Dermatology: Dog Pruritis Flashcards
(104 cards)
1
Q
An unpleasant sensation of the skin that provokes the urge to scratch is?
A
Pruritus aka Itch
2
Q
You have an owner come in with the complaint of biting, licking, chewing, scratching gnawing, and/or rubbing. What is top on your differential list?
A
Pruritus
3
Q
What do we see early on with Pruritus(3)?
A
Alopecia
Erythema
Excoriations
4
Q
True or False: Depending on the cause, pruritic skin looks the same in most cases.
A
FALSE!
Irrespective of the cause. Location is the key.
5
Q
What do we see in the Chronic stage of Pruritus?
A
Lichenification
Hyperpigmentation
Seborrhea
6
Q
True or False: It is important when looking at a pruritic case to look for treatable diseases.
A
True!
You want to find good/treatable diseases when working up the case.
7
Q
What does it mean to be systematic in your approach with pruritic cases?
A
Determine factors contributing to pruritus.
Diagnostically (Derm pushups) & Treatment
Eliminate factors until diagnosis is obtained
Keep owner informed so they understand each step of the process.
8
Q
What are the 4 differentials for allergy causes of Pruritus in a dog?
A
Flea allergy
Atopic dermatitis
Cutaneous adverse food reaction
Insect bit hypersensitivity/contact dermatitis
9
Q
What are the 3 main categories of pruritis in a dog?
A
Allergy
Ectoparasite
Infections
10
Q
What are the 5 ectoparasites we are worried about with pruritus in a dog?
A
Sarcoptes Demodex Cheyletiella Lice Chiggers
11
Q
What is secondary to Demodex in dogs?
A
Pyoderma
12
Q
What are the 3 infections we are worried about with pruritus in dogs?
A
Staph pyoderma
Yeast
Dermatophytes
13
Q
You have a dog come in with caudal dorsum pruritus. What is the most likely cause?
A
Flea Allergy
14
Q
A dog comes in with pruritus on its elbows and ears. What is the most likely cause?
A
Sarcoptic Mange
15
Q
A dog comes in feet licking and chewing. What is the most likely cause?
A
Atopy or Food Allergy
16
Q
What does the phrase “rears and ears” refer to?
A
Food Allergy
17
Q
What two things can be both seasonal and not?
A
Flea Allergy
Atopy
*depends on if multiple allergens or geographic location
18
Q
What 3 things that cause pruritus in a dog is seasonal?
A
Flea Allergy
Atopy
Insect Allergy
19
Q
What 6 things that cause pruritus in a dog are not seasonal?
A
Scabies Food Allergy Flea Allergy Atopy Secondary Infections Demodex
20
Q
What is the scale for grading pruritus?
A
Scale of 1-10
Reference point to judge response to treatment
21
Q
What are the top differentials for a grade 9-10 pruritus?
A
Scabies
Flea Allergy
Food Allergy
22
Q
What are your top differentials if pruritus came before lesions?
A
Allergies
Scabies
23
Q
What are your top differentials if lesions came before pruritus?
A
Demodex
Dermatophytes
24
Q
What are we looking for in a good PE to help narrow down causes of pruritus?
A
Lesions that confirm historical information
Pyoderma, lesion distribution, hair loss, etc
General health
Immunosuppresion
Ear check
25
What is the most important thing to check when doing a PE of a pruritus patient?
Ears!
| Often Involved!!!
26
What is important for you to tell the client when they are going to bring their pet in for pruritus?
Do NOT bathe before the visit (for a couple days). You want the organisms to still be there to find.
27
What are the 5 mainstays of the treatment plan for pruritus patients?
```
Flea control
Treat pyoderma if present
Treat Malassezia infection
Treat Sarcoptes if suspected
Treat ear disease if present
```
28
When should you re-assess after treatment for pruritus?
1 week... possibly 2 but no later
29
True or False: Skin disease are usually cured with one visit.
FALSE
They are rarely cured with one visit
Many chronic ones are 'life long' but controllable
30
Systemic exposure to allergens occurs when _____ in Flea Allergic Dermatitis.
fleas take a blood meal
31
What type of hypersensitivity is FAD?
Type 1 (antigen-antibody reaction)
32
What signs do you see with FAD?
Itching
Inflammation
Excoriations
33
True or False. Flea Allergic Dermatitis is very common.
True!!! Should always be on the list! Use a flea comb every time.
34
What is it about the flea that causes the hypersensitivity?
Saliva!
Contains many antigens, amino acids, aromatic compounds, polypeptides, phosphorus
Sensitizes the Th cell
35
What is the classical distribution seen on a pruritic dog that has FAD?
Lumbo-sacral!
36
What are the primary and secondary lesions seen in FAD on a dog?
P - Papules
| S - Crusts
37
Does FAD show any self inflicted lesions? If so, what are they?
Yes!
Excoriations (itching)
Alopecia
38
What chronic changes do you see with FAD in a dog?
Lichenification
| Hyperpigmentation
39
True or False. You will always see fleas with FAD.
FALSE.
| Fleas or flea dirt may or may not be present. It only takes one!!! Excessive grooming may have removed the fleas.
40
What is the normal age range for dogs with FAD?
1-3 years old
41
What differential for pruritus usually has the clinical alopecia sign of "pants"?
FAD
| *Dorsal lumbosacral, tailbase, caudomedial thighs, ventral abdomen, flanks
42
What two test can you do for FAD? Which is the gold standard?
Serum test
| Intradermal flea allergy test (Gold standard)
43
What are you looking for with a Serum test for FAD?
Flea allergen specific - IgE
44
True or False: A negative result for IgE rules out FAD?
FALSE
| Can get false negatives
45
Explain what an intradermal flea allergy test is.
3 ID injections
- negative control
- positive control
- flea antigen
46
What percentage of skin allergies are flea related?
80%
| Consider all dermatoses flea related until proved otherwise!
47
What do you treat FAD with?
Flea Eradication (on pet and in house/yard)
48
What are the secondary problems associated with FAD?
Bacterial pyoderma
| Malassezia
49
True or False: You can go ahead and start the pruritic patient on Prednisolone for pruritus while treating for pyoderma.
alse
50
What is important to remember about dosing with Prednisolone especially in use of treating pruritus?
Reduce by 25% every 7-10 days. Try to decrease to every other day treatment. Give in the early morning.
Need to get to lowest dose that will control signs while rigorously implementing Flea Control.
51
True or False: Client Education is not important in eradicating the source of FAD.
FALSE
Estimated 95% of flea eggs, larvae, & pupae live in the environment, not on the pet
Owners need to know to treat all aspects of the environment
52
True or False: You should use Insect Growth Regulator (IGR) ectoparasitic in the environment and adulticides on all in-contacts when treating FAD.
True.
| Can change to IGR on in-contacts once clinical signs under control
53
Atopy is a hypersensitivity type _____ to _____.
Type 1
| Aeroallergens
54
What is the lesion distribution for Atopy?
Face, ears, ventrum, feet, antebrachium, perineum
55
What is the age of onset (range) of Atopy?
4 m to 7 y (most 1-3 years)
56
Other than age and lesion distribution what characterizes Atopy in a dog?
Pruritus
| Chronic or relapsing (seasonal often)
57
True or False: Secondary infections are common with Atopy or AD.
TRUE
58
What secondary infectious are common with Atopy or Allergic dermatitis?
```
Staph pyoderma (68%)
Malassezia
Otitis externa (>50%)
Lick granulomas
*AD is the most common cause of primary otitis!
```
59
True or False. AD often occurs separately from other allergic or pruritic diseases like FAD, food allergy
FALSE
| Often occurs concurrently
60
Once AD is diagnosed clinically, what can you do next?
Either serum or skin testing is done if owner wishes to use immunotherapy treatment. Results determine which allergens will be used to improve the allergy.
61
Is there a test to confirm Atopy/AD?
No!
62
What two tests detect allergen-specific IgE using serum?
RAST (radioallergosorbent test)
| ELIZA (enzyme linked immunosorbent assay)
63
The 3 tests that detect allergen-specific IgE are?
RAST
ELIZA
ID (intradermal skin test)
64
What is the gold standard to test for allergen-specific IgE?
ID skin test
65
Anti-pruritic drugs must be stopped ____ before ID testing.
Weeks!
| Also depends on which drugs as to how long they need to be off of it.
66
True or False. You have to stop using anti-pruritic drugs before ID testing and serum test.
FALSE
| You do not have to stop using anti-pruritics for serum tests.
67
What are the things that should be avoided before a testing consult with a dermatologist (3)?
Avoid oral and topical steroids for at least 1 month before
Avoid antihistamines & essential fatty acids 2 weeks before
No baths for 5 days before
68
What is the positive and negative controls for the ID skin test?
Positive - histamine
| Negative - saline
69
How do you read the ID test?
Grade reactions from 1 (none) to 4 (large) in comparison to controls
Darken room, use light at angle to see reaction & palpate
70
What is the multimodal approach to treat AD?
1. Diagnose & control all infections
2. Allergen avoidance
3. Break itch scratch itch cycle (use antihistamines, low dose corticosteroids, cyclosporine, or others)
4. Allergen-specific immunotherapy (ASIT)
71
What are Dermoscent, Duoxo (duke-so), & Allerderm Spot On?
Dermoscent - Linoleic Acid (spot on)
Duoxo - Phytosphingosines (shampoo, spray, spot on)
Allerderm - Ceramides, fatty acids
72
What are the 3 categories of symptomatic relief for AD/Atopy?
```
Weak evidence of efficacy (antihistamines, antidepressants, essential fatty acids, topicals)
Fair evidence (skin lipid therapy)
Strong evidence (glucocorticosteroids, cyclosporine A (Atopica), Oclacitinib (Apoquel), Lokivetmab (CytoPoint), Recombinant k9 interferon gamma (Interdog))
```
73
Antihistamines have H1 blocking affects, what does that entail?
Anti-histamine
Anti-cholinergic
Sedative
Local anesthetic effect
74
What are the side effects of antihistamines?
Drowsiness, lethargy, anorexia, vomition, diarrhea, dry eyes/mouth, increased pruritus
Potentiate glaucoma and retentive urinary conditions
75
Name some common antihistamines.
```
Hydroxyzine
Cetirizine
Clemastine
Chlorpheniramine
Diphenhydramine
Dimetindene
Fexofenadine
```
76
Fatty acids (FA) fit into the weak evidence of efficacy and are important parts of cell membrane _____ _____.
Phospholipid layer
77
What are the two Fatty Acids used to treat Atopy?
Eicosapentaenoic acid (EPA) & docosahexaenoic acid (DHA)
78
What is used as the "crisis buster" in response to Atopy?
Corticosteroids!
| Also used as a therapeutic trial if AD is strongly suspected
79
When is best to give prednisolone?
In the morning!
80
What are the disadvantages to long term corticosteroids?
PU/PD/PP/weight gain
Iatrogenic Cushing's/Addison's
Less effective over time = higher doses needed
More susceptible to infections
81
Explain what Cyclosporine A (Atopica) does to the body?
T cell inhibitor
Decreases IL-2
Anti-allergic & immunosuppressive
82
What are the side effects of Cyclosporine A (Atopica)?
GI, exacerbates skin infection
Gingival hyperplasia, papilloma
Infections, neoplasia
83
True or False. Atopica is best absorbed with food and should be used for at least 4 weeks to see if effective.
FALSE
Best absorbed on an empty stomach but if vomiting, give with food.
4 week trial minimum
84
Is it okay to use generics for Cyclosporine A?
No. Do not use generic even if cost is a factor.
85
How does Oclacitinib (Apoquel) work?
AD triggers cytokine induction triggers Janus Kinase (JAK) enzymes. Apoquel inhibits JAK1 & JAK3 enzymes
Reduces proinflammatory cytokines
Decreases itching and inflammation
86
What are the FDA restrictions on Apoquel for dogs with AD?
12 months or older
87
What are the side effects of Apoquel?
May increase susceptibility to infection & demodicosis
May exacerbate neoplastic conditions
Avoid using in breeding dogs & pregnant or lactating ones.
*Most common - vomiting, diarrhea
88
What does Lokivetmab (Cytopoint) do in the body?
Monoclonal antibody to interleukin (IL)-31
| Targets & neutralizes IL-31, a key itch-inducing cytokine
89
What are the side effects of Lokivetmab?
Little to no side effects
90
What is the dose protocol for Lokivetmab?
1 SQ injection q 4-8 weeks as needed
91
What is Recombinant canine interferon-gamma (IFNy) used to treat?
Atopy in Dog!
92
What is the MoA of IFNy?
Potent inducer of T helper type 1 immune responses
93
What is the important thing to remember about Recombinant feline interferon-omega?
Shown to provide some inconsistent reduction of skin lesions and pruritus in dogs with AD.
94
If you are using Allergen-specific immunotherapy (ASIT) what do you have to do to the allergen over time?
Increase dose/frequency of allergen over time.
95
What are the factors effecting clinical efficacy of ASIT or Hyposensitization?
```
Patient Selection ( <10 specific allergens show a better response; eliminate other diseases first)
Allergens (correct ones chosen? Issues with batch?)
Owner Compliance (12-18 months to assess results & maintenance therapy lifetime)
```
96
True or False. Classic CAFR a separate disease from AD?
FALSE.
Food is a trigger for AD just like other triggers. Identical to AD
*challenge to diagnose
97
What are the signs for CAFR?
```
Non-seasonal pruritus
Otitis externa
Secondary Pyoderma
Secondary yeast dermatitis
Possible GI signs
```
98
What other diseases are CAFR like?
Allergic dermatitis
Flea bite allergic dermatitis
Scabies
99
Food allergy is the ____ most common hypersensitivity skin disease.
3rd
100
What age group is expected with food allergy?
50% <1 year
| <6 months, food allergies more common than atopy
101
True or False. GI signs are concurrent with Food Allergies.
True. (10-15% of cases)
| Vomiting, Diarrhea, Colic
102
Secondary ____ infections are common with Food Allergies.
Bacterial/yeast skin infections
103
What is the only way to diagnose food allergy?
Positive Response to an elimination diet
* 95% of dogs improve within 3 weeks
* biggest limitation is owner compliance
104
True or False: It is important to include no other food sources when doing a food trial.
True.
Need strict compliance
Just water and trial diet
And no flavored pills
