Anamnesis, nationale, physical

examination in small animal

dermatology

University of Veterinary Medicine,

Department and Clinic of Internal Medicine

Noémi Tarpataki, PhD, Dipl ECVDt

tarpataki.noemi@univet.hu
1.History
(ideal: true and full=base of diagnosis)

2.Physical examination

3. Additional examinations
(possibilities)
 Way to diagnosis

 HISTORY
 Why has the owner come to the doctor? („the pet
is itchy, smelly, has got no hair, dull haircoat etc.”)
 Nationale (breed, age, sex, color, weight)
 Dermatological history (first skin lesions,
localisation, onset, severity, spreading, newer
signs, progress, grade of pruritus , localisation,
other pets, their and the owner’s signs,
seasonality, nutrition, diet, environment, sleeping
place, pretreatment and effectiveness)
 Other diseases
 The client
 Way to diagnosis

 Detailed history
 General questions
 Vaccinations, antiworm therapy
 Nutrition
 GI signs
 Appatite
 PD/PU
 Oestrous cycle (missing), activity, having puppies, kittens
 Respiratory symptomes (atopy)
 Environment
 Travel
 Way to diagnosis

 Detailed history
 Dermatological history
 (The questions presented to the client do not suggest the answers or tend
to shut off discussion!)
 Date and age of onset, original location,
initial appearance
 Pruritus? Severity?
 Seasonality?
 What was the first sign: pruritus or skin
lesion?
 Location of lesions? (cranial: AD, FA, demodicosis, caudal: FAD)
 Tendency to progression or regression?
 Way to diagnosis

 Detailed history
 Fleas, anti-flea-therapy?
 Previous medication?
 Animals in the pet’s environment?
 Indoor/outdoor/both; cloth of resting-place
 Travel/contact to other animals?
 Any other previous diseases and their
treatments?
 It is helpful to ask questions (How many times daily do
you see your dog scratch? Does it itch in many sites, or just a few?
Does it shake its head? Does it lick its paws? Does it lick the front
legs or other areas? Does it roll on its back or rub its chin, ears, or
body against things?)
 Way to diagnosis (II.)

 Physical examination
 General impression (fat, thin, unkept, well groomed)
 Primary and secondary skin lesions
 Quality of the hair coat (texture, elasticity, thickness,
density, shiny, dull, dry, oily, scaling, coarse, fine, etc.)
 To establish the morphologic features, distribution
and configuration of the skin lesions and any
abnormalities. (Special patterns of lesions are
diagnostic, together, they often represent the natural
history of the skin disease.)
 Establishing the differential - diagnosis
 Way to diagnosis (III.)

 Diagnostic plan
 To discuss our plan with the owner on the basis of
tentative diagnosis
 First the simple diagnostic options are proposed
 Second the more complicated tests are
recommended
 Diagnostic-therapeutic procedures
 The client may choose the therapeutic probe (It is
allowed to try only by a specific drug (antibiotica,
antimicotica, insecticida) and not allowed to give
glucocorticoids, progestational drug)
 „Diagnosis ex juvantibus”
 Way to diagnosis (IV.)

 Narrowing differencial-diagnosis
 Further tests
 Reevaluation of the therapeutic trials and clinical
symptoms

 Establishing of final diagnosis

Nationale
 Breed (breed predilection)
Cocker spaniel: primary idiopathic seborrhea
Nationale
 Breed
 Dachshund: acanthosis nigricans, juvenilis cellulitis
 Nationale
 Breed
Chow Chow: Adrenal sex hormone abnormalities
(hypogonadism of intact males); hypothyreoidism,
hyposomatotropism ; Alopecia X)
 Nationale
 Breed
Collie, sheltie: SLE, pemphigus complex, FDLE
Nationale
 Breed
Husky,malamut: Zink-responsive dermatosis,
uveodermatologic syndrome
Nationale
 Breed
Terriers: allergodermatitis (AD, ARF)
Nationale
 Breed
Boxer: atopy, demodicosis, skin tumors
 Nationale
 Breed
 GSH: atopy, GSH deep pyoderma, FAD (flea all.derm.)
 Nationale
 Breed
Doberman pinscher: demodicosis, acral lick derm.
 Nationale
 Breed
Persian cat: dermatophytosis, primary idiopathic
seborrhoea, idiopathic facial dermatitis
 Age
 Younger than 6 months: demodicosis,
dermatophytosis, juvenilis cellulitis, viral
papillomatosis, hipofízer törpe,
impetigo, pituitary dwarfism
 Age
 1 to 3 years: allergodermatitis
(atopy), color dilution, alopecia,
hyposomatotropism, primary
idiopathic seborrhoea
 Age
 Older than 6 years:
hypothyreoidism, feminization
with testicular tumor,
endocrinopathies, neoplasma
 Age
 Senile dogs: alopecia, decubital ulcer, thin, fragile skin
 Sex
 Male: male feminization with testicular tumor,
circumanal adenomas
 Sex
 Tomcats: abscesses in fighting cats
 Females: relationship to the
oestrus cycle or to castration
 Color
 White-eared cats: solar dermatitis,
squamous cell carcinoma (SCC)
 In white-skinned, thinly haired region of dogs (in white
bull terrier, Staffordshire bull terrier, boxers,
Dalmatians, beagles, Whippet, Great Danes): solar
dermatitis, solar-related hemangioma, squamous cell
carcinoma, actinic-keratoses
 Color
 Dogs with diluted coat color or
piebald breeds(Doberman
pinscher):color dilution
alopecia

 Yellow-eyed, „smoky” Persian

cat: Chédiak-Higashi syndroma

 Bodyweight
 Weight gain: endocrinopathies, CS-therapy
 Physical examination
 Recognize of skin lesions and their location and pattern
 Primary skin lesion: is the initial eruption that developes spontaneously as a direct
reflection of underlying disease. They may appear quickly and then disappear rapidly.
 Secondary skin lesions: evolve from primary lesions or are artifacts induced by the
patients or by external factors such as trauma and medications.
 Primary Both Secondary
macule,patch alopecia epidermal collarette
papule, plaque scale scar
pustule crust excoriation
vesicule, bulla follicular casts erosion, ulcer
wheal comedo fissure
nodule pigmentary abn. lichenification
cyst callus
 Primary lesions

 Macule: a circumscibed, nonpalpable spot up to 1 cm in diameter

and characterized by a change in the color of the skin; result from
 1.pigment

 Melanin pigmentation: melanoderma, naevus, vitiligo,

postinflammatory hypo-hyperpigmentation
 Local haemorrhage:
 petechia (pinpoint)
 purpura (bleeding into skin)
 vibex (line-form)
 ecchymoses, suffusio (>1 cm)
 sugillatio
 Primary lesions

 Patch: a macule larger than 1 cm in size

 2.vascular (erythema=redness)
 Functional: active hyperaemia, passive hyperaemia
 Anatomical: hyperplastic or aplastic
 Primary skin lesions

 Papula: a small solid elevation of the skin up to 1 cm in

diameter that can always be palpated as a solid mass. Many
papules are pink or red swelling produced by tissue infiltration
or inflammatory cells in the dermis, by intraepidermal and
subepidermal edema or by epidermal hypertrophy. They may
involve or not involve hair follicules.
 e.g.: erythematous papules:scabies, FAD, superficial bacterial
folliculitis, allergic contact dermatitis
 Primary skin lesions

 Plaque: a larger, flat-topped elevation formed

by the extension or coalition of papules.
 Primary skin lesions

 Pustule: a small, circumscribed elevation of the epidermis

that is filled with pus. Pustules may be intraepidermal, subepidermal and
follicular in location. Their color is usually yellow but may be green or red. Most
commonly, pustules primarily contain neutrophils and are infectious in origin;
however, eosinophils may predominate (especially in parasitic or allergic disorders)
and may be sterile (pemphigus foliaceus). Green pustules imply gram-negative
infection or marked toxic changes (acne, folliculitis, impetigo).
 Primary skin lesions

 Abscess: a demarcated
fluctuant lesion resulting from
a dermal or subcutaneous
accumulation of pus. The pus
is not visible on the surface of
the skin until it drains to the
surface. Abscesses are larger
and deeper than pustules.
 Primary skin lesions

 Vesicle: a sharply circumscribed elevation of the

epidermis filled with clear fluid. It can be intraepidermal
or subepidermal. Vesicles are rarely seen in dogs and cats
because they are fragile and transient. They occur in viral and
autoimmune dermatoses, or in dermatitis caused by irritants.
Vesicles are lesions up to 1 cm in diameter. Those with a
diameter greater than 1 cm are called bullae.
 Primary skin lesions

 Wheal (urtica): a sharply circumscribed raised

lesion consisting of edema that usually appears and
disappears within minutes or hours. Wheals usually
produce no changes in the appearance of the overlying skin and
haircoat. Wheals are characteristically white to pink elevated
ridges or round edematous swellings that only rarely have
pseudopods at their periphery. They blanch on diascopy (viewing
the skin through a glass slide that is pressed firmly against lesion).
E.g.: urticaria, insect bites, positive reations to IDT
 Primary skin lesions

 Angioedema: is a huge hive of a distensible region

such as the lips or eyelids.
 Primary skin lesions

 Nodule: a circumscribed, solid elevation greater

than 1 cm in diameter that usually extend into
deeper layers of the skin. Nodules usually result from
massive infiltration of inflammatory or neoplastic cells into
the dermis or subcutis. Deposition of fibrin or crystalline
material also produces nodules.
 Primary skin lesions

 Tuber: inflammatory elevation of papillary zone

of skin or mucous membrane with different
shape and size
 Tumor: a large mass that may involve any
structure of the skin or subcutaneous tissue.
Most tumors are neoplastic or granulomatous in
origin (fibroma, mastocytoma, melanoma,
lipoma).
 Primary skin lesions

 Cysta: an epithelium-lined cavity containing fluid or

a solid material. It is smooth, well-circumscribed,
fluctuant to solid mass. Skin cyst are usually lined by
adnexal epithelium (hair follicle, sebaceous, or
epitrichial) and filled with cornified cellular debris or
sebaceous or epitrichial secretions.
 Primary skin lesions

 Alopecia: loss of hair and may vary from partial to

complete
 primary: endocrin disorders, follicular dysplasias
 secondary: to trauma or inflammation
 Primary skin lesions

 Scale: an accumulation of loose fragments of the horny layer

of the skin (cornified cells). The corneocyte is the final product
of epidermal keratinization. Normal loss occurs as individual
cells or small clusters not visible to naked eye. Abnormal scaling
is the loss in larger flakes. Flakes vary greatly in consistency;
they can appear branny, fine, powdery, flaky, platelike, greasy,
dry, loose, adhering, or „nitlike”. The color varies from white,
silver, yellow, or brown to gray.
 primary: color dilution alopecia
primer idiopathic seborrhoa,
follicular dysplasia
 secondary: chronic inflammation
 Primary or secondary lesions

 Crust: is formed when dried exudate, serum, pus,

blood, cells, scales, or medications adhere to the
surface. Unusually thick crusts are found in hairy areas
because the dried material tends to adhere more
thightly than in glabrous skin.
 primary: primary idiopathic seborrhea, Zn-responsive
dermatosis
 secondary: pyoderma, fly strike, pruritus
 Primary or secondary lesions

 Crust: to adhere more tightly than in glabrous skin.

 Brown or dark red: haemorrhagic crust in pyoderma;
 yellowish green: crusts appear in some cases of
pyoderma;
 tan, lightly adhering crusts are found in impetigo;
 dark crusts imply deeper tissue damage or hemorrhage:
traumatic wounds, furunculosis, fly strike dermatitis, and
vasculitis;
 honey-colored crusts are more commonly infectious in
nature;
 thicker dry yellow crusts: typical of scabies and zink-
responsive dermatosis;
 tightly adherent crusts are typical in zinc-responsive
dermatosis and necrolytic migratory erythema, seborrhea.
 Primary or secondary lesions

 Vegetations: heaped-up crusts seen in pemphigus vegetans

 Follicular cast: an accumulation of keratin and follicular
material that adheres to the hair shaft extending above the
surface of the follicular ostia.
 primary: vitamin A-responsive dermatoses, primary idiopathic
seborrhea, sebaceous adenitis
 secondary: demodectic mange and dermatophytosis
 Primary or secondary lesions
 Comedo: a dilated hair follicle filled with cornified
cells and sebaceous material. It is the initial lesion of
feline acne and may predispose the skin to bacterial
folliculitis.
 primary: initial lesion of feline acne and may predispose
the skin to bacterial folliculitis, infection with Demodex and
dermatophytosis, vitamin A-responsive dermatosis,
Schnauzer comedo syndrome, Cushing’s disease, sex
hormon dermatoses, idiopathic seborrhea disorders
 secondary: to seborrheic skin disease, to occlusion with
greasy medications, or to the administration of systemic or
topical corticosteroids
 Primary or secondary lesions

 Abnormal pigmentation: skin coloration caused by a

variety of pigments but most commonly melanin, which is
responsible for many skin colors:
 black: melanin present throughout the epidermis (lentigo)
 blue: melanin within melanocytes and melanophages in the middle
and deep dermis(dermal melanocytoma)
 gray: diffuse dermal melanosis or superficial dermal melanosis from
pigment incontinence
 tan, brown, black: various shades of normal skin color in breeds are
due to melanin
 brown: hemochromatosis is due to primarly to melanin, not
hemosiderin
 red, purple: hemorrhagein the skin is red at first, becoming dark
purple with time (bruises)
 yellow-green: accumulation of bile pigments (icterus)
 Primary or secondary lesions

 Hypopigmentation (hypomelanosis): loss of

epidermal melanin
 primary: vitiligo-like disease
 secondary: postinflammatory change
 Leukoderma: is a general term for white skin, whereas vitiligo refers
to a specific disease.
 Leukotrichia, achromotrichia: lack of pigment in hair
 Primary or secondary lesions

 Hyperpigmentation
(hypermelanosis,
melanoderma): increased
epidermal and , occasionally,
dermal melanin. Melanophages
may be found in the superficial
dermis.
 primary: endocrine - diffuse
 secondary: postinflammatory,
chronic, traumatic – latticework
appearance
 Melanotrichia: excess pigment
 Secondary lesions

 Epidermal collarette: a special type of scale

arranged in a circular rim of loose keratin flakes or
peeling keratin. It represents the remnants of the roof
of a vesicle, bulla, pustule, or papule, or the
hyperkeratosis caused by a point source of
inflammation as seen with papules and pustules.
 Secondary lesions

 Excoriation: erosions or ulcers caused by

scratching, biting or rubbing. They are self-produced
and usually result from pruritus; they invite
secondary bacterial infection. They are often partly
recognized by their linear pattern.
 Secondary lesions

 Erosion: a shallow epidermial defect that does not

penetrate the basal laminar zone and consequently
heals without scarring. It generally results from
epidermal diseases and self-inflicted trauma.
 Secondary lesions

 Ulcer: there is a break in the continuity of the

epidermis, with exposure of the underlying dermis. A
deep pathologic process is required for an ulcer to form.
It is important to note the structure of the edge: Is it undermined, fibrotic and
thickened, or necrotic (vasculitis, neoplastic, fibrosing, vascular)? The firmness
of the ulcer depth and the type of exudate in the crater should also be noted.
A scar is often left after an ulcer heals. Examples are feline indolent ulcer,
severe deep pyoderma and vasculitis.
 Secondary lesions

 Scar (cicatrix): an area of fibrous tissue that has

replaced the damaged dermis or subcutaneous tissue.
Scars are the remnant of trauma or dermatologic lesion. Most
scars in dogs and cats are alopecic, atrophic and depigmented.
Proliferative scars do occur and in dark-skinned dogs scars can
be alopecic and hyperpigmented. Scars are observed following
severe burns and deep pyoderma.

3 ws →6 ws →10 ws
→6 ms → 1 year
 Hydrogel, hydrocolloids
Calcium alginate swab („Nobaalgin”)
 Secondary lesions

 Fissura: a linear cleavage into the epidermis, or

through the epidermis into the dermis, caused by
disease or injury. Fissures may besingle or multiple tiny cracks or
large clefts several centimeters long. They have sharply defined
margins and may be dry or moist and straight, curved, or branching.
They occur when the skin is thick and inelastic and then subjected
to sudden swelling from inflammation or trauma, especially in
region of frequent movement. Examples are found at ear margins,
and at ocular, nasal, oral, and mucocutaneous borders.
 Secondary lesions

 Lichenification: a thickening and hardening of the

characterized by an exaggeration of the superficial skin
markings. Lichenification areas often result from
friction. They may be normally colored but are more often
hyperpigmented. Crusted lichenified plaques usually have a bacterial
component and improve with antibiotic therapy. Occasionally, Malassezia are
found with these lesions.
 Examples are the axillae in acanthosis nigricans, chronic atopic dermatitis
(normo- or hyperpigmented).
 Secondary lesions

 Callus: a thickened, rough, hyperkaratotic,

alopecic, often lichenified plaque that developes
on the skin. Most commonly, calluses occur over
bony prominences and result from pressure and
chronic low-grade friction.
Histopathological-clinical diagnosis
 Hyperkeratosis: hyperproliferation of str.
corneum. Dd.: on footpads:canine distemper, DM,
hepatocutan syndroma, pemphigus foliaceus.
Regional diagnosis of non-neoplastic dermatoses
 Haed: atopy, demodicosis, dermatophytosis, facial fold intertrigo,
feline FA, bacterial folliculitis, feline Scabies, juvenilis cellulitis,
pemphigus erythematosus, pemphigus foliaceus, SLE, vasculitis
 Ear: otitis externa, atopy, FA, demodicosis, dermatophytosis,
dermatomyositis, Otodectes, Scabies, fly dermatitis, vasculitis,
marginal (pinna) seborrhea
 Nasal planum: discoid LE, drug eruption, pemphigus
erythematosus, pemphigus foliaceus, uveodermatologic syndrome
 Lip: demodicosis, feline indolent ulcer, LE (lupus erythematosus),
bacterial muzzle furunculosis, canine oral papillomatosis,
uveodermatologic syndrome
 Oral cavity: eosinophil granuloma, plaque, indolent ulcer
 Mucocutaneous-junction: SLE, mucocutaneous pyoderma
Regional diagnosis of non-neoplastic dermatoses
 Neck: feline AD, -FA, -FAD, kutya: Malassezia dermatitis
 Axilla: acanthosis nigricans, atopy, Scabies, FA, Malassezia d.
 Back: atopy, FAD, Cheyletiellosis, FA, hypothyroidism, primary
seborrhea, feline psychogenic dermatitise or alopecia
 Trunck: generalized demodicosis, hyperadrenocorticism,
hypothyroidism, sebaceous adenitis
 Abdomen: feline symmetric alopecia, eosinophilic plaque, fFA, fAD,
feline psychogenic alopecia and dermatitis, impetigo,
hyperadrenocorticism, canine contact dermatitis
 Tail: feline symmetric alopecia, FAD, hyperplasia of tail gland, „stud
tail”, mechanical irritation, feline psychogen dermatitis or alopecia
 Anus: anal sac disease, perianal gland hyperplasia
Regional diagnosis of non-neoplastic dermatoses
 Legs: acral lick dermatitis, contact dermatitis, demodicosis,
dermatophytosis, elbow callus, canine Scabies, feline: eo. gr.
 Paws: atopy, demodicosis, dermatophytosis, FA, Malassezia d.
pemphigus foliaceus, digital pad hyperkeratosis, contact
dermatitis
 Claws: feline hyperthyroidism, paronychia (bacterial, feline-
leukemia, traumatic), trauma, lupoid ochynodystrophy

Establishing the differential-

diagnosis