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Dermatology (Otitis (The August classification system (Predisposing…

- - - - may require sedation even for the masters to see everything
      - 항상 괜찮은 귀부터 먼저 검사
      - Try to visualize tympanic membrane
  - - - decreased ventilation, inappropriate tx, immune suppression
      - Cocker Spaniels, Springer Spaniels, Labradors, Shar-Peis, Chows
      - Conformation : stenotic canals, hair, pendulous pinna
    - - Hypersensitivity disorders : atopy, food allergy, contact allergy
      - Parasites : esp, Otodectes cynotis(ear mites)
    - - Bacteria : opportunistic pathogens(Staph; Strep; Entero; Pseudomonas; Proteus; E.coli; Klebsiella; Corynebacterium)
      - Yeast : Malassezia pachydermatis; Candida albicans
      - Overcleaning
  - - - Remove or control primary factors.
      - Clean and dry the ears.
      - Reduce inflammation(break the vicious cycle).
      - Resolve secondary infections.
    - - Sterile saline
      - Anti-septic cleaners : betadine, ethanol, isopropyl alcohol, weak acids, CHX, TrisEDTA
      - Ceruminolytic cleaners : propylene glycol, dioctyl sodium sulfosuccinate(DSS), dioctyl calcium sulfosuccinate, toluene
    - - Topical medications : antibiotic(AG, neomycin은 이독성 주의), anti-fungal, anti-inflammatory, miticides
      - Systemics : antibiotics, anti-fungal, anti-inflammatory
- - - - Steroids : prednisone, methylprednisolone(oral), dexamethasone, triamcinolone
      - Cytotoxic agents
        
        피부에서는 그다지 권장하지 않음.
        
        anti-metabolites-mimic molecules used in DNA & RNA synthesis
        
        Azathioprine
        
        부작용으로 골수 억압(>90% anemia, lymphopenia)
        
        장기간 치료 시 demodicosis, recurrent bacterial pyoderma or dermatophytosis in 10%
        
        고양이에 사용x(leukopenia, thrombocytopenia)
        
        5-fluorouracil
        
        Alkylating agents
        
        Chlorambucil
        
        골수 억압, 탈모
        
        useful in pemphigus, bullous pemphigoid, SLE, DLE, immune-mediated vasculitis, cold agglutinin dz, lymphocytes/plasma cell malignancies
        
        Cyclophosphamide : 골수 억압, sterile hemorrhagic cystitis(in dogs 30%, usually chronic therapy)
        
        Cyclosporine : gingival hyperplasia, papillomatosis, anorexia, renal toxicity(human)
      - Anti-inflammatory
        
        Chrysotherapy
        
        Sulfones/Sulfonamides
        
        Dapsone
        
        Tetracycline/Niacinamide
        
        Tetra : 항염증 & 면역 조절 효과
        
        T+N combination : DLE, PE, PF in dogs(25~65% of excellent response)
        
        Niacinamide : blocks IgE induced histamine release
  - - - auto-Ab to desmoglein1
      - erythematous macule pustule
      - Pustules rupture crusting lesions
      - Ab deposition in intercellular spaces within the uppermost epidermal layers(acantholysis)
      - Dogs
        
        65% before 5 years of age
        
        Akitas, Jindo, etc.
        
        Clinical features
        
        Mucocutaneous involvement is usually minimal.
        
        Footpads contain pustules or are cracked, crusted, hyperkeratotic.
        
        Primary lesions : superficial pustules
        
        Secondary lesions : superficial erosions, crusts, scales, epidermal collarettes, alopecia
        
        Distribution of lesions
        
        initially on face, pinnae, nasal planum
        
        Lesions are wax and wane and generally worse in summer.
      - Cats
        
        병변은 개와 비슷한 양상이나, pustule이 더 일시적
        
        around mammary glands and nail beds more commonly than dogs
      - Dx
        
        DDx : exfoliative superficial pyoderma, pustular dermatophytosis
        
        Histology
        
        subcorneal pustule w/ neutrophils and acanthocytes
        
        'cling-ons' and 'rafts' of acanthocytes
        
        epidermal hyperplasia
        
        punch or excisional biopsy
      - Aggressive therapy
        
        corticosteroids - immunosuppressive doses
        
        +azathioprine or chlorambucil in dogs
        
        +/- tetracycline/niacinamide in mild cases
        
        topical steroids or tacrolimus on more localized lesions
  - - - sunscreen/avoidance → SPF 15
      - tetracycline/niacinamide(75%)
      - topical glucocorticoids
      - Protopic(0.03%, 0.1% tacrolimus)