Approach to Dermatology Patient

Question 1

DAMNITV

Answer 1

Degenerative
Anomalous
Metabolic
Nutritional/neoplasia
Iatrogenic/Immune-mediated/Infectious
Toxic/Traumatic
Vascular

Question 2

Most common DAMNITV categories for skin disease

Answer 2

Metabolic
Neoplastic
Immune-mediated
Infectious
Traumatic

Question 3

Overview of clinical approach to dermatology patient

Answer 3

1. Signalment
2. History
3. Clinical exam
4. Differential diagnosis
5. Initial diagnostic tests
6. Diagnosis

Question 4

1. Signalment

Answer 4

Age
Breed
Sex
Species

Question 5

Age

Answer 5

Age at onset vs age now
Immature animals - immunologically immature
□ Demodicosis
□ Dermatophytosis
□ Viral papillomas
Young adult
□ Environmental atopy
Older animal
□ Endocrinopathies
Hypothyroidism
Hyperadrenocorticism
□ Other systemic diseases
□ Neoplasia

Question 6

Sex

Answer 6

○ Entire male
Endocrine changes from testicular neoplasia
○ Entire female
Post-whelping bitch can suffer temporary generalised alopecia

Question 7

Breed dispositions

Answer 7

Welsh ponies – Culicoides hypersensitivity
Feathered horses/ponies – Chorioptic mange
Persian cats, Yorkshire terriers – dermatophytosis
Staffordshire Bull Terriers, Shar Peis, Bullogs – demodicosis
Shar Peis, French/English bulldogs, Labradors (+ others!) – environmental atopy

Question 8

2. History

Answer 8

General health history
Lifestyle/management
Dermatological history

Question 9

General health history

Answer 9

○ Underlying systemic disease
PUPD in hyperadrenocorticism
○ Systemic disease that may affect diagnostic or treatment plan
Concurrent cardiac failure
○ Drug history
Cutaneous drug reaction/intolerance
Iatrogenic effects

Question 10

Lifestyle/management

Answer 10

○ Housed/stabled
Lice, dermatophytosis more common in housed farm animals/horses
Chorioptes more common in stabled horses
Culicoides hypersensitivity more common if out at grass at dawn/dusk
○ Nature of environment
Dermatophilosis (rain scald/mud fever) more common in wet conditions
○ Recent introductions to group
○ Contact with other species
○ Hunting terriers
More prone to trichophyton dermatophyte infections
○ Hunting cats
Risk of cowpox

Question 11

Dermatological history

Answer 11

○ Details of in-contact animals
Skin problems?
○ Lesions on in-contact people?
○ Past dermatological history
Age of onset of initial episode
○ Onset of current problem
When?
Nature of lesions?
Areas of body affected by lesions/pruritus?
Progression?
Seasonality?
○ How long owned?
○ Treatments given and response
○ Travelled abroad?
○ Ectoparasite control? What and when?
○ Exposure to potential sources of infection

Question 12

3. Clinical Examination

Answer 12

General health exam
Dermatological exam
Record findings accurately for clinical notes

Question 13

General health exam

Answer 13

○ Signs of systemic disease
□ Underlie dermatological disease
□ Affect diagnostic approach
□ Affect treatment of skin
○ Signs associated with dermatological disease
□ Lymphadenopathy (reactive) secondary to demodicosis, severe inflammation
□ Lymphadenopathy from metastasis of skin neoplasm

Question 14

Dermatological exam

Answer 14

○ Adequate restraint and good lighting
○ Be systematic
Do not just look at areas noticed by owners!
Remember
□ Areas that are harder to access – e.g. under tail, inguinum
□ Mucocutaneous junctions
□ All feet, including undersides
□ Ears
○ Feet and smell coat too
○ Look at skin beneath hair