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Questions and Answers
What is the first step in approaching a clinical case of pruritis?
What is the first step in approaching a clinical case of pruritis?
Which of the following methods is NOT suggested for refining differential diagnoses?
Which of the following methods is NOT suggested for refining differential diagnoses?
What diagnostic procedure is appropriate for investigating causes of pruritus?
What diagnostic procedure is appropriate for investigating causes of pruritus?
Which of the following factors is NOT relevant in the history taking for a pruritis case?
Which of the following factors is NOT relevant in the history taking for a pruritis case?
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When developing a treatment plan for pruritis, what is a crucial consideration?
When developing a treatment plan for pruritis, what is a crucial consideration?
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What is essential to include in the problem list for a pruritis case?
What is essential to include in the problem list for a pruritis case?
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What aspect of pruritis management is emphasized in the clinical approach?
What aspect of pruritis management is emphasized in the clinical approach?
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Which of the following is part of the approach to clinical case management for pruritis?
Which of the following is part of the approach to clinical case management for pruritis?
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What does an increase in pruritus indicate in animals?
What does an increase in pruritus indicate in animals?
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Which of the following is NOT a behavioral manifestation associated with pruritic skin disease?
Which of the following is NOT a behavioral manifestation associated with pruritic skin disease?
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Which of the following is included in the multidimensional approach to treating pruritic skin disease?
Which of the following is included in the multidimensional approach to treating pruritic skin disease?
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In the differential diagnosis of pruritic skin disease, which factor is represented by the letter 'I'?
In the differential diagnosis of pruritic skin disease, which factor is represented by the letter 'I'?
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How can environmental factors influence pruritus in animals?
How can environmental factors influence pruritus in animals?
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What is the recommended treatment for neurogenic causes of pruritus?
What is the recommended treatment for neurogenic causes of pruritus?
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Which of these treatments is primarily used for addressing infections in pruritic skin disease?
Which of these treatments is primarily used for addressing infections in pruritic skin disease?
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What role do antiparasitics play in treating pruritic skin disease?
What role do antiparasitics play in treating pruritic skin disease?
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Study Notes
Approach to Pruritus
- Students should be able to identify presentations of pruritic skin disease.
- Students should be able to create a differential diagnosis list for causes of pruritus.
- Students should be able to determine appropriate diagnostic procedures for pruritus.
- Students should be able to determine appropriate treatment options for causes of pruritus.
Current Evidence
- Skin problems are common in small animal practice.
- Ectoparasites are a major cause of skin problems in dogs and cats.
Approach to the Clinical Case
- History of the animal
- Signalment (breed, sex, age)
- Physical examination (general, dermatological)
- Problem list
- Refine problem list
- Differential diagnoses
- Diagnostics
- Clinical pathology
- Other tests
- Trial treatment
- Allergy testing
- Diagnosis
- Prognosis
- Treatment/Management
- Prevention
Recommended texts
- Muller and Kirk's Small Animal Dermatology, 7th Edition
- BSAVA Manual of Canine and Feline Dermatology, 3rd Edition
- Clinical Reasoning in Small Animal Practice
- BSAVA Small Animal Formulary
Points to remember for exam questions
- Define and refine your problem list and use all aspects of investigation for a refined problem list
- Use pattern recognition (check the first two text books)
- Use clinical reasoning
- What systems/systems involved?
- List your differential diagnoses
- What clinical management would you undertake in the clinic and after?
- Prognosis: What further tests would you do, and when?
- Prescribe appropriate treatments for species involved
Approach to Pruritic Skin Disease - History
- Any other animals or people affected?
- How long has the problem been going on?
- Worsening over time?
- Medications/how medications have helped in the past ?
- Ectoparasite treatment history
- Environmental changes
- Does the animal scratch, lick etc. which areas?
- Dietary changes
- Any changes in diet
Problems/Behavioural manifestations with Pruritic Skin Disease
- Irritability
- Depression
- Lethargy
- Interrupted behaviours
- Restlessness
- Threshold (Pruritus threshold):
- All patients tolerate varying degrees of pruritus
- Once threshold is exceeded, clinical signs start
- Threshold level varies depending on individual patient
Pruritic Visual Analog Scale (PVAS)
- Tool for quantifying pruritus
- Scale from 0 to 10
- 0 – Not Itchy; 10 – Extremely Itchy
- Score relates to observable behaviours
Approach to Pruritic Skin Disease - Diagnostics
- History, signalment, and clinical examination
- Lesion distribution
- Tape strips, impression smears
- Cytology, bacteria, yeasts, parasites
- Skin scrapes
- Wood's lamp (ringworm identification)
- Hair examination (self-trauma, fungi)
- Coat brush (flea dirt)
- Culture and sensitivity
- Bacteria/dermatophytes
- Intradermal skin testing (allergens, hypersensitivities)
- Serology Test results, allergies, etc
- Biopsy
- Treatment Trial
Approach to Pruritic Skin Disease – Parasites
- Fleas (flea allergy dermatitis)
- Lice
- Sarcoptic mange/scabies
- Demodecosis
- Cheyletiella infestation
- Trombicula autumnalis (harvest mites)
- Otodectes
- Insect bite hypersensitivity
- Chorioptes
- Psoroptes (sheep scab)
- Ticks
- Flies
- Midges (horses)
- Sweet itch
Approach to Pruritic Skin Disease - Allergies
- Hypersensitivities
- Urticaria
- Contact allergy
- Food allergies
- Atopy
Approach to Pruritic Skin Disease - Infection
- Secondary bacterial infections
- Pyotraumatic dermatitis
- Malassezia
- Ringworm
- Dermatophilosis
- Anal sac impaction
- Skin fold dermatitis
- Greasy pig disease
Approach to Pruritic Skin Disease - Dermatophytosis
- Cats – Microsporum canis
- Dogs – Trichophyton mentagrophytes / M. canis
- Environmental contamination
- Circular patches
- Zoonotic, particularly in children
- Diagnosis: Woods lamp, scrapings, microscopic analysis
- Treatment: itraconazole (licensed), malazeb
- Monitoring and continuous testing & cure for treatment
Approach to Pruritic Skin Disease - Neurogenic/Neoplastic
- Cutaneous T-cell lymphoma
- Feline orofacial pain syndrome
- Acral lick dermatitis
- Feline psychogenic alopecia
- Scrapie
Approach to clinical disease: Treatment
- Multidimensional approach
- Client communication
- Therapeutics:
- Antiparasits
- Antibiotics/Anti-fungals
- Steroids
- Antihistamines
- Cyclosporin
- Immunotherapy
- Wound management
- Topical treatment
- Environmental management
Prognosis
- Control the itch (below a “threshold”?)
- Control of the environment
- Curable conditions (e.g., ringworm, parasites)
- Need for lifelong management (e.g., Atopy, hypersensitivity)
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Description
This quiz focuses on the approach to diagnosing and treating pruritic skin diseases in small animals. Students will learn to identify presentations, create differential diagnoses, and determine appropriate diagnostic and treatment options based on current evidence and clinical case considerations.
