Dermatology

  1. diagnostic testing and dermatology
    • tests SUPPORT dx, don't make it!!  A skin scrape missed demodex 75% of the time
    • HISTORY is your number one tool - skin reflects the systemic environment
  2. How to tell if deep lesions are gone
    feel for them with your fingers.  Looking only shows superficial
  3. primary vs secondary lesions
    • primary created from disease, good for testing.
    • secondary are ruptured, usually from (self) trauma.  No longer good for testing
  4. primary skin lesion examples (7 or 11)
    • macuole or patch
    • papule or plaque
    • nodule or tumor
    • pustule
    • vesicle or bulla
    • wheal
    • cyst
  5. macule or patch
    • area of altered pigmentation.  A macule is <1cm, a patch is >1cm
    • primary lesion
  6. papule + (3) common causes
    • solid elevated mass <1cm in diameter (larger is nodule)
    • squeeze for cytology
    • staphylococcal, parasitic, dermatophytic
    • primary lesion
  7. nodule + 4 common causes
    • solid elevated mass >1cm (smaller is papule)
    • FNA for testing (firm)
    • staphylococcal, fungal, neoplastic, sterile disorders
    • primary lesion
  8. nodules vs tumors
    • none, really, until diagnostics.  Size difference is unclear.
    • primary lesion
  9. ultimate testing in derm
    Histopathology!  Cytology disrupts normal architecture, so histo needed for staging.
  10. plaque
    • flat-topped solid elevated mass
    • hives pit with pressure (so different)
    • can't FNA (but can palpate), so have to biopsy.
    • primary lesion
  11. wheal
    • flat-topped but boggy mass.  Pits with pressure (plaques are solid).  Steep walled.  
    • Hives = type 1 hypersensitivity (zebra urticaria!)
    • primary lesion
  12. pustule (2)
    • fluid-filled lesion filled with pus
    • infection = degeneratie neutrophils.  Non-degenerate = sterile.  Erythematous = inflamed
    • knock the top off and sample, must be intact!
    • staphylococcal disorders, sterile disorders (pemphigus)
    • primary lesion
  13. Vesicle and common causes (3)
    • fluid-filled lesion not filled with pus, <1cm
    • have to biopsy skin in a hemorrhagic blister/vesicle, because blood won't tell you anything (coag?  Hemangiosarc?)
    • sterile disorders, vascular disorders, neoplastic conditions
    • primary lesion
  14. bulla
    • fluid-filled lesion not filled with pus (blister) >1cm
    • have to biopsy skin in a hemorrhagic blister/vesicle, because blood won't tell you anything (coag?  Hemangiosarc?)
    • primary lesion
  15. cysts
    • lots of different times, congenital or acquired.  
    • Diagnose via examination of cyst wall.  
    • Lesion full of stuff (NOT sebaceous, can be full of anything (else), sweat etc.). Can look like pustules (miliary), hair growing out (dermoid)
    • fluid drains right out
    • primary lesion
  16. mixed etiology skin lesions (6)
    • alopecia
    • scale
    • crust
    • comedo
    • hair cast
    • pigmentary abnormality
  17. hypotrichosis
    less than normal numbers of hairs
  18. alopecia
    • complete hair loss
    • can be just one kind, like primary hairs, or a color
  19. hypertrichosis
    increased numbers of hairs
  20. scale
    • accumulation of exfoliated epithelial cells
    • (sunburn or low humidity.  Weight-reducing diet so no fat?  Skin needs fat)
  21. crust vs oozing
    dried liquid vs cells on skin's surface.  Sweat or serum ooze to the surface and dry
  22. comedo
    • dilated hair follicle filled with keratin
    • open is a blackhead, closed is miliary pattern
  23. hair casts
    • disorder of follicular keratinization
    • hair follicle filled with keratinogenous plug extending above skin's surface, hair comes out in clumps, hair pasted together
  24. secondary skin lesion examples (7)
    • epidermal collarette
    • excoriation
    • erosion or ulcer
    • fissure
    • scar
    • lichenification
    • callus
  25. epidermal collarette
    • "footprint" of a pustule or a vesicle
    • poor lesion to sample (secondary)
    • no diagnosis from ruptured!  Find a primary lesion to sample!!
  26. excoriations
    • self-induced lesions caused by scratching, chewing, licking, licking, rubbing, rolling
    • secondary lesions
  27. erosion
    • loss of epidermal tissue, most shallow, above BMZ
    • secondary lesion
  28. ulcer
    • loss of epidermal tissue and dermal tissue, below BMZ (will scar, deepest)
    • secondary tissue
  29. Fissure
    • loss of epidermal and dermal tissue, linear ulcer
    • secondary lesion
  30. scar
    • healed ulcer
    • secondary lesion
    • 10x more likely to get SCC with sun
  31. lichenification
    • sign of chronicity
    • lesions often hyperpigmented (tree bark)
    • secondary lesion
  32. callus
    • found over bony prominences
    • protects underlying tissues (pressure point proliferation)
    • secondary lesion
  33. bilaterally symmetric lesions indicate _________
    systemic disease
  34. deep lesions are ___________
    out of sight, just a BUMP
  35. trichogram
    • pluck 10-15 hairs, mount in mineral oil
    • Should be bulb, shaft, tapered tip with cuticle, cortex, medulla.  
    • Normal response is mix of anagen and telogen hairs, mix of primary and secondary hairs in dogs
  36. Fine needle aspirate
    • used to collect samples (cytology) from solid or deep lesions
    • suction vs trocar
  37. cytospin cytology
    • used to sample fluid filled lesions
    • clinical microhematocrit tubes and centrifuge used
    • avoid bloody or viscid fluids
  38. diascopy
    • differentiates vascular dilitation from vascular leakage
    • vascular dilatation blanches with pressure
    • vascular leakage (coagulopathy or vasculopathy) does not blanch with pressure - indicates RBC OUTSIDE of vessels
  39. wood's light exam
    • UV light
    • microsporum canis only
    • fluorescence due to triptophan metabolites
    • many false positives and negatives
  40. fungal culture (DTM)
    • modified Sabouraud's agar with pH indicator to detect dermatophytes
    • protein metabolism to alkaline metabolites to red color change
    • color change and colony growth occur simultaneously
  41. bacterial culture and susceptibility testing
    • CYTOLOGY FIRST
    • indicated when organism can't be ID'd, rational tx are ineffective or tx vary widely in expense
    • culture INTACT lesions, use reliable lab
  42. skin biopsy
    • underused! Inflammatory must be examined by veterinary dermatopathologist
    • incisional or excisional techniques
    • contraindicated in deep or fragile lesions
    • could use punch or blade technique
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    wheal (zebra urticaria), hives
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    wheal
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    vesicle
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    ulcer
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    tumor
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    • sucking louse, anoplura
    • operculated eggs stuck to hairs, grossly visible
    • more likely to cause hypersensitivity and be killed by systemic drugs
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    scar
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    scale
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    pustule
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    lichenoid plaques
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    plaque
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    papule
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    papule
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    • otodectes
    • non-burrowing psoroptid ear mite, also on rest of body.  
    • usually puppies and kittens
    • NO HOST SPECIFICITY
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    open comedo
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    nodule
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    miliary comedo
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    macule, patch
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    lichenification
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    lice and eggs
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    hair casts
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    hair casts
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    erosion, ulcer
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    epidermal collarette
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    dermatoid cyst
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    • demodex gatoi, feline demodicosis
    • fecal float or tape cytology
    • CONTAGIOUS, asymptomatic carriers
    • variable signs
    • surface parasite, lives on surface of skin, variable symptoms.  
    • Itchy!
    • usually ventral because contagious
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    • demodex cati, feline demodicosis
    • immunosuppression (kittens or FeLV, FIP, lymphoma etc.)
    • non-itchy alopecia = something wrong with follicle!  Demodex or dermatophytosis
    • follicular or otic
    • DEEP scrape, cure difficult. 
    • Don't need to tx in kittens
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    cyst
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    crust
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    chorioptes
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    • cheyletiella, 3 kinds (cheyletiella yasguri, C. blakei, C parasitivorax)
    • no host specificity (but some host preference)
    • SURFACE parasite with non-operculated eggs cemented to hairs
    • Hurts when bites!!!
    • longest off-host life (10+ days)
    • Clinical signs: variable.  none to dorsal seborrhea, +/- pruritis. Variable clinical signs, often none or dorsally oriented walking dandruff (seborrhea +/- pruritus, scabies-like pruritus)STARTS AT TOPLINE AND WORKS DOWN
    • will bite O through clothes 
    • Dx: fecal float, tape, flea comb, treatment test
    • don't suck blood!  So blood-borne drugs won't help (bravecto)
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    • chewing louse, mallophaga
    • operculated eggs stuck to hairs, grossly visible (can't see chyletiella)
    • less likely to cause hypersensitivity than sucking.
    • Can't use systemic as well.
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    callus
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    bulla
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    broken hairs
  79. papules to pustules to crusts
    • centered on hair follicles
    • pathologic, progressive: invasion of follicle wall, progression into lumen, rupture of pustule or follicle wall.  Infectious most common reason.  
    • Most things in the hair follicle will be neutrophilic
  80. impetigo
    • nonfollicular bacterial pustular disease (non-haired or injured skin, little inflammation).  Usu staph (puppy pyoderma)
    • uncommon in dogs, rare in cats.  
    • puppies 0-6months, asymptomatic otherwise.  Otherwise immunosuppressed.
  81. staphylococcal folliculitis and furunculosis
    • pre-existing reason needed for infection (immune deficiency, metabolic disorder, skin disease)
    • common species like staph pseud, aureus. Resistance a problem.
  82. nasal furunculosis
    • secondary to nasal trauma (pruritic disorder vs rodent hole burrowing, etc)
    • slowly progressive
    • painful or pruritic
    • heals with scarring
  83. chin and muzzle furunculosis
    • "canine acne"
    • initiated by trauma to chin
    • initially sterile, heals with scarring
  84. post-grooming folliculitis and furunculosis
    • commonly short-coated breeds, follows bathing by 12-24h
    • contaminated shampoos, water or bathing utensils
    • painful, systemic signs of illness
    • cytology mandatory
  85. mucocutaneous staphylococcal pyoderma
    • chronic recurrent condition
    • GSD commonly affected
    • infection starts at mucocutaneous junction (lips, nares, eyelids)
  86. acute moist folliculitis & furunculosis
    • mimics acute moist dermatitis ("hot spot")
    • sudden onset of self trauma to "normal" skin
    • painful
    • distinguish from "hot spot" by palpation, presence of satellite lesions
  87. acral lick folliculitis & furunculosis
    • follows behavioral issue, skin trauma, deep seated disease
    • hairs imbedded deeply, heals with scarring
  88. pedal furunculosis
    • triggered by conformation of foot, pruritic pedal disorders, environmental factors
    • progressive disorder
    • heals with scarring
  89. feline staphylococcal infections
    • uncommon
    • mimics noninfectious conditions (miliary dermatitis)
    • secondary to pruritic skin disorders, chronic glucocorticoid use
  90. equine staphylococcal infections
    • uncommon
    • follow skin damage or overzealous O treatments
    • Staph in horses is itchy--which came first, the staph or the trauma?
  91. dermatophilosis
    • streptothricosis, rain scald, rain rot, lumpy wool, strawberry foot rot, mycotic dermatitis, aphis
    • activated by water (pruny skin, stratum corneum peels off, enough damage to cause top line dz, exudative dermatitis
    • peel off crust to tx, send in for dx.  Sedate to peel, painful!
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    acral lick folliculitis
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    acute moist folliculitis, mimics hot spot
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    dermatophilosis
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    impetigo
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    impetigo (skin was previously broken)
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    mucocutaneous staphylococcal pyoderma
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    muzzle furunculosis
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    nasal furunculosis
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    pedal furunculosis
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    staphylococcal folliculitis
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    staphylococcal folliculitis
  103. aural, abbreviations
    • of or relating to ear or sense of hearing
    • AD = right ear
    • AS = left ear
    • AU = both ears
  104. otitis and kinds
    • inflammation of ear, sterile or with infection
    • otitis externa (pinna to tympanic)
    • otitis media (tissues comprising or contained within middle ear)
  105. cerumen
    yellow waxy substance comprised of secretions from ceruminous and sebaceous glands comingled with desquamated keratinocytes (ear wax)
  106. glandular hyperplasia
    • increase in # of glandular cells, usu incited by inflammation
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  107. stenosis
    abnormal narrowing of tubular structure
  108. fibrosis
    excessive fibrous CT formation in a repairative or reactive process (long term)
  109. dystrophic mineralization
    • calcium deposition within cells resulting in phosphate accumulation and microcrystal formation
    • response to tissue damage
  110. where does the otoscope go?
    • intertragic incisure
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  111. parts of the tympanum
    • pars flaccida: vascular, can bulge from air pressure/respiration
    • pars tensa: translucent
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  112. def of otitis primary vs secondary causes, predisposing vs perpetuating factors
    • primary: create disease in normal ear
    • secondary: create disease in abnormal ear
    • predisposing factor: prior to development of ear disease
    • perpetuating factor: result of otic inflammation
  113. Primary causes of otitis
    • hypersensitivity diseases: atopic dermatitis, food, adverse drug rx, contact most common from medications or vehicles, 90% or greater
    • parasites: otodectes cynos most, mites, tick and flies
    • foreign bodies: inflammation blocks canal, predisposes
    • keratinization disorders: chronic ceruminous otitis (cockers make too much), idiopathic seborrhea (rest of body too), hypothyroidism
    • immune-mediated diseases
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    • hypersensitivity otitis externa
    • contact most common, meds or vehicles
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    otodectes cynos, otitis externa
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    • otodectes cynos, otitis externa
    • non-burrowing psoroptid ear mite, also on rest of body.  
    • usually puppies and kittens
    • NO HOST SPECIFICITY
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    demodectic mange otitis externa, can see demodex mites on cytology, should also see on rest of body
  118. secondary causes of otitis externa
    • in an ABNORMAL CANAL
    • bacteria: staph pseudintermedius most common, pseudomonas, proteus, e coli, klebsiella.  Inflammation is the difference between infection and overgrowth
    • yeast: malassezia pachydermatis, candida
    • topical acquired irritant rxns
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    bacterial otitis, SECONDARY to something else!!!
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    yeast otitis, SECONDARY to something else!!!
  121. Otitis externa predisposing factors (4)
    • won't CAUSE but will exacerbate
    • conformation: floppy decrease circulation, stenotic breeds increase glandular secretions, humidity (don't pluck!)
    • excessive moisture: increased risk with swimming, water may be contaminated
    • obstructive ear disease: nasopharyngeal polyps, ceruminous cystomatosis, ceruminous gland neoplasia
    • primary otitis media:
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    nasopharyngeal polyp, obstructive disease PREDISPOSING young cats to otitis externa
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    • ceruminous cystomatosis
    • obstructive disease usually throughout ear canal, debris trapped, PREDISPOSES to otitis externa
  124. myringotomy
    • hole in tympanic membrane, suck out fluid and culture
    • for otitis media.  Culture and flush.
  125. systemic therapy for otitis externa
    • only in some cases: parasites, severe or refractory otitis externa, marked proliferative changes, otitis media, O can't administer, topical adverse rxns
    • tx must be use AT LEAST 1 WEEK after resolution (cytological)
  126. lateral ear canal resection
    • removes vertical canal only, only if dz is ONLY there.  For non-responsive otitis externa, permanent exposure of horizontal canal.  Improves drainage, reduces humidity.  50% effective. 
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  127. KEYS to treating otitis externa (4)
    • address predisposing, primary, secondary, perpetuating causes
    • cytology initially and at rechecks
    • appropriate treatment, dose and time
    • follow up!!
  128. aural hematoma
    • accumulation of blood within pinna, secondary to head-shaking or trauma (often secondary to otitis externa)
    • cartilate of pinna sheared, blood accumulates intracondrally.
  129. blood vessels are on the _________ side of the ear
    • convex.  
    • concave side less vascular
  130. techniques for draining aural hematoma
    • teat cannula
    • suction drain
    • multiple perforations with skin punch or laser (VERTICAL)
    • multiple aspirations
    • plastic rivets or BUTTONS
    • incision with through-and-through sutures
    • TREAT OTITIS!!!
  131. Surgical technique for aural hematoma
    • anesthesia
    • treat otitis externa
    • clip and prep pinna
    • linear incision on concave side, entire span of hematoma
    • remove fibrinous material (better cosmetic result)
    • Full thickness sutures PARALLEL to long axis (preserve blood supply)
    • Suture through non-adherent pad on convex side of ear, through-and-through. 
    • knots over non-adherent pad on convex side, snug to compress pinna (so can find knots in 3 weeks)
    • pendulous pinna wrapped over head to prevent shaking, remove sutures in 3 weeks, keep treating otitis.
  132. surgical technique for lateral ear canal resection
    • can do bilaterally.  Clip and prep, clean canal, measure depth of vertical. 
    • Skin incision 50% longer than vertical canal, parallel incision lateral to tragus, connect with "U", dissect skin flap up to tragus
    • incise cartilage of vertical canal between lateral and cranial wall, lateral and caudal wall with mayo scissors, fold down (parallel, don't cut off!)
    • suture skin flap down, leave cartilage down as drip track.
    • wrap and analgesia for 3-5 days, sutures removed in 10-14.  Tx otitis.
  133. feline inflammatory polyps
    • cats 1-3 years old
    • hx of URI virus when young
    • polyps originate in middle ear, expands nasopharyngeally or aurally
    • may see Horner's, vestibular signs
    • occasionally bilateral or unilateral mixed
  134. feline aural polyp
    • 1-3yo cats with hx of URI virus when young, polyp in middle ear grows laterally
    • chronic otitis externa, refractory to medical mgmt.
    • extracted through ear, 40% recur if you don't get it all so LOOK with otoscope (only 13% recurrence)
  135. feline nasopharyngeal polyp
    • 1-3yo cats with hx of URI virus when young, polyp in middle ear grows medially
    • UR signs like nasal d/c, sneezing, stertor, dyspnea
    • mid-point of soft palate, so compression and possible occlusion of nasopharynx
    • extract through the mouth, 10-41% recurrence, lower with steroids (oral or aural)
    • Possible transient Horner's, ventral bulla osteotomy for recurring
  136. per-endoscopic trans-tympanic traction
    removal of feline aural polyp that is otoscope-guided with alligator forceps, so you can get it all (in the canal)
  137. total ear canal ablation (TECA)
    • removal of entire ear canal surgically
    • remove vertical, horizontal and annular cartilages
    • lateral bulla osteotomy - CAREFUL with facial nerve!
    • T-shaped incision over lateral aspect of vertical canal. Encircle external canal, dissect off auricular muscles, dissect out branch of facial nerve, dissect annular cartilage from petrous temporal bone
    • bone ronguer expands external auditory meatus for access, lateral bulla osteotomy with bone curette (VENTRAL portion only, avoid vestibular apparatus and cochlea)
    • lavage with saline, close deep tissues then T in skin. 
    • analgesics, head wrap, E collar, 3 weeks of abx based on culture.
  138. indications for teca
    • nonresponsive otitis externa with severe epithelial hyperplasia
    • neoplasia of ear canal (ceruminous gland adenocarcinoma)
    • revision of failed lateral ear canal resection
  139. complications of TECA
    • 10% facial nerve paralysis
    • <5% facial fistula (didn't get all the infection)
    • <1% vestibular signs
    • 100% hearing loss
  140. why to biopsy (6)
    • acute and severe
    • therapy has significant side effects
    • suspected neoplasia
    • lesions appear unusual
    • new lesions WHILE on therapy
    • lesions don't respond to therapy
  141. where to biopsy
    • TAKE 3-5!!!  If generalized.
    • 6mm ideal, NO SMALLER than 4mm.
    • Shoot for primary lesions first.
  142. who to send biopsy to, and what to send with
    • a DERMATOPATHOLOGIST
    • concise history (signalment, description/photos, location, clinical signs? duration)
    • abx before biopsy if secondary infection suspected
    • steroids STOPPED before biopsy
    • fix in 10% formalin, and stick the SQ to cardboard or tongue depressor to prevent curling or rolling (don't need for full thickness when >6mm)
  143. biopsy don'ts (8)
    • DON'T scrub/prep
    • DON'T clip too close
    • DON'T squeeze the sample
    • DON'T reuse biopsy punches
    • DON'T use cautery on small samples
    • DON'T ship over the weekend in winter (freezing)
    • DON'T use a punch for deep or fragile lesions (wedge biopsy!)
    • DON'T sample the center of an ulcer
  144. epidermal change - hyperkeratosis and 2 kinds
    • increased thickness of stratum corneum
    • orthokeratotic: composed of completely cornified cells.  developmental, endocriopathies
    • parakeratotic: retain nuclei in stratum corneum (incomplete cornification).  Ectoparasites, malassezia
    • nondiagnostic, found in most chronic dermatitis
  145. epidermal change - Hyperplasia (5 kinds)
    • increased thickness of noncornified epidermis due to increased NUMBER of cells. Can cause rete ridge (pegs projecting into dermis, only normal in pig).  Common in chronic inflammatory.
    • regular: evenly thickened
    • irregular: uneven, pointed rete ridges
    • psoriasiform: evenly elongated rete ridges, clubbed and fused at base. Chronically traumatized skin lesions.
    • papillated: digitate projections above skin surface
    • pseudocarcinomatous: extremely irregular due to underlying dz with chronic ulcers
  146. epidermal change - civatte bodies and sunburn cells
    • apoptotic keratinocytes, seen in any hyperplastic epidermis
    • cell shrinks, becomes denser, cytoplasm more eosinophilic, loses normal contacts, pyknosis or karyorrhexis.  
    • aka Civatte are when in stratum basale, sunburn cells when caused by UV radiation
  147. epidermal change - spongiosis
    • intercellular edema (widening of intercellular spaces).  Severe forms vesicles within epidermis.
    • no displacement of nucleus
  148. epidermal change - intracellular edema
    • DISPLACED NUCLEUS so different than spongiosis.
    • increased size and cytoplasmic pallor.  Severe causes reticular degeneration and intraepidermal vesicles.
  149. epidermal change - ballooning degeneration
    • koilocytosis
    • degeneration seen in epidermal cells
    • swollen stippled cytoplasm without vacuolization, enlarged or condensed or multiple nuclei, loss of cohesion (acantholysis).
  150. epidermal change - hydropic degeneration of basal cells
    • intracellular edema only in stratum basale
    • rarely can cause intrabasalar or subepidermal clefting
    • uncommon
  151. epidermal change - acantholysis
    • loss of cohesion between epidermal cells, causes epidermal clefts, vesicles and bullae.
    • free epidermal cells in vesicles are acantholytic keratinocytes
  152. epidermal change - Microabscesses and pustules
    • intraepidermal and subepidermal cavities with inflammatory cells
    • degenerate neutrophils: MO infection
    • nondegenerate neutrophils: pemphigus
    • eosinophils: ectoparasites, eosinophilic granuloma, eosinophilic folliculitis, pemphigus, malassezia
    • Pautrier's microabscess: abnormal lymphoid cells, epitheliotropic lymphoma
    • mononuclear cells: atopy, contact hypersensitivity
  153. dermal change - collagen changes (6)
    • hyalinization of collagen fibers
    • lysis and loss of structure
    • dystrophic mineralization
    • atrophy
    • dysplasia
    • "flame figure" - altered collagen surrounded by eosinophils and granules in starburst pattern.
  154. dermal change - pigmentary incontinence
    • melanin granules free within subepidermal and perifollicular dermis within dermal macrophages (melanophages)
    • seen when stratum basale and basement membrane zone damage, esp hydropic degeneration.  (canine demodecosis)
  155. dermal change - mucinosis, myxedema
    • lots of amorphous, stringy, granular, basophilic material that separates, thins or replaces dermal collagen fibrils and surrounds vessels.  Small amounts normal.  
    • Lots in Shar Pei, hypothyroid, acromegaly.  
    • Eosinophilic dermatoses can have mucuin in epidermis and hair follicle outer root sheath
  156. dermal change - follicular changes
    • affected by epidermal changes
    • perifolliculitis (around), mural folliculitis (wall of follicle, lumen spared. 4 subtypes), luminal folliculitis (MOST COMMON, usu infectious) and furunculosis (follicular rupture, usu from lumenal) are degrees of follicular inflammation
    • follicular atrophy is gradual involution and miniaturization
    • examine follicles for stage of growth to help with dx.
  157. dermal change - glandular
    • sebaceous glands: involved in suppurative and granulomatous inflammations, late stage can have no sebaceous glands left. Can atrophy or become hyperplastic, assess in regards to location.  
    • Melanosis
    • Epitrichial sweat gland
  158. interstitial reaction
    infiltration of cells between collagen bundles of the dermis, does not obscure anatomy of skin.
  159. interface reaction
    • dermoepidermal junction is obscured by hydropic degeneration, lichenoid cellular infiltrate or both.  
    • Can see apoptotic bodies, satellite cell apoptosis with pigmentary incontinence seen.
  160. 4 subtypes of mural folliculitis
    • (wall, not lumen)
    • interface mural
    • infiltrative mural - lymphocytes and histiocytes
    • necrotizing mural
    • pustular mural
  161. panniculitis
    • inflammation of subcutis
    • most cases sterile, idiopathic 
    • dogs, cats, horses
    • solitary or multiple
    • commonly on trunk
    • SQ nodule to fluctuant "cystic" lesion +/- draining tracts
  162. dermatophytosis
    • ringworm
    • microsporum and trichophyton species (animals usually)
    • 3 groups: geophilic (soil, like gypseum), zoophilic (adapted to animals, rarely in soil, canis, equinum, distortum, T equinum), anthropophilic (adapted to humans, not in soil, audouinii)
    • M. canis, M gypseum, T. mentagrophytes most common in dogs and cats
  163. pathogenesis of dermatophytosis (transmission, genre affected, how and where, how long)
    • more in hot, humid
    • transmission via contact with infected animals (cats), environment, fomites
    • very young, very old, immunocompromised
    • genetics (persian cats, yorkies, jack russels, pekinese)
    • ARTHROSPORE is infective, survives in environment for 18 months
    • infects disrupted parts of stratum corneum (ectoparasites, fleas, etc)
    • invades ANAGEN hair follicle, arthrospores adhere to keratin and germinate in 6 hours.  Keratolytic enzymes penetrate cuticle and migrate toward hair bulb
    • clinical lesions in 7-14d, enlarge for 6-8wks, spontaneous resolution in 12-14wks (telogen phase stops keratin production, inflammation)
  164. where dogs get ringworm, and basic diagnosis tip
    • localized: face, pinna, paw, tail.  Usually less than 1 year old, +/- pruritus
    • Tip: if it looks like ringworm, it's probably staphylococcal folliculitis
  165. sylvatic ringworm
    • from wild animals
    • in adult dogs, from sticking heads into burrow
    • T. mentagrophytes, M. persicolor
  166. onychomycosis
    • rare in dogs and cats
    • one digit or multiple digits on one paw get paronychia or onychodystrophy
    • T. mentagrophytes (ringworm) in dogs
  167. fungal kerion
    • nodular infection from furunculosis
    • baggy, exudative, may have draining tracts
    • usually in adults and solitary on face or distal limb.
    • M gypseum or T mentagrophytes (ringworm)
  168. feline ringworm/dermatophytosis: presentation, who gets it, signs, TIP, different presentations
    • one or more annular areas of alopecia +/- scales
    • more common on head, pinnae, paws, can get "stud tail" (dermatitis of dorsal tail)
    • cats <1year
    • +/- pruritus
    • esp long-haired, persians
    • GENERALIZED more common in cats than dogs
    • TIP: if it looks like ringworm in a cat, it probably is
    • widespread severe alopecia with little inflammation, pruritic miliary dermatitis, chin folliculitis (acne), generalized seborrheic-like eruptions, crusting over bridge of nose, pinnae and paronychia resembling pemphigus, dermatophytic pseudomycetoma (Persians)
  169. equine dermatophytosis: common organism, who is affected, presentation, resistance? How common?  Ddx, prevention
    • Trichophyton equinum most common
    • <2 years old
    • face, neck, dorsolateral thorax and girth, pruritus variable, pastern dermatitis (grease heel, wax and wane), lesions can by symmetric, rarely solitary, general disease rare. 
    • COMMON - 9% of skin disease.  
    • ddx: staph (most common, dermatophytes #3), dermatophilosis (#2), pemphigus, sterile eosinophilic folliculitis
    • Everyone needs their own tack and brush!
  170. bovine dermatophytosis: organism, genre affected, season, presentation, ddx
    • trichophyton verrucosum like goats
    • <1year old, fall and winter in confined animals
    • face, head, pinnae, neck, rump, tail, perineum.
    • Crusted papules that become THICK grey crusts, pruritus rare.
    • ddx: staphylococcal folliculitis, dermatophilosis, dermodecosis, stephanofilaria, sterile eosinophilic folliculitis, zinc-responsive dermatosis
  171. caprine dermatophytosis: organism, presentation
    • trichophyton verrucosum like cows
    • face, head, pinnae, neck and legs
    • <1 year
    • pruritus rare
  172. porcine dermatophytosis: organism, presentation
    • Microsporum nanum
    • face, pinnae, trunk
    • brown to orange annular crusts, may be large
    • alopecia and pruritus rare
  173. zoonosis of ringworm
    • children, elderly, immunocompromised
    • most come from cats
    • usually microsporum canis
    • horse to human infections rare
  174. diagnosis of ringworm
    • history--exposure, pruritus
    • PE--folliculitis
    • wood's lamp: 50% fluoresce, so lots of false + and false -, needs to be warmed up
    • scrapes and trichogram--40-70% positive
    • fungal culture of hair/scale--MOST RELIABLE but can still have false + and -
    • biopsy for kerion and pseudomycetomas
  175. fungal culture for ringworm
    • dermatophyte test medium (DTM)
    • sabouraud's dextrose agar containing cycloheximine, gentamicin and chloretetracycline
    • pH indicator phenol red, should turn red ASAP once you see growth.  Dermatophytes use protein and alkaline metabolites turn media red.  Other fungi use carbs first, will turn red later
    • Examine DAILY for 10 days.
  176. malassezia dermatitis
    • normal flora in dogs, cats.  Live in haired skin, ear canal and mucosal areas.  Colonize superficial epidermis. 
    • Can cause hypersensitivity in dogs.  Other animals have some underlying comorbidity first (allergy, endocrinopathy, keratinization prob, corticosteroids, etc)
    • predisposed: westies!  cockers!  
    • presentation: moderate to severe PRURITUS, alopecia, excortiations (self-induced), erythema, seborrhea.  Chronic will cause lichenification, hyperpigmentation, hyperkeratosis
    • interdigital, ventral neck, axillae, perineal, skin folds, paronychia (claw beds), ear canals (secondary otitis!!)
  177. malassezia dx and tx
    • Hx and PE, smear/impression/tape, culture (normal resident!), biopsy, response to therapy
    • tx: address underlying cause, topicals for mild localized dz, systemic if generalized, chronic or super severe, or super deep (paronychia).  Tx until resolution + 1 week.  Not contagious
  178. Nodules
    • circumscribed, solid lesions >1cm.  May be elevated or SQ.  
    • Aka tumor?
  179. tumor
    a swelling part of the body.  Abnormal benign or malignant new growth of tissue.  Aka nodule?
  180. plaques
    circumscribed, elevated, solid, flat-topped.  SUPERFICIAL
  181. hamartomas
    benign focal malformation resembling a neoplasm in tissue of origin.  Grows at same rate as surrounding tissue.  Made of tissue elements usually found at that site, just growing disorganizedly.
  182. 3 causes of inflammation
    • granulomatous to pyogranulomatous
    • 1: infection - bacterial, fungal, protozoal, parasitic
    • 2: foreign body - plant material, ruptured cyst or hair follicle
    • 3: sterile idiopathic - immune mediated?  Diagnosis of exclusion
  183. sterile granuloma syndrome (dog vs cat/horse)
    • dogs: granulomatous, pyogranulomatous on head/face, paw, often multiple lesions, cause unclear. 
    • cats, horses: eosinophilic granulomas or plaques, lots of presentations, could be due to insect bites, hypersensitivity, injection rxn, etc.
  184. feline eosinophilic granuloma complex
    • cutaneous reaction pattern, not a diagnosis
    • caused by allergy - environmental, food, fleas, mosquitos, idiopathic
    • bacterial infections
    • feline eosinophilic granuloma: often idiopathic, cutaneous, mucocutaneous or oral mucosal lesions of cats.  Papular, nodular, raised oval to linear, firm, erythematous to yellow-orange, chin and caudal thighs common but can be anywhere
    • feline eosinophilic plaque: severe pruritus, single or multiple, well-circumscribed, raised, erythematous, eroded, oozing, often ulcerated plaques, oval to linear, abdomen and medial thighs, secondary infection common.Image Upload 61
  185. feline indolent ulcer
    • common oral mucosal ulcer of cats
    • commonly licking, usually upper lip near filtrum, may be unilateral or bilateral
    • early lesion in flea allergy dermatitis?  
    • infection common
    • Image Upload 62
  186. equine eosinophilic granuloma
    • common especially in spring and summer
    • single or multiple papules and nodules
    • round, elevated, well-circumscribed
    • skin and hair coat NORMAL
    • no pain or pruritus
    • hypersensitivity?  Trauma?  body-clipping?  Injection sites due to silicone-coated needles?
  187. Habronema
    • fairly common, three nematodes involved: habronema muscae, Habronema majus, drachia megastoma
    • pruritus mild to severe
    • hypersensitivity?  Fly picks up larvae in feces and deposits in eye/muzzle/prepuce/wound, Larvae cause habronema.  Eosinophils!
  188. cutaneous cysts and 4 kinds
    • non-neoplastic, simple sac-like structure with EPITHELIAL LINING
    • classify based on lining, sometimes contents.  Usu solitary, esp head, neck, trunk, proximal limbs
    • Follicular (common), epitrichial (common), dermoid (rare), sebaceous (rare)
  189. follicular cysts (4 kinds)
    • solitary, well-circumscribed, round, smooth, firm to fluctuant lesions, dermal to SQ (NOT attached to deeper tissue). Aspiration gives white cheesy material
    • infundibular: from infundibular portion of hair follicle
    • isthmal: arise from isthmus
    • matrical: arise from inferior section
    • hybrid: 2-3 types of follicular epithelium
  190. epitrichial gland cysts
    • common in dogs, uncommon in cats
    • duct obstruction
    • usually solitary, well-circumscribed, smooth, tense to fluctuant
    • BLUE HUE, alopecic
    • head, neck, limbs
    • aspiration = clear fluid
    • Image Upload 63
  191. dermoid cyst
    • developmental abnormality, congenital and hereditary
    • solitary or multiple, often along dorsal midline
    • boxers, kerry blue terriers, rhodesian ridgebacks
  192. sebaceous gland cyst
    • rare
    • sebaceous duct cyst
    • solitary, firm, <1cm
  193. 5 syndromes of canine papilloma virus
    • oral papillomatosis: self-limiting in YOUNG dogs, regress spontaneously
    • cutaneous exophytic: ANY AGE, single or multiple, head, eyelids, paws, regress spontaneously
    • Image Upload 64
    • cutaneous inverted papilloma: usually under 3 years, abdomen, groin, limbs, digits, DON'T regress spontaneously
    • Image Upload 65
    • pigmented plaques: YOUNG adults, mostly mini schnauzers and pugs
    • Image Upload 66
    • pigmented papules: rare, long-term glucocorticoids or compromised
  194. equine papillomavirus
    • papillomatosis like dogs, young horses, on haired skin of muzzle and distal limbs, spontaneous resolution in 2-4 months
    • aural plaques, flat, in ear, don't progress or resolve.  Fly vector.  
    • gentical warts, may evolve into invasive SCC in chronic
    • papillomatosis, can do any of the above
  195. bovine papillomatosis
    • two types
    • fibropapilloma on teats and penis of young cattle (exophytic, BPV-1)
    • multiple lesions of head, neck, dewlap of young cattle (BPV-2)
    • both spontaneously resolve in 12 months
    • epithelium AND FIBROBLASTS, not like horse/dog (those are just epithelial
  196. trichoblastoma (basal cell tumor)
    • common in older cats, usually benign, often melanotic
    • may be alopecic, ulcerated
  197. sebaceous gland tumors
    • common in dogs, 98% benign, seen in older/adult.  Solitary or multiple.  Begin smooth, shiny, waxy, pink to orange papules, become cauliflower-like.  Can become hyperpigmented or ulcerated
    • nodular hyperplasia, adenoma, epithelioma (less common, low grade malignancy, locally invasive but don't metastasize), carcinoma (less common. metastasize late in dz?)
  198. epitrichial sweat gland tumors
    • adult dogs and cats
    • benign or malignant, usu solitary
    • head, neck, dorsal trunk, limbs
    • commonly blue and cystic
    • may be solid and ulcerated
  199. lipoma
    • very common in older dogs, solitary or multiple
    • trunk, abdomen, proximal limbs
    • well-circumscribed, soft to firm and SQ
    • may be multilobulated and pedunculated
  200. mast cell tumor
    • common in dogs, benign to super malignant
    • less common in cats and horses, usually benign
    • dermal or SQ
    • variable appearance
    • Boxers, Boston Terriers, Lab retrievers, beagles, schnauzers, shar peis
  201. Histiocytoma
    • 50% of tumors in dogs under 2 years old
    • Langerhans cells
    • usually solitary, head pinnae and limbs
    • appear suddenly
    • "button tumor", often ulcerated.  
    • Spontaneous remission in 3-4 months
  202. melanocytic neoplasms
    • dogs, 70% are benign in haired skin, adult/aged.  
    • usually solitary
    • head (eyelid, pinna), trunk
    • lesions on digits, scrotum and lip/oral are more commonly malignant
  203. equine melanoma
    • variable biologic behavior, usually solitary and benign in younger
    • common in older grey horses, esp perineum and tail. Also pinna, periocular, distal limbs
    • 2/3 metastasize eventually, usu no clinical signs
  204. equine sarcoids and 5 kinds
    • most common equine skin neoplasm
    • 3-6 years old
    • fibropapilloma
    • inguinal>head>axilla>abdomen>thorax>neck>distal limbs
    • locally aggressive, no metastatic
    • multifactoral causes.  Genetic (quarter horses), viral (bovine papilloma), skin trauma
    • occult: mildest, superficial, around eyes or mouth, neck, sheath, shoulder
    • verrucous: slow growing, seldom aggressive, like face, neck, axilla, groin, sheath, coronary band
    • nodular: large and alopecic nodules, more aggressive when ulcerated or traumatized, like periorbital, groin, sheath
    • fibroplastic sarcoid: locally invasive, irregularly nodular, ulceration and exudation, may resemble exuberant granulation tissue
    • malevolent: rare aggressive and invasive, irregularly nodular, may infiltrate lymphatics, potentially involve local LN (not metastatic)
  205. pruritus
    an unpleasant sensation that provokes the desire to scratch
  206. flea dermatitis, where it appears on dogs and cats
    • irritation or allergy
    • pruritic papular eruption
    • dogs: rump, inguinal, posterior thighs
    • cats: neck rump
    • fewer symptoms = MORE FLEAS, because less hypersensitivity (IgE kills the fleas)
  207. atopic dermatitis definition
    genetically predisposed inflammatory and pruritic skin disease with characteristic clinical features associated with IgE abx most commonly to environmental allergens
  208. atopic-like dermatitis definition
    a genetically predisposed inflammatory skin disease with clinical features identical to atopic dermatitis but with NO IgE antibodies to environmental allergens
  209. canine atopic dermatitis
    • early age at onset (6-36 months), familial history or breed predisposition, initially seasonal (pollen season).  Progressive. 
    • signs: hives, recurrent otitis externa, facial and pedal pruritus, axillary +/- inguinal pruritus, generalized pruritus.  
    • CONTACT DERMATITIS - face, feet, axillary
    • staph, malassezia, pyotraumatic, acral lick, anal sacculitis, hyperhidrosis
  210. feline atopy
    • adult onset
    • lesional or nonlesional pruritus, protracted seasonality, +/- asthma, pruritus stops with glucocorticoids
    • pruritic ears, face, head/neck, generalized, miliary dermatitis, traumatic alopecia, eosinophilic granuloma complex.  NO HIVES because cats are sneaky
  211. equine atopy
    • 1.5 to 6 year onset
    • can be seasonal or nonseasonal
    • variable presentation (nonlesional pruritus, urticaria, symmetrical eosinophilic folliculitis), COPD.  Pruritus stops with glucocorticoids
  212. food hypersensitivity
    • no genetic predisposition, ANY age (after 7-14 days of sensitization)
    • variable clinical presentation (skin or not).
    • canine signs: persistent urticaria, atopy-like pruritus, recurrent acute moist dermatitis, lumbosacral/scabies-like/generalized pruritus
    • feline: SAME AS ATOPY facial otic head neck generalized pruritus, miliary dermatitis, traumatic alopecia, eosinophilic granuloma complex
    • equine: atopic-like pruritus, pruritic or non-pruritic urticaria,
  213. chyletiellosis
    • cheyletiella yasguri, C. blakei, C parasitivorax
    • no host specificity, 3 wk life cycle.  Surface parasite, cement eggs to hair shaft.  
    • Variable clinical signs, often none or dorsally oriented walking dandruff (seborrhea +/- pruritus, scabies-like pruritus)
    • STARTS AT TOPLINE AND WORKS DOWN
  214. culicoides disease in LA
    • very common
    • genetic predisposition to allergy
    • mini-mosquitos, "no-see-ums"
    • seasonal
    • thinly haired skin first, face around eyes.  Horses rub, cause alopecia, more places to bite. UNDER MANE, tail head. Can attach to hair and walk down to skin
    • eggs laid in damp areas
    • feed dusk to dawn
  215. causes of horse tailhead rubbing
    • culicoides hypersensitivity (summer)
    • pediculosis (winter)
    • stall vice (in stalls)
    • psorioptic mange (winter)
    • oxiuriasis (only on rear, not face)
    • allergy
  216. icthyosis
    • rare primary keratin disorder of dogs and cats
    • onset at or near birth, lifelong.  Many variations, difficult to control.
    • Jack Russels, norfolk, golden, american bulldog, CKCS.  There are genetic tests
  217. Follicular parakeratosis
    • disease of HAIRED skin (pads and nose normal) with metabolic or systemic problems.
    • rare (female rottweilers and huskies)
    • stunted, non-cutaneous defects, hard to manage.
  218. epidermal dysplasia
    • keritinization defect with susceptibility to Malassezia hypersensitivity (westies only?)
    • Onset between 6 and 12 months
    • variable greasiness and pruritus
    • eliminating yeast allows successful management
    • Looks like atopy, but in this case the cutaneous signs CAUSE the itch (timing--HISTORY)
    • smell!  Look in folds for yeast and bacteria, treat for yeast and see what's left (won't go back to normal).
    • R/O allergy
  219. canine generalized primary seborrhea
    • edge hyperkeratosis in nose and footpads, flaking, dull coat, ceruminous otitis, seborrheic dermatitis
    • early onset, worsens with age
    • involves all keratinized surfaces, susceptible to malassezia or secondary bacterial.
    • No systemic complaints
    • inflammation causes increased epidermal turnover, causing increased grease, which increases bacteria and yeast, which causes scarring, = TECA.  Self-perpetuating
    • common in Cocker, english springer spaniel, westie, EBD, beagle, basset
  220. ectodermal dysplasia dogs
    • congenital abnormality of pilosebaceous unit causing follicular hypoplasia (=hairless breed) and abnormal sebacious and/or epitrichial sweat glands (and bronchial glands).  
    • Prone to heat stroke and dry skin, comedones (plugged follicles because no sebaceous glands), lead to milia/closed comedone and sterile furunculosis.  Need anti-comedone therapy!  And moisturizing--start early
    • Worse as get older, hard to manage.
  221. canine generalized secondary seborrhea
    • common, onset at any point in life, may not involve ALL keratinized surfaces
    • susceptible to secondary bacterial or malassezia
    • variable systemic signs
    • includes cradle cap (self-curing within 1 month), low-fat diet, malassezia overgrowth (foldy skin), hypothyroid, epitheliotropic lymphoma
  222. feline generalized secondary seborrhea
    • low incidence, onset at any point in life.  May not involve ALL keratinized surfaces
    • susceptible to secondary bacterial or malassezia
    • variable systemic signs.  
    • Fastidious groomers, so dry or greasy uncommon. 
    • low humidity, cheyletiella dermatitis, liver dz.  
    • primary seborrhea is greasy, secondary is flaky.
  223. exfoliative dermatoses
    • many causes, indicates serious disease
    • large sheets of skin
    • rare but important
    • drug induced, lupus, FeLV, thymoma vs non-thymoma,
  224. callus
    • hyperkeratotic plaques over pressure points
    • environmental trigger (like laying on a hard floor)
    • don't soften unless changing environment, this is a PROTECTIVE thing
  225. senile nasodigital hyperkeratosis
    • common in middle-aged to old dogs (boxer, boston, EBD)
    • rare symptomatology
    • keratin builds up but doesn't wear off, long fronds on nose.  Similar to digital disuse hyperkeratosis
  226. disuse digital hyperkeratosis
    • uncommon, associated with prolonged periods of limited exercise--keratin builds up but doesn't get worn down.  
    • rare symptomology
    • goes away once they start walking again
  227. feline acne
    • common
    • singular, multiple or persistent episodes
    • variable symptomology
    • evaluate chronic for malassezia or demodex.  
    • idiopathic.  Can be in cats that don't groom.  Once they get it they keep it forever
    • face, feet, caudodorsum (sebaceous glands.  
    • Blackheads first, cat doesn't care.  Could turn into sterile furunculosis, so treat!
    • topical keratolytics, glucocorticoids, possible abx, retinoids, stridex/alcohol/listerine
  228. hypotrichosis
    condition of abnormal hair patterns, predominantly loss or reduction
  229. hypertrichosis
    abnormal amount of hair growth over body
  230. alopecia
    partial or complete absence of hair from areas of the body where it normally grows
  231. canine hypothyroidism
    • most common endocrine disease
    • need T4 to start anagen phase of hair growth, initial hair loss in frictional areas, moves to everywhere.  
    • signs: mental dullness/lethargy, weight gain/obesity without increase in appetite, heat-seeking behavior, skin changes, cardio signs, neuropathy and myopathy, repro system irregularities, coagulopathy sometimes? tragic face
    • hair loss esp on caudal thigh, tail, patchy over ventral trunk.  Rat tail, spares head, topline and distal extremities (don't shed as often).  FRICTIONAL AREAS
  232. feline hypothyroid
    • rare
    • lethargy/obesity
    • seborrhea sicca, matting of hair.  
    • bilaterally symmetric truncal alopecia (including ear tips)
    • disproportionate dwarfism, mental dullness, constipation, hypothermia, bradycardia (congenital hypothyroid)
  233. feline hyperthyroid
    PUPD, polyphagia with weight loss, hyperactive, v/d, CV or resp abnormalities, unkempt haircoat, matted or greasy or dry, claws grow FAST and long
  234. canine hyperadrenocorticism, bilateral hyperplasia
    • most common
    • constitutional signs always present
    • predictable pattern: systemic signs, altered hair coat (slow growth), hair loss (thinner by 6 months)
    • PUPD, polyphagia (1st sign), hepatomegaly, pot-belly, skin changes (6months), repro changes (clitoral hyperplasia or testicular atrophy), hypertension, excessive bruising and poor wound healing. 
    • predisposed to infection, increased panting, neuro.
    • Pred head!  muscle loss, myotonia (down on hocks).
    • Truncal hair loss, topline and belly, spares head, tail and inner limbs?
    • excessive glucocorticoids decrease everything: sebum, epidermal turnover, hair growth, alters coat color, predispose to comedones, decreased elasticity, calcinosis cutis (calcinosis ossification)
  235. canine hyperadrenocorticism; adrenal neoplasia
    • constitutional signs develop CLOSE TO HAIR LOSS (SAME TIME)
    • glucocorticoids +/- sex hormones
    • head, tail and inner limb-sparing alopecia
    • clitoral hyperplasia, perianal donut (increased testosterone), tail gland hyperplasia, calcinosis cutis with no hair loss, coat color changes.  Hair loss at collar = sex hormone changes
  236. feline hyperadrenocorticism
    • rare
    • skin changes variable and atrophic
    • ears flop or curl, coat color changes, SKIN FRAGILITY SYNDROME, phlebectasia - bursting vasculature making petechiae?,
  237. gonadal sex hormone disorders
    • patterned alopecia, no constitutional signs, variable coat color alteration
    • androgen and estrogen receptors on hair follicles, different with gender and body site. 
    • males lose fur at tail head, caudal thighs, at shoulder blades and collar
    • females lose over hips, caudal thigh, behind hear and ventrum
  238. intact female gonadal disorders (5), tx
    • hyperestrogenism: ovarian cyst/tumor, constant estrus, patterned alopecia, nipple enlargement, comedones
    • hyperprogesteronism: ovarian tumor, growth hormone production = acromegaly and DM.  Cutaneous signs due to anti-androgen. Tragic face, widened dental arcade
    • cutaneous pseudocyesis: hair loss ~6wk post-estrus, behavioral/mammary changes present, spontaneous resolution.
    • primary anestrus: 
    • estrogen-responsive alopecia: 
    • resolved by neutering
  239. intact male gonadal disorders (4) and treatment
    • testicular neoplasia: tumors benign, estrogens produced by sertoli and seminomas (LINEAR PREPUTIAL ALOPECIA), testosterone produced by interstitial cell tumors.
    • "normal" testes
    • hyperandrogenemia
    • primary testicular atrophy
    • tx via castration
    • hair loss around collar, tail head, behind shoulders and caudal thighs
  240. FDA regulations
    • traditional medications given orally, topically or parenterally.
    • Extra-label usage WITH INFORMED CONSENT (companion animals)
    • Vet-pateint relationship NECESSARY
  241. EPA regulations
    • environmental anti-infectives and parasiticides
    • MUST FOLLOW LABEL
    • no need for vet-patient relationship
  242. seresto collars
    • insecticide and arachnid-icide
    • 8 months
    • EPA
  243. preventic collars
    • One of the best
    • ticks only not fleas
    • dogs only
    • EPA
  244. fipronil/frontline Spray
    • GREAT
    • absorbs into sebaceous and replenishes skin, so monthly
    • EPA
  245. lime sulfur dip
    • DILUTE
    • great for parasites, bacteria, fungal, pruritic, keratolytic
    • smelly, drying, stains
  246. spot-on modes of action
    • surface distribution: applied over back and spreads out, concentrates on skin and within sebaceous glands, sebaceous replenishes
    • transdermal absorption: whole body circulation THEN concentrates in sebaceous glands, takes a few days
  247. advantage II
    • insecticide and growth inhibitor, fleas and lice
    • 30 days, no replenishment
    • WEEKLY DOSING ON LABEL - ONLY ONE
    • EPA
  248. Advantix II
    • insecticide, arachnicide, insect repellant, insect growth regulator
    • dogs only, no replenshiment
    • monthly or WEEKLY - ONLY ONE
    • EPA
  249. advantage multi, Advocate
    • broad-based parasiticide (fleas, ear and scabies mites, HWP, GI parasites, advocate adds lice, demodex, lungworms)
    • FDA!!!
  250. Frontline Plus, Frontline Gold, Frontline Tritak
    • insecticide and arachnicide, flea birth control
    • replenishing
    • EPA
  251. Vectra, Vectra 3D
    • insecticide for cats
    • insects and arachnids for dogs
    • EPA
  252. Selamectin/Revolution
    • insecticides, arachnicide, internal parasites
    • FDA
  253. capstar/Nitenpyram
    • insecticide, rapid onset.  Fleas not ticks
    • FDA (OTC now)
  254. Afoxolaner/NexGard
    • flea/tick, protein-bound
    • FDA
    • extra-label for demodex, scabies mites
  255. Sentinel Spectrum
    • fleas, intestinal parasites, tape wroms
    • FDA
  256. Furalaner/Bravecto
    • Flea/tick
    • protein bound
    • 3 months
    • oral, topical version for cats
    • FDA
    • demodex, scabies extra-label
  257. insect growth regulators
    • prevent flea egg hatch and larval molting
    • okay for one animal household
    • EPA
  258. Macrocyclic Lactones
    • avermectins, milbemycins
    • paralysis of mites and insects
    • no mammalian toxicity at licensed dose
    • FDA
    • external parasite disease  = HIGH dose, so no MDR1 (white feet don't treat)
  259. Image Upload 67
    Image Upload 68
  260. Image Upload 69
    • canine scabies, sarcoptes scabiei
    • lives in epidermis
    • lives in house 24h, barn 7d, fox den 60d
    • burrowing, skin scrape!  Can scratch it off! 
    • Ear tip crusts, pinnal-pedal reflex
    • intense pruritus
    • RARELY on topline, works its way up
    • dx: intermediate skin scrape 25% effective, response to tx
  261. What do eosinophils mean in a cat?  In a dog?
    • cat: allergy or parasite
    • dog: parasite
  262. Image Upload 70
    • Notoedres cati
    • cat and exotics scabies (sarcoptes too), rare, easy to find the mites.
  263. demodicosis
    • normal fauna, transferred to neonate while nursing, live in hair follicle
    • don't feed on blood so no hypersensitivity (usu), not pruritic, self-curing, no genetics.
    • dx: deep skin scrape, trichogram, pustular cytology
    • Localized (<7 spots) or generalized (juvenile onset vs adult, which is triggered by systemic disease like Cushings - mite specific immuno-incompetence, genetic predisposition)
  264. demodex injae
    • long cigar mite
    • genetic predisposition
    • non-pustular
    • face, feet, dorsal midline/caudal dorsum.  
    • Facial and pedal pruritus
    • mites are few and DEEP in follicle  
    • Dogs are greasy and itchy.
  265. Image Upload 71
    • fleas.  Many species. 
    • feed on blood, bite causes allergy/irritation.  
    • LONG life cycle, leave town for 3 months and they'll be waiting.
    • Eggs LAID ON HOST then fall off into environment, feed on adult flea's feces
Author
XQWCat
ID
331038
Card Set
Dermatology
Description
derm Va
Updated