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Clinical Atlas of Canine and Feline Dermatology
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List of contributors xv Preface xvii Acknowledgments xix About the companion website xxi 1 Dermatology diagnostics 1 1.1 Skin scrapings 1 1.2 Cytology - Skin and ear 4 1.3 Cytology - Mass aspirates 6 1.4 Trichograms 8 1.5 Dermatophyte culture technique 15 1.6 Wood's lamp examination 15 1.7 Dermatophyte culture medium selection and incubation 16 1.8 Identification of dermatophytes 16 1.9 Dermatophyte PCR 18 1.10 Bacterial culture 19 1.11 Skin biopsies 19 1.12 Allergy testing 22 2 Dermatology lesions and differential diagnoses 23 2.1 Primary lesions 23 2.1.1 Macule/Patch 23 2.1.2 Papule/pustule 23 2.1.3 Plaque 26 2.1.4 Vesicle/bulla 27 2.1.5 Wheal 28 2.1.6 Nodule 29 2.1.7 Cyst 30 2.2 Primary or secondary lesions 31 2.2.1 Alopecia 31 2.2.2 Scale 34 2.2.3 Crust 35 2.2.4 Follicular cast 36 2.2.5 Comedo (Comedones) 36 2.2.6 Pigment change 37 2.3 Secondary lesions 40 2.3.1 Epidermal collarette 40 2.3.2 Scar 40 2.3.3 Excoriation 41 2.3.4 Erosion 42 2.3.5 Ulcer 42 2.3.6 Lichenification 43 2.3.7 Callus 44 2.3.8 Fissure 44 3 Lesion location and differentials 47 3.1 Face 47 3.1.1 Nasal planum 47 3.1.2 Lips/Eyelids 47 3.1.3 Muzzle 49 3.2 Ears 56 3.2.1 Pinnal margin 56 3.2.2 Pinna 57 3.2.3 Outer ear canal 57 3.3 Paws 60 3.3.1 Interdigital 60 3.3.2 Palmar metacarpal/plantar metatarsal 63 3.3.3 Paw pad 63 3.3.4 Nailbed 65 3.4 Claws 66 3.5 Perianal/perivulvar 67 3.6 Tail 68 3.7 Pressure points (elbows/hocks) 69 3.8 Trunk (dorsal and/or lateral) 70 3.9 Inguinal/axillary 78 3.10 Oral cavity 81 4 Causes and workup for pruritus in dogs and cats 85 Algorithm 4.1 Pruritic dog - Causes/Workup 86 Algorithm 4.2 Pruritic cats - Causes/Workup 87 5 Causes and workup for alopecia in dogs and cats 89 Algorithm 5.1 Canine non?inflammatory truncal alopecia - Causes/Workup 90 Algorithm 5.2 Canine multifocal alopecia - Causes/Workup 91 Algorithm 5.3 Feline alopecia - Causes/Workup 92 6 Breed?related dermatoses 93 Table 6.1 Canine breed?related dermatoses 93 Table 6.2 Feline breed?related dermatoses 107 7 Parasitic skin diseases 111 Table 7.1 Canine and feline ectoparasites 112 Demodex 112 Sarcoptes 113 Notoedres 114 Otodectes 114 Cat fur mite 114 Cheyletiella 114 Lice 115 Chiggers 115 Hookworm Dermatitis 115 Cuterebra 115 Myiasis 115 Fly bite dermatitis 116 Pelodera dermatitis 116 Dracunculiasis 116 Spider bite 116 Fleas 117 Ticks 117 Table 7.2 Flea control product options 130 Table 7.3 Tick control product options 130 8 Bacterial, fungal, oomycete, and algal infections 133 Table 8.1 Superficial bacterial skin infections 133 Impetigo 133 Pyotraumatic dermatitis 133 Intertrigo 133 Mucocutaneous pyoderma 133 Bacterial overgrowth syndrome 134 Bacterial folliculitis 134 Algorithm 8.1 Approach to chronic recurrent bacterial pyoderma 143 Table 8.2 Deep bacterial skin infections 144 Bacterial furunculosis 144 Canine acne 144 Callus furunculosis 144 Acral lick dermatitis 144 Pedal folliculitis/furunculosis 145 Post?grooming furunculosis 145 Table 8.3 Meticillin resistance 150 Table 8.4 Underlying causes for recurrent pyoderma 152 Table 8.5 Commonly used antibiotics for canine pyoderma 152 Table 8.6 Topical antibacterial products 153 Table 8.7 Subcutaneous bacterial infections 154 Subcutaneous abscess 154 Botryomycosis 155 Cellulitis 155 Necrotizing fasciitis 155 Actinomycosis 155 Nocardiosis 156 Plague 156 L?form infection 156 Table 8.8 Mycobacterial infections 159 Non?tuberculous mycobacteria 159 Feline leprosy 160 Canine leproid granuloma 160 Obligate mycobacterial infections/tuberculosis 161 Table 8.9 Yeast infections 164 Malassezia 164 Candida 165 Table 8.10 Dermatophytosis 170 Table 8.11 Environmental decontamination in dermatophytosis 180 Algorithm 8.2 Treatment of generalized dermatophytosis 181 Table 8.12 Deep fungal, oomycete, and algal infections 182 Blastomycosis 182 Cryptococcosis 182 Histoplasmosis 183 Coccidioidomycosis 184 Sporotrichosis 184 Phaeohyphomycosis 185 Pythiosis 185 Lagenidiosis 186 Zygomycosis 187 Protothecosis 187 9 Viral, rickettsial, and protozoal dermatologic diseases 199 Table 9.1 Viral dermatologic diseases 200 Feline herpesvirus dermatitis 200 Feline calicivirus dermatitis 201 Viral papillomas - Dogs/Cats 201 Cowpox virus 203 Feline infectious peritonitis (FIP) 203 Canine distemper 203 Table 9.2 Rickettsial diseases 208 Rocky Mountain Spotted Fever 208 Ehrlichiosis 208 Table 9.3 Protozoal diseases 210 Leishmaniosis 210 Toxoplasmosis 211 10 Allergic skin diseases in dogs and cats 215 Table 10.1 Hypersensitivity disorders and treatment of allergic skin diseases 216 Algorithm 10.1 Canine atopic dermatitis treatment 231 Table 10.2 Allergy treatment toolkit 232 Table 10.3 Allergy testing: Intradermal and serologic methods 235 Table 10.4 Considerations in allergen formulation 236 Table 10.5 Protocols for allergen specific immunotherapy (ASIT) 237 Table 10.6 Performing an adequate diagnostic hypoallergenic diet trial 239 Table 10.7 Feline manifestations of cutaneous allergy 244 Table 10.8 Eosinophilic granuloma complex 248 11 Autoimmune and immune?mediated dermatologic disorders 255 Table 11.1 Autoimmune and immune?mediated dermatologic disorders 256 Discoid lupus erythematosus 256 Pemphigus foliaceus 256 Pemphigus vulgaris 256 Vesicular cutaneous lupus erythematosus 257 Mucocutaneous lupus erythematosus 257 Alopecia areata 257 Uveodermatologic syndrome 257 Autoimmune subepidermal blistering diseases 258 Vasculitis 259 Post?vaccination injection site alopecia 259 Drug eruption 260 Erythema multiforme 260 Toxic epidermal necrolysis 261 Sterile panniculitis 261 Sterile granuloma/pyogranuloma 261 Juvenile cellulitis 262 Plasma cell pododermatitis 262 Pseudopelade 262 Symmetric lupoid onychitis 263 Nasal arteritis 263 Metacarpal/metatarsal fistulas 264 Canine sterile neutrophilic dermatitis (Sweet's?like syndrome) 264 Canine acute eosinophilic dermatitis with edema (Well's?like syndrome) 264 Superficial suppurative necrolytic dermatitis 265 Systemic lupus erythematosus 265 Algorithm 11.1 Treatment of canine pemphigus foliaceus 269 Algorithm 11.2 Treatment of feline pemphigus foliaceus 270 Table 11.2 Typical glucocorticoid doses for treatment of autoimmune and immune?mediated disorders 286 Table 11.3 Non?steroidal immunosuppressant or immunomodulatory drugs as adjunctive or primary treatments of autoimmune/immune?mediated diseases 287 12 Endocrine skin diseases 291 Table 12.1 Canine endocrine skin diseases 292 Hypothyroidism 292 Spontaneous hyperadrenocorticism (HAC, Cushing's disease) 292 Iatrogenic hypercortisolemia 293 Atypical Cushing's disease (ACD) 293 Food?induced Cushing's disease 293 Topical corticosteroid application 293 Pituitary dwarfism 293 Calcinosis cutis 294 Exogenous estrogen?related alopecia 294 Spontaneous hyperestrogenism 294 Spontaneous hyperandrogenism 295 Tail gland hyperplasia 295 Table 12.2 Trilostane treatment and monitoring 303 Table 12.3 Endocrine skin diseases of cats 304 Hyperthyroidism 304 Hypothyroidism 304 Hyper adrenocorticism (HAC) 304 Feline acquired skin fragility 305 Diabetes mellitus (DM) 305 Acromegaly 305 13 Non?endocrine alopecia 309 Table 13.1 Non?endocrine alopecia of dogs 310 Localized Alopecia 310 Post?clipping alopecia 310 Traction alopecia 310 Congenital follicular/ectodermal dysplasia 310 Regional to Multifocal Alopecia 310 Color dilution alopecia 310 Black hair follicular dysplasia 310 Non?color, breed?related follicular dysplasia 310 Cyclic flank alopecia 311 Pattern alopecia 311 Follicular lipidosis 311 Generalized Alopecia 311 Alopecia X 311 Anagen/telogen effluvium 312 Non?color breed?related follicular dysplasia 312 Table 13.2 Non?endocrine alopecia of cats 318 Congenital hypotrichosis 318 Hair shaft disorder of Abyssinian cats 318 Pili torti 318 Feline preauricular "alopecia" 318 Feline pinnal alopecia 318 Feline psychogenic alopecia 318 Mural folliculitis 319 Mucinotic mural folliculitis 319 Pseudopelade 319 Trichorrhexis nodosa 319 Feline paraneoplastic alopecia 319 14 Diagnosis and treatment of acute and chronic otitis 323 14.1 Approach to otitis 323 14.2 Otoscopic examination 323 14.3 Choice of otic medications 323 Algorithm 14.1 Diagnostic and treatment steps for acute otitis externa 324 14.4 Indications for systemic steroid/antibiotic therapy in otitis treatment 326 14.5 Choice of otic cleanser/flushes 326 Algorithm 14.2 Diagnostic and treatment steps for chronic otitis 327 14.6 Educate owners on how to correctly use ear flushes 328 14.7 Diagnosis and treatment of otitis media 330 14.8 When to refer for surgery 333 14.9 Ototoxicity 333 Table 14.1 Ototoxic agents 336 15 Metabolic/nutritional/keratinization dermatologic disorders 345 Table 15.1 Keratinization, metabolic, and nutritional disorders 346 Seborrhea (secondary) 346 Vitamin A responsive dermatosis 346 Sebaceous adenitis 346 Schnauzer comedo syndrome 347 Nasodigital hyperkeratosis 348 Callus 348 Xeromycteria 349 Ear margin dermatosis 349 Canine acne 349 Feline acne 350 Zinc responsive dermatosis 350 Necrolytic migratory erythema 351 Exfoliative dermatitis associated with thymoma 351 Xanthomas 352 Split paw pad disease 352 16 Congenital/hereditary dermatologic disorders 363 Table 16.1 Congenital/hereditary dermatologic disorders 364 Primary seborrhea 364 Idiopathic facial dermatitis of Persian and Himalayan cats 364 Ichthyosis 365 Nasal parakeratosis of Labrador Retrievers 365 Dermatomyositis 365 Congenital alopecia 366 Cutaneous asthenia (Ehlers Danlos) 366 Mucinosis 366 Urticaria pigmentosa 367 Ulcerative nasal dermatitis of Bengal cats 367 Dermoid sinus 367 Acrodermatitis 367 Acral mutilation syndrome 368 Congenital keratoconjunctivitis sicca (KCS) and ichthyosiform dermatosis in the Cavalier King Charles Spaniel (CKCS) 368 Exfoliative cutaneous lupus erythematous 368 Epidermolysis bullosa 368 17 Pigmentary dermatologic disorders 375 Table 17.1 Pigmentary dermatologic disorders 376 Lentigo 376 Acquired hormone?associated 376 Acquired post?inflammatory hyperpigmentation 376 Vitiligo 377 Nasal hypopigmentation "snow nose" 377 Nasal hypopigmentation "Dudley nose" 377 Acquired aurotrichia 377 "Dalmatian bronzing" syndrome 377 18 Environmental skin disorders 385 Table 18.1 Environmental skin disorders 386 Solar dermatitis 386 Burns 387 Radiant heat dermatitis 389 Frostbite 389 Irritant contact dermatitis (ICD) 389 Grass awns/burs 390 Post traumatic alopecia 390 Hygroma 391 Pressure sore 391 19 Skin tumors 401 Table 19.1 Benign and malignant skin tumors in dogs and cats 402 Squamous cell carcinoma (SCC) 402 Bowenoid in situ carcinoma 402 Basal cell carcinoma 403 Sebaceous gland tumors 403 Follicular tumors 404 Dilated pore of Winer 405 Follicular cyst 405 Cutaneous horn 405 Apocrine gland tumors 406 Feline ceruminous (apocrine) cystomatosis 407 Perianal gland tumors 407 Apocrine gland tumors of anal sac origin 407 Lipoma 408 Infiltrative lipomas 408 Liposarcoma 408 Mast cell tumor 409 Fibroma 409 Dermatofibroma 409 Nodular dermatofibrosis 410 Acrochordon 410 Mammary tumors 410 Hemangioma 411 Hemangiosarcoma 412 Cutaneous progressive angiomatosis 412 Hemangiopericytoma 413 Lymphangioma 413 Lymphangiosarcoma 413 Fibrosarcoma 413 Cutaneous epitheliotropic lymphoma 414 Cutaneous non?epitheliotropic lymphoma 415 Feline cutaneous lymphocytosis 415 Plasmacytoma 415 Melanocytoma 416 Malignant melanoma 416 Canine cutaneous histiocytoma 417 Canine reactive cutaneous histiocytosis 417 Canine systemic histiocytosis 417 Feline progressive histiocytosis 417 Canine cutaneous langerhans cell histiocytosis 418 Collagenous hamartoma 418 Calcinosis circumscripta 418 Transmissible venereal tumor 419 Feline lung?digit syndrome 419 20 Dermatology formulary 453 Table 20.1 Systemic antibiotics 454 Table 20.2 Systemic antifungals 458 Table 20.3 Systemic antiviral/antiprotozoal medications 459 Table 20.4 Antihistamines 459 Table 20.5 Systemic glucocorticoids 461 Table 20.6 Non?steroidal immunomodulating and immunosuppressive drugs 463 Table 20.7 Behavior modifying medications/analgesics 467 Table 20.8 Systemic antiparasitic drugs 468 Table 20.9 Topical antiparasitics 470 Table 20.10 Nutritional supplements/vitamins/retinoids 471 Table 20.11 Non?glucocorticoid hormones 472 Table 20.12 Topical non?steroidal antipruritic therapies 474 Table 20.13 Topical glucocorticoids 475 Table 20.14 Topical antimicrobials/otics 475 Table 20.15 Topical antiseborrheics 477 Table 20.16 Topical immunomodulators and retinoids 477 Index 479

About the Author

The Editor Kimberly S. Coyner, DVM, DACVD, is a veterinary dermatologist at Dermatology Clinic for Animals in Lacey, WA and a consultant for the Veterinary Information Network.

Reviews

"In my opinion, anyone who treats dogs and cats with dermatologic conditions should have this book in their reference library... For each disease discussed, there is a plethora of color photographs of gross lesions. In my opinion, these images represent the most diverse collection of clinical images for veterinary dermatologic diseases published to date.... In summary, I highly recommend this book for veterinary students, veterinary technicians, primary care veterinarians, and veterinary dermatologists who treat dogs and cats for dermatologic diseases." - JAVMA, Mar 15, 2020, Vol.256, No.6

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