trichography?

A
  • Bulb e.g. alopecia areata
  • Shaft e.g. dermatophytosis
  • Tip e.g. damage through self trauma or clipping
  • External surface e.g. Follicular casts
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13
Q

How do you differentiate primary and secondary pruritis?

A
  • Is it a rash that itches or an itch that rashes?
  • Does the itch resolve with treatments for infections?
  • Is there is pruritus only where this is infection, but marked lesions elsewhere?
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14
Q

Give some examples of skin infections that cause pruritis

A
  • Superficial bacterial pyoderma
  • Malassezia dermatitis
  • Malassezia, Staphylococcal and Pseudomonas otitis
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15
Q

Give some examples of ectoparasites that cause pruritis

A
  • Sarcoptes scabei var canis / Notoedres cati
  • Demodex gatoi
  • Cheyletiella spp
  • Fleas
  • Lice
  • Otodectes cyanotis
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16
Q

How does superficial pyoderma present?

A

Spots, crusts and patchy hair loss

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17
Q

What are the 4 main clinical signs of Malassezia dermatitis

A
  • Erythema
  • Pruritus: often severe facial irritation
  • Malodour
  • Dark coloured exudate
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18
Q

What is the genus and species of the main flea associated with infestation and disease in the UK?

A

Ctenocephalides felis

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19
Q

What is the reaction associated with fleas?

A

Flea allergic dermatitis

- Type I and Type IV hypersensitivity reactions

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20
Q

What are the primary signs of Ctenocephalides felis?

A

Pruritis
Papules
Erythema

21
Q

What are the secondary signs of Ctenocephalides felis?

A

Excoriation
Alopecia
Crusts
Pyoderma

22
Q

In which part of the fur does alopecia secondary to a flea infestation occur?

A

Caudodorsally

23
Q

How is Ctenocephalides felis diagnosed - 3 methods?

A
  1. Direct observation – good in severe infestation, but unreliable
  2. Wet paper test – brush and comb coat onto damp paper and observe digested blood in faeces
  3. Coat brushings / sellotapes – direct microscopy may reveal coiled faeces or occasional find fleas
24
Q

How are fleas managed and treated?

A
  • Early environmental control: cleaning, vacuuming, environmental sprays
  • Adulticide to all animals
25
Q

Sarcoptic mange is caused by which parasite?

A

Sarcoptes scabei var canis

26
Q

Which species are affected by sarcoptic mange?

A

Dogs and immunosuppressed cats

27
Q

Describe the pathogenesis of sarcoptic mange

A
  • Induce marked type I hypersensitivity reaction
  • Pruritus starts 3-4 weeks after infestation
  • Female mites make tunnels in the stratum corneum, feeding and lay eggs. Males more commonly on surface
28
Q

What are the primary signs of sarcoptic mange?

A

Pruritis
Papules
Erythema

29
Q

What are the secondary signs of sarcoptic mange?

A

Excoriation, alopecia, crusts, pyoderma signs

30
Q

Where on the body is most affected by sarcoptic mange?

A

Ears, ventral chest, elbows and hocks

31
Q

How is sarcoptic mange diagnosed?

A
  • Skin scrapes: high specificity (100%) & low sensitivity (50%)
  • Serology: variable sensitivity and susceptibility
32
Q

How is sarcoptic mange treated?

A

Common topical and oral treatments are useful:

  • Moxidectin
  • Selamectin
  • Isoxazolines

Environmental control using cleaning, vacuuming and sprays

33
Q

Which 2 Demodex species are associated with primary pruritis?

A

Demodex injai - dog

Demodex gatoi - cat

34
Q

Most species of Demodex are associated with which signs?

A

Alopecia
Comedone formation
Secondary infection

35
Q

Which dogs species are most commonly affected by Demodex injai?

A

Terriers - border, welsh, west highland

- early adulthood age of onset

36
Q

What are the clinical signs of Demodex injai?

A
  • Greasiness
  • Truncal pruritus and alopecia (2˚)
  • Variable 2˚ bacterial infection
37
Q

How is Demodex injai diagnosed?

A

Deep skin scrapes and biopsy

- mites live deep in follicles and sebaceous glands

38
Q

What is the genus and species of harvest mites?

A

Neotrombicula autumnalis

39
Q

What are the clinical features of a harvest mite infection?

A
  • Localised pruritis at the site of larval attachment
  • Orange dots on skin
  • Seen seasonally from mid June to the end of September
40
Q

How are harvest mites treated?

A

Fipronil spray for the legs is often recommended (not licenced)

41
Q

What is the name given to ear mites?

A

Otodectes cyanotis

42
Q

How is Otodectes cyanotis diagnosed?

A
  • Direct observation of photophobic mites using otoscope
  • Ear wax examination
  • Take wax using a swab or curette and mix gently with liquid paraffin to avoid bubbles
  • Mites and elongated eggs are diagnostic
43
Q

What are the signs of Cheyletiella infection?

A
  • Scale affecting the trunk and sometimes around the head
  • Miliary dermatitis in the cat
  • Variable pruritus
  • Alopecia
  • Marked self trauma
44
Q

How is a Cheyletiella infection diagnosed?

A
  • Coat brushings – crawling dandruff
  • Skin scraping from scaly areas
  • Faecal flotation has been used in cats where excessive grooming is present
45
Q

What are the features of food hypersensitivity reactions?

A
  • young age of onset
  • pruritis
  • resembles atopic dermatitis
  • 2 or more cutaneous reaction patterns in cats
46
Q

How are food hypersensitivity reactions diagnosed?

A

Strict food trial

47
Q

What are the features of atopic dermatitis and where on the body is affected?

A
  • young age of onset
  • bilateral symmetrical pruritus affecting the ventral abdomen, axillae, feet, face and ears initially, often complicated by 2˚ infection
48
Q

Describe pemphigus foliaceus and its characteristics

A
  • Disease of adult dogs and cats
  • Characterised by sterile pustule/crusts affecting the face, nose and feet particularly
  • Can be very pruritic
49
Q

Describe epitheliotropic lymphoma, its signs and presentation

A
  • Disease of older dogs
  • Lymphocyte invasion of epidermis causes depigmentation, ulceration and plaques
  • Can be pruritic
  • Variable presentation means that dogs may look like atopic dermatitis (but age is a big flag that cAD is not likely)

Y3 MOD Dermatology (12 decks)

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