Dermatological Emergencies UGA CE Banovic
Some shampoos accidentally contain Pseudomonas, oer Burkholderia. The case he showed was a ten year old bottle of craptastic shampoo.
Post Grooming Furunculosis
- Right after grooming the dog develops a severe deep pyderma with depression, fever, painful boils, appetite drops off. Can go septic. QUINOLONE antibiotics.
- Face seems to be rotting off, especially muzzle, but some lesions showing up on muzzle. YOUNG dogs. “Puppy Strangles” sometimes bacteria can be grown but it seems mainly to be sterile dermatitis. Lymph nodes can be large. Steroids – Pred plus or minus dexamethasone kickoff.
- Antibiotics for possible secondary infections
- Pain meds / Tramadol
- The slide ho showed was horrid. Oozy, red, even bullous. Probably would not have thought demodex for that, because it was so wrecked.
- BRAVECTO (afoxolaner) is very effective for demodex and otodectes.
Eosinophilic Folliculitis / Furunculosis
- Bloody pustules on the bridge of the nose.
- Etiology usually unknown.
- Biopsies / cytology is diagnostic. Eosinophils.
- Draining tracts
Toxic Epidermal Necrolysis (TEN) (happens to be the same disease as Steven-Johnson Syndrome) (SJS)
- Skin gets wrecked, red, exudative and you can see the epidermis coming off like wet tissue paper. The dermis is fine on the histopath.
- Management is basically wound management, analgesics, withdrawal of the culprit drug. Watcch plasma/fluid losses through skin.
- I got an image of the screen he shows for suspect drugs but antibiotics sulfas and cephalosporins are high on the list. But there are MANY.
- Steroids are a dubious thing. But they use them, dex IV, cyclosporine, Pred.
- Dog suddenly gets red all over but that’s dry, then skin starts dying in blisters and those slough leaving ulcerations. It was groomed two days ago. Eventually the ulcerations coalesced. And granulated in. It was a burn from a malfunctioning dryer. Superheated the plastic the dog was lying on.
Acute Eosinophilic Dermatitis
- Dog vomiting and diarrhea and suddenly goes red (erythroderma) with atopic looking ears.
- No draining tracts.
- Steroids and novel-protein diet. Ceterizine.
- Foot pads cracking and dry look like pale clay, in between toes – interdigital pododermatitis – very high liver enzymes – always starts with liver enzyme elevation.
- From Chronic Hepatopathy
- Or, glucagon producing tumors, or Phenobarbital, mycotoxins and very rarely, gastrointestinal issues.
- Manage liver: IV Amino Acids $400 (single dose sometimes work), Essential fatty acids, Zinc methionine, octreotide helps SKIN SIGNS but not the liver disease.
For horrid skins, there’s no way you’d proceed without a detailed “what happened recently, exclude nothing” and bloodwork for liver, skin scrape, and full thickness skin biopsy.
BIOPSY SITE SELECTION
Certain conditions you can get from ONE core. And most labs allow you four cores – use them all.
Get the middle, edge, adjacent pink areas, “each different type of pathology you can see”
Dr. Banovic seems to like “margins” and he always uses 8 mm punches.
“Collect primary skin lesions”
Skin lesions common terms: Patches, plaques, pustules, vesicle or bulla, wheal, nodule.
Nodules <= biopsy right in the middle of the mass
Erosions / ulcerations <= don’t bother biopsying right in the middle of the advanced lesion. Pick “advancing” areas.
Vaccine induced vasculitis – Looks like a thin spot in the fur.
Alopecia -> Center -> Margin -> Perfect skin