SAM.D1-2: Diagnostic Approach and Dermatologic Database.

Top 10 reasons to go to the vet that include derm (3)

Skin allergies.

ear infections.

skin infections.

Most common dermatological complaints (5)

Alopecia.

Dermatitis.

Fleas.

Otitis externa.

Skin tumors.

Evidence of pruritus includes (4)

Alopecia.

Excoriations.

Saliva staining.

broken hairs.

Etiologies of pruritus may include

pyoderma.

ectoparasites.

(etc)

5 points of derm (6)

Collection of Data.

Pathogenesis of skin problems - layers upon layers.

Timing is important in overall management of the case.

Selection of proper tx/admin of tx.

Follow up + rechecks.

Client education.

Collection of data concept

garbage in, garbage out (take a good hx in order to get something out of the exam)

Predisposing factors in Derm(5)

Breed.

Age.

Endocrine disorders.

Husbandry.

Environment - temp and humidity.

Primary (underlying) factors (4)

Allergic dz.

Ectoparasites.

Inflammatory dz.

Disorders of cornification - Seborrhea.

Primary factor - allergic dz includes (4)

Atopy.

Adverse rxn to food.

Contact allergy.

Flea allergy.

Primary factors - inflammatory dz include (2)

Autoimmune - pemphigus and SA.

infectious - dermatophytosis.

Perpetuating factors for derm (4)

Bacterial infections.

Malassezia.

Dermatophytes/fungal.

Inappropriate tx - excessive bathing.

Behavior - Boredom.

Behavior does NOT

cause dermatologic problems, but it can exacerbate them.

Clinical factors impact on derm cases (3)

Predisposing factors - modify the rxn.

Primary factors - start the process.

Perpetuating factors - modify (amplify) and perpetuate.

Clinical manifestation - aka what the client sees (6)

Pruritus.

Otitis externa.

Sores/lesions (papules, scales, crust).

lumps and bumps (nodules/tumors).

Alopecia.

Malodor.

Overall strategy for an initial derm visit (3)

Identify secondary/perpetuating factors.

Tx secondary/perpetuating factors.

Begin to identify underlying/primary factors.

Steps of the initial derm visit (5)

1. Signalment, hx, PE.

2. Dermatologic database.

3. Manage Secondary perpetuating factors.

4. Follow-up exam.

5. Identify the primary factors.

Hx for a derm case includes (3)

Chronology of condition - age of onset, seasonality, and progression.

Severity.

effect of previous tx.

(Get a complete hx)

PE for Derm case

PE.

Look for evidence of pruritus and cause of pruritus.

Dermatologic Database (4)

Skin scraping.

Impression for yeast.

Trichogram (hair pluck).

Fungal eval.

Fungal eval includes (3)

Culture is preferred.

KOH trichogram.

Wood's lamp.

Optional tests for derm (7)

Fungal culture.

Bacterial culture.

Fecal Float.

Initiate flea control.

Begin HA diet.

Skin biopsy.

Blood work-up

Manage Secondary factors - Malassezia pachydermatitis

most common cause of prednisone resistance.

Manage secondary factors - bacterial dermatitis

increased carriage v. pyoderma.

Staph infection.

Follow-up exams are important to (6)

Eval efficacy of tx.

Eval current CS.

Redo Hx as you clear secondary tissues.

Repeat dermatology database.

Consider next phase pf tx.

Client education (critical).

Identification of the primary factors (6)

Allergy testing.

Diet trials.

Hematology.

Endocrine Eval for recurring pyoderma.

Skin biopsy.

Environmental isolation.

Tx goal basic concept

avoid shotgun therapy and choose focus therapy. This will mask the underlying problem and won't tell you what tx was the one that worked.

Focus therapy will (3)

give sense of efficacy.

Clear secondary problems.

Allows clearer view of underlying dz.

Tx goal: Shift to maintenance

after secondary issue clears. allows you to control itch while you investigate primary dz.

Clearence of secondary issues, then start the maintenance program is done to

prevent recurrence while addressing underlying cause.

when O's decline additional work-up.

Technician role in the dermatological database

Can and should perform most of the diagnostics as they have more patience and more time, thus getting better net results.

What is most important initial part of derm appt

clinical hx

Important indicators in signalment (3)

age.

breed.

sex.

Derm Database: Hx (4)

Brief past medical hx.

Environmental hx - local environment and hx.

Diet hx - what do they eat and who feed them.

Hx of present condition.

4 reason to have a derm hx form

Don't want people to wait.

Ask questions so you don't forget.

Clients shift focus onto pet.

It's fun to see crazy responses.

Dermatologic Database (5)

Skin scraping.

Trichogram.

Impression smears for yeast.

Fungal eval.

Cytology.

Primary fxn of a skin scrape

Identify ectoparasites

Skin scrape procedure (4)

Clip hair or scrape hairless area.

Squeeze/Kneed (better than pinching) the skin prior to scraping.

Scrape sufficient area.

Scrape to proper depth.

Squeezing the skin is done prior to scraping to

find Demodex.

evident on skin scraping by presence of follicular plugs being present on slide.

Eval for yeast is done by (2)

Demonstration of organism - Impression smears (or swab folds) or skin scraping.

Culture +/- Histopath - is not sensitive.

Key to success when eval for yeast (5)

Hairless area.

Press slider FIRMLY and wear gloves.

Label slides w/ location.

Heat fix/warm slide before stain.

Acetate tape or adhesive slides are good.

Helpful tips for tape staining

Don't use the alcohol fixative.

Make sure to do counterstain and stain - you technically only need to use the stain, but counterstain may help to ID yeast.

Trichogram def

plucked hairs - eval for intergity of hair shaft.

Trichogram - tests for

demodicosis and dermatophytosis

Procedure for Trichogram (3)

Firm pluck of hair - both anagen (difficult to get out) and telogen (resting - come out easily) hairs.

Place on slide w/ mineral oil/cover slip.

Eval under 4-40x.

When evaluating a Trichogram (4)

Distal end for evidence of pruritus.

Hair shafts for developmental defects and fungal evidence.

Roots to determine growth phase.

Root area and slide for ectoparasites.

Eval of the distal end of hair for evidence of pruritus may be evident if there is

structural damage

Eval of the hair shaft for fungal evidence is done for

dermatophytes - hyphae and spores.

Eval of root area and slide for ectoparasites is done for

demodex - follicular mites.

Kets to success for a Trichogram (2)

Collect from more than one body area.

Firm grasp of hairs and orient in one direction on slide.

Fecal flotation is reco for

pruritic P's - look for demodex and sarcoptes.

Summary of Diagnostic procedures: Best practice is to

work up in a logical matter.

Summary of Diagnostic procedures: 5 parts of diagnostic database

Skin Scrape.

Trichogram.

Impression smears.

Fungal eval.

Cytology.

Summary of Diagnostic procedures: general (4)

Don't miss the simple stuff.

Repeat database at recheck.

Minimal cost to client w/ max benefits.

Necessary to practice high quality medicine.