Pruritus and Its Evaluation

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Questions and Answers

Which of the following best defines pruritus?

A condition that primarily affects the subcutaneous tissues.

A skin condition characterized by excessive dryness and scaling.

A sensation that provokes the desire to scratch. (correct)

A reaction of the skin due to a bacterial infection.

Which factor is LEAST likely to exacerbate pruritus?

Anxiety.

Moderate exercise. (correct)

Extreme temperatures.

Boredom.

Which of the following is LEAST helpful when evaluating a patient's pruritus?

The distribution of the itch.

The patient's breed. (correct)

Whether other animals or people in the household are affected.

Whether the itch is seasonal or non-seasonal.

According to the provided material, which of the following is NOT a primary cause of pruritus?

Nutritional deficiencies. (C) Signup and view all the answers

What is the primary purpose of a pruritus score, such as the Visual Analog Scale (VAS)?

To objectively assess and quantify the itch level of a patient. (B) Signup and view all the answers

What is a key aspect of IL-31 administration?

It requires 1-3 days to work. (C) Signup and view all the answers

What is a significant benefit of using immunotherapy?

It modifies the immune responses. (A) Signup and view all the answers

How long does it generally take to see improvement with immunotherapy?

4-6 months (B) Signup and view all the answers

Which condition is associated with the use of Cytopoint?

Safe for all ages (D) Signup and view all the answers

Which of the following statements about intradermal allergy testing is correct?

It is still commonly performed by most dermatologists. (A) Signup and view all the answers

What role does sublingual immunotherapy play in treating allergies?

Targets mucosal dendritic cells. (D) Signup and view all the answers

Why is serum testing generally not indicated for food allergies?

It has no correlation between findings and disease. (B) Signup and view all the answers

What is a common misconception about allergy testing?

Allergy testing is a diagnostic test. (D) Signup and view all the answers

What is the duration of an elimination diet trial?

8-12 weeks (B) Signup and view all the answers

Which of the following is NOT advised during the elimination diet?

Prescription diet food (A) Signup and view all the answers

What should be done if there is no response to the diet trial?

Consult a vet for other diagnoses (B) Signup and view all the answers

What is a common skin reaction in dogs with fleabite hypersensitivity?

Caudal papular dermatitis (A) Signup and view all the answers

What action should be taken to manage fleabite hypersensitivity in pets?

Use anti-pruritic medications (B) Signup and view all the answers

When should new ingredients be introduced during the challenge phase of diet testing?

Every two weeks (C) Signup and view all the answers

What is a potential allergen source in diets aside from proteins?

Food additives (B) Signup and view all the answers

Which symptom is NOT associated with fleabite hypersensitivity in cats?

Corn-cobbing of the legs (B) Signup and view all the answers

What should be monitored every six months while using glucocorticoids?

CBC/Chemistry/Urinalysis/Urine Culture (B) Signup and view all the answers

Which of the following is an adverse effect associated with glucocorticoids?

Increased appetite (D) Signup and view all the answers

What is recommended regarding the use of Depo-Medrol?

Avoid using it if possible. (C) Signup and view all the answers

What combination is suggested to help achieve steroid-sparing effects?

Trimeprazine and fatty acids (A) Signup and view all the answers

Which condition should be approached with caution when using glucocorticoids in cats?

Hypertrophic cardiomyopathy (HCM) (D) Signup and view all the answers

What is the recommended treatment approach for superficial pyoderma?

Use topical therapies and systemic antibiotics until clinical resolution (D) Signup and view all the answers

Which topical therapies are commonly used to treat Malassezia dermatitis?

Miconazole/Ketoconazole shampoos and medicated wipes (B) Signup and view all the answers

In treating atopic dermatitis, what is one of the multiple benefits of frequent bathing?

It helps remove allergens, bacteria, and yeast from fur (A) Signup and view all the answers

Which systemic therapy is NOT recommended for pets on a food trial according to the treatment of atopic dermatitis?

Fatty Acids (D) Signup and view all the answers

What should be investigated if an atopic pet experiences a sudden flare-up?

Possible exposure to allergens and underlying infections (A) Signup and view all the answers

What is the most common clinical lesion associated with atopic dermatitis in dogs?

Erythema (B) Signup and view all the answers

Which of these is NOT a characteristic feature of feline atopic syndrome (FAS)?

Presence of IgE antibodies to environmental allergens (A) Signup and view all the answers

What is a key difference between atopic dermatitis in dogs and cats?

The specific nomenclature used to describe the condition differs (A) Signup and view all the answers

What is the primary factor contributing to self-trauma in dogs with atopic dermatitis?

Pruritus (B) Signup and view all the answers

Atopic dermatitis is considered a multifactorial disease. Which of the following factors is NOT generally considered to play a role in its development?

Hormonal imbalances (A) Signup and view all the answers

What is the typical age range for the onset of atopic dermatitis in dogs?

6 months to 3 years old (A) Signup and view all the answers

Which of the following clinical signs is NOT commonly associated with atopic dermatitis in dogs?

Epilepsy (B) Signup and view all the answers

Which of the following is a common area of hair loss in dogs affected by atopic dermatitis?

Axillae (C) Signup and view all the answers

Study Notes

Pruritus Overview

Pruritus is itching, a sensation that provokes a desire to scratch.
It is a common symptom in dermatological conditions.
Other factors like anxiety, boredom, heat, or cold can worsen itching.

History Taking

Important factors to consider include: seasonal versus non-seasonal itching, distribution of the itch, affected animals or people, duration of the problem, and successful treatments.
A thorough history and physical exam are key for differential diagnoses.

Visual Analog Scale (VAS)

Used to assess the intensity of pruritus.
A scale ranging from 0 (no itch) to 10 (extreme itch), helps quantify the level of itch experienced by the animal.

Causes of Pruritus

Allergic dermatitis is a potential cause.
Parasites, infections, keratinization disorders, neoplasia, and autoimmune conditions may also cause itching.

Atopic Dermatitis

Defined by the ACVD Task Force as a genetically predisposed, inflammatory, and pruritic allergic skin disease.
Characterized by IgE reactions primarily directed against environmental allergens
Multifactorial, encompassing genetic predisposition, defective skin barrier function, abnormal epidermal differentiation, and immunological abnormalities.
Dogs show onset of symptoms between six months and three years of age. Symptoms can transition from being seasonal to non-seasonal. Older dogs may show symptoms after relocating to a warmer climate.
Pruritus, with hairless areas (axillae, inguinal region, interdigital), can be generalized or localized.
Clinical lesions often include erythema, lichenification, hyperpigmentation, and acral lick granulomas, along with secondary infections.

Cats

Feline atopic syndrome (FAS) is a similar condition in cats.
Diagnosis of atopic dermatitis or similar conditions is based on exclusion and history.

Feline Eosinophilic Complex

Affecting skin, mucocutaneous junctions, and the oral cavity.

Feline Eosinophilic Granuloma

Recognized in three forms: cutaneous, mucocutaneous, and oral.
Frequently occurs simultaneously.

Feline Eosinophilic Plaque

Lesions are identified as single or multiple, well-circumscribed, raised, erythematous, or ulcerated plaques
Commonly found on the abdomen and medial thighs.
Pruritus is typically severe.
Secondary infections are common.

Rodent Ulcers

Early lesions are usually crusted, erythematous, and depressed ulcers of the lip margin.
Lesions may enlarge and develop red-brown pigmentation.
Usually found on the upper lip, sometimes unilaterally or bilaterally.
Can progress to squamous cell carcinoma.

Treatment

Treatment for the eosinophilic granuloma complex requires identifying underlying causes, including hypersensitivity disorders.
Antibiotics like amoxicillin clavulanate are often used.
Other treatments might include prednisolone or cyclosporine.

Atopic Dermatitis Diagnosis

A diagnosis is based on exclusion of other diseases and consideration of history and clinical signs.
Allergy testing and biopsies are not conclusive for diagnosis.

Differential Diagnoses

For dogs: food allergies, secondary infections, flea allergies, dermatophytosis, parasites.
For cats: flea allergies, food allergies, dermatophytosis, parasites, and secondary infections.

Elimination Diet Trial

The trial requires a complete diet change to an exclusive novel protein diet.
All other treats and medications should be considered during the trial.
A trial of 8-12 weeks could reveal the allergen.

Other Important Considerations

Owners should always be mindful of the potential for secondary infections or parasites related to pruritus.
In case of reoccurring problems or unexpected flare-ups, further evaluation is recommended.

Immunotherapy (ASIT)

Allergen-specific immunotherapy.
Long-term allergic control.

Important Considerations on Treatment and Diagnoses

Avoid OTC diets.
Evaluate the use of cyclosporine, a specific treatment for hypersensitivity reactions and itchiness, with caution and careful monitoring regarding potential side effects.
Be aware of possible off-label therapies and related side effects.

Topical and Systemic Therapies

Frequent bathing and topical therapies (such as chlorhexidine/miconazole shampoos, hypoallergenic shampoos, wipes) remove allergens, bacteria, and yeast in topical application.
Systemic therapies, such as antihistamines, glucocorticosteroids, and other immune-modulating agents.

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Description

This quiz focuses on understanding pruritus, including its definitions, exacerbating factors, and evaluation methods. Test your knowledge about the primary causes of pruritus and the effectiveness of various assessment tools like the Visual Analog Scale (VAS).