Flea

combing Superficial
Scrape gently
History of parasiticide application Scrape a large area of skin
Deep
D ouglas J. D eBoer, D .V.M., D iplomate A.C.V.D . Squeeze!
School of Veterinary Medicine Superficial and deep scrapings Several small areas
U nivers ity of W is cons in-Madis on
AND hair pluckings Want to see a little blood!
Lesion, normal, interdigital, lipfold

Especially for difficult patients

Especially for difficult areas (interdigital, There is a primary disease, BUT…
periorbital, lipfold)
Treat empirically for scabies – once, Also “layers” of secondary complications
then repeat in 2 weeks.
Selamectin or moxidectin Impossible to see the true nature of the
Amitraz dips primary disease
Ivermectin Identify and treat all possible secondary
Fluralaner, sarolaner, afoxolaner complications

Collect surface debris with spatula ANTIBIOTICS

Smear in small spot on slide Use the correct antibiotic
Heat briefly (2 sec) under slide with flame Treat for 1-2 weeks past clinical recovery
(clearing of visible lesions); often this is
Stain and examine under oil immersion at least 3-4 weeks
(1000X) OR TOPICAL CHLORHEXIDINE
 Yeast Overgrowth (Malassezia dermatitis)

Pruritus, often severe

Moist or greasy skin, especially certain areas
Odor
Resistant to corticosteroid treatment
Lichenification and hyperpigmentation of skin
“Elephant Skin”

Frequently unrecognized in small animal practice

Systemic Treatments
For active infection, may Schedule a recheck in 2-4 weeks
Treatment trial with oral
ketoconazole, fluconazole, or work slower than oral No concurrent corticosteroids
itraconazole, 5-10 mg/kg Miconazole-chlorhexidine, or May lengthen the course of infection
once daily for 2-4 wks ketoconazole-chlorhexidine Does not help yeast
How much does itch shampoo, once to twice You want to see response to infection control!
decrease? weekly Antihistamines are OK

WHAT REMAINS AFTER INFECTION

CONTROL?
Evaluate patient’s response to elimination Chronic or recurrent yeast infections
of infections
Clue to underlying cause
Helps to plan further testing
Generally 4 different categories of response
Lesions gone, but pruritus remains
Most likely diagnoses:
ALLERGY!
Atopic dermatitis or food allergy
Onset of signs under 3 years of age
Dog lives mostly indoors
Glucocorticoid-responsive pruritus
Affected front feet
Affected ear pinnae
Non-affected ear margins
Non-affected dorsal lumbosacral region
5/8 = 85% sensitivity, 79% specificity

Favrot et al., Veter inar y Dermatology21:23-31, 2010

 Some lesions remain, pruritus remains
Repeat skin scrapings
Most likely diagnoses:
Dietary restriction-provocation trial Parasitism (mites, fleas) Repeat skin cytology (yeast?)
Allergy testing Concurrent Malassezia dermatitis Treat for scabies mites
Food allergy Diet trial
Primary seborrhea Dermatophyte culture
Dermatophytosis Skin biopsy, esp. if seborrheic

Disease still pruritic, lesions not No lesions, no pruritus after infection

resolving Bacterial culture and susceptibility control
Most likely diagnoses: Fungal culture for dermatophytes
Antibiotic resistant bacteria
Skin biopsy
Dermatophytosis
Something less common
Pemphigus foliaceus
Cutaneous T-cell lymphoma

1. Look for the obvious: eliminate

parasites.
2. Infection control
3. What remains?
4. Logical diagnostic evaluation