Derm2- Misc Pruritus

  1. What ingredients of topical medications (esp. otic) are widely implicated in contact dermatitis? (2)
    neomycin, propylene glycol
  2. What are common components of a history with contact dermatitis?
    corticosteroid responsive, with allergen one animal affect/with irritants all animals affected
  3. What are the 2 types of contact dermatitis?
    • with allergen one animal affect
    • with irritants all animals affected
  4. Clinical signs of contact dermatitis? (9)
    highly pruritic, poorly haired areas (ventrum, scrotum, axillae, medial pinnae, mouth, interdigital), erythema, exudation, papules, crusting/scaling, alopecia, hyperpigmentation/ lichenification, well-demarcated
  5. What lesions are commonly associated with contact dermatitis? (7)
    • Primary: erythema, papules
    • Secondary: exudation, crusting, scaling, alopecia, hyperpigmentation/ lichenification
  6. How do you diagnose contact dermatitis? (3)
    • rule out AD, CAFR, and parasites
    • treat secondary infections
    • bathe and board for 1-2 weeks (get out of home environment)
  7. How do you treat/manage contact dermatitis? (3)
    • avoidance (if you can ID cause)
    • glucocorticoids
    • pentoxifylline
  8. How do you rule out AD when diagnosing contact dermatitis?
    • although body sites are similar, contact dermatitis is limited to unhaired body regions and it is well-demarcated, whereas AD does not stay to specifically unhaired areas
    • Also, contact dermatitis has primary lesions (papules), which are NOT seen with AD
  9. What are the "3 P's" that cause canine acral lick dermatitis (lick granuloma)?
    • primary causes: boredom/stress, psychogenic, allergic dz, focal stimulus, foreign body, neuropathy, endocrinopathy
    • predisposing factors: change in environment, new pet, change in routine, anxiety, inadequate exercise, clipping fur
    • Perpetuating factors: bacterial infection, keratin FB, fibrosis, osteomyelitis/arthritis, learned behavior
  10. What is the itch-lick cycle?
    lick--> endorphin release--> euphoria
  11. What breeds usually get lick granulomas?
    large breeds- doberman, great dane, rott, retriever, GSD
  12. Describe the lesions of lick granuloma. (7)
    cranial carpal, tarsal, metatarsal alopecia-->firm ulcers--> hard, pigmented, nodular, NON-PAINFUL
  13. What are differentials for a nodular, ulcerated plaque on the distal limb of a dog? (4)
    lick granuloma, neoplasia (mast cell tumor), nodular dermatitis, demodicosis
  14. What is the diagnostic approach for lick granuloma? (6)
    FNA, biopsy (histopath + culture- deep infection), radiographs, measure lesion, if suspect underlying allergies- work up for allergies, if suspect metabolic (thyroid)- blood work
  15. How do you treat lick granulomas? (4)
    ID/treat primary cause, control secondary deep infection (long course of antibiotics), decrease inflammation, behavior modification
  16. What topical therapies are commonly used for lick granulomas? (3)
    • glucocorticoids- synotic (flucinolone in DMSO, carrying it deep into the tissue)
    • NSAIDs
    • analgesics (capsaicin- if neuopathy)
  17. What systemic therapies are commonly used with lick granulomas?
    • Tricyclic antidepressant drugs: Doxepin (also antihistamine properties), Clomipramine
    • Selective serotonin reuptake inhibitors: Fluoxetine (psychogenic, neuropathic lickers)
    • Serotonin antagonist reuptake inhibitors: Trazodone
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Derm2- Misc Pruritus
vetmed derm2