THE VETERINARY PUBLISHING COMPANY SMALL ANIMALS
Pet Owner Educational Atlas
DErmAtOlOgy Reviewer: Carmen Lorente
Pet Owner Educational Atlas
Dermatology TECHNICAL SPECIFICATIONS Author: Servet. Reviewer: Carmen Lorente. Format: 22 x 28 cm. Number of pages: 60. Binding: Hardcover, wire-o. Year: 2013. ISBN: 978-84-941014-7-2. PVP: 60 e.
This illustrated work aims at helping veterinary surgeons to communicate with pet owners. In keeping with the previous volume about surgery, the illustrations of this atlas dedicated to dermatology will simplify the explanations given by vets to their clients about the anatomical, physiological and pathological characteristics of skin, as well as those about the diagnostic tests, treatments and surgical techniques that may need to be carried out in some cases. Every illustration was designed to help in the different clinical aspects of the dermatology consultation, from the anatomical and physiological considerations about the skin and its annexes, to the graphic description of infectious, inflammatory, endocrine, allergic or tumoral disease processes which cause dermatological conditions. The clarity and accuracy of the illustrations, designed to make the explanations given to owners easier to understand and less timeconsuming, turn this atlas into another useful clinical tool.
Aimed at veterinary surgeons, students, teachers and other professionals in the veterinary sector.
Centro Empresarial El Trovador, planta 8, oficina I - Plaza Antonio Beltrán Martínez, 1 • 50002 Zaragoza - España Tel.: 976 461 480 • Fax: 976 423 000 • pedidos@grupoasis.com • Grupo Asís Biomedia, S.L.
The veterinary publishing company
Pet Owner Educational Atlas . Dermatology TABLE OF CONTENTS 1. Anatomy of the skin and hair Healthy skin cross-section Structure of the hair follicle Skin barrier Characteristics of the nail. Trimming technique
2. Physiopathology of the skin and hair Stages of wound healing Good against poor wound healing Primary lesions: Macule Papule Plaque Pustule Vesicle Nodule Tumour Cyst Bite Wart
Lesions that can be primary and secondary: Scale Alopecia Crust Ulcer Erosion Follicular cast Blackhead Alteration of pigmentation
Secondary lesions: Blackhead Epidermal collarette Scar Fissure Excoriation
Lichenification Erosion Callus (hyperkeratosis)
Diseases of the hair follicle Types of alopecia: inflammatory and non-inflammatory Characteristics of pruritus
3. Medical and surgical treatments Types of wounds: Cuts Puncture wounds Contusions Lacerations/avulsions Abrasions Bites Gunshot wounds
Types of burns: First-degree burn Second-degree burn Third-degree burn
Dressings. Moist healing Procedures to avoid skin tension (I). Relaxing incisions: Simple Multiple Punctate incisions Z, V and Y-plasties
Procedures to avoid skin tension (II). Suture patterns: Walking suture Subdermal suture Relaxation suture
Local, distant and axial flaps
Centro Empresarial El Trovador, planta 8, oficina I - Plaza Antonio Beltrán Martínez, 1 • 50002 Zaragoza - España Tel.: 976 461 480 • Fax: 976 423 000 • pedidos@grupoasis.com • Grupo Asís Biomedia, S.L.
The veterinary publishing company
4. Diseases of the skin Parasites
Eyes and ears
FAD. Flea-Allergy Dermatitis
Entropion and resolution
How ticks bite and attach to the skin
Ectropion and resolution
Types of manges (I): Sarcoptes, Cheyletiella and Otodectes
Normal ear. Correct cleaning and washing procedure
Types of manges (II): Demodex
External otitis. Ear exudate smears
Mosquito bite and transmission of diseases
Otitis media and interna
Miasis larvaria
Ear haematoma. Types of resolution
Fungi and yeasts
Neoplasms
Dermatophytosis: Microsporum, Trichophyton and Epidermophyton
Nodules. Inflammatory or neoplastic process?
Cutaneous mycoses
Fibrosarcoma and surgical resolution with wide safety margins
Dermatitis caused by Malassezia
Mastocytoma and metastases
Bacterial infection
Squamous cell carcinoma
Pyotraumatic dermatitis, acute moist dermatitis or hot spot
Mammary tumour
Deep and superficial pyoderma
Frequent foot pad disorders
Mucocutaneous pyoderma and epitheliotropic lymphoma
Interdigital fistula caused by a foreign body (splinters)
Sebaceous adenitis
Anal sac diseases
Infectious and sterile panniculitis
Dental fistula
Skin folds (I). Lip fold dermatitis and its surgical resolution
Pemphigus foliaceus. Autoimmune mechanism
Skin folds (II). Tail fold dermatitis and its surgical resolution
Allergies and atopies
Miscellaneous
Anaphylactic reaction. Angioedema Endocrine diseases Kerato-seborrheic disorders
Centro Empresarial El Trovador, planta 8, oficina I - Plaza Antonio Beltrán Martínez, 1 • 50002 Zaragoza - España Tel.: 976 461 480 • Fax: 976 423 000 • pedidos@grupoasis.com • Grupo Asís Biomedia, S.L.
Pet Owner Educational Atlas
Dermatology Reviewer: Carmen Lorente
7
Anatomy of the skin and hair
1
Healthy skin cross-section
9
Physiopathology of the skin and hair
5 Secondary intention
healing phases
STRATA:
2 Proliferative phase
1 Inflammatory phase
Corneum Granulosum
Haemorrhage
Spinosum
Suppuration (pus) Fibrin clot
Neutrophil diapedesis
Basale
Arrival of fibroblasts that synthesize collagen
Platelets aggregate Initial vasoconstriction (5-10 minutes)
Phagocytosis cell migration
Posterior vasodilatation and increase of the vascular permeability
Interstitial oedema
Proliferation of endothelial cells
Granulation tissue formation
Nerve endings
Superficial
Epidermis
3 Remodelling phase
New epidermis
Migration of epithelial cells over the granulation tissue
Resorption of old collagen
Apocrine gland Hair follicle
Remodelling and contraction of the wound
Connective tissue formation
Deep
Nerve
Vascular neoformation
Arteriovenous plexus
Middle
Dermis
Epithelialization phase
Collagen synthesis and deposit
Sebaceous gland
Subcutaneous tissue
4
Cutaneous muscle Artery Vein
Bacteria
Erythrocytes
Macrophages
Platelets
Eosinophils
Neutrophils
Panniculus adipose tissue
Fibroblasts
Physiopathology of the skin and hair
7 Primary lesions
11
13
Medical and surgical treatments
15 Dressings. Wet healing Wet secondary intention healing of wounds with dressings
Macule Change in colour of the epidermis without altering elevation, consistency or thickness. It may be erythematous and hyper or hypopigmented
Papule Small elevated lesion, erythematous and slightly hardened of up to 1 cm in length caused by cellular infiltration or proliferation
Nodule Solid lesion over 1 cm in diameter, dermal location and usually extended into the deep layers of the skin. It may be of inflammatory or neoplastic origin
1 Clean the lesion and disinfect the area
2 Shave the hair of surrounding areas
3 Wash the wound thoroughly with saline solution
4 Surgically debride of the wound
exhaustively
Tumour Large mass that can affect any skin structure. It may be of inflammatory or neoplastic origin
under pressure. Remove detritus or contaminating particles
Plaque Elevated lesion, flat, solid and wide of more than 1 cm in length associated to cellular infiltration or proliferation
Pustule Small circumscribed cutaneous elevation that contains purulent material. It may be intraepidermal, subepidermal and follicular
and its edges
Cyst Cavity delimited by an epithelium, which is clinically presented as a nodule or tumour. Desquamative materials or glandular secretions are stored in its interior
Skin wheal Oedematous cutaneous area, raised and irregular that often changes size and shape
5 Apply a bandage with dressings that promote the correct formation of granulation tissue. Monitor the healing
Layers of the dressing Tertiary or retaining layer
Vesicle Small circumscribed elevation with a collection of clear fluid within the epidermis or below it. It can be intraepidermal or subepidermal
Wart Solid elevation of the epidermis with a formation of exophytic projections and generally covered by a scab
Secondary or absorbent layer Wound
Primary or contact layer
15
Skin pathologies
Skin pathologies
20 Tick bites and
35 Entropion and resolution
attachment to the skin Female tick ingesting blood in order to lay the eggs
Lesions in the cornea of the eye
The edge of the eyelid is folded and is in contact with the cornea
Surgical resolution techniques Tick head (retractable sucking mouthparts)
HOTZ-CELSUS TECHNIQUE The tick secretes a substance that attachs its mouthparts into the host’s skin
Palps Chelicerae
Inflammatory skin reaction
Hypostome
Solves the entropion of the lower eyelid
MODIFIED HOTZCELSUS TECHNIQUE: ARROWHEAD Solves the entropion of the lateral edge of the eyelid
The saliva of the tick has an anticoagulant effect and causes a small haemorrhage from which it feeds
The tick inoculates the pathogenic agents during feeding
FRANS STADES TECHNIQUE Solves the entropion of the upper eyelid
17
19
Skin pathologies
42 Fibrosarcoma
47 Interdigital fistula caused
and resolution
by a foreign body (spikelet)
Surgical removal with wide safety margins Nodule on the withers
21
Skin pathologies
Deep penetration of the spikelet
Fibrosarcoma is a malignant neoplasm that may appear as a nodule in the skin. Its surgical resolution can be accompanied by radiation therapy
Lateral safety margins Location of the spikelet
Course of the fistula
When removing a malignant neoplasm (highly invasive) security surgical margins should be established. As a result, the resulting wound is larger than the tumour but this procedure also reduces the likelihood of recurrence or metastasis
Infiltrative digitations of the neoplasm
Interdigital inflammation
Spikelet entry point
Safety margins in depth
The veterinary surgeon introduces alligator forceps by the fistulous trajectory to access the spikelet. Sometimes surgery is needed to remove the foreign body and close the fistula