Veterinary Medicine - Dermatology Flashcards
Atopic Dermatitis - General age of onset , and most common age of onset)
6 Months - 6 Years of age. Most common - 1 to 3 years of age
Atopic Dermatitis - Commonly associated allergens
Dust, Dust Mites, Pollens, Mold, Fungal elements
Atopic Dermatitis - 3 Main predisposed dog breeds
WHWT, Golden Retriever, Labrador Retriever
Atopic Dermatitis - Clinical signs
Pruritus, Alopecia, Erythema, Lichinefication. Typical locations: Paws, Inguinal region, Abdomen, Chest, Axillary region, Ears, Muzzle, Around the eyes. Brown-salivary staining where the dog licks. Otitis externa (Can sometimes be the only clinical sign). Hyperhidrosis (“Wet dog”)
Name the 4 feline non-specific cutaneous reactions
Self-induced alopecia, Head and neck pruritus and excoriations, Milliary Dermatitis, Eosinophilic skin lesions: -Granuloma -Indolent ulcer -Plaques
Atopic Dermatitis - Diagnosis
Classic history - Seasonal pruritus, Onset < 6 Years old, Breed predisposition. Matching skin lesion distribution (Ventral pruritus, ears, eyes, muzzle +/- Otitis externa). Diagnosis of exclusion; Rule out adverse food reaction (AFR), Flea allergy dermatitis (FAD), Ectoparasites. *Skin cytology for secondary infections
Atopic Dermatitis - Treatment
Allergen avoidance, Treat secondary infections, Anti-pruritic treatment (Steroids / Cyclosporine / Apoquel / Cytopoint), Improve skin barrier - Shampooing, Omega-6 supplement
Adverse Food Reaction - Age of onset
Any age. But if < 6 Months - Suspect
Adverse Food Reaction - Clinical signs
Same as Atopic dermatitis - Pruritus, Alopecia, Erythema, Lichenification - Paws / Inguinal / Axilla / Muzzle / Around eyes/ Inside of ears. Brown-salivary stains where they lick. Otitis Externa. GI Signs (e.g. Chronic vomiting/diarrhea/borborygmus)
Adverse Food Reaction - What is the most common cutaneous reaction in cats
Head & neck pruritus (60-80% of cases)
Adverse Food Reaction - Diagnosis
Elimination diet trial - Novel / Hydrolyzed protein exclusively for 6-8 weeks. If truly AFR - pruritus should subside within 1-2 weeks (but anti-pruritic treatment during that time is recommended). After 6-8 weeks - perform the Challenge test - Gradually change back to previous diet. If clinical signs return - diagnosis of AFR is achieved
Flea Allergy Dermatitis - Clinical signs
Pruritus, Alopecia, Erythema, Lichenification - Lumbo-Sacral region , Periumbilical, Neck region. Hot Spots
Flea Allergy Dermatitis - What is the most common clinical sign
Pruritus + Alopecia at the Lumbo-sacral region
Flea Allergy Dermatitis - Regular anti-flea treatment rules out FAD (T/F)
False
Flea Allergy Dermatitis - Diagnosis
Ectoparasite Treatment Trial
Flea Allergy Dermatitis - Treatment
Treat animal for fleas. If already receiving treatment - shorten interval (e.g - Bravecto - from every 3 to every 2 months, Nexgard from every 4 weeks to 3 weeks). Treat the environment for fleas. Treat 2nd Infections. Hot spots - Short course of steroids
Acute Moist Dermatitis (“Hot Spot”) - Typical locations of lesion
Lumbo-sacral region, Lateral thigh region
Acute Moist Dermatitis (“Hot Spot”) - 3 Common causes
FAD, Foreign body, Anal sacs disease
Acute Moist Dermatitis (“Hot Spot”) - Treatment
Treat underlying cause, Topical/Systemic steroids (Short course), Topical antibiotics
Intertrigo - Treatment
Shave region, Steroids (Short course) +/- antibiotics - Topical cream/Shampoo
Impetigo - Signalment
Young / Adolescent Dogs - 8 Weeks - 1 Year old
Impetigo - Common clinical signs and locations
Non-follicular Pustules, Non-pruritic. Abdomen / Inguinal region / Axilla
Impetigo - Treatment
Generally no treatment required (Self limiting). If want to treat - Local antibiotic (Shampoo)
Impetigo in Feline - Location
Withers / Head
Bullous Impetigo - Signalment & Clinical signs
Old dogs with immunosuppression . Non-follicular bullas with pus
Folliculitis - 3 Main causes
Bacteria, Demodicosis, Dermatophytes
Bacterial Hypersensitivity - Classic history
Superficial dermatitis that resolves with antibiotic treatment but returns after treatment is finished
Bacterial Hypersensitivity - Treatment of choice
Staphage Lysate
Nodules / Pustules / Fistulas - Associated with Superficial / Deep Pyoderma
Superficial Pyoderma - Pustules, Deep Pyoderma - Nodules, Fistulas
Deep Pyoderma - Usually occurs due to…? Causes systemic clinical signs (T/F)
Immunosuppressive diseases. True: Can cause Anorexia, Lethargy, Lymphadenopathy
Deep Pyoderma - Treatment
Systemic antibiotics per Culture & Sensitivity for 6-8 Weeks (2-3 Weeks after clinical healing)
Pyo-Traumatic folliculitis & Furunculosis (“Hot Spot-Like”) - Common “signalment” and commonly associated with..?
Thick fur breeds (e.g. Retrievers, Rottweiler, Saint Bernard). Commonly associated with Otitis Externa
Pododermatitis - Common signalment and which type of pyoderma is it
Large breeds, Deep Pyoderma
Acral Lick Dermatitis (“Lick Granuloma”) - Common Locations
Meta-carpus / Carpus / Radius, Meta-tarsus / Tarsus / Tibia, Tail
Acral Lick Dermatitis (“Lick Granuloma”) - Classic appearance of lesions
Elevated nodules with hyperpigmented margins +/- fistulas
Acral Lick Dermatitis (“Lick Granuloma”) - Name the specific treatment and what does it do?
Capsaicin. Substance-P depletion (apply Lidocaine prior to use - as it causes local burning sensation)
Superficial Pyoderma - Empiric antibiotic treatment (3 Options)
Clindamycin, 1st Gen. Cephalosporin (e.g. Cefalexin), Augmentin
Demodicosis - Clinical signs
Alopecia (Non-pruritic), Erythema, Scales. Can be focal or generalized
Demodicosis - Diagnosis
Deep skin scrapes (Best), Trichogram, *Can be seen in skin cytology but not common
Demodicosis - Treatment
In young dogs (<1.5 y) - Self limiting. *In generalized demodicosis to best to treat to prevent deep pyoderma Isooxazolines Bravecto / Simparica / NexGard
Demodicosis in cats - 4 underlying diseases that can lead to a generalized disease
DM, FIV, FeLV, Cushing’s disease
Demodicosis in cats - What are the 2 unique features of D.Gatoi?
Infectious, Highly pruritic
Demodicosis / Scabies - Where does each reside in the skin?
Demodicosis - Hair follicle Scabies - Stratum Corneum
Scabies - Clinical signs and distribution
Intense (!) pruritus, alopecia, hyperpigmentation, Lichenification . Regions with low hair amount: Ventral Region, Elbows, Tip of the ears
Scabies - Diagnosis (2 Methods)
Superficial skin scrapes (Only 50% sensitivity) . Isooxazoline trial
Scabies - Diagnosis (2 Methods)
Superficial skin scrapes (Only 50% sensitivity) . Isooxazoline trial
Scabies - Treatment
Isooxazolines (Simparica / NexGard / Bravecto). 1st Week - Steroids (for 2nd skin lesions). Clean the environment
Feline Scabies - Name of the parasite
Notoedric Mange
Cheyletiellosis - Common “pathognomonic” sign
“Walking dandruff” on the dorsal region of the body
Cheyletiellosis - Diagnosis
Cytology, Superficial skin scrape
Cheyletiellosis - Treatment
Isooxazolines
Straelensiosis - Common lesions and distribution
Alopecia, Papules, Nodules. Head, Legs , Ventrum
Straelensiosis - Diagnosis
Histopathology: “Red rim” of mucin around follicles. Deep skin scrapes (Rare)
Straelensiosis - Treatment
Isooxazolines
Ear Mites (Otodectes) - Signalment
Kittens. Can also affect adult dogs and cats
Ear Mites (Otodectes) - Diagnosis
Otoscopy. Cytology (Collect typical black-dry secretions with swab dipped in oil)
Ear Mites (Otodectes) - Treatment
Isooxazolines
Dermatophytosis - Where on the body can dermatophytes be found?
Keratinic tissues: S.Corneum of the epidermis, Hair, Nails
Dermatophytosis - Most common signalment
Young, outdoor kittens
Dermatophytosis - Clinical signs, Common distribution
Alopecia (non-pruritic), Crusts, Scales, Erythema, Kerion. Face, Ears, Feet, Tail
Dermatophytosis - Zoonotic?
Some but not all. Especially to Kids, Elderly, Pregnant women, people with immunosuppressive diseases
Dermatophytosis - Main zoonotic dermatophyte
M.Canis
Dermatophytosis - Diagnosis
Wood’s lamp (only detects M.Canis), Sample for culture (Mycology), DTM, Trichogram (Difficult)
Dermatophytosis - 3 Elements of Treatment
Treat the fungus (Systemic), Treat the Spores (local), Treat the environment (Not necessarily - depends on results of mycology)
Dermatophytosis - Treatment
Local - Lime Sulfur + Enilconazole. Systemic - Azoles. Environment - Vacuum, Clean sofas, “AHP”“(Accelerated Hydrogen Peroxide), everything possible - put in the laundry
Malasezzia - Most common skin reaction
Hyperpigmentation
Malasezzia - Treatment
Anti-mycotic shampoo
Demodicosis / Scabies / Cheyletiellosis / Straelensiosis / Dermatophytosis - Which are Zoonotic?
Scabies, Cheyletiellosis, Dermatophytosis (Microsporum Canis)
Pemphigus Foliaceus - Clinical signs and distribution
Pustules / Crusts / Epidermal collarets . Face, around the eyes - Bilateral lesions (90% of cases). Hyperkeratosis, Fissures on the foot pads and nasal planum. Pinna of the ears - Demarcated lesions. Generalized disease (66% of cases). Can also have signs of systemic disease if onset is rapid (Anorexia, Lethargy, Fever, Lymphadenopathy)
Pemphigus Foliaceus - Diagnosis
Cytology - Acantholytic cells, Biopsy - Pustules or crusts spanning few hair follicles
Pemphigus Foliaceus - DDs for Acantholytic cells
Pemphigus Foliaceus, Dermatophytosis - T. Mentagrophytes , Leishmaniasis, Deep Pyoderma
Pemphigus Foliaceus - Which dermatophyte can create the same skin reaction? What are the clinical signs? How to differentiate between them?
T. Mentagrophytes. Pustules, Crusts. PAS Staining
Pemphigus Foliaceus - Treatment
Immunosuppression: Steroids +/- 2nd drug (e.g. Cyclosporine / Cellcept). Another option: Doxycycline + Niacinamide
Pemphigus Foliaceus - What is the drug of choice for treatment in cats?
Chlorambucil
Pemphigus Foliaceus - Common breeds
Akita, Chow-Chow, Cocker Spaniels , Dachshunds, English Bulldog, Labrador Retrievers
Pemphigus Erythematosus - Clinical signs
Similar to PF but localized only to face and neck. Hypopigmentation of nasal planum
Pemphigus Vulagris - Clinical signs
Ulcers and erosions in mucocutaneous tissue (e.g. Ears, Mouth, Genitals)
Pemphigus Vulagris - Diagnosis
Histology: Suprabasillar Acantholysis
Discoid Lupus Erythematosus (DLE) - Clinical Signs
Nasal planum depigmentation (Grayish - bluish color). Loss of nasal planum “cobblestone” structure . Ulcers, Erosions, Scale on nasal planum, eyelids, ears. Symmetric bilateral lesions
Discoid Lupus Erythematosus (DLE) - Diagnosis
Histology: lymphocytic interface dermatitis reaction pattern with basal keratinocyte vacuolar degeneration, apoptosis, loss of basal cells and basement membrane thickening
Discoid Lupus Erythematosus (DLE) - Treatment
Avoid sunlight! Topical steroids, Doxycycline + Niacinamide
Symmetric Lupoid Onychitis (SLO) - Common breeds
Gordon Setter German shepherd
Symmetric Lupoid Onychitis (SLO) - Important DD
Leishmaniasis
Symmetric Lupoid Onychitis (SLO) - Treatment
Antibiotic for 2nd Infection, Nail care and trimming, Doxycycline + Niacinamide, Pentoxifylline, Omega 3 and 6 FA, Can try immunosuppression (Steroids +/- Azathioprine)
Feline Idiopathic Ulcerative Dermatitis - Clinical sign
Non-healing ulcer between the scapulas
Feline Idiopathic Ulcerative Dermatitis - Treatment
Surgical removal. Behavioral change (could be stress related)
Plasma Cell Pododermatitis (Cats) - Clinical signs and diagnosis
Swelling, Erythema and ulceration in multiple foot pads which leads to lameness. Can also causes systemic signs (e.g. Lethargy, Fever). Cytology (Foot pads) - Plasma cells. Histology (Gold standard)
Feline Skin Fragility Syndrome - Main causes
Cushing’s disease, DM, Liver diseases
What is the feline equivalent of Acral Lick Dermatitis? What are the clinical signs?
Feline Psychogenic Alopecia. Bilateral symmetric alopecia: Abdomen, Back , Hindlegs
Alopecia X - Poster breed
Pomeranian
Alopecia X - Clinical signs
Complete trunk alopecia without head and distal limb involvement . Hyperpigmentation (“Black skin disease”)
Alopecia X - Treatment
Neutering (50% Success), Melatonin , Benign neglect
Alopecia X - Diagnosis
Signalment, History and clinical signs . Normal CBC, Panel and T4. Histopathology
Hepatocutaneous Syndrome (“Superficial Necrolytic Dermatitis”) - Clinical Signs
Ulcers, Erosions, Crusts - Foot Pads, Elbow, Perineum , Muzzle. Mucocutaneous lesions. Foot Pads - Hyperkeratosis, Fissures. Vomiting, diarrhea
“Honeycomb Pattern” on US - in the liver it means…? in the spleen it means…?
Hepatocutaneous Syndrome Splenic Torsion
Hepatocutaneous Syndrome (“Superficial Necrolytic Dermatitis”) - Diagnosis
Clinical signs. Elevated liver enzymes. Classic appearance of the liver on US - “Honeycomb Liver”. Histopathology - parakeratosis and laminar intracellular edema (“French Flag”)
Hepatocutaneous Syndrome (“Superficial Necrolytic Dermatitis”) - Treatment
Amino acids given IV, Raw egg yolks, Zinc, Omega-3 fatty acid
Juvenile Cellulitis - Signalment & Distribution of lesions
Puppies - 3 weeks - 4 months old. Face - Lips, Nose, Chin, Periocular +/- Otitis Externa
Juvenile Cellulitis - Clinical signs
Facial pustules and granulomas, Otitis Externa, Significant submandibular lymphadenopathy
Juvenile Cellulitis - Diagnosis
History and Clinical Signs. Histology
Juvenile Cellulitis - Treatment
Steroids
Granulomatous Sebaceous Adenitis - Most common dermatological findings and distribution
Erythema, Scales, Alopecia, Follicular casts In the beginning - Head, Ears, Tail. Proceeds to become Generalized
Granulomatous Sebaceous Adenitis - Name other DDs for the clinical appearance of GSA
Granulomatous Sebaceous Adenitis - Name other DDs for the clinical appearance of GSA
Granulomatous Sebaceous Adenitis - Diagnosis
Trichogram - Follicular casts. Histology - Inflammatory infiltrate where sebaceous glands are/were
Granulomatous Sebaceous Adenitis - Treatment for mild cases? Drug of choice for more severe cases?
Mild - Keratolytic shampoo, Emollient oil, Propylene Glycol . Drug of choice for severe cases - Cyclosporine
Solar Dermatitis - Signalment, Common distribution (Dogs and Cats)
White / Light colored skin animals. Dogs - Nasal planum. Cats - Ears / Eyelids / Nose / Lips
Solar Dermatitis - Dermatological lesions
Erythema, Scales, Alopecia, Exudation / Crusts / Ulceration
Solar Dermatitis - Treatment (Dogs and Cats)
Sun avoidance, Steroids in cases of severe inflammation, Cats - Imiquimod
Vasculitis - Common causes
Drugs, Vaccines (Up to 6 months before), Infectious diseases, Neoplasia, Adverse food reactions, Idiopathic
Vasculitis - Common Distribution
Pinnae, Tail, Foot pads, Claws, Distal limbs, Oral mucosa
Vasculitis - Treatment
Pentoxifylline , Topical Tacrolimus, Steroids
Hyperestrogenism - Clinical signs + Lab findings
Symmetric bilateral alopecia: Perineum, Inguinal, Flank (and later generalized). Comodones, Hyperpigmentation in the inguinal region and vulva. Enlarged nipples (Gynecomastia) in both males and females - and vulva in females. Males - Linear preputial dermatosis. Females - Abnormal estrus cycle. Males - Attraction of other males. Lab finding: Pancytopenia
Color Dilution Alopecia - Signalment and classic history
Dog with blue / fawn colored fur. Within the first year started developing localized / generalized hypotrichosis
Color Dilution Alopecia - Diagnosis
Trichogram - Melanin clamping on hair follicles (Not specific). Biopsy
What dermatological condition is a variant of Color Dilution Alopecia - specific to black fur color
Black Hair Follicular Dysplasia
Pattern Baldness - What are the 3 Common presentations and in what breeds
Dachshunds - Pineal alopecia. Whippet, Greyhound, Boston Terrier, Dachshunds, Chihuahua - Periauricular / Ventrum / Caudo-medial thighs. Greyhound - Caudo-medial thighs
Pattern Baldness - Onset age
First Year - Early adulthood
Pattern Baldness - Treatment
Melatonin
Color Dilution Alopecia / Black Hair Follicular Dysplasia - Treatment
None
Color Dilution Alopecia / Black Hair Follicular Dysplasia - Treatment
None
Cyclic Flank Alopecia - Common breeds
Boxer, Airedale terrier, Bulldog
Cyclic Flank Alopecia - Common dermatological findings
Flank Alopecia, Hyperpigmentation, Non-pruritic, Non inflammatory
Cyclic Flank Alopecia - Treatment
Melatonin
Zinc Responsive Dermatitis - Common breeds
Hasky, Alaskan Malamute
Zinc Responsive Dermatitis - Common breeds
Husky Alaskan Malamute
Zinc Responsive Dermatitis - Common causes
Type 1- Genetic problem in zinc absorption (puppies - young). Type 2 - GI disease - Loss of zinc
Zinc Responsive Dermatitis - Dermatological findings / Distribution
Alopecia / Crusts / Scales, Eyes / Mouth / Ears, Foot pad hyperkeratosis
Zinc Responsive Dermatitis - Diagnosis
Histopathology
Zinc Responsive Dermatitis - Treatment (2 Elements)
“Zinc. Steroids (Increases zinc absorption in the GI)
Dermatomyositis - Common breeds
Collie, Sheltie
Dermatomyositis - Most common time of onset
< 6 Months
Dermatomyositis - Clinical signs
Alopecia / Erosions / Ulcers / Crusts on extermeties, nose, tail, ears. Temporal muscle atrophy. GI - Dysphagia / Regurgitations (Megaesophagus) *2nd aspirations pneumonia. Stiff walking
Dermatomyositis - Diagnosis
Temporal muscles EMG Biopsy
Dermatomyositis - Treatment
Steroids Pentoxifylline
Uveo-Dermatologic Syndrome (VKH Like Syndrome) - Common breeds
Samoyed, Akita, Husky
Uveo-Dermatologic Syndrome (VKH Like Syndrome) - Clinical signs
Uveitis, Depigmentation (Pinkening) of Nose / Lips / Eyelids / Scrotum / Anus / Foot pads , As the disease progresses - Erosions & Ulcers / Crusts
Uveo-Dermatologic Syndrome (VKH Like Syndrome) - Diagnosis (And the Finding)
Histopathology: Pigmentary Incontinence
Uveo-Dermatologic Syndrome (VKH Like Syndrome) - What is the cause for the ocular disease
Anti-retinal antibodies
Uveo-Dermatologic Syndrome (VKH Like Syndrome) - Treatment
Immunosuppressive
Tail Gland Hyperplasia - Dermatological Findings & typical location (Dogs / Cats)
Alopecia & Scales (Seborrhea). Dogs - Proximal 1/3 of tail. Cats - All along the tail
Tail Gland Hyperplasia - Common Signalment
Intact male dogs & cats
Tail Gland Hyperplasia - Treatment
Anti-seborrheic
Seborrhea Sicca - Treatment options
Anti-Keratolytics / Keratoplastics : Sulfur / Salicylic Acid. Emollients / Moisturizers (Urea / Propylene Glycol / Glycerin)
Seborrhea Oleosa - How To Treat
Benzoyl Peroxide
Topical Anti-bacterial treatment - Treatment options
Anti-bacterial ointment / Shampoo, Chlorhexidine, Iodine, Benzoyl Peroxide (Also Anti-keratolytic / Keratoplastic for Seborrhea Oleosa), Propylene Glycol (Also moisturizer for Seborrhea Sicca), Ethyl Lactate
Otitis Externa - Common primary causes
Allergies (Atopic dermatitis/AFR), Parasites (e.g. Otodectes/Demodex), Foreign body, Endocrinopathies (e.g. Hypothyroidism / Cushing’s disease), Epithelialization Disorders
Otitis Externa - Name 2 common secondary causes
Bacteria, Malasezzia
Otitis Externa - Predisposing factors
Anatomic: (e.g. Large floppy ears, Excessive hair), Neoplasia / Polyps, Primary otitis media, Excessive ear cleaning, Excessive water / moisture (e.g. Swimming)
Otitis Externa - Perpetuating factors
Stenotic / Edematous / Calcified ear canal, Otitis media, Epithelialization failure / Altered migration
Otitis Externa - What is the “Holy Trinity” of topical ear treatment?
Anti-bacterial, Anti-fungal, Steroids
Otitis Externa - Treatment for Stenosis / Edema? What type of factor is this?
Steroids’, Perpetuating
Otitis Externa - Treatment for decrease / failure of migration? What type of factor is it?
Ear flushing, Perpetuating
6 Steps of Otoscopy
1) Pinna Examination 2) Canal Width 3) Quality and Quantity of Secretions 4) Canal Skin Evaluation 5) Sensitivity of the Ear Canal 6) Tympanic Membrane Examination
Otitis Externa - Indications for Culture & Sensitivity
Unresponsive or Recurrent Otitis Externa, Otitis Media, Ulcers
Dermatophytosis - When can you stop treatment
After full treatment regiment (6-8 weeks), Remission of dermatological lesions, Negative Wood’s lamp, Negative fungal culture
Skin biopsy for diagnosis of alopecia - How many samples and where to sample from?
At least 2 samples 1) Normal hair region 2) Alopecia region *Not in-between areas
The Pruritic Patient - Important History questions
When did it Start? Where in the body does it scratch? Intensity? Seasonality? What does it eat? Other symptoms (e.g. GI Signs) Ehat appeared first - scratching or skin lesions? Traveled lately? Regular flea treatment? Other animals or people in the house affected? Medication? Previous history? Outside-inside animal?
What is the minimum allowed age for Apoquel use in dogs? If the dog is below that age, what is another option for anti-pruritic medication? (Beside steroids)
12 Months. Cytopoint
You’ve decided on Cytopoint as an anti pruritic. You gave the injection and saw the animal again 2-4 weeks later. The dog is still pruritic. Should you try another dose of Cytopoint?
Yes. Very possible the dog will respond to treatment after 2 or even 3 shots