MOTIVATION

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MOTIVATION

• Our deepest fear is not that we are inadequate,
  our deepest fear is that we are powerful beyond
  measure
• -Marianne Williamson

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DERMATOLOGY

• NOT DONE YET!

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OTITIS EXTERNA

• An acute or chronic inflammatory disease of the
  external ear canal
• Clinical signs
• Head rubbing or shaking
• Ear scratching
• Head tilt with the affected ear tilted down
• Malodorous otic discharge (brown,
  greenish-yellow)
• Lichenification, hyperpigmentation, crusts,
  erythema and excoriations may be present
• Aural hematoma

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OTITIS EXTERNA
NOTE THE EXCESS BROWN EXUDATE
ERYTHEMA, HYPERPIGMENTATION, LICHENIFICATION
AURAL HEMATOMA
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OTITIS EXTERNA

• PREDISPOSING FACTORS
• Conformation
• Heavy, pendulous ears
• Stenotic ear canals
• Ear hair
• Excessive moisture
• Frequent bathing or swimming
• Hypersensitivities
• Food allergy, atopy

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OTITIS EXTERNA

• DIAGNOSIS
• Otoscopic exam
• Clinical signs
• Cytology, ear smear
• Yeast, bacteria, cerumen, skin cells

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OTITIS EXTERNA

• MALASSEZZIA OTITIS

Malassezzia resemble footprints, bowling pins,
or snowmen
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OTITIS EXTERNA

• BACTERIAL OTITIS

ROD-SHAPED BACTERIA AND A SKIN CELL
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OTITIS EXTERNA

• TREATMENT
• Always treat the underlying condition if present
• Topical meds instilled daily
• Antibacterial, antifungal, or combination
  products often with steroids (otomax, tresaderm,
  baytril otic)
• Cleaning ears during treatment
• Surgical intervention may be required
• Aural hematoma
• Chronic conditions (Total Ear Canal Ablation)

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ANAL SAC DISEASE

• The anal sacs are located between the muscle
  layers of the anus at the 4 and 8 oclock
  positions. Each sac connects to the surface
  through a narrow duct.
• Sebaceous glands produce a foul-smelling oily,
  brown fluid. The sacs are naturally expressed
  during defecation, but can sometimes overfill.

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ANAL SAC DISEASE
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ANAL SAC DISEASE

• IMPACTION
• When the sacs overfill, the water can be
  reabsorbed, and the material dries out.
• Sacs become a source of discomfort for the dog
  and are difficult to express at this time.
• Impaction can lead to abscessation and rupture.
• Clinical signs include scooting rear end across
  the floor, painful defecation, tail chasing,
  perianal erythema, and/or swelling

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ANAL SAC DISEASE
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ANAL SAC DISEASE

• DIAGNOSIS
• Palpation (rectally or externally)
• Clinical signs
• TREATMENT
• Express contents
• Flush sac
• Instill antibiotic ointment
• Oral antibiotics, anti-inflammatories
• Surgery?

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ANAL SAC DISEASE
WEARING GLOVES, GENTLY MILK THE GLANDS IN AN
UPWARD MOTION TO EXPRESS.
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TUMORS OF THE SKIN

• Tumors are a new growth of tissue characterized
  by progressive, uncontrolled proliferation of
  cells.
• Benign vs. Malignant
• Localized vs. Invasive
• Adenoma/Carcinoma vs. Sarcomas

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BENIGN TUMORS OF THE SKIN

• HISTIOCYTOMA small, button-like tumors that are
  usually pink, hairless, and raised. They are
  rapidly growing

Common locations include the pinnae, head, and
legs
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BENIGN TUMORS OF THE SKIN

• HISTIOCYTOMA
• Occurs almost exclusively in young dogs lt4yrs old
• DIAGNOSIS
• Appearance
• biopsy
• TREATMENT
• These tumors may spontaneously regress, but
  surgical excision is the treatment of choice

ROUND CELL TUMOR
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BENIGN TUMORS OF THE SKIN

• LIPOMA tumor of the subcutaneous adipocytes (fat
  cells) that are typically freely movable and
  well-circumscribed
• Common in older, female, obese dogs
• DIAGNOSIS
• Biopsy
• Fine needle aspirate

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BENIGN TUMORS OF THE SKIN

• LIPOMA
• TREATMENT
• Surgical excision
• Benign neglect

lipocytes
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BENIGN TUMORS OF THE SKIN

• PAPILLOMAS wart-like growths that develop as
  smooth, white/pink/pigmented, elevated lesions in
  the oral cavity (oral papillomatosis) or on the
  skin (cutaneous papillomas)
• These growths are caused by a papillomavirus

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BENIGN TUMORS OF THE SKIN

• PAPILLOMAS
• DIAGNOSIS
• Appearance
• Biopsy
• TREATMENT
• Usually spontaneous regression
• Autogenous vaccine

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BENIGN TUMORS OF THE SKIN

• SEBACEOUS GLAND CYSTS Slow growing,
  encapuslated, round, and exude a gray, cheeselike
  material. Caused by degenerative changes in the
  glandular area surrounding the follicle.
• Common in cocker spaniels
• DIAGNOSIS
• Contents of the cyst
• histology
• TREATMENT
• Surgical removal of entire encapsulated cyst

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BENIGN TUMORS OF THE SKIN
SEBACEOUS CYSTS
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MALIGNANT SKIN TUMORS

• FELINE VACCINE-INDUCED FIBROSARCOMAS rapidly
  developing, highly invasive, malignant tumors
  that occur at the site of vaccination 4-6 weeks
  later.
• VACCINES MOST COMMONLY IMPLICATED ARE THOSE WITH
  ADJUVANTS (substance that enhances the immune
  response by increasing the stability of a vaccine
  in the body) SUCH AS FeLV AND RABIES

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MALIGNANT SKIN TUMORS

• VACCINE-ASSOCIATED SARCOMAS
• DIAGNOSIS
• Biopsy of fine needle aspirate
• Physical exam findings
• Swelling in area of recent vaccination
• Rapidly growing firm elongated mass

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MALIGNANT SKIN TUMORS

• VACCINE-ASSOCIATED SARCOMAS
• TREATMENT
• Radical surgical excision which may involve limb
  amputation is the treatment of choice
• CLIENT INFORMATION
• Poor prognosis if not detected early and treated
  aggressively
• Inflammatory lumps may do develop after vaccines
  but usually disappear within 1-2 weeks

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MALIGNANT SKIN TUMORS
FELINE VACCINE-ASSOCIATED SARCOMAS
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MALIGNANT SKIN TUMORS

• MAST CELL TUMORS firm nodules on the skin that
  may be ulcerated or edematous. Mast cells contain
  histamine and heparin

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MALIGNANT SKIN TUMORS
FINE NEEDLE ASPIRATE OF MAST CELL TUMOR NOTE THE
NUMEROUS GRANULES
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MALIGNANT SKIN TUMORS
IN CATS, MAST CELL TUMORS ARE USUALLY BENIGN AND
MAY SPONTANEOUSLY REGRESS
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MALIGNANT SKIN TUMORS

• MAST CELL TUMOR
• TREATMENT
• Chemotherapy
• Radiation therapy
• BENADRYL
• H2 blockers to treat gastric ulceration and
  irritation
• PROGNOSIS
• Depends on biopsy grading results

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MALIGNANT SKIN TUMORS

• MELANOMA (Benign or Malignant)
• BENIGN small, slow growing, hairless, pigmented
• MALIGNANT large, dome-shaped sessile /-
  pigmentation
• Ex Tumors of the oral cavity and digits
• Poor prognosis
• Metastasize readily
• Recurrence after surgery is common

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MALIGNANT SKIN TUMORS
TREATMENT INVOLVES SURGICAL REMOVAL AND POSSIBLY
TREATMENT WITH THE VACCINE
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Immune mediated conditions

• Pemphigus (blistering disease)Foliaceus
• Pemphigus Erythematosus
• Pemphigus Vulgaris
• Bullous Pemphigoid
• Lupus Erythematosus
• Alopecia Areata
• Pseudopelade

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Immune mediated

• antibody-mediated or cell-mediated immune
  response directed against normal components of
  the skin
• Pemphigus complex pemphigus foliaceus (PF),
  pemphigus erythematosus (PE), panepidermal
  pustular pemphigus, pemphigus vulgaris (PV), and
  paraneoplastic pemphigus
• autoantibodies target adhesion proteins, intra-
  or subepidermal separation results in autoimmune
  blistering skin disease

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Pemphigus Foliaceus

• target the desmosomes between keratinocytes
• IgG autoantibodies
• Genetics Akitas and chows
• age of onset is variable
• 1 to 16 years in dogs
• less than 1 year of age to up to 17 years of age
  in cats
• UV light

A pustule just caudal to the planum nasale of a
dog alopecia and erythema are also present in
the dorsal nasal region
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Pemphigus Foliaceus

• Drugs cimetidine, cephalexin, amoxicillin and
  clavulanic acid, ampicillin, and
  trimethoprim-sulfonamide combinations
• Lesions
• erythematous macules that then progress rapidly
  to a pustular stage
• crusting dermatitis, Scale, alopecia, erosions,
  collarettes, and erythema
• "face, feet and ears"

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Pemphigus Foliaceus
Ulceration from a deep pyoderma in a patient
with pemphigus foliaceus. Ulcers should not be
seen in pemphigus foliaceus patients unless
another condition such as a pyoderma is present.
Note the symmetrical appearance of the facial
lesions.
Crusts from ruptured pustules on a dog's nasal
planum and dorsal nasal region.
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Pemphigus Foliaceus

• Clinical signs
• Skin lesions
• Systemic signs such as fever, lethargy, anorexia,
  and lymphadenopathy
• /- Pruritus (skin lesions develop before
  pruritus)

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Pemphigus Foliaceus

• mild and localized disease
• erosions and yellowish crusts
• Dx
• acantholytic keratinocytes (arrows), histology,
  IFA
• Dogs can have a mild to moderate leukocytosis
  with neutrophilia and a mild to moderate
  nonregenerative, normocytic, and normochromic
  anemia (anemia of chronic disease
• Cats as above and basophilia, eosinophilia,
  lymphopenia, and monocytosis

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Pemphigus Foliaceus
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Pemphigus Foliaceus

• Treatments
• Glucocorticoids
• Prednisone is initially started at 2 mg/kg/day
  orally in dogs,
• prednisolone is initially started at 2 to 4
  mg/kg/day orally in cats
• cats, triamcinolone can be initially dosed at 2
  to 4 mg/kg/day orally, and dexamethasone can be
  initially dosed at 0.3 to 0.6 mg/kg/day orally

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Pemphigus Foliaceus

• Prognosis
• Mortality from pemphigus foliaceus can occur
  because of disease progression, medication side
  effects, or client-requested euthanasia.
• Severe cases of pemphigus foliaceus can result in
  marked cachexia or sepsis secondary to
  infections.
• Adverse effects are common with most of the
  medications used for pemphigus foliaceus.
• Euthanasia accounted for almost 70 of deaths in
  pemphigus foliaceus dogs in one retrospective
  study
• Client education

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References

• Common diseases of companion animals, Alleice
  Summers, 2007
• Immune-Mediated Feline Skin Diseases (V69),
  Western Veterinary Conference 2010, Lauren R.
  Pinchbeck
• http//veterinarymedicine.dvm360.com/vetmed/Articl
  eStandard/Article/detail/653149