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Dermatology (Diagnostic Tests (Cutaneous cytology (Adhesive tape : dry,…

- - - - sensitivity ~50%, specificity 100%
      - Pruritic, scaly animals - flea infestations, pediculosis(lice), Cheyletiellosis(walking dandruff)
    - - sensitivity ~50%, specificity 100%
      - multiple lesion!
      - Pruritic, scaly, alopecic animals : Sarcoptes scabiei, Cheyletiellosis, Trombicula, Otodectes cynotis, Notoedres cati, Demodex mites
      - Two types - superficial & deep
  - - - melanin clumps(macromelanosome)
      - vary in size and shape and are dispered irregularly.
      - They don't change hair shaft anatomy.
- - - - Sarcoptes, Cheyletiella, Notoedres, Otodectes
      - nonseasonal, intensely pruritic, highly contagious
      - Clinical features
        
        Sarcoptes scabiei infestation
        
        alopecia and erythematous rash - pinnae, elbows, hocks, ventral abdomen, and chest
        
        Lesion on ear margins : vary from barely perceptible scaling to alopecia or crusts; ear canals not affected
        
        Chronic : periocular and truncal alopecia; secondary crusts, excoriations, and pyoderma; diffuse papular eruption
        
        Possible peripheral lymphadenopathy
    - - Positive pinnal-pedal reflex : occurs in 75~90% of cases of scabies, notoedres, and otodectes; not diagnostic
      - Superficial skin scraping : scabies and notoedres
      - Touch tape prep and "flea combing" : cheyletiella
      - Ear swab in mineral oil : otodectes
      - Fecal flotation : occasionally reveals mites or ova
  - - - 모든 개의 27% 정도가 영향받음.
      - type1 hypersensitivity - threshold를 넘어서면 발증
      - Environmental allergens : pollens, house dust mites, molds, etc
      - Signalment
        
        Terriers, Labs, Goldens, Shar-peis, Dalmatians, Bulldogs, Bichons, Pugs, German Shepherds
        
        age of onset 1~3 years, < 6 months or > 7 years is uncommon
        
        up to 80% initially seasonal, 80% eventually nonseasonal
        
        Feline
        
        no reported breed, age of onset variable
        
        less common than in dogs
      - 확진 방법 없음. 임상증상과 병소를 보고 판단
      - Distribution : face, ears, feet, axilla, groin, conjunctiva, flexor surface of limbs
      - Lesions : erythema, alopecia, excoriations, hyperpigmentation, lichenification, papules, pustules, crusts
      - Atopic dz
        
        Majority of cases : self-trauma, diffuse erythema, erythema of the ear flap and vertical ear canal
        
        Secondary changes : purulent otitis, proliferative otitis, pyoderma(usually folliculitis)
        
        Chronic cases : Malassezia(greasy erythema), hyperpigmentation & lichenification, scaling
      - Consequences : pyoderma(68%), Malassezia dermatitis, otitis externa(up to 80%), seborrhea(12~23%), hotspots, acral lick granulomas
      - Feline
        
        Distribution : head, neck, pinnae, ventrum, dorsum, perineum, caudal thighs
        
        C/S : miliary dermatitis, ceruminous otitis externa, eosinophilic granuloma complex, symmetrical alopecia, pruritus, respiratory
        
        Eosinophilic granuloma complex
        
        Indolent ulcer(eosinophilic ulcer, rodent ulcer)
        
        Eosinophilic plaques
        
        Eosinophilic granuloma
      - Dx
        
        history, signalment, PE
        
        treat secondary infections
        
        r/o flea allergy, parasites, food allergy, others(basic initial workups : cytology skin scraping and fungal culture)
        
        Intradermal skin test(IDAT=IDST), Serum IgE tests(RAST, ELISA, liquid phase) ← 확진하는 검사법들x
      - Management
        
        Avoidance : cats, house dust, molds, pollens
        
        Antihistamines : 개체별 반응 다양. well tolerated. 장기 치료에 사용 가능
        
        Essential fatty acid(EFA) supplements : arachidonic acid를 대사하는 효소에 대해 경쟁. 피부용 사료에 많이 포함됨.
        
        Topical therapy
        
        Bathing
        
        Main effects : anti-pruritic, anti-bacterial, anti-seborrhoeic, anti-Malassezia, anti-inflammatory, epidermal barrier
        
        Antipruritic agents
        
        Glucocorticoids
        
        use as little as possible, use oral only and long term, use alternate day protocol
        
        Long term effects include sepsis, 2nd infections, thromboembolic dz, diabetes, hepatic failure, iatrogenic Cushing, etc.
        
        atopy에 효과 좋음.
        
        Immunotherapy
        
        only specific treatment for allergies
        
        involving many adjustments and much client communication
        
        Cyclosporine A
        
        T-cell proliferation과 cytokine 생산 억제
        
        should not administer within 2h of a meal
        
        Side effects : vomiting(31%), diarrhea(20%), skin infections(29%), gingival hyperplasia and gingivitis
        
        Apoquel - JAK1 or JAK3 inhibitor
  - - - bacterial folliculitis, pyoderma
      - Primary reasons that cutaneous bacterial infections are more common in dogs.
      - thin compact stratum corneum
      - relatively high cutaneous pH(basic, 7.5)
      - Three main types
        
        Surface(epithelium) : acute moist dermatitis(hot spot), skin fold pyoderma(intertrigo)
        
        Superficial pyoderma(epidermis & follicles) : impetigo(puppy pyoderma), mucocutaneous pyoderma, superficial folliculitis
        
        Deep pyoderma(ruptured follicle, dermis & subQ) : muzzle folliculitis & furunculosis, bacterial granuloma(acral lick dermatitis), nasal & pedal pyoderma, pressure point pyoderma, pyotraumatic folliculitis & furunculosis
      - Tx : 항생제, benzoyl peroxide or chlorhexidine shampoo; MRSA 주의
    - - systemic immune incompetence(metabolic dz)
      - trauma(pressure, licking, scratching, parasites, etc.)
      - follicular damage(demodex mites, scratching, etc.)
      - dermal damage(collagen disruption, extension of dz, etc.)
      - physical factors(poor grooming, laceration of the skin, heat, humidity, etc.)
      - inappropriate antibacterial therapy : too short a course, poor drug choice, inappropriate dose