Approach to Pruritis PDF

Approach to Pruritis Dynatra Subasinghe BVSc, PG Dip., MSc, PhD, MRCVS, SFHEA Learning objectives By then end of this lecture, students should be able to: 1.Identify the presentations of pruritic skin disease 2. Create a differential diagnosis list related to causes of pruritus 3....

Approach to Pruritis Dynatra Subasinghe BVSc, PG Dip., MSc, PhD, MRCVS, SFHEA Learning objectives By then end of this lecture, students should be able to: 1.Identify the presentations of pruritic skin disease 2. Create a differential diagnosis list related to causes of pruritus 3. Determine appropriate diagnostic procedures to determine cause of pruritus 4. Determine appropriate treatment options for causes of pruritus Current evidence Details of the most commonly nominated conditions for the most commonly nominated small animal (a) and large animal (b) species as outlined by 3982 veterinary clinicians. Why are you here today? How common are skin problems in small animal practice? Is it important? T. D. Nielsen et al. Veterinary Record 2014;174:324 Source - © British Veterinary Association. Approach to the clinical case History Signalment general clinical examination Dermatological examination Problem list Define and refine Differential diagnoses Differential diagnoses Diagnostics – clinical pathology, other tests, trial treatment, allergy testing…. Diagnosis Prognosis Treatment/Management Prevention Some of the texts to refer -for lectures Tip -Points to remember when you answer exam questions for this module - When you are asked a clinical case-based question – Define and refine your problem list ✓Use all aspects of your investigation listed in the following slides to come up with a refined problem list. 1.Use pattern recognition skills (as per the first two text books) 2.Use clinical reasoning (Clinical Reasoning in Small Animal Practice by Jill E. Maddison, Holger A. Volk, David B. Church 2015) ✓What systems or systems are involved? ✓List your differential diagnoses ✓Use various tests and evidence-based medicine to refine your differential diagnoses ✓What clinical management would you undertake in the clinic and after? ✓what is the prognosis? What further tests would you do and when? ✓Prescribe treatments accordingly (for small animals-The BSAVA Small Animal Formulary, look at equine and farm animal texts depending on species you are dealing with) Approach to pruritic skin disease Any other animals or people in the house affected? How long has it been going on? Has the problem got worse with Is your pet on any medications / have time? History medications helped in the past? What is the ectoparasite Has it happened before? treatment history? - Could it be seasonal? Don’t forget Does your animal scratch, chew, lick Anything itchy will end up with Is there a change in the or rub? Which areas? environment? infections, ulceration or hair loss What diet? Any change in Where on the body did the Other presentations mask the diet? problem start? primary cause Secret Scratchers Chronic problems Multi factorial Problems with Pruritic Skin Disease Behavioural manifestations Irritability Depression Lethargy Interruptive behaviours Restlessness ‘Aggression’ Pruritic Threshold The multitude of stimuli All patients can tolerate some level of pruritus without exhibiting signs Once threshold exceeded clinical signs begin Varies between individuals Lowered by stress, environmental factors Approach to pruritic skin disease Olivry.T, Marsella.R, Iwasaki.T, Muller.R 2007 Approach to pruritic skin disease Differential Diagnosis “itching is a PAIN” P –Parasites A –Allergies I –Infection N –Neurogenic / Neoplastic Approach to pruritic skin disease Treatment Multidimensional approach Client Communication Therapeutics ▪ Antiparastics ▪ Antibiotics / Antifungals ▪ Steroids ▪ Antihistamines ▪ Cyclosporin / Oclacitinib ▪ Immunotherapy Wound management Topical treatment Environmental management References Jackson., H, Marsella., R., (2012). BSAVA Manual of Canine and Feline Dermatology, 3rd Edition., Wiley: ISBN: 978-1-905-31927-5 Kumari KN, Reddy CBK, Kumar MY. (2016) A Case Of Erythema Multiforme Minor In A Dog.;5(6):3856-3859. Maddison., J. M., Volk h. A., Church d. B., (2015) Clinical Reasoning in Small Animal Practice.; Wiley-Blackwell; ISBN: 978-1-118-74175-7 Miller, W. H., Muller, G. H., Scott, D. W., Griffin, C. E., & Campbell, K. L. (2013). Muller and Kirk's Small Animal Dermatology. St. Louis, Mo: Saunders. Thank you