SA Medicine II Dermatology
Terms
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- Dermatological Hx should include:
-
⬢Signalment: age, sex, breed, color
⬢Chief Complaint
⬢Age of Onset
⬢Pruritus, Seasonality, Progression, Travel, Contagion, Response to therapy, Environment
⬢General Medical History - Com'n Skin Dz's younger than 6 months
-
-Black Hair Follicle dysplasia
-K9 muzzle furunculosis (K9 acne)
-Cutaneous asthenia
-Demodecosis
-Dermatomyositis
-Dermatophytosis
-Ichthyosis
-Impetigo
-Juvenile Sterile granulomatous dermatitis and lymphadenitis (juvenile Cellulitis)
-Viral papillomatosis - Com'n Skin Dz's in 1-3 year old animals
-
-Blastomycosis
-K9 Atopic dermatitis
-Color dilution alopecia - Com'n Skin Dz's in animals older than 6 yo
-
-Cushing's
-Sertoli Cell tumor assoc. dysplasia
-Superficial necrolytic dermatitis - General quality of skin and hair to be noted
- Is the hair dull, dry, brittle, oily, or thin? Is the skin thinned, hyperelastic, or thickened? Are there any pigmentation changes or abnormalities? Are there obvious lesions that will need special attention during closer examination?
- Types of Primary Skin Lesions
-
-Macule
-Patch
-Papule
-Nodule
-Pustule
-Vesicle
-Bulla
-Wheal
-Plaque
-Tumor
-Abscess
-Cyst - Types of Secondary Skin Lesions
-
-Epidermal Collarette
-Scar
-Callus
-Erosion
-Ulcer
-Fissure
-Lichenification (can be seen w/ hyperkeratosis & pigmentation involved)
-Sinus
-Fistula
-Excoriation - Types of Primary or Secondary Skin Lesions
-
-Alopecia
-Scale
-Crust
-Follicular casts
-Comedo (blackheads)
-Hyper/Hypopigmentation - Pustules may be:
- Follicular, non-follicular, large w/ multiple follicles (usually immunosuppresive)
- Most com'n sign of Sarcoptic mange
- Alopecia and crusts around the ears
- Terms used to describe lesion configuration
-
-Annular
-Single
-Multifocal
-Polycyclic
-Grouped
-Sepiginous
-Linear
-Arciform
-Iris (target) - Com'n Lesions found on the Head
-
-Atopic dermatitis
-Demodicosis
-Notoedres
-Juvenile sterile granulomatous dermatitis & lymphadenitis - Com'n Lesions found on the Ear
-
-Atopic dermatitis
-Food intolerance
-Fly bite dermatitis
-Sarcoptes
-Notoedres
-Solar dermatitis (feline) - Com'n Lesions found on the Eyelid
- Demodecosis
- Com'n Lesions found on the Nasal Planum
-
-Discoid lupus erythematosus (collie nose)
-Nasodigital hyperkeratosis
-Pemphigus foliaceus
-Sterile pyogranuloma syndrome
-Uveodermatological syndrome - Com'n Lesions found on the Lips
-
-Demodicosis
-Indolent ulcer
-Intertrigo
-Oral papillomatosis - Com'n Lesions found in the Oral Cavity (mucosa)
-
-Eosinophilic granuloma
-Erythema multiforme
-Plasma cell stomatitis
-Pemphigus vulgaris
-Systemic lupus erythematosus - Com'n Lesions found on the Mucocutaneous Junctions
-
-Epitheliotropic lymphoma
-Erythema multiforme
-Mucocutaneous pyoderma
-Superfical necrolytic dermatitis (TEN) - Com'n Lesions found on the Chin
-
-Demodicosis
-Acne
-Dermatophytosis - Com'n Lesions found on the Neck
-
-Feline atopy
-Flea bite hypersensitivity, feline
-Injection site reaction - Com'n Lesions found on the Ventral Chest
-
-Bacterial folliculitis
-Sternal callus
-Contact dermatitis - Com'n Lesions found in the Axillary region
-
-Acanthosis nigricans
-Atopic Dermatitis
-Malassezia dermatitis - Com'n Lesions found on the Back
-
-Atopic dermatitis
-Bacterial folliculitis
-Flea bite hypersensitivity
-Schnauzer comedo syndrome
-Cheyletiellosis
-Seborrhea, primary - Com'n Lesions found on the trunk
-
-Demodicosis
-Bacterial folliculitis
-Hypothyroidism
-Hyperadrenocorticism
-Sebaceous adenitis - Com'n Lesions found on the Abdomen
-
-Atopy, feline
-Eosinophilic plaque
-Impetigo
-Psychogenic alopecia
-Solar dermatitis
-Contact dermatitis
-Atypical mycobacteriosis
-Pelodera derematitis - Com'n Lesions found on the tail
-
-Anal sac dz
-Food intolerance - Com'n Lesions found on the Legs
-
-Acral lick dermatitis
-Demodicosis - Com'n Lesions found on the Paws
-
-Sarcoptes
-Demodicosis
-Adverse food reaction
-Foreign body
-Malassezia dermatitis
-Pemphigus foliaceus
-Plasma cell pododermatitis
-Contact dermatitis
-Superficial necrolytic dermatitis (NME) - Com'n Lesions found on/near the Claws
-
-Lupoid onychodystrophy
-Bacterial paronychia
-Systemic lupus erythematosus
-Pemphigus foliaceus - Superficial Skin Scraping
-
Performed over large area, collecting abundant material
-Taken from intact, crusted lesions of p's suspected of having Sarcoptes
-Elbows, chest, pinna margins com'n areas -
Dermanyssus gallinae
(Poultry mites) -
May be collected w/ superficial skin scrapings
Tend to be very scarce
Scrape near excoriated sites
Acetate tape impressions may be used -
Lynxacarus radovsky
(Feline Fur mite?) -
Attach to hairs over spine
-Rare
-Dx via Trichography - Deep skin scrapings
-
Taken most often when there is a suspicion of demodicosis
-Shar Pei's, particularly deep scrapings needed - Pelodera strongyloides
-
Free living nematode may invade skin of dogs
-600um larvae seen w/ deep skin scrapings - Trichography
-
Direct examination of plucked hairs
If ringworm suspected, KOH clearing of keratin may help - Trichography especially useful when:
-
-Demodex suspected in difficult area to scrape
-Cat fur mites
-Pediculosis
-Cheyletiellosis
-Dermatophytosis - Increased number of Hairs in Anagen:
- Suggests an endocrinopathy or follicular arrest
- Skin surface cytology types
-
Direct impression
Acetate Tape impression
Cotton tipped-swab - Acetate tape impression
- Tape pressed against dry skin, mounted on a slide, then stained w/ blue part of diff-Quik stain
- Bacterial culture and susceptibility testing indicated in:
-
-Cases responding poorly to appropriate antimicrobial therapy
-Suspected deep Pyoderma
-Cases when resistant or uncom'n org's are suspected d/t chronicity or unusual presentations (atypical mycobacteria, Pseudomonas, Nocardia) - Abx in regard to C/S
- Should be d/c 48-72 hrs prior to culture
- Deep skin infections best cultured via:
-
Best cultured using a skin biopsy, external surface of sample is excised and discarded
-Let lab know that you want it minced and if a special media is needed - Dermatophyte Test Media (DTM)
- Contains Abx, an antifungal, and a pH indicator (phenol red- selectively metabolize available proteins before carbs, producing alkali metabolites and turning the media red)
- 3 most com'n spp of dermatophytes in SA's
-
-#1- Microsporum canis
-Microsporum gypseum
-Trichophyton mentagrophytes - Wood's Light Examination
-
Emits 253.7nm UV light reacting w/ tryprophan metabolites in some spp to emit a yellow-green fluorescence
-Hairs should be exposed for 3-5 minutes - Skin biopsy indicated when:
-
1) Have lesions suspicious of neoplasia
2) Have lesions consistent w/ a dz which is most readily dx'd by biopsy
3) Display an unusual presentation
4) Have a poor response to therapy
5) Might require long-term and/or expensive therapy - TEST TIPS
-
-Be able to recognize a M. canis macroconidia
-Trichophyton mentagrophytes are cream-colored colonies, powdery to granular, microconidia usually round, macroconidia cigar shaped, may have spiral shaped hyphae - Objectives Lect. 2
-
1. Be able to describe and provide examples of resident and transient bacteria of dogs and cats.
2. Describe the therapeutic approach for acute moist dermatitis.
3. Know the factors which may adversely affect the response of a skin infection to antibiotic therapy.
4. Be able to compare acute moist dermatitis with pyotraumatic folliculitis and furunculosis.
5. Understand the causes and therapeutic options for acral lick dermatitis.
6. Describe the typical clinical presentation of feline opportunistic mycobacterial infection. - Defense Mechanisms of normal skin
-
Physical (hair, s. corneum)
Chemical (sebum, sweat)
Microbial (competition for niches, antimicrobial substances) - Resident Bact of dogs
-
#1- S. intermedius
Clostridium spp
Propionibacterium acnes
Actinobacter spp
Micrococcus spp - Transient bact of dogs
-
E. coli
Proteus mirabilis
Corynebacteria spp
Bacillus spp
Pseudomonas spp - Transient flora of cats
-
B-hemolytic strep
E. coli
P. mirabilis
Pseudomonas spp
Bacillus spp - Topical Antimicrobials
- Chlorhexidine, providone-iodine (careful w/ cats), ethyl lactate, benzoyl peroxide (best ABx topical tx), Abx
-
Most com'n Abx used for skin infxns
*know mech's of axn* -
Cephalexin (80% of time for pyoderma)
Cefpodoxime (simplicef)
Amoxicillin-clavulanate
Dicloxacillin
Clindamycin
Enrofloxacin
Marbofloxacin
Doxycycline
Trimethoprim-sulfamethoxazole
Rifampin - Immunomodulation/Immunostimulation
-
Should be given w/ systemic abx tx until pyoderma resolved
Staphage Lysate: S. aureus phage lysate for SC injection.
ImmunoRegulin: killed Propionibacterium acnes preparation for IV injection.
Autogenous staphylococcal bacterins: not widely used.
Levamisole: 2.2 mg/kg q. 48 hrs.
Cimetidine: 10 mg/kg TID.
IFN-α: human recombinant form has been used at 1-3 million IU/dog po or sc q. 1-3 days. - Superficial Bact Infxns
-
-Acute moist Dermatitis
-Impetigo
-Mucocutaneous pyoderma
-Superficial bact folliculitis
-Dermatophilosis - Deep Bact Infxns
-
-Pyotraumatic folliculitis and furunculosis
-Bacterial folliculitis and furunculosis
-Nasal folliculitis and furunculosis
-Muzzle folliculitis and furunculosis
-Interdigital pyoderma
-GSD Pyoderma
-Acral lick dermatitis & furunculosis
-Subcutaneous abscesses
-Bact pseudomycetoma
-Opportunistic mycobacterial granuloma
-Plague
-Actinomycosis
-Actinobacillosis
-Nocardiosis - Acute Moist Dermatitis- General info
-
-AKA Hot spot, Pyotraumatic dermatitis (PTD)
-Uncom'n in cats - Acute Moist Dermatitis- Etiopathogenesis
-
-Dvlp in minutes/hours in response to focused self-trauma
-Most often 2ndary to FAD, but many other causes - Acute Moist Dermatitis- Therapy
-
-Clip/Clean wound
-Non-steroid antipruritic spray (lidocaine, oatmeal)
-Topical corticosteroid/Abx spray (gentamycin/betamethasone)
-Oral pred
-Abx for 14-21 days
-E-collar - Impetigo- General info
-
Puppy pyoderma and bullous impetigo represent 2 subtypes
-NOT contagious
-Common - Impetigo- Etiopathogenesis (puppy form)
-
-Coagulase positive Staph. spp cultured from pustules
-May occur in assoc w/ parasitism, poor nutrition, or poor sanitary condtns, or sporadically in healthy dogs - Bullous Impetigo- Etiopathogenesis
-
Occurs secondary to immunosuppressive conditions such as Cushing's, hypothyroidism, and diabetes mellitus
-Staph, Pseudomonas may be involved - Impetigo- Signalment
-
2-12 mos (puppy pyoderma)
Middle age+ (bullous) - Impetigo-Clinical presentation
-
-Non-follicular pustules in the abdominal and axillary skin
-Usually non-pruritic
-Ruptured pustules dvlp into crust and epidermal collarettes - Impetigo- Therapy
-
-Topical Abx ointment (mupirocin)
-Abx shampoo (chlorhex, benzoyl peroxide products)
-Systemic abx if severe - Mucocutaneous Pyoderma- general
-
AKA- MCP
Uncom'n - Mucocutaneous Pyoderma- Etiopathogenesis
- Unknown
- Mucocutaneous Pyoderma- Signalment
- GSD's predisposed, but may occur in any breed/age/sex
- Mucocutaneous Pyoderma- Cx
-
-Scale, erythema, and swelling initially
-Lip commisures and wings of nostril most com'nl affected
-Lesions progress to painful crusts, exudate, and depigmentation - Mucocutaneous Pyoderma- Dx
-
Clinical recognition
Skin biopsy
Response to therapy - Mucocutaneous Pyoderma- Tx
-
-Topical abx
-Systemic abx 3-6 wks - Superficial Bacterial Folliculitis- general
-
AKA Staph folliculitis
Com'n in dogs (short hair > long hair) - Superficial bacterial folliculitis- Etiopathogenesis
-
-S. intermedius in most cases
-2y to demodicosis, irritant contact derm, atopic derm, FAD - Superficial bacterial folliculitis- Signalment
- More com'n in short-haired breeds
- Superficial bacterial folliculitis- Cx
-
-Variably pruritic
-Follicular papules, pustules
-Elevated tufts resemble hives
-Multifocal alopecia - Superficial bacterial folliculitis- Dx
-
-Clinical recognition of Cx
-R/O demodex and dermatophytosis
-Cytology--> PMN's and cocci - Superficial bacterial folliculitis- Tx
-
-Tx signs or work up underlying condtns
-Abx shampoo 1-2/wk
**Systemic abx for min. 3 wks - Dermatophilosis- General
-
AKA Cutaneous Steptotrichosis
-Very rare in SA's - Dermatophilosis- Etiopathogenesis
-
Dermatophilus congolensis
-Aerobic, Gram +
-Flagellaed, motile zoospores
-Does NOT penetrate intact skin
-Diplococci "railroad tracts" - Dermatophilosis- Cx
-
-Papules and coalescing circular crusts
-Crusts are adherent, yellow, incorporate hair
-Cats abscess more often - Dermatophilosis- Dx, Dogs
-
-Crusts minced in water, stained w/ Wright-Giemsa
-Orthokeratotic and Parakeratotic - Dermatophilosis- Dx Cats
- Biopsy and histopath of nodule is the method of choice
- Dermatophilosis- Tx, Dogs
-
Abx Shampoo and crust removal
-Penicillin V 14-21 days - Pyotraumatic folliculitis and furunculosis- General
-
-Hot spot
- Pyotraumatic Dermatitis (PTD) - Pyotraumatic Folliculitis and Furunculosis- Cx
-
-Eroded to ulcerated, alopecic, erythematous, purulent macules
-Pruritis and pain
-Com'n on cheek and neck - Pyotraumatic Folliculitis and Furunculosis- Dx
-
-Cx signs
-Skin biopsy - Pyotraumatic Folliculitis and Furunculosis- Tx
-
-Same as hot spot tx
-More resistant to tx
-Continue Abx 14d past Cx
-Discontinue pred ASAP - Bacterial Folliculitis and Furunculosis- General
-
-AKA Deep folliculitis, furunculosis, cellulitis
-May be assoc. w/ systemic illness
-Com'n in dog, rare in cat - Bacterial Folliculitis and Furunculosis- Etiopathogenesis
-
**S. intermedius most com'n
-Pseudomonas, Proteus, E. coli more com'n in deep than superficial
-Secondary to demodecosis, dermatophytosis, immunosuppression - Bacterial Folliculitis and Furunculosis- Cx
-
Lesions localized or generalized
-papules, pustules, hemorrhagic bullae, sinuses, nodules, etc - Bacterial Folliculitis and Furunculosis- Dx
-
-By Cx, may be febrile
-Cyto. exam to see bacteria and rule out fungal
-Tissue eosinophilia com'n - Bacterial Folliculitis and Furunculosis- Tx
-
-Severe cases may require IV fluids and parenteral Abx
-Frequent bathing w/ Abx shampoo
-Tx 2-3 wks past cure, Often 6-12 wks - Nasal Folliculitis and Furunculosis- General
-
AKA Nasal pyoderma
*UNCOMMON
S. intermedius most com'n - Nasal Folliculitis and Furunculosis- Cx
-
-Painful papules/pustules on dorsal muzzle
-Rapidly progressive
*UNCOMMON - Nasal Folliculitis and Furunculosis- Ddx
- -Pemphigus foliaceus, discoid lupus erythematosus, eosinophilic folliculitis and furunculosis, demodecosis, Dermatophytosis
- Nasal Folliculitis and Furunculosis- Tx
-
-Abx for 7-14d post-cure
-Soak and clean lesions TID w/ Chlorhex or Burrow's solt'n - Muzzle folliculitis and furunculosis- General
-
AKA- Canine Acne
*Common* - Muzzle Folliculitis and Furunculosis- Etiopathogenesis
-
-Probably 2ndry infxn of a sterile process
-Underlying etio may be a genetic keratinization disorder aggravated by local trauma - Muzzle Folliculitis and Furunculosis- Signalment
-
-Young dogs
-Short-haired breeds - Muzzle Folliculitis and Furunculosis- Cx
-
-Early papules are sterile follicular papules around the lips and on the chin
-Chronic-- lg bleeding/oozing pustues dvlp - Muzzle Folliculitis and Furunculosis- Tx
-
-Modify behavior which predispose chin to trauma, if possible
-Mild cases may respond to regular Antibact cleaning/topical Abx
-Infected- ORal abx for 4-6wks - Interdigital Pyoderma- General
- -AKA pododermatitis, pedal folliculitis/furunculosis
- Interdigital Pyoderma- Etiology
-
-Primary or idiopathic
-S. intermedius most com'n, but G - orgs may be involved and more resistant to Tx
-One foot--> FB's (awns), trauma, ostiomyelitis, fungal
-Multiple feet--> Hypothyroidism, Demodecosis, Atopy, food allerg., immunodef, hookworms, Pelodera, FB's - Interdigital Pyoderma- Dx
- -Rule out underlying causes w/ skin scraping, fungal culture, skin biopsy, FB exploration, Radiography
- Interdigital Pyoderma- Tx
-
-Tx w/ syst ABX for 6-8wks or 2 wks past clinical resolution
-Topical Abx/chorhex may help
-Chronic cases may me difficult to tx and require debridement, and or fusion podoplasty - GSD Pyoderma- General
-
-Hereditable dz of GSD's
-Underlying immunodeficiency
-Results in inflamm that is out of proportion to the underlying cause - GSD Pyoderma- Cx
-
-Rump, thighs, back, ventral abd, chest most affected
-Papules, pustules--> crusts, ulcers, fistulae - GSD Pyoderma- Tx
-
-Tx underlying dz if ID'd
-Clip and clean matted/ulcerated lesions
**Systemic ABX for 8-12 wks
-ABX shampoo
-Chronic ABX Tx may be needed - Acral lick Dermatitis and furunculosis- General
-
AKA- Lick Granuloma
-Com'n
-Chronic lesions carry poor prognosis for resolution - Acral lick Dermatitis and furunculosis- Etiology
-
-Single lesions = Boredom, local trauma, jt pain
-Multiple lesions = Atopic derm or hypothyroidism
-Often 2ndrly infected w/ Stapylococcus/other bact - Acral lick Dermatitis and furunculosis- Signalment
-
-Lg Breeds
-Middle age to old dogs - Acral lick Dermatitis and furunculosis- Tx
-
** Long term Tx, 6-12wks ABX
-Behavior modification
-Amytriptyline, fluoxetine, CLOMIPRAMINE, variable efficacy
-No single modality works in most cases - SQ Abscesses- General
-
-Frequent in cats, uncom'n in dogs
-WEAR GLOVES!! - SQ Abscesses- Etiology
-
-Bite wounds (Pasturella multocida)
-Non-healing may result from immunosup, Y. pestis, mycobacterial infxn, Actinomyces, Nocardia spp - SQ Abscesses- Dx
-
Cx w/ evidence of skin puncture is characteristic
**serology to check FeLV/FIV status** - Bacterial pseudomycetoma- General
-
-AKA Botryomycosis, cutan. bact. granuloma
UNCOMMON - Bacterial pseudomycetoma- Etiology
-
-2ndry to penetrating wound most com'n
-Staph most com'n
-Pseudomonas, Proteus, Strep, Actinobacillus less com'n - Bacterial pseudomycetoma- Cx
- Single/multiple nodules w/ draining fistulae
- Bacterial pseudomycetoma- Dx
-
Skin biopsy
Histopath shows granulomatous to pyogranulomatous inflammation surrounding tissue granules composed of bact and eosinophilic material
-Bact C & S - Bacterial pseudomycetoma- Tx
-
-Surgical excision
-Systemic ABX - Opportunistic Mycobacterial Granuloma- General
-
-AKA= Atypical mycobacterial granuloma
-Uncom'n in cats
-Rare in dogs
-Guarded prognosis - Opportunistic Mycobacterial Granuloma- Etiology
-
-Facultative pathogens found in soil
-Ubiquitous organisms (Mycobact. fortuitum, M. chelonei, M. phlei, M. smegmatis) - Opportunistic Mycobacterial Granuloma- Cx
-
-SQ nodules, ulcers, draining tracts and fistulae
-Most com'n location is the inguinal rgn in cats
-Dogs--> nodules on pinnae - Opportunistic mycobacterial granuloma- Dx
-
-Cx
-Demonstrate acid fast orgs
-C & S= alert lab of your suspicion, difficult to grow - Opportunistic mycobacterial granuloma- Tx
-
-Surgical excision when practical
-Enrofloxacin, Doxycycline
**Months of tx usually necessary (4-6wks past clinical cure) - Plague- General
-
-Cats/rodents much more susceptible
-30-40 spp of wild rodents as natural reservoirs
-Transmitted b/t rodents/fleas
-Bubonic, pneumonic, septicemic forms - Plague- Etiology
-
-Yersinia pestis
-G Neg, fac anaerob, nonmotile, bipolar staining coccobacillus
-Rocky mtn states and Hawaii - Plague- Cx
-
-Febrile (105-106F)
-Dehydration
-Submand, retropharyng, cervical LN's abscess and drain (bubo formation)
-Bubonic form may progress to septicemic form and pulmonic form (least com'n) - Plague- Dx
- -Cytology of exudates and aspirates: monomorphic population of Gram Neg bipolar coccobacilli
- Plague- Tx
-
Gloves/mask should be worn
-Tx should begin BEFORE laboratory confirmation - Fungal sections Objectives
-
1. Be able to discuss the three species of dermatophytes which most commonly infect small animals.
2. Describe three clinical presentations of feline dermatophytosis.
3. Describe how to reach a diagnosis of Malassezia dermatitis.
4. Know the geographic distribution of the systemic mycoses.
5. Know which fungal infections carry the greatest risk of zoonosis. - Superficial Mycoses
-
-Dermatophytosis
-Malassezia
-Candidiasis - Dermatophytosis- General
-
-Ringworm
-Overdiagnosed d/t over-reliance of Wood's light examination - Dermatophytosis- Etiology
-
-Fungal infxn of the s. corneum, hair, and/or claw by:
-Microsporum, Trichophyton, or Epidermophyton spp. - Dermatophytosis- 3 most com'n org's
-
Microsporum canis
M. gypseum
T. mentagrophytes - Microsporum canis
-
-Most often acquired from cats
-Spindle-shaped macroconidia w/ thick walls and 6+ cells
-White to buff, cottony colony - Microsporum gypseum
-
-Most often acquired from soil
-Ellipsoidal macroconidia w/ THIN walls and 4-6 cells
-Beige, granular colonies - Trichophyton mentagrophytes
-
-Most often acquired from rodents or enviro
-Numerous grape-like clusters of microconidia, few cigar-shaped macroconidia, spiral hyphae
-White to cream, powdery to granular colony - Dermatophytosis- signamlent
-
-Long haired cats
-Yorkies, dalmatians
-Poor nutrition, immunosuppressed at incr risk - Miliary Dermatitis
-
Characterized by multiple, small, crusted papules and pruritis
-RARELY caused by M. canis, much more com'n from Flea allergies - Dermatophytosis- Cx- Dogs
-
-Annular lesions w/ alopecia, follicular papules, scale and crust most com'n
-Folliculitis, furunculosis and scarring alopecia seen w/ T. mentagrophytes - Kerion
- Nodule w/ purulent exudate
- Dermatophytosis- Dx
-
-DTM
-Wood's Light
-Trichography (ectothrix spores)
-Skin biopsy (not as sensitive as DTM) - Dermatophytosis- Tx
-
-Isolation
-Environmental deconamination
-spores viable for 18mos
-1:10 or 1:20 bleach
-Destroy Bedding/grooming aids
-Topical-- CLOTRIMAZOLE, miconazole, terbinafine
-Shampoos--chlorhex, miconazole
-Rinses-- Lime sulfur
-Systemic-
Griseofulvin
-Microsized (Fulvicin U/F)
-Ultramicrosixed (Gris-PEG)
Fluconazole
Itraconazole
Ketoconazole - Malassezia Dermatitis- General
-
-Yeast dermatitis
-Com'n in dogs, rare in cats - Malassezia Dermatitis- Etiology
-
M. pachydermatis (syn Pityrosporum canis)is a normal inhabitant of K9 skin/ears
-Other factors may predispose to overgrowth, various dermatites, FAD, etc - Malassezia Dermatitis- Cx
-
-Pruritis
-Generalized or regional
-Lichenification and hyperpigmentation if chronic
-Paronychia and claw infxns w/ brown discoloration and waxy accum on claws and nail biting - Malassezia Dermatitis- Dx
-
Skin surface cytology
-Direct impression
-Acetate tape impression
-Cotton-tipped swab
Skin biopsy less sensitive b/c outer half of s. corneum lost during processing - Malassezia Dermatitis- Topical Tx
-
Ointments: Clotrimazole, miconazole, terbinafine
Shampoos and rinses: Chlorhex, miconazole - Malassezia Dermatitis- Systemic Tx
-
Ketoconazole
Itraconazole, fluconazole
***Griseofulvin is NOT effective*** - Candidiasis- General
-
AKA- Moniliasis, Thrush
-RARE
-Normal inhabitants of alimentary, upper resp, genital mucosa - Candidiasis- Signalment
- -Dogs w/ Diabetes mellitus, Cushing's, Hypothyroidism, neoplasia, taking immunosuppressive drugs
- Candidiasis- Cx
-
-Grey plaques/ulcers in mucocutaneous jxns, ear canal, intertriginous areas, interdigital areas
-Papular to pustular lesions - Candidiasis- Dx
-
-Cutaneous cytology
-Narrow-based budding org's - Candidiasis- Tx
-
-Correct underlying dz
-Control moisture by clipping and cleaning, when approp.
-Topical antifungals
-Systemic antifungals
-Ketoconazole
-Itraconazole - Subcutaneous Mycoses
-
-Often introduced via trauma, grow in living tissue
-Eumycotic mycetoma
-Phaeohyphomycosis
-Zygomycosis
-Sporotrichosis
-Rhinosporidiosis - Eumycotic mycetoma- General
-
-Maduromycosis
-Tropical dz
-Rare in US - Eumycotic mycetoma- Etiology
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-Most com'nly caused by Pseudoallescheria boydii
-Gains entry via wound contamination - Eumycotic mycetoma- Cx
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-Solitary nodules, draining tracts and tissue grains
-Head/limbs most affected - Eumycotic mycetoma- Dx
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Cytology
Histopathology
Fungal culture - Eumycotic mycetoma- Tx
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-Surgical excision or limb amputation
-Poor prognosis - Phaeohyphomycosis- General
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-AKA Chromomycosis
-Pigmented hyphae
-RARE to UNCOMMON - Phaeohyphomycosis- Etiology
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-Many dematiaceous soil saprophytes are capable of causing this
-Bipolaris spiciferum
-Xylohypha bantiana - Phaeohyphomycosis- Dx
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Cytology and histopath
-Granulomatous to pyogranulomatous dermatitis and panniculitis - Phaeohyphomycosis- Tx
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-Poor prognosis w/ recurrence com'n
-Ketoconazole
-Itraconazole
-Flucytosine
-Amphotercin B
-Wide surgical excision - Zygomycosis- General
- -Mucormycosis, entomopthoromycosis
- Zygomycosis- Etiology
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-RARE in dogs & cats
-Multiple fungi cause this
-Rhizopus, Mucor, Absidia, Conidiobolus, Basidiobolus - Zygomycosis- Cx
- -Solitary or multiple ulcerated, draining nodules on extremities
- Zygomycosis- Tx
- -Surgical excision or debulking along w/ antifungal therapy
- Sporotrichosis- General
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-UNCOMMON
-Zoonotic
-Exudates and tissues from cats are infective - Sporotrichosis- Etiology
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-Sporothrix schenckii
-Mycelial form in environment, yeast form in tissue
-Gains entry via wound
-Dogs- splinters and thorns
-Cats- Contaminated claws - Sporotrichosis- Cx
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-Cutaneous, cutaneolymphatic, disseminated froms may occur concurrently
-Lesions begin distally and travel up
-Cats dvlp abscesses and cellulitis under puncture wound
-Dissemination often evident at necropsy - Sporotrichosis- Dx
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**Suspect this dz when an abscess or wound responds poorly to tx**
-Fluorescent Ab testing - Sporotrichosis- Tx- Dogs
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-Supersaturated solution of potassium iodide (SSKI) is the tx of choice
-If iodism is a concern, use ketoconazole or itraconazole - Sporotrichosis- Tx- Cats
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Itraconazole is Tx of choice since cats are more susceptible to SSKI and Ketoconazole SE's
-Monitor for hepatotoxicity, anorexia, vomiting, wt. loss - Rhinosporidiosis- General
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RARE in dogs
NOT reported in cats - Rhinosporidiosis- Etiology
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Rhinosporidium seeberi
Difficult to culture
Mucous Mb trauma may predispose to infxn - Rhinosporidiosis- Tx
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Surgicl excision of polyps is often curative
-Dapsone or Ketoconazole may help w/ recurrence - Systemic Mycoses (Cutaneous manifestations)
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-Blastomycosis
-Coccidiomycosis
-Cryptococcosis
-Histoplasmosis
Hematogenous and lymphatic spread of deep or systemic mycoses may lead to skin infxn
Primary cutaneous infxn is extremely rare - Blastomycosis- General
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UNCOMMON in dogs
VERY RARE in cats
-MS, OH, MO river valleys
-NOT zoonotic by aerosol from infected pets, but humans have gotten infected at the same time as pets - Blastomycosis- Etiology
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Blastomyces dermatitidis, a dimorphic saprophyte
-Inhalation of spores from mycelial growth in enviro
**Infection established in the lungs** - Blastomycosis- Signalment
- 1-5 yo, male, outdoor, hunting dogs most com'nly affected
- Blastomycosis- Cx
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-Skin lesions in 20-40% of infected dogs
-Planum nasale, face, and nail beds most com'n sites
-Papules, plaques, nodules, ulcers, draining tracts, abscesses
-Multi-system involvement:
fever, dry harsh lung sounds, ocular lesions, lameness and bone involvement, wt loss - Blastomycosis- Dx
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-Cytology of exudates shows round to oval yeast
-Histopath
-Fungal culture
-Serology
-Radiograph chest, and lame limbs - Blastomycosis- Tx
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-Itraconazole Tx of choice**
-Amphotericin B and Ketoconazole alternatives
-Fair prognosis if no brain involvement or bad lung dz - Coccidiodomycosis- General
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-San Joaquin Valley Fever
-Valley Fever
-UNCOM'N (dogs) to RARE (cats)
-Southwestern US - Coccidiodomycosis- Etiology
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Coccidiodes immitis, a soil-borne fungus
-Epidemics may follow wind, recent rain, or earthquakes
-Inhalation of arthroconidia
-Most asymptomatic - Coccidiodomycosis- Signalment
- 1-4 yo male dogs predisposed
- Coccidiodomycosis- Cx
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-Multi-system involvement:
fever, anorexia, wt. loss, depression
-Skin lesions 2ndry to disseminated dz
**Papules, nodules, ulcers and draining tracts usually over site of infxn in DISTAL long bone** - Coccidiodomycosis- Dx
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Cytology and histology may work, but not com'nly
-Dx based on clinical signs, radiograph findings, and serology
-Fungal culture should be avoided - Coccidiodomycosis- Tx
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Guarded prognosis w/ frequent relapses
-Ketoconazole, itraconazole, fluconazole, Amphotericin B - Cryptococcosis- General
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-RARE in dogs
-UNCOMMON in cats
**Pigeon droppings serve as the main reservoir**
-NOT Zoonotic - Cryptococcosis- Etiology
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Cryptococcus neoformans is a ubiquitous, saprophytic, round, yeast-like fungus
-Forms a capsule when growing in tissue, hindering Ag presentation
-Rte of infxn--Inhalation - Cryptococcosis- Signalment
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-Siamese cats susceptible
-In dogs, young adults
-Doberman, Great Danes, American Cockers - Cryptococcosis- Cx
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-Skin lesions in 40% of cats, 20% of dogs
-Nasal cavity involved in 80% of cats (polyps)
-Papules, nodules, ulcers, draining tracts
-Other signs: CNS, ocular, wt loss, mild fever - Cryptococcosis- Dx
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-Cytology of nasal exudates, skin exudates, CSF, tissue impressions
-Fungal culture, histopath, serology - Cryptococcosis- Tx
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-Long term tx - 7-10 mos
-Serial latex agglutination testing help to monitor response
-ITRACONAZOLE drug of choice
-Fluconazole for CNS involvement
-Ketoconazole- Use w/ CAUTION w/ cats
-Amphotericin B and Flucytosine used less com'nly d/t toxicity - Histoplasmosis- Etiology
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Histoplasma capsulatum
-Survives best in soils w/ bat and bird excrement
-Inhalation probable route of inoculation - Histoplasmosis- General
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UNCOMMON in dogs/cats
-Most cases in MI, MO, OH River valleys - Histoplasmosis- Signalment
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-Young cats and dogs (<4yo)
-Pointers, Weim's, Brittany spaniels - Histoplasmosis- Cx
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-Disseminated dz most com'n
-Skin infrequently affected
-Papules, nodules, ulcers, tracts
-Usually multiple lesions
-Face, nose, pinnae
-Depression, wt loss, anorexia, dyspnea
-Dogs--> Lg bowel diarrhea - Histoplasmosis- Dx
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-Org's usually numerous in exudates and tissues
-Intracellular small, round yeast in mononuclear cells
-Basophilic center and light halo caused by shrinkage
-Fungal culture should be avoided (let the pro's do it)
-Serology unreliable - Histoplasmosis- Tx
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-Itraconazole
-Fluconazole (CNS)
-Ketoconazole less effective -
Parasitic Skin Diseases I: Mites, Helminths, & Flies
Objectives: -
1. Be able to describe the clinical features, diagnosis, and treatment of canine demodicosis.
2. Be able to recognize the mites affecting dogs and cats.
3. Understand why ivermectin is more toxic to certain individuals.
4. List three techniques for the collection of Cheyletiella mites. - Demodicosis- General
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AKA-Follicular mange, Red mange
-Com'n in dogs
-RARE in cats - Demodicosis- Etiology in Dogs
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-Demodex canis
-Normal resident of skin
-Juvenile onset assoc. w/ immune abnormalities and genetics
-Adult onset assoc. w/ Immuosuppression, metabolic dz, neoplasia - Demodicosis- Etiology in Cats
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Demodex cati assoc'd w/ systemic dz (FIV, FeLV, diabetes mellitus, SLE)
-Plumper mite
-CONTAGIOUS - Localized Demodicosis
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-5 or less discrete lesions
-Periocular, perioral, limbs most com'nly affected
-Mild erythema, alopecia
-Non-pruritic - Generalized Demodicosis
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>5 patches, lg rgns, or generalized
-Any rgn of the body, esp feet
-Mild-severe erythema, alopecia
-Swelling, sinus tracts may dvlp
-May dvlp deep bact folliculitis/furunculosis
-Greasy and malodorous - Felin Demodicosis
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-Periocular, head, neck alopecia
-Erythema, scale, crust
-Ceruminous otitis externa
-Pruritis variable, severe w/ D. gatoi - Demodicosis- Tx- dogs
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-Localized, should resolve w/o tx
-Topical benzoyl peroxide gel or rotenone
-Repeat monthly skin scapings until 2 negatives
-Amitraz (Mitaban)- *ONLY approved tx
-Don't bathe b/t dips
-Ivermectin
-Milbemcyin (Interceptor) - Demodicosis- Tx- cats
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-Often self-limiting
-Weekly lime-sulfur dips for 4 wks if generalized or D. gatoi - Canine Scabies- Etiology
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-S. scabiei var. canis
-Front legs short w/ UNJOINTED pedicles and suckers
-Burrow in the s. corneum - Canine Scabies- Cx
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-Pruritis severy by 3-4wks
-Positive pinnal-pedal reflex
-Ventral chest, abdomen, legs, elbows, pinnal margins
-Papules, alopecia and erythematous, excoriated crusted macules - Canine Scabies- Dx
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-Superficial skin scrapings positive less than 50% of time
-When scabies suspected, but not seen, trial tx w/ Revolution
-Skin scrapings over large areas - Canine Scabies- Tx
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-Isolation
**Tx ALL dogs in house**
-Selamectin (Revolution) every 2 wks for 3-4 tx's
-Ivermectin SQ wkly for 3-4wks
-Milbemycin
-Lime-sulfur dips
-In many cases the pruritis will worsen at first, by 14d improvement should be seen - Notoedric Mange- General
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-AKA Feline scabies, Head mange
-HIGHLY contagious
-ZOONOTIC - Notoedric Mange- Etiology
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-Notoedres cati (a sarcoptiform mite)
-Smaller than sarcoptes, look similar, w/ dorsal anus - Notoedric Mange- Cx
- -Pinnae, face, neck, legs, feet, perineum mostly affected
- Notoedric Mange- Dx
- Skin scrapings reveal mites w/ UNJOINTED pedicles (shorter than sarcoptes) w/ suckers
- Notoedric Mange- Tx
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Selamectin
Ivermectin a good alternative - Cheyletiellosis- General
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"Walking Dandruff"
-Dogs, cats, rabbits
-Zoonotic - Cheyletiellosis- Etiology
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Dogs- C. yasguri
Cats- C. blakei
Rabbits- C. parasitivorax