Medicina pediátrica en pequeños animales
PRESENTATION BROCHURE
Pet owner educational atlas
Diagnosis in dermatology Review and texts: Dr Carmen Lorente
Pet owner educational atlas
Pet owner educational atlas
Diagnosis in dermatology
Diagnosis in dermatology
Review and texts: Dr Carmen Lorente
Review and texts: Carmen Lorente MĂŠndez. Format: 22 Ă— 28 cm. Number of pages: 60. Number of sheets: 50. Binding: hardcover, wire-o.
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This second volume of the pet owner educational atlas about
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dermatology continues with the goal established on the first work: helping veterinarians in their communication with pet owners. This new work goes even further, as its contents go deeper into the specialty of dermatology and will therefore allow veterinary surgeons to consolidate and update their knowledge.
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Pet owner educational atlas. Diagnosis in dermatology
Presentation of the book As Carmen Lorente pointed out in the previous work, the skin is the largest organ of the body and nearly the most visible. Therefore, skin diseases are very apparent and may become the most concerning for pet owners since, even though they do not usually endanger the animal’s life, they can enormously decrease the quality of life of pets and their owners. Cooperation of pet owners will be indispensable to achieve the resolution of the problem and their degree of involvement will depend on their understanding of the disease, its evolution and the therapeutic approach to be carried out. In order to make explanations easier and the time taken to explain more profitable, the veterinarian can rely on this work that gathers physiological aspects of skin functioning, the main diagnostic tests that can be performed and several skin disorders which were not included in the first volume and are now described through a diagnostic approach, starting from lesions or other main clinical profiles, among other contents. This second volume looks deeply into many skin disorders that may not be as frequent as the ones included in the previous volume, but are equally important and have to be taken into account for the differential diagnosis. It is necessary to count on the knowledge and clinical resources to diagnose these diseases and establish the appropriate treatments. That is the reason why this atlas will not only help the communication between veterinarians and pet owners, but it will also be useful for veterinarians as a base for updating and reviewing all these processes. The clarity and accuracy of the drawings in each one of these sheets, along with the texts of a specialist in dermatology such as Carmen Lorente, turn this atlas into a practical tool for the daily practice.
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Pet owner educational atlas. Diagnosis in dermatology
Review and texts Carmen Lorente Méndez She graduated and obtained her PhD in Veterinary Medicine from the Complutense University of Madrid (1988, 2005) and is certified in Dermatology by the European College of Veterinary Dermatology (ECVD). She began her professional career by founding the Cercedilla Veterinary Clinic in 1989, where she worked until 2002. In 2000 she moved to Valencia as a tenured professor at the Faculty of Veterinary Medicine of the CEU Cardenal Herrera University (UCH-CEU) and head of the Dermatology Service of the UCH-CEU Veterinary teaching Hospital. In 2007 she went back to Madrid and founded the Adervet Veterinary Dermatology Centre, which she has been managing up to now. From 2007 to 2009, she combined her work at Adervet with the management of the areas of small animal dermatology and internal medicine at the Veterinary Teaching Hospital of the Alfonso X el Sabio University in Madrid. Full member of the European Society of Veterinary Dermatology (ECVD), member of the International Society of Veterinary Dermatopathology (ISVD), of AMVAC, of AVEPA and of the GEDA Scientific Committee. Master in Dermatology by the European School of Advanced Veterinary Studies (ESAVS) in 1998. Speaker in many congresses, courses, conferences, seminars, practical workshops and author of several national and international publications. Member of the AMVAC Scientific Committee and part of the AMVAC Board of Directors since November 2011. Member of the Local Organising Committee for the European Congress of Dermatology ESVD-ECVD 2013. Regular guest on the radio show “Como el perro y el gato” (“Like cats and dogs”) of the Spanish radio station Onda Cero.
Communication services Web site Online visualisation of the sample chapter. Presentation brochure in PDF format. Author´s CV. Sample chapter compatible with iPad.
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Pet owner educational atlas
Diagnosis in dermatology Review and texts: Dr Carmen Lorente
Table of contents 1. Structure and function 1. Follicular cycle 2. Defence mechanisms of the skin 3. The skin as an indicator of health status
ALOPECIA
16. Types of alopecia and diagnostic plan 17. Noninflammatory alopecia 18. Follicular dysplasias 19. Ischaemic skin diseases
2. Diagnostic tests 4. Skin scrapings
20. Scarring alopecia and telogen effluvium
5. Trichogram
21. Feline symmetrical alopecia
6. Skin surface cytology
22. Alopecia and skin atrophy secondary to topical corticosteroid treatment
7. Fine-needle aspiration (FNA) cytology 8. Culture of dermatophytes 9. Bacterial culture and sensitivity tests 10. Skin biopsy 11. Ear examination
3. Clinical manifestations and pathological processes PRURITUS
23. Cyclic flank alopecia 24. Post-shaving and traction alopecia 25. Pattern baldness PUSTULES AND EPIDERMAL COLLARETTES
26. Pyoderma 27. Antibiotic treatment of pyoderma 28. Other processes that cause pustules
12. Skin diseases that cause pruritus
EROSIONS AND ULCERS
13. Diagnostic protocol for allergic triad
29. Trauma-induced erosions and ulcers
14. Chronic pruritus: hyperpigmentation, acanthosis 15. Acral dermatitis or lick granuloma
30. Immune-mediated diseases 31. Diseases with erosive and ulcerative lesions
32. Feline idiopathic ulcerative dermatitis
MISCELLANEOUS
33. Feline viral infections
46. Canine paraneoplastic diseases
34. Feline eosinophilic granuloma complex
47. Skinfold dermatitis or intertrigo
KERATOSEBORRHEIC DISORDERS
49. Shar pei mucinosis
35. Seborrhoea 36. Nasodigital hyperkeratosis 37. Ear margin seborrhoea 38. Schnauzer comedo syndrome 39. Sebaceous adenitis 40. Calluses and callus pyoderma 41. Canine and feline acne 42. Zinc-responsive dermatitis PIGMENTATION DISORDERS
43. Diseases associated with skin depigmentation 44. Skin hyperpigmentation
45. Feline paraneoplastic diseases
48. Canine oral papillomatosis 50. Surgical treatment of abscesses 51. Shampoo therapy 52. Controlling pruritus 53. Long-acting antibiotics
7 STRUCTURE AND FUNCTION
1
Follicular cycle Hair is synthesised in structures called hair follicles, which are anchored in the skin. Hair follicles can be active, generating hair (anagen phase), or at rest (telogen phase). The transition between these two phases is known as the catagen phase.
ANAGEN PHASE
All follicles progress through each of the following stages in a cyclical manner:
ANAGEN PHASE (ACTIVATION)
anagen รฐ catagen รฐ telogen CATAGEN PHASE
ANAGEN PHASE (ACTIVATION)
At the end of the telogen phase the anagen phase is reinitiated; the newly formed hair pushes out and replaces the old hair, resulting in moulting. The duration of each phase is genetically regulated, and determines the hair length of the animal.
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TELOGEN PHASE
Some diseases can cause a shutdown of the follicular cycle, resulting in hair loss and alopecia.
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Defence mechanisms of the skin The skin covers the entire body to form a barrier that is essential for life. It protects against physical and chemical attacks, prevents the entry of microorganisms, and maintains internal equilibrium, preventing the loss of water and other substances essential for survival.
Physical barrier The epidermis is a continuously renewed, highly resistant shield, which is impermeable to water and many other substances.
Pathogens Keratinocytes Langerhans cells Surface lipid film Lymphocytes Macrophages
Immunological barrier
Chemical barrier
The immune system works in concert with the skin to prevent the possible entry of foreign agents into the body.
The skin produces numerous secretions that aid its role as both a physical and immunological barrier.
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9 STRUCTURE AND FUNCTION
3
The skin as an indicator of health status The skin and hair are indicators of bodily health. Damaged, dry, or dull skin or hair may be indicative of disease or poor nutrition. Skin and hair are continuously renewed and therefore require a high nutritional and energetic intake. Nutritional deficiencies are reflected in the skin.
What factors can affect skin condition? Poor nutrition
Lack of proper care
Unbalanced diet
Poor health status
Parasitic diseases
Metabolic diseases
Infections
Neoplastic processes
Recommendations ■■ The
diet should be balanced and nutritious, and should fulfil the energy requirements of the animal. It should always be adapted to the individual animal, their age, and activity. ■■ Hair should be kept brushed, without knots or clumps of dirt that prevent ventilation of the skin.
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Skin scrapings Skin scraping is a simple test used to detect parasites that may be causing skin disease. Surface scrapings only remove material from the epidermis. Deeper scrapings reach the dermis and may cause slight bleeding.
Surface scraping Surface skin scrapings are used to locate Sarcoptes scabiei. Several scrapings should be performed in areas in which this parasite is most commonly located: the elbows, tarsal regions, edges of the ears, and crusted lesions. Diagnosis is based on visual identification of the parasite, although its absence does not rule out the disease. Surface skin scrapings are also required to detect Notoedres cati and Cheyletiella spp.
Skin after surface scraping to diagnose mange
Epidermis
Dermis
Depth scraping Deep scrapings are performed to detect Demodex spp. (although a trichogram is equally useful and less aggressive) and less commonly nematodes (Pelodera strongyloides, Filaria).
Detail of the skin after deep scraping for diagnosis of demodectic mange
This produces a small lesion with some bleeding (erosion)
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11 DIAGNOSTIC TESTS
1 5
Trichogram Hair
A trichogram is a simple test that involves microscopic analysis of the hair. Oil
1. Demodex
2. Fungal spores
Coverslip
3. Melanosomes
Spores
Unstructured hair This technique can identify parasites such as Demodex, Cheyletiella, and lice.
4. Hair fractures
The presence of hair shaft fractures indicates that the animal is itching.
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The presence of spores and destruction of the hair structure can be observed in dermatophytosis.
5. Follicular casts
Follicular casts indicate inflammation of the hair follicle or keratoseborrhoeic disorders.
In follicular dysplasias, fragmentation of the hair by melanosomes can be observed.
6. Hair cycle
The roots of the hair are rounded during growth and in the anagen phase. During the telogen phase they are spear-shaped.
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Skin surface cytology Cytology is the microscopic observation of cells. These cells are obtained from tissues and then stained for identification under the microscope. Samples can be taken with sticky tape, swabs, or by directly pressing a slide onto the lesion.
1. Sticky tape
Malassezia
Reddened, exfoliated, or hairless areas.
2. Imprint
3. Swab
Ulcerated area
Skin surface cytology samples the most superficial skin cells in order to identify inflammatory cells and pathogens (mainly bacteria and Malassezia). This technique is essential to identify the presence of an infection and the causative agent.
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13 DIAGNOSTIC TESTS
7
Fine-needle aspiration (FNA) cytology All nodular or tumoural lesions should be punctured to identify the type of cells produced within and to determine whether the lesion is inflammatory or neoplastic.
Sampling Using a syringe filled with air, the collected sample is ejected from within the needle
Skin nodule
Spreading of the sample in a monolayer
Differentiation between inflammation and neoplasia Cytology of inflammation Macrophages
Cytology of neoplasia Round neoplastic cells
Lymphocytes Neutrophils The types of cells present in inflammatory lesions provide an indication as to the possible origin of the lesion, whether additional tests are necessary, and the type of treatment required.
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In neoplastic lesions cytology can be used to diagnose the type of neoplasia, or at least provide an indication as to whether the process is malignant or benign. This test should always be complemented by histopathology (biopsy) after removal of the neoplasm.
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Culture of dermatophytes
Diagnosis of fungal dermatophyte infection (ringworm) should always be based on and confirmed by culture. Culture should be performed in two media: Sabouraud agar and DTM.
Sampling Hair from the periphery of the lesion is sampled and inoculated into culture media. In cats it may be necessary to brush the entire animal with a sterile brush in order to collect the sample.
Sabouraud agar culture
DTM culture
A colour change to red should occur within 24 hours of the start of colony growth.
Usually in cases of infection a result can be obtained in 7 to 10 days, but confirmation of a negative result takes about 3 weeks.
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Once the colony has grown, a smear is taken to identify the type of dermatophyte involved based on its microconidia.
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19 CLINICAL MANIFESTATIONS AND PATHOLOGICAL PROCESSES
PRURITUS
15 Diagnostic protocol 13
for allergic triad Allergies are complex diseases with a genetic component. Avoiding contact with substances that cause allergies can help to keep an animal disease-free. This is possible in cases of flea allergy dermatitis (FAD) and food allergies, but not with environmental allergies (e.g. atopic dermatitis).
Flea allergy dermatitis (FAD) FAD is the most common allergic disease. While it often manifests with characteristic clinical features, affecting the caudal third of the body, it can be confused with or complicate the other two allergy types. Continuous and effective flea control is essential in any allergic animals.
Food-induced allergic dermatitis (FIAD)
Atopic dermatitis (AD)
Food allergy and atopic dermatitis are indistinguishable based on their clinical presentation.
Diagnosis It is important to be patient and follow an ordered diagnostic protocol consisting of the following three measures:
1. Strict flea control: treatment throughout the entire year. 2. Maintenance of a strict hypoallergenic diet, recommended by a veterinary surgeon, for a minimum of two months. 3. Atopic dermatitis is diagnosed clinically after FAD and FIAD are ruled out.
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PRURITUS
14 Chronic pruritus:
hyperpigmentation, acanthosis The trauma induced by scratching leads to alopecia and chronic skin alterations, characterised by thickening of the skin (acanthosis or lichenification) and hyperpigmentation. Desquamation is common, and scaly, greasy crusts can also develop. Skin odour is another characteristic feature of animals with chronic inflammatory processes. Bacterial or yeast infections may be associated with these alterations.
Alopecia
Hyperpigmentation
Bad odour Infection Scaly, greasy crusts
Lichenification and thickening
Desquamation
How do dogs and cats scratch? ■■ Scratching
with paws.
■■ Licking. ■■ Rubbing
against objects (walls, sofas). ■■ Rolling on the floor. ■■ Shaking the head or body. ■■ Gnawing.
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The publishing strength of Grupo AsĂs Editorial Servet, a division of Grupo AsĂs, has become one of the reference publishing companies in the veterinary sector worldwide. More than 15 years of experience in the publishing of contents about veterinary medicine guarantees the quality of its work. With a wide national and international distribution, the books in its catalogue are present in many different countries and have been translated into nine languages to date: English, French, Portuguese, German, Italian, Turkish, Japanese, Russian and Chinese. Its identifying characteristic is a large multidisciplinary team formed by doctors and graduates in Veterinary Medicine and Fine Arts, and specialised designers with a great knowledge of the sector in which they work. Every book is subject to thorough technical and linguistic reviews and analyses, which allow the creation of works with a unique design and excellent contents. Servet works with the most renowned national and international authors to include the topics most demanded by veterinary surgeons in its catalogue. In addition to its own works, Servet also prepares books for companies and the main multinational companies in the sector are among its clients.
Servet (División de Grupo Asís Biomedia S.L.) Centro Empresarial El Trovador, planta 8, oficina I Plaza Antonio Beltrán Martínez, 1 • 50002 Zaragoza (España) Tel.: +34 976 461 480 • Fax: +34 976 423 000 • www.grupoasis.com