Veterinary Medicine - November 2008 - (Page PD3)

Are the lesions symmetrical or asymmetrical? Document lesions and alopecia by type and extent on an outline of the dorsal and ventral surface of the pet. Assemble a dermatology toolbox. Save time looking for misplaced items by placing a dermatology toolbox in each examination and treatment room. The toolbox should be kept clean and restocked weekly. For a complete list of tools to include and basic dermatologic diagnostic tests to consider, see Table 1. Schedule a follow-up examination before the client leaves the hospital. The follow-up examination ensures continuity of care, allows you to judge response to therapy, and is another opportunity for client education. It also allows you to proceed with your diagnostic plan for underlying disease if treatment has not been successful. If treatment has been successful, the followup visit can help prevent recurrence of the original problem. Have the owners bring back their medication bottles to assess compliance. To download a dermatologic history form, visit: www.dvm360.com/59 Table 1. Basic dermatologic diagnostic tests This checklist will help you avoid missing common dermatologic parasites and infections. In more challenging cases, additional diagnostics or referral to a board certiﬁed veterinary dermatologist may be needed. Test Skin scraping (superﬁcial, deep) Skin cytology Tools needed Microspatula, dull no. 10 scalpel blade, glass slides, mineral oil Double-sided tape, glass slides, 25-ga needles, cotton swabs Cotton swabs, glass slides A ﬂea comb—one with a handle and metal tines is preferable to plastic Thumb and foreﬁnger scratch edge of pinnae, ipsilateral hind leg reﬂexively scratches Fecal loops, lubricant Derm Duet (Bacti-Labs) preferred What to look for • Superﬁcial-Sarcoptes, Cheyletiella, lice • Deep-Demodex • Bacteria (cocci, rods) • Malassezia • White blood cells • Bacteria (cocci, rods, neutrophils) • Malassezia • Fleas, ﬂea feces, occ. Cheyletiella Ear cytology Flea combing Pinnal-pedal reﬂex • 85% accurate for scabies • False positives with pruritic otitis • False negatives if no pinnal lesions • Adult mites and eggs • Color change to red with simultaneous white cottony growth Fecal analysis Fungal culture Additional diagnostics tests: Bacterial culture and sensitivity. Consider performing this test if there is no response to empirical antibiotic treatment, rods and neutrophils are seen on cytologic examination, or if deep pyoderma is diagnosed. This test is important to rule out methicillin-resistant Staphylococcus aureus (MRSA), Staphylococcus intermedius, Staphylococcus schleiferi, or Pseudomonas. You may obtain cultures by wearing sterile gloves and rupturing an intact pustule, papule, or nodule with a sterile 25-ga needle; removing crusts and scales from a collarette; lifting a crust and swabbing the eroded or ulcerated skin and discharge underneath; or by obtaining in a sterile fashion a 6-mm punch biopsy of skin placed in a tube of sterile saline for macerated tissue culture (preferred for deep pyoderma culture). Skin biopsy for histopathologic examination. Consider performing this test if there are no signiﬁcant ﬁndings with the basic dermatologic diagnostic tests above, there is no response to symptomatic therapy, or if the disease process appears unusual or severe. Take multiple biopsies from early and active primary lesions that depict the spectrum of the disease, avoiding ulcerated skin and chronic lesions. Send the lesions to a veterinary pathologist with expertise in dermatology and include a complete history, clinical description of lesions, and clinical photos if possible. SPONSORED BY PFIZER ANIMAL HEALTH 3 http://www.dvm360.com/59

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Veterinary Medicine - November 2008 Contents Leading Off Editors' Guest Just Ask the Expert Letters Practice Makes Perfect Clinical Exposures Practice Matters Idea Exchange Author Guidelines A Challenging Case: Esophageal Leiomyoma in a Dog Osteoarthritis in Cats: What We Now Know About Recognition and Treatment Product Preview CE Form/Advertiser Index Marketplace/Classifieds Mind Over Miller

Veterinary Medicine - November 2008

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