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LEAH FCP > Approach to common dermatological presentations > Flashcards

Approach to common dermatological presentations Flashcards

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1
Q

How does pruritus present in different species?

A

Dogs: Licking feet, scratching, chewing

Cats: Overgrooming (self-induced alopecia)

Horses: Stamping, rubbing

Small furries: Barbering (must differentiate from normal grooming)

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2
Q

What are the major causes of pruritus?

A

Hypersensitivities (atopic dermatitis, food allergy)

Parasites (fleas, mites, lice)

Microbial infections (bacterial pyoderma, Malassezia)

Other causes (neoplasia, immune-mediated diseases)

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3
Q

What tests help rule out parasitic and microbial causes of pruritus?

A

Parasites: Coat brushing, skin scraping, trichogram, acetate tape strips

Microbial Infections: Cytology (bacteria, Malassezia), Wood’s lamp, fungal culture

Consider treatment trials if test sensitivity is low (e.g. fleas, scabies)

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4
Q

What should be done if parasites and infections are ruled out as causes of pruritus?

A
  1. Elimination diet trial:
    - 6-8 weeks with novel or hydrolysed protein (dogs/cats)
    - Limited forage diet (horses)
    - Challenge with old foods to validate results
    - If diet works: diagnose with food-induced allergy
  2. If diet trial fails: Diagnose environmental atopic dermatitis by exclusion
  3. Treatment options:
    - Anti-pruritics &/or anti-inflammatory drugs
    - Prophylactic treatments to control secondary infections
    - Allergen-specific immunotherapy (ASIT) if IgE tests confirm environmental triggers
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5
Q

What is the step-by-step systematic approach to pruritus?

A
  1. Signalment, history & clinical signs → Make ranked d/d list
  2. Investigate & rule out parasites & infections first
  3. If pruritus remains → Conduct elimination diet trial
  4. If pruritus still persists → Diagnose environmental atopic dermatitis

Biopsies used for rare conditions or when presentation is unusual.

Client communication is essential – Process takes time!

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6
Q

What are some important considerations when assessing the signalment in pruritic animals?

A

Species:
- Diseases affect different species with different frequency
- e.g. Farm animals: Environmental atopy rare; ectoparasites more important
- e.g. Prion disease (scrapie) important in sheep

Age:
- Consider not only age, but age of ONSET of first signs of pruritus
- e.g. Parasites → Any age (Demodex in young/old)
- e.g. Atopy → Environmental (young adults); Food-induced (<1 year)
- e.g. Older animals → Rule out neoplasia & secondary infections

Sex:
- e.g. (older) ME dog: Sertoli cell tumour → secondary pyoderma

Breed predispositions:
- Care that these don’t have unconsidered effect on diagnosis

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7
Q

What questions would you ask/what would you want to find out for the history of the pruritic animal?

A

Animal background, details of husbandry (eg housing, bedding, diet)

Routine medical care & when administered (esp re parasites)

History of contagion/zoonosis

Details of skin condition – age of onset/duration, initial clinical signs/progression, seasonality

Evidence of systemic disease

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8
Q

What are the key considerations in eliminating parasites and microbial infections in dermatological cases?

A

Use wide range of tests

Choose effective anti-parasiticides

Consider antibiotic stewardship

Combine parasite control & microbial testing for:
- Better welfare
- Easier interpretation of results
- Clear communication with owners

In large animals, parasite control is main focus due to economic impact

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9
Q

What are the next steps if a pruritic animal improves with parasite control?

A

Continue parasite control

Reassess need for ectoparasitic therapy based on:
- Parasite type
- Environment
- Cost

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10
Q

What are the next steps if a pruritic animal improves with antimicrobial treatment?

A

If pruritus resolves after stopping treatment → monitor closely

If pruritus returns after stopping treatment → investigate further (consider other signs, owner wishes & antibiotic stewardship)

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11
Q

How should parasite control and antimicrobial therapy be assessed in a pruritic animal?

A

If both treatments were given & animal improved → stop antimicrobials first & observe response before deciding on further interventions

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12
Q

Are pustules and papules primary or secondary lesions?

A

Always primary

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13
Q

Define papule

A

Small solid elevation of skin <1cm diameter

Often erythematous

May → crusts of serum, pus or blood

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14
Q

Define pustule

A

Small (<1cm) skin elevation, filled with pus

Often start as papule

Depth in epidermis varies with disease

Fragile, short-lived so often see as crusts/ epidermal collarettes

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15
Q

What are some common causes of pustules & papules?

A

Infections
- Superficial bacterial pyoderma/folliculitis! (dog, horse)
- Dermatophytosis (cat)
- Malassezia dermatitis (dog)

Ectoparasites
- Fleas (dog, cat)
- Surface mites
- Burrowing mites (e.g. Sarcoptes)
- Demodicosis (dog)

Hypersensitivities
- Fleas (dog, cat)
- Environmental/food (dog, cat, horse)
- Insect bites (horse, farm animal)

Autoimmune disease (rare)
- Pemphigus foliaceus (dog, cat)

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16
Q

What key factors should be assessed during a dermatological clinical examination of lesions?

A

Follicular lesions? Suggests bacterial folliculitis, demodicosis, dermatophytosis

Lesion distribution:
- Caudal/dorsal trunk (dog) → Fleas
- Ventral abdomen, pinnal margins, elbows, hocks (dog) → Sarcoptic mange
- Lesions on face/pinnae/head? Consider autoimmune disease
- Lesions at different stages? Suggests superficial pyoderma
- Lesions appearing in waves? Consider pemphigus

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17
Q

Describe the diagnostic approach for pustules/papules

A
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18
Q

Are scale and crust primary or secondary lesions?

A

Usually secondary, rarely primary

(Where scale occurs in diseases, its secondary to underlying primary cause: secondary keratinisation disorders)

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19
Q

Define scale

A

Rafts of immature keratinocytes which accumulate at skin surface

Due to hyperkeratosis (increased depth of cornified layer)

Caused by increased or disrupted epidermal turnover

Loose or tightly adherent

Form scurf when desquamate

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20
Q

Define crust

A

exudates (serum, pus or blood) that dried on skin surface

Often also involves surface squames, hair, topical medications

Can be associated with:
- scaling diseases
- pustular/papular diseases
- ulcerative/erosive diseases

Very non-specific finding

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21
Q

What are some common infectious causes of scale and crust?

A

Bacterial
- Pyoderma/folliculitis! (dog, horse)
- Dermatophilosis! (farm, horse)

Fungal
- Dermatophytosis! (cattle, horse, cat)
- Malassezia dermatitis (dog)

Viral
- Viral papillomas (cattle, horse)
- Occult sarcoids (horse)

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22
Q

What are some common parasitic causes of scale and crust?

A

Ectoparasites
- Fleas (dog, cat)
- Lice (farm, horse)
- Surface mites
* Chorioptes (horse, cattle)
* Cheyletiella (rabbit)
* Psoroptes (sheep, rabbit)
- Burrowing mites
* Sarcoptes (dog)
* Trixacarus (guinea pig)
* Cnemidocoptes (bird)
- Demodicosis (dog, hamster)

Endoparasites (horse)

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23
Q

What are some common hypersensitivity causes of scale and crust?

A

Flea (dog, cat)

Environmental/food (dog, cat, horse)

Insect bites (horse, farm)

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24
Q

What are some common nutritional/metabolic causes of scale and crust?

A

Photosensitisation (cattle, horse)

Hypothyroidism (dog)

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25
What are primary keratinisation disorders?
Defects in normal keratinisation process - Abnormal formation of keratinocytes - Abnormal sebaceous gland function Often breed-related & tend to occur in younger animals Diagnosis of exclusion
26
Describe the diagnostic approach for scale/crust
27
What lesion is this?
Crust
28
What lesion is this?
Scale
29
What lesion is this?
Papule
30
What lesion is this?
Pustule
31
Give examples of swellings of non-dermatologic origins
Hernias Oedema - E.g. due to right sided heart failure, hypoalbuminaemia Bursitis Emphysema Mammary tumours
32
How does oedema (swelling of non-dermatologic origin) present?
Ill-defined, soft, painless swelling from, e.g. R sided heart failure, hypoalbuminaemia Pits on pressure Clear fluid on FNA
33
What is emphysema and what causes it?
gas in subcutaneous tissue crepitant without pain or swelling caused by: - Severe respiratory disease or lung puncture - Introduction of air through cutaneous wound - Rumenotomy or rumen cannulisation - Clostridial infections
34
How can skin masses be classified?
35
Give examples of infectious inflammatory skin masses
Abscess/ cellulitis - e.g. post trauma/FB/ bite (farm animal, cat, also rabbit secondary to dental disease) Furunculosis - e.g. staphylococcal deep pyoderma - e.g. Demodex Bacterial granulomas - e.g. Mycobacteria - e.g. Actinobacillus, Nocardia, Actinomyces Deep/subcutaneous or systemic fungal granuloma
36
Give examples of non-infectious inflammatory skin masses
Urticaria, angioedema (horse>dog>cat) Seroma Haematoma Others - e.g. eosinophilic granulomas, tick/insect bite granulomas, sterile panniculitis
37
What is urticaria/angioedema?
Degranulation mast cells --> oedema (painless, pit on pressure) Can be allergic (type I or III) or non-immunologic cause Urticaria --> wheals (+/- pruritus) Angioedema --> large oedematous swelling, usually involving head – can be fatal - same process but bigger area
38
What is a seroma?
Accumulation of serum under skin Painless, non-pitting Frequently occurs post-surgery
39
What is a haematoma?
Loss of blood from damaged/ruptured blood vessels under skin; painless, non-pitting Usually due to trauma, occasionally due to clotting problems
40
Give examples of common neoplastic causes of cutaneous skin masses in different species
Most common in older animals --> uncommon in farm animals Horse – esp. melanomas (grey horses), sarcoids Dogs – skin neoplasms common - e.g. lipomas, sebaceous adenomas, mast cell tumours Cats – neoplastic skin masses less common
41
What is a cyst?
Epithelial-lined cavity, containing fluid or solid material produced by cells of cyst lining Smooth, well-circumscribed Fluctuant/solid – dependent on nature of contents
42
What key factors influence the differential diagnosis for skin masses?
Species - e.g. abscess in cat, cattle, rabbit; skin neoplasm in old dog Breed/colour - e.g. Melanomas in grey horse, mast cell tumours in boxers Age - e.g. neonate: umbilical abscess - e.g. old animal: neoplasia General & dermatologic history
43
What are examples of history findings that suggest specific conditions in cutaneous skin masses?
Recent trauma, fight, surgery → Abscess, haematoma, seroma Recent injection → Abscess, panniculitis Systemic signs (e.g. weight loss, respiratory signs) → Neoplasia, systemic fungal infections
44
What are key factors to look for in a general clinical examination of a patient with a cutaneous skin mass?
Pyrexia → Often seen with systemic or severe cutaneous microbial infections & abscesses Peripheral Lymphadenopathy → Lymph node enlargement due to metastatic neoplasia or reaction to infection/inflammation Other Systemic Abnormalities → May influence diagnostic/treatment choices or directly relate to mass - Animals with lung metastases may have no clinical signs Non-Dermatological Swelling? → Consider bursa, joint swelling, or hernia
45
What are we assessing in a dermatological examination of a patient with a cutaneous skin mass?
Solitary/multiple lesions? Area of body? Size? Well-defined? Ill-defined? Freely moveable? Draining tracts/sinuses? Pits on pressure? Painful/painless? Inflammatory?
46
What cytology investigations can be done to a cutaneous skin mass?
Fine needle aspirate 1. ‘Needle only’ with no suction 2. ‘Continuous suction’ 3. ‘Intermittent suction’ Impression smear of surface Smears/touch impressions of sinus contents
47
How can cytology help differentiate types of inflammatory cutaneous masses?
Sterile vs. Septic – Presence of organisms suggests septic inflammation - may be difficult to detect, esp. in pyogranulomatous inflammation - Some organisms (e.g. mycobacteria) require special stains Chronic vs. Acute – Chronic inflammation may show macrophages & fibrosis, while acute inflammation is often neutrophilic
48
What are the three main categories of neoplastic cells in cutaneous cytology?
Round cell Epithelial cell Spindle cell
49
How does cytology help identify cystic skin masses?
Cyst contents are produced by epithelial lining, leading to different aspirates: - Sebaceous material, keratinised debris, cholesterol crystals Granulomatous inflammation may be present if cyst has ruptured Often amorphous appearance
50
What are the limitations of cytology?
Not all cell-types shed easily, so not always representative May take unrepresentative sample Gives no info re tissue architecture thus can't grade neoplasm - Requires subsequent histopathology if grading required
51
When is tissue biopsy recommended?
When FNA is inconclusive, for histopathology confirmation, and for tissue culture if needed
52
What skin mass is this?
Urticaria
53
What skin mass is this?
Angioedema of muzzle
54
What skin mass is this?
Seroma
55
What skin mass is this?
Aural heamatoma
56
What skin mass is this?
Eosinophilic granuloma (horse)
57
What skin mass is this?
Melanoma of perineum
58
What is alopecia, and what are the two main types?
Partial or complete hair loss, can be: - Primary – Failure of normal hair growth - Secondary – Hair grows normally but is later damaged or lost
59
What is the difference between true and apparent alopecia?
True alopecia – Direct damage to hair follicle unit --> loss of whole hair follicle Apparent alopecia – Hair shafts damaged but not lost from follicle --> hair cropped short
60
What are the key mechanisms leading to primary alopecia?
Lack of stimulation of anagen phase → Hair fails to enter growth phase Abnormal growth factors → Leads to miniaturised/dysplastic hairs that break off or shed Elongation of telogen phase → Hair remains in resting phase indefinitely, preventing new growth
61
What are the major categories of alopecia causes?
Folliculitis!/furunculosis/bulbitis – Inflammatory damage to hair follicle unit Hair cycle abnormality – Hair stops growing (e.g. endocrinopathy) Hair morphology defects – Hair is malformed and breaks off Congenital aplasia (rare) – Hair never grows
62
What factors should be considered when creating a differential diagnosis list for alopecia?
Species: - Ringworm → Cattle, horses, cats, hedgehogs. - Demodicosis, pyoderma → dogs - Occult sarcoids → Horses Age: - Young → Infections (e.g. demodicosis, dermatophytosis, superficial pyoderma) - Older → Endocrinopathies, neoplasia, chronic demodicosis Breed: - Terriers & Boxers → hyperadrenocorticism - Staffies → demodicosis - Dachshunds → Pattern baldness - Jack Russell Terriers → Trichophyton infections from rodents/hedgehogs Sex: - Entire female guinea pigs → Ovarian neoplasia - Entire male dogs → Sertoli cell tumours
63
How can history help identify the cause of alopecia?
Contagious/Zoonotic Causes → Consider dermatophytosis (ringworm) or ectoparasites Systemic Signs: - PUPD, polyphagia → HAC? (dog) - Weight gain, lethargy → Hypothyroidism? Pruritus? - If present, investigate as self-trauma (pruritic alopecia), not true alopecia
64
In what cases can alopecia be normal?
Preauricular/pinnal alopecia of cats Sphinx cats Irish water spaniels Flank scent glands on hamsters
65
What differentials do different distributions of alopecia suggest?
Localized or Multifocal/diffuse patchy alopecia → Dermatophytosis, pyoderma, demodicosis Symmetrical alopecia → Dermatophytosis, pyoderma, demodicosis, Endocrinopathies, pattern alopecie, follicular dysplasias (+- colour linked), trace element deficiency (cattle)
66
How can we investigate whether an animal has true or apparent alopecia?
Trichogram - Ease of epilation at periphery - Easily epilated → true - Requires some effort → apparent - Broken distal tips → apparent * NB often seen with trauma/pruritus so if pruritic investigate as per pruritus protocol
67
What lesion is seen here (alongside alopecia) and what condition is it suggestive of?
Calcinosis cutis --> Hyperadrenocorticism (dog)
68
What lesion is seen here (alongside alopecia) and what condition is it suggestive of?
Comedones, skin thinning --> Hyperadrenocorticism (dog)
69
What lesion is seen here (alongside alopecia) and what condition is it suggestive of?
Epidermal collarettes, papules --> pyoderma (dog)
70
What lesion is seen here (alongside alopecia) and what condition is it suggestive of?
Draining sinuses, furunculosis --> demodicosis (dog)
71
What tests help differentiate causes of alopecia?
Skin scrapings - esp. Demodex mites Dermatophyte testing - Direct microscopy, culture - Wood’s lamp for ringworm Trichogram (hair analysis): - Telogen dominance → endocrinopathies - Melanin clumps → colour dilution alopecia (dog) - Arthrospores/hyphae → dermatophyte infection - Follicular casts → sebaceous adenitis (dog) - Broken hair tips → trauma/pruritus
72
If no definitive diagnosis is reached in a alopecia case following skin scrapings, dermatophyte testing & trichogram, what further tests can be done?
Cytology – Helps diagnose secondary bacterial pyoderma Endocrine testing Skin biopsy to see: - Folliculitis – e.g. bacterial, demodicosis, dermatophytosis - Atrophic changes - e.g. endocrinopathy - Follicular dysplasias - Autoimmune cause - e.g. sebaceous adenitis or alopecia areata
73
What lesion is this?
Palatine lesion
74
What lesion is this?
Plaque
75
What lesions are these?
Plaques & ulceration
76
What lesion is this?
Lip ulcer
77
What lesion is this?
Excoriation on face
78
Fred is 11-month-old cat with 3-month history of severe pruritic skin disease. He is systemically well & lives in a multi-cat household. Based on the history, what test would you want to do?
Wet paper tests (fleas) and thorough testing for other parasites
79
Label the cells and what condition does it suggest?
80
11-year-old Cavalier King Charles Spaniel with severe pruritus & redness of skin. He has mild cardiac disease, but this is adequately treated & he is generally well. He is receiving monthly afoxolaner & has good appetite & normal thirst. Owner has googled allergic skin disease & considers this most likely diagnosis. Why is cAD unlikely: Based on history? Based on lesions?
Based on the history? - Age of onset very late for allergic disease (75% of cases start between 6m & 3y of age) Based on the lesions? - Distribution – esp. nose leather & top of head would be very unusual in cAD - Nature of lesions – erosions, depigmentation, scale, alopecia & small hyperpigmented macules suggestive of disease attacking basement membrane
81
What test is best for diseases of basement membrane?
biopsy or cytology from exudative lesions
82
What are examples of diseases of the basement membrane?
Epitheliotropic lymphoma, cutaneous lupus, vitiligo
83
Describe these lesion. Are the lesions suggestive of endocrine alopecia?
Well demarcated, irregular alopecia affecting lateral flank with hyperpigmentation of exposed skin Distribution appears geographical rather than generalised, indicating localised process rather than widespread telogenisation Lesions don't suggest endocrine alopecia, where hair loss occurs due to wear & tear, often presenting with diffuse & poorly demarcated edge
84
2½ year old MN mastiff cross has 4-month history of alopecia affecting sides. He is non-pruritic & owner reports that he has had no other lesions & is fit & well. His weight is normal & static. Its March at time of consultation. What history points would you consider helpful in considering endocrine problems?
Age - very young dog for neoplastic endocrinopathy (e.g. HAC or hyperoestrogenism due to Sertoli cell tumour) - Immune-mediated endocrine problem (e.g. hypothyroidism) more likely, but dog is still quite young for this disease Normal behaviour is noted & no weight gain Problem started in winter, if it resolves in summer it would be strong hint that endocrine disease isn't present
85
What basic tests can help investigate hormonal alopecia?
Haematology & Biochemistry: - Stress leukogram, increased ALP → Hyperadrenocorticism - Raised cholesterol → Hypothyroidism Urine Tests: - high USG → HAC unlikely - Urine Creatinine:Cortisol: Useful as rule-out test for HAC Thyroid Function Tests: - T4 & TSH → Used to rule out hypothyroidism
86
Give examples of primary causes of feather loss in parrots
Hypovitaminosis A Allergies Hypothyroidism Feather cyst Giardia
87
Give examples of secondary causes of feather loss in parrots
Fungal/parasitic Mites (Knemidocoptes) Ringworm Systemic illness
88
Give examples of behavioural causes of feather loss in parrots
Stress Self mutilation Boredom Mating behaviours Overbonding with owner
89
Give examples of primary causes of feather loss in chickens
Dermayssus Gallinae (red mite) Nutritional deficiencies
90
Give examples of behavioural causes of feather loss in chickens
Feather pecking (hierarchy) Poor enrichment Stress Overmating Brooding
91
Give examples of causes of hair loss in guinea pigs
Cystic ovarian disease Ectoparasites Pyoderma Post partum alopecia Overgrooming Endocrine disease Vit C deficiency Dermatophytes!
92
What are the 3 most common equine skin neoplasia?
Melanoma - Black, spherical or plaque like, common around perineum & parotid region of grey horses Sarcoid - Multiple types, usually hairless, sometimes ulcerative, common in groin, axilla & around eyes Squamous cell carcinoma - Raised, irregular, pink, locally invasive, common around genitals & eyes
93
What are equine sarcoids?
Most common skin tumour in horses, caused by Bovine Papillomavirus
94
What are key characteristics of equine sarcoids?
Locally invasive, fibroblastic & wart-like Can be single or multiple lesions Six different types exist
95
How are equine sarcoids diagnosed?
Based on visual appearance, but confirmed by biopsy Histologically, they show dense dermal fibroblasts in interlacing bundles
96
How are equine sarcoids (Bovine Papillomavirus) transmitted?
Flies act as vectors, spreading virus between horses Common in areas where flies frequently bite (e.g. groin, axilla & around eyes)
97
What type of equine sarcoid is this?
Occult
98
What type of equine sarcoid is this?
Verrucose
99
What type of equine sarcoid is this?
Nodular
100
What type of equine sarcoid is this?
Fibroblastic
101
What type of equine sarcoid is this?
Malignant
102
What type of equine sarcoid is this?
Mixed
103
What are the treatment options for equine sarcoids?
Laser surgical removal Cryotherapy Caustic cream application Elastrator band application (causes hypoxic necrosis in nodular sarcoids) Radiotherapy (particularly for periocular sarcoids)
104
How can melanomas around the perineum be treated?
Removed with a surgical laser
105
What are the key features of Squamous Cell Carcinoma (SCC)?
Locally invasive, pink, irregular, sometimes ulcerated lesions Can grow rapidly Often affects genitals, eyes, penis & third eyelid
106
What is the standard treatment for SCC?
Complete surgical excision is recommended as SCC can progress & spread rapidly Histological confirmation ensures complete removal Early intervention is curative in most cases
107
What are eosinophilic granulomas?
Small, firm, non-itchy, non-painful raised nodules with normal hair covering Commonly found on withers & back Not neoplastic; their exact cause is unknown
108
How are eosinophilic granulomas diagnosed?
Based on clinical appearance Confirmed via fine needle aspirate or biopsy
109
What is the treatment for eosinophilic granulomas?
Often not required unless interfering with tack Can be treated with surgical excision or corticosteroid injections if necessary
110
What are juvenile papillomas?
Multiple, small, irregular, verrucose (wart-like) grey proliferative lesions Commonly found on muzzle, face & sheath of young horses Caused by equine papillomavirus
111
What is the typical progression and treatment of juvenile papillomas?
They are usually self-limiting, so treatment is not required Cryotherapy may be considered for severe cases
112
What are the key characteristics of equine melanomas?
Typically benign, black, nodular & slow-growing Most common in grey horses, esp. in perineum, sheath & parotid region

LEAH FCP (151 decks)

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