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2013-10-06 21:55:16

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  1. epidermis
    • stratum corneum
    • keratin and melanin
    • appendageal system-follicles,apocrine and sebaceous glands
  2. dermis
    • vascular plexi
    • nervous tissue
    • fibrous tissue
  3. subcutanous tissue
    • fat
    • vessels
  4. normal physiology
    • largest organ in body-protection
    • barrier to traumatic insults
    • barrier to disease
    • barrier to fluid loss
    • thermoregulation
    • UV protection
    • immunologic messenger
  5. common primary lesions
    • raised lesions:
    • papules-red bumps
    • pustules-red bumps with pus-white heads, pimple, pyoderma are bacteria skin infection and they are famous for pustules when they rupture they form crusty circles, look like ringworms called epidermal coluret
    • wheals/urticaria-flat, steep sided, hives, large raised "welt" (histamine) allergic respond
    • nodules/tumors
  6. common seconday lesions
    • scales-flakes of stratum corneum
    • crusts-dried remains of exudative lesions
    • lichenification- bark like skin, liken scally layers, cronic irritation to skin, cronic allergic dog, it will get leathery thickened,crusty alligator skin looking, dogs with cushing disease will get on belly,raised thickening irregular suface of the skin usually cronic irritation/scratching
    • alteration in pigmentation
  7. common reactions in the skin
    • inflammation-edema(fluid build up), exudation(discharge), raised leasions, etc.
    • acceleration of turnover of cells-scales, skin always turnsover possibly shedding
    • increases mitotic activity-thickening
    • increased melanocytes-pigmentation
  8. common diagnostics
    • wood lamp-used for ringworms, base of broken hair shaft will turn candy apple green, flacky skin will turn green and will trick you
    • DTM-dermatophyte test media-agar used to culture ring worms, pluck hair out on edge of lesion and press in agar and look for color change
    • c/s-not done on skin much
    • cytology- #1 diagnostic is the 3 slide tech. should be done on every skin case (otocytology, skin scrape, tape prep)
    • impression-open ilceration mass,clean off first than take slide and press on lesion
    • FNA- fine needle aspret, stick needle into it, material is going to be left in hub, blast on slide
    • skin scraping
    • biopsy-skin masses, skin lesions, tumors, auto immune disease like piphygus open vesicles on the edge of nose
    • immune testing-ANA, coomb's,SLE
  9. common medications
    • antimicrobials-topical and systemic
    • antiinflammatories-steriofd low dose
    • antihistamines-burn, inflammorty, cascade
    • nutraceuticals
    • desensitization injections
    • shampoos
    • dips
    • rinses
  10. noval protein source
    • food never been exposed to
    • noval means new
    • for food allergies
    • can take several months
    • no treat will ruin food trial
  11. what mite is characterized by intense iching
    scapbies which are in elbow,edge of trunk and ears, rule out scabies with ivermectin make sure they are heartworm negative and not shelties or collies before despensing
  12. allergic disease
    • skin is the primary organ affected-GI tract and respiratory tract
    • relaease of histamines, chemotactic factors in repsonse to a irritant-insects, plant material, fibers, food, others
    • any lesion possible for reddness to severe trauma secondary to pruritis=excoriation which is self induced trauma
  13. what is the number one cause of ear and skin problems
    • allergies
    • rarely find out what they are allergic to
  14. what is the active ingrediant in atopica
    • cyclosporine
    • amino supressent dugs used a lot in allergic dogs
    • suppresses the immune system
  15. contact dermatitis
    • allergic-immune reaction to antigen in contact
    • rare in young
    • chronic exposure
    • irrirant-damage to keratinocytes from a substance-any age
    • least common dermatitis seen
    • easiest to diagnose and easiest to get rid of
    • can be bedding or chemicals like laudry detergent
    • ask if anything in their envt has changed
    • localized
  16. clinical signs of contact dermatitis
    • generally has hairy skin-ventrum, chin,scrotum, between the toes
    • distinct lesion line at hair line-hair coat great protection
    • erthema to severe lesions
  17. diagonsis for contact dermatitis
    • biopsy
    • patch testing
  18. treatment for contact dermatitis
    • avoidance
    • steroids
  19. client education on contact dermatitis
    • if know tge problem,px good for treatment
    • if unknown, treatment may be lifelong
  20. atopy
    • IgE mediated (allergic reaction)(type 1) sensitivity to antigen
    • histamine, cytokines, proteolytic, enzymese,etc.
    • pollen, fibers, mold, dust, epithelium
    • early onset 1-3 years may be seasonal
    • allergic reaction to envt can be inhaled or dilivered transdermally
  21. clinical signs for atopy
    • pruitis to severe lesions
    • axillary, facial, and pedal pruritis-inflammed ear
    • recurrent pyoderma or otitis
  22. diagnosis for atopy
    • steroid trail-to rule it out see if it responds
    • intradermal skin test
    • serologic tests-RAST,ELISA-measure allergen specific IgE
  23. treatment for atopy
    • hyposensitization vaccines-allery shots, serum shots- start weak than go strong slowly exposing body to it to desenitize it
    • steriods-prednazone
    • antihistamines
    • nutraceuticals-OFA essital fatty acid can block some steps of allergic reaction (omega 3 capsule) not enough by themself
  24. client education for atopy
    • steriod side effects
    • cariable success
    • frequent rechecks esp. early on
    • life long battle
    • cushing disease-giving too much steriofd
    • steriod play a role on stress
  25. flea allergy dermatits
    • allergic reaction to antigen in flea saliva
    • worsens with age
    • even 1 bite can have serious effects
    • can be 1 flea something in the saliva
    • found on base of tail
    • hair lose on base of tail
    • get rid of fast with capstar
    • monthly version is confortis
  26. clinical signs for flea allergy dermatitis
    • dogs-christmas tree hair loss at tailhead
    • cats-miliary dermatitis
  27. diagnostic for flea allergy dermatitis
    • presence of flea
    • IDST (serum test) and serologic test
    • Bx-biopsy
  28. treatment for flea allergy dermatitis
    • short term steriods
    • flea control
  29. client education for flea allergy dermatitis
    flea control
  30. what are the two allergic skin disease that is hard to tell the difference and why
    atopy and food allergy because atopy clinical signs is facial rubbing and licking of paws and food allergies mimic that
  31. food allergy dermatitis
    • reaction to Ag in food
    • most pets on food for over 2 years to sensitize
    • poorly responsive to medication
  32. clinical signs for food allergies
    • no set group signs
    • lesions vary as always
    • if less that 6 months or greater that 6 years most likely a food allergy than atopy
  33. diagnosis for food allergy dermatitis
    • food trail-take away what they are on and give them something noval, not treats, small amount work
    • provocative exposure-ex. if allergic to liver give a lot to see what reaction they get
    • Bx
    • med trail
  34. treatment for food allergy dermatitis
    avoid what they are allergic to
  35. client education on food allergy dermatitis
    • "life change" not food change
    • its forever
  36. acne
    • inflammatory reaction on the chin
    • dogs-young, short coat breeds, probable genetic basis (bacteria infection around the face), DP, EBD, GD, Wm, Rot, GSHP,Mast
    • cats-any age or breed, probable poor grooming called "feline acne" black heads
  37. clinical signs for acne
    • dogs-folliculitis(molecules will get raised, plugged up follicles), furumculosis (recurring oil)
    • cats-comedones(black head), pustules
    • found on face can be food bowls if plastic
  38. diagnosis for acne
    • clinical signs
    • Bx
    • C/S
  39. treatment for acne
    • topical cleaning-bensoyle peroxide, Abx, shampoos
    • topical meds-retinoids, mupirocin, other Abx
    • steroids or Abx systemically
  40. client education on acne
    • cats-intermittent treatment
    • dogs-long term treatment
  41. acral lick dermatitis
    • excessive licking leads to plaque
    • boredom-lick grainuloles, thicken fibros, open, possible allergies, lost of sensation, hyoersensitivity
    • local change in sensation
    • possibly alergic disease
    • large breed dogs, variable age
  42. acral lick dermatitis clinical signs
    • thick, firm, ulcerated plaque
    • usually dorsal/lateral carpus, tarsus, MC, MT
  43. diagnosis for acral lick dermatitis
    • lesion and location
    • any indicated additional tests
    • need to break the cycle
  44. treatment for acral lick dermatitis
    • increased activity
    • covering
    • you name it
    • topical stuff
    • entralesion
    • steroids
    • antihistamine
    • antibiotics
  45. client education acral lick dermatitis
    • can be very rewarding or very poor response
  46. pyoderma
    • bacterial skin infection
    • generally not a primary condition
    • organisms include staph intermedia, and sometimes e.coli, proteus, and pseudomonas when complicated
    • rarely if ever seen in cats
    • secondary problem like to demodex and mostly allergies
  47. clinical signs for pyoderma
    • vary with depth of involvement
    • superficial-papules, pustules, epid collarrettes
    • deep-furunculosis, cellulitis, abscess
    • often pruritic from the PD and the first condition
  48. diagnosis for pyoderma
    • presence of papules and pustules
    • C/S-to rule out yeast
    • SS-skin scrape-to run out mites
    • Cytology
  49. treatment for pyoderma
    • Abx-based on C/S-longterm couple of week until skin clears
    • ROT-10-14 days past clinical cure
    • empirical-clavamox, first generation cephalexin
    • seconday-baytril, advanced penicillins
    • systemic antibiodics for skin use cyclosporine
    • topical and antimicrobial shampoo
  50. treatment for pyoderma
    • steroids
    • only short acting forms for initial pruritis like dexomethazone- to break cycle to make owner and animal happy
    • long term use sets up for resistance
  51. client education for pyoderma
    • need to find underlying cause and treat that
    • use Abx as directed or can set up recurrence/resistance
  52. pyotraumatic dermatitis
    • something stimulates intense licking and chewing
    • trauma
    • insect bite
    • other localized inflammation
    • trauma and moisture add to the irritation-cause irritation
    • common in breeds with denser undercoat-GS, GR, LR, chow
    • like acral lick dermatitis
    • self induced
    • something gets their attention and they start licking and chewing
    • hot spot
    • shave and clean, steroids, sedate topical antibacterial
    • momedomax good for hot spot
  53. clinical signs for pyotraumatic dermatitis
    • localized area of moist, ulcerated, inflamed skin
    • acute onset-few hours
  54. diagnosis for pyotraumatic dermatitis
    whatever is needed to find underlying cause
  55. treatment for pyotraumatic dermatitis
    • corticosteroids-topical and/or systemic
    • antibiotics
    • correction of cause
  56. client education for pyotraumatic dermatitis
    • common in humid weather
    • watch for fly strike in OD dogs
    • can recur and be frustrating
  57. abscess
    • generally roaming male felines
    • canine bites or penetrating trauma also
    • contaminate bacteria "injected" in close space
    • no area to drain out, build up pressure in the tissue layer, often e.coli, pseudomonas, staph, strept
    • bacteria gets into tissue than there is a bacterial infection think of tom cat, fluid build up, usually need to drain it, side of face-anaerobic bacteria
    • may or may not culture them
    • WBC increase
  58. clinical signs for abscess
    • acute onset swelling
    • area often very painful to the touch
    • sometimes very thin area or has already ruptured
    • pyrexia (fever) and malaise
    • history of fighting
  59. diagnosis for abscess
    • by PE and history
    • aspiration
    • C/S or cytology
  60. treatment for abscess
    • lance and drain
    • +/- Abx- clavamox, antirobe (clindamycin)
  61. client education for abscess
    • generally recover well
    • neutering and keeping in preventative
  62. dermatophytosis
    • grow in keratinized tissue
    • carrier states in non symptomatic pets
    • fibrosis masses
    • fungal infection
    • systemic fungal infection
    • hard to treat
    • topical fungal infection-ringworm
  63. clinical signs for dermatophytosis
    • dogs-lesions vary
    • cats- more classic circular lesion
  64. diagnosis for dermatophytosis
    • wood lamp
    • hair follicle examination
    • DTM with mircoscopic identification of growth
  65. treatment for dermatophytosis
    • griseofulvin
    • ketoconazole
    • topical treatment after shaving-lime sulfur, miconazole shampoo
  66. client education for dermatophytosis
    • drug side effects
    • griseo-bone marrow suppression
    • ketocon-hepatopathy
    • quarentines sometimes needed-breeding facilities
    • *potential zoonosis
    • good hygiene usually preventative
    • consult MD for treatment if contracted
    • human RW (T.pedis, T. corpora) not transmissible to pets
  67. cheyletiella
    • genus of mite living on the skin surface
    • entire cycle is on the host-can live up to 10 days off host
    • spread by contact
    • walking dandruff
    • easy to treat
    • can burrow in humans but cant finish life cycle
  68. clinical signs for cheyletiella
    dandruff and pruritis
  69. diagnosis for cheyletiella
    • acetate tape exam
    • SS
  70. treatment for cheyletiella
    • topical pyrethrin based products over 3 weeks
    • clean environment
  71. client education for cheyletiella
    • easily treated
    • slight temporary zoonosis
  72. demodectic mange
    • demodex canis mites live in the hair follicles
    • *transmission from mom to pup at nursing
    • normal fauna after that
    • feline form exits but very rare
    • normal inhabit of the skin
    • exist in small numbers
    • genetic predisposition
    • deep scraping if no blood on microscope do again
    • not a lot of false negative
    • aka red mange
    • can be localized on face or generalized-underlying immune disorder
    • first seen in hair loss around the eyes
    • symptoms are secondary to inflammation-unless mites in excess, no symptoms
    • usually a dog that develops demodex has some underlying immune issue that's allowing the mites to take over
    • localized demodex can cure themself
    • demodecosis-mite has taken over (generalized state of mange)
    • look like cigar with 8 legs when doing repetitive skin scraping looking for how many and if they are dead or alive
  73. clinical signs for demodectic mange
    demodex can look like anything -hair loss
  74. diagnosis for demodectic mange
    • SS from multiple sites
    • easy to find on scraping
    • generalized found in many sites, normal or not
    • localized-only in affected skin
    • SS used to evaluate response to treatment
    • almost all cases of generalized demodex have secondary pyoderma so all are put on antibiotics
  75. treatment for demodectic mange
    • only for generalized form
    • amitraz (mitaban, tactic)- several protocols
    • ivermectin and milbemycin
    • treat until we see 2 negative skin scraping in a row
    • don't treat localized forms
    • if client ask can treat using ointment called gowanal
  76. client education for demodectic mange
    • drug effect-ivermectin in colles, dip
    • DO NOT BREED patient with generalized Dz because genetic
    • cure not always possible
    • does not transmit to people or other pets
  77. sarcoptic mange
    • sarcoptes scabei canis-dog
    • cat-notedres cati
    • lives on and burrows into the skin
    • sensitivity to mite, feces, eggs, and dander
    • transmission by direct contact-reservoir in wild canids-fox, wolf?
    • scabies is zoonotic but cant complete its life cycle it will burrow under your skin and cause irritation
    • most common pieces to find scabies is edge of ears, elbow and inguinal area
    • ear scratch reflex test if positive will scratch when scratching pinna in pups 
  78. clinical signs for sarcoptic mange
    • severe pruritis
    • generally thin hair areas-ear tips and elbow
    • secondary traumatic skin lesion
    • aka excoriation cause self trauma from scratching
    • scabies can have a lot of false negative
    • treat with ivermectin to take off list
  79. diagnostics for scaroptic mange
    • skin scrape-a lot of false negative
    • difficult to diagnose
    • pinna response-consider 75-90% accurate-ear scratch reflex
    • response to treatment
  80. treatment for sarcoptic mange
    • ivermectin po or sq
    • 1-2 weeks past cure
    • topical dips-lime sulfure, paramiters
    • don't use much anumore unless its sheltie or collie some if they have demodex
  81. client education for sarcoptic mange
    • very responsive to treatment
    • does have a strong but short lived zoonotic potential
    • can cause intense pruritis in people
    • about a 10 day duration
  82. perianal fistulas
    • cause is unknown
    • apocrine gland inflammation
    • infection/impaction of anal sinuses
    • anal sacculitis
    • genetics suspected but not proven
    • GS and IS most common breeds
    • mean age 7 years- 7 months to 12 years
    • draining tracts around the perional bacterial infection
    • usually rupture demotological conditions
  83. clinical signs for perianal fistulas
    • dermatologic signs
    • multiple chronic fistulas tracts and ulceration sinuses near the perianal region
    • discharge and odor
    • rectoanal signs
    • tenesmus
    • dyschezia
    • licking and self mutilation
    • a lot of irritation back there
    • bloody
  84. diagnosis for perianal fistula
    • slinical signs
    • possible biopsy
    • german shepard prone to it inflammatory infection anal gland
    • fistulas tract-a draining tract that may not end
    • unknown causes
  85. treatment for perianal fistula
    • surgical treatment-no one technique-electrosurgery, cruosurgery, resection, laser, add anal sacculectomy
    • medical treatment-promising results with cyclosporine-suppress inflammatory response
  86. client education for perianal fistula
    • keep area clean
    • medication-consistent use
    • results variable based on treatment and severity
    • guarded in all but the minor causes
    • not seen often 
    • don't really know what causes it
  87. immune mediated disease
    • pemphigus foliaceus-think auto immune
    • pemphigus vulgaris
    • bullous pemphigoid
    • discoid lupus erythematosis- effect skin and organs, kidney problems
    • location in vesicles (bubbles), may rupture, or blisters
    • effect different layers of skin on nose (black part)
    • diagnose with biopsy
    • generally an unknown cause
    • alteration of the immune system to attack self-attacks layers of the skin-varies with disease, layers separate and fill with fluid, cause lesions
    • generally very uncommon conditions
  88. clinical signs for immune mediated disease
    • mild signs similar to pyoderma
    • classic signs include vesicles (bubbles) rupturing to erosions and ulcers
    • location on the body differs with disease
  89. pemphigus vulgaris
    • more generalized distribution including MM, MCJ
    • more severe deep erosions
    • secondary infections and other complication
  90. Bullous Pemphigoid
    • similar distribution to p vulgaris
    • severity between foliaceus and vulgaris
  91. discoid lupus erythematosus
    • primarily around the head
    • nasal planim, face, ear, mm
    • lesion may be simple depigmentation at first
    • progression to erosions and ulcerations
  92. diagnosis for immune mediated disease
    • biopsy- shoes depth/severity
    • additional systemic testing-ANA, SLE, other
  93. treatment for immune mediated disease
    • steroids
    • cytotoxis agents
    • chrysotherapy-gold salts
    • complication-Abx, fluiods, etc.
    • comb test
  94. client education for immune mediated disease
    • treatment can be lifelong
    • rechecks very important
    • vulgaris and bullous can be fatal
    • discoid lupus can go into remission with treatment-progressive but not fatal without treatment