Scabies incognito in dog

stef artStroe Marina- Ștefania

6-th year student at FMVB, Faculty of Veterinary Medicine of Bucharest

Rottweiler dog, 1 year old, male, intact develop intense pruritus, mild erythema, crusts and less-hairy skin on the phalanges, hocks; no other cutaneous lesion than this diffuse erythema.

  • Other differentials (demodicosis, dermatophytosis, contact dermatitis, Malassezia dermatitis, hipersensitivity).
  • Pinnal-pedal reflex: rubbing of the ear margin and may obtain a scratch reflex.
  • The pinnal-pedal reflex in this case was positive
  • Microscopy

Superficial skin scraping: negative but false-negative results are commnon because mites are extremely difficult to find.

derm3

Macroconidia Alternaria alternata

derm2

Eggs/ova mites

Deep skin scraping: negative (for Demodex).

derm4

Malassezia spp.

Scotch test: detection of eggs/ova mites Sarcoptidae like, derm5 derm6Malassezia 8/OIF, bacterial cocci, macroconidia Alternaria alternata.

Serology (ELISA): detection of IgG antibodies against Sarcoptes. This is highly specific and sensitive test but false-negative results can occur. In this case the test was negative.

 

Diagnosis: “Scabies incognito”

 

Treatment and prognosis

  • Topical treatment applied to the entire body two times per week, 4-6 weeks. Bathing with a shampoo that contain chlorhexidine and antifungal (ketoconazole) – KetoHexidine shampoo 1%ketoconazole, 2%chlorhexidine.
  • Omega 3 and Omega 6 fatty acid supplements, which reduce inflammation and itching – Megaderm >10 kg, 1 dose/day, 1-2 months.
    • Systemic treatment with Ivermectin: 300-400 mcg/kg po or sc, once weekly for weeks. I use this scheme for 5 administration.
    • Recheck: progress, hair regrowth, decrease of the lesions.
    • The prognosis is good. S. scabiei is a highly contagious to other animals and to humans.

 

 

Diagnosing the allergic patient: a practical approach.

unnamedAlberto Martin Cordero, D.V.M

VETDERM: Dermatologia Veterinaria Especializada.

                Argentina 690, Guadalajara, Mexico

                   vetderm25@gmail.com

Allergic disease in animals and humans is a common condition. In dogs and cats is considered one of the main dermatosis affecting around 10% of the population. It is a pruritic, inflammatory, chronic disease with breed predisposition (1). Understanding the physiopathology and clinical characteristics is mandatory not only for the clinician, but the owner itself, due to the fact, most of the long-term treatment and management it is done by clinician-owner collaboration.

 

First of all, one of the main characteristics we may find on an allergic patient is pruritus. Pruritus is defined as the unpleasant sensation that triggers the desire of itching, this may be manifested as chewing, biting, licking, scratching or rubbing in our patients; due to this manifestations the clinician must be aware that most owners will associate pruritus only with itching, by this matter, a correct approach for the clinical history should be done addressing this questions correctly to include most of the manifestations of pruritus.

 

We must try to obtain a complete clinical history of the patient condition.

 

The second step is to rule out the common causes of pruritus. Bacteria, yeast and scabies may enhance or be the main cause of pruritus in some patients, however, the first two, most of the time have an underlying cause.

 

The clinician must use basic tools like skin scraping and cytology in order to detect secondary infection or scabies.

 

Scabies and allergies

 

Scabies may be a “tricky” condition; is capable of emulate perfectly clinical signs associated with allergic disease, leading to a misdiagnosis and even to therapeutic mistakes. A negative skin scraping is not guarantee of absence of the Sarcoptes mite, by the other way, the chances of finding the mite or its ova are around 30% performing a correct superficial skin scraping technique.

 

Some tips we may use in order to detect scabies are: low response or non-response of pruritus to corticosteroids, positive pinnal-podal reflex, and ear margin affectation.

 

Allergic patients respond fairly well to corticosteroids administration, being one of the most used therapies for short and middle management of pruritus. Its use must be concomitant to cautions by the clinician about side effects. Nevertheless, patients with scabies normally have a poor respond to corticosteroids. The clinician must be aware of the existence of secondary infections by bacteria or yeast, due to the fact they are able to exacerbate itch.19181716

 

Pinnal podal reflex is obtained by vigorously rubbing the tip of one earflap on to the base of the ear for five seconds, and it is considered positive if the ipsilateral hind leg made a scratching movement. On a recent study the specificity of testing for scabies by the pinnal-pedal scratch reflex was 93.8 per cent, and the sensitivity was 81.8 per cent (2). This test is not pathognomonic for Scabies, however is really helpful in determining if we need to establish a therapeutic trial to diagnose scabies.20

 

In the same study ear margin affectation was evaluated 73% of the dogs with scabies had pinnal dermatitis. Crust or desquamation of the ear margin is characteristic of scabies in some pruritic patients.

 

Therapeutic trial in scabies is referred to the administration of therapy for scabies and observation of diminish of the clinical signs to confirm the disease.

 

Once scabies have been ruled out, secondary infections by bacteria or yeast must be eradicated using the respective therapy. Cytology must be performed on the affected areas of the allergic patients in order to detect microorganisms.11

 

            Clinical signs of allergic disease.

 

Dogs and cats manifest differently clinical signs related to allergy. Differentiating a patient with food allergy or atopic dermatitis only with clinical manifestations is not an exact or easy task.10

 

Dogs and cats with food allergy or environmental components of allergy react the same and may have the exact pattern of lesions.15

 

Lesions normally occurring in allergic dogs are: papules, pustules and epidermal collarets characteristics of secondary bacterial infection; ear disease: pinnal erythema, otitis externa; erythema of: periocular region, axilla, ventral neck, chest, flexor surface of the elbow, interdigital areas, inguinal region, perianal region (3).

 

If we carefully perform and examination of the ear canal we may find mild clinical signs of allergic ear disease as react of the ear canal glands, erythema or mild inflammation of the ear canal. The author recommends exploring the ears on all patients suspicious of allergic disease.14

 

Flea allergic dermatitis or a flea component in the allergic patient may show clinical sign on the dorsolumbar region; and in some cases, flea feces “flea dirt” or the flea itself may be found.

 

Some patients may develop moist acute dermatitis “hot spots” on the lateral aspect of the head (this may be related with otitis externa) or in the dorsolumbar region (related to flea allergy); however, we must recall that moist acute dermatitis is not solely related to allergic disease.698

 

Cats may be develop any of the eosinophilic granuloma complex lesions as well as military dermatitis, feline acne, excoriations of the neck and on the back of the head, alopecia by excessive grooming. Secondary bacterial infections are not common in cats as in dogs.12

 

 

 

            Otitis externa in the allergic patient.

 

Otitis externa is defined as the inflammation and subsequent infection of the external ear canal. The causes and factors of otitis externa may be divided in 4 according to a classification proposed by Griffin. Predisposing, primary, secondary and perpetuating factors of otitis externa is the most accepted classification at this moment and is currently used by the author in patient classification.

 

Predisposing factors include: anatomical characteristics of the ear canal, such as hairy or stenotic ears, excessive moisture, and overtreatment with ear cleaners or swabs.

 

Primary factors include allergies, keratinization disorders, autoimmune and immune mediated conditions, endocrine diseases, and foreign bodies. Being allergy one of the main causes for recurrent otitis externa especially in dogs (4).

 

Secondary factors are related to bacteria or yeast infection.

 

Perpetuating factors normally are related to chronic pathological changes of the structure of the ear canal as well as complications within the middle ear.45

 

 

Evaluating level of itch

 

Pruritus level must be evaluated in allergic patients, a visual analogue score published by Hill et al., allows owner to effectively assess pruritus using a scale form 0 to 10 (5). This scale may be used at the rechecks or during the administration of allergen specific immunotherapy.3

 

Favrot criteria.

 

Favrot criteria are useful as a clinical aid in the diagnosis of canine atopic dermatitis (6). Following this criteria in combination with ruling out pruritic skin disease reduce the probabilities of false diagnosis of canine atopic dermatitis. Favrot criteria include:

 

  • Age of onset < 3 years
  • Mostly indoor
  • Corticosteroid responsive pruritus
  • Chronic or recurrent yeasts infections
  • Affected front feet
  • Affected ear pinnae
  • Non affected ear margins
  • Non affected dorsolumbar area

 

Establishing allergic components in the patient.

 

Allergic patient may have an environmental component, food component or flea allergic dermatitis. We must resist temptation to separate allergic diseases in all this major three allowing a patient to be diagnosed as “allergic”. Our diagnostic goal is to identify the allergenic components in the patient, being aeroallergens, food ingredients, flea or insects; separate or altogether in order to create a control plan for each individual (7).alberto 1

 

Patients with non-seasonal pruritus must be suspicious for food allergy, especially if the have gastrointestinal signs present. Questions like number of bowel movements, form of the feces, gases and increase of intestinal noises should be asked to owners. A recent study was able to determine the average number of bowel movements per day as 1 to 3 in 96% of the dogs of the study (8).

 

A correct restrictive diet must be performed in non-seasonal pruritic patients in order to confirm or rule out food allergy. The average length of the food trial is for 6 to 8 weeks (9). During this time, clinician must use hydrolyzed diet, novel protein diet or home cooked restrictive diet with limited ingredients.

 

Hydrolyzed proteins are composed by proteins chemically and physically “broken” in small particles. The smaller the allergen, smaller the capability of the IgE to catch this proteins even if the y are allergic to them. Prescription hydrolyzed diets claim a protein size from 3,500 to 10000 Daltons; novel diets mainly composed by amino acid ingredients claim a size lower than 1000 Daltons. Some studies have evaluated that up to 21% of patients with food allergy may react to hydrolyzed proteins (10).

 

 

The principle of using a novel protein diet is to administer ingredients to which have never be exposed before. The problem with “novel proteins” especially in over the counter pet foods are that the novel ingredients shown are only part of the ingredients contained and common ingredients in pet foods are generally used as additives. The clinician must advise pet owner to read all the ingredients in the dog food in order to avoid previously ingested ingredients. Even tough, another problem is secondary contaminants particles that may be found in “selective ingredients” pet foods as a result of the manufacturing process. A recent study evaluated secondary contamination by PCR and microscopically analysis of several commercial diets used on food trials (11).

 

Home cooked diets with limited ingredients seem, to be the best choice to perform a food trial, however, owner availability to cook for their pets, acceptance by the patient or choose of the correct ingredients are important factors to consider before prescribing this choice.

 

A good, low hydrolyzed prescription diet with small particle size is commonly the best choice to diagnose food allergy in dogs and cats.

 

Pruritus may be controlled the first couple of weeks of the food trials to avoid further injures using shot term pruritic management as short length corticosteroids or oclacitinib to diminish the initial clinical signs. Anti pruritic therapy should be discontinued in order to correctly evaluate the response to the restrictive diet.

 

During the food trial, owner and clinician will observe one of three manifestations: absence, diminish or continuation of pruritus.

 

An absence of pruritus should be continued with a re exposure to the previous ingredients or pet food ingested by the patient, and during the first week, clinical signs must re appear confirming the diagnosis of food allergy.

 

Diminish of pruritus must be addressed as previously stated with a re challenge to pet food, however, in this case, possibility of aeroallergens reaction must be suspected. The patient could be diagnosed as a patient with atopic dermatitis with a food allergy component.

 

Continuation of clinical signs after or during the food trial could lead us in the direction where no food allergy exist, but aero allergens and insect allergen may be the primary allergenic cause in the patient. Re challenge to previous diets is not needed on this case.

 

Allergy testing.

 

Allergy testing is reserved for the elaboration of allergen specific immunotherapy, an effective treatment for hyposensitize patients with environmental allergies. This test may be performed by intradermal application of allergens as well as measuring specific IgE in serum. Allergy testing should not be used with the purpose of diagnosing a patient with canine atopic dermatitis, must be strictly reserved for the elaboration of “allergy vaccines”, that are mixtures of allergens to which the patient is reactive and are applied with increasing concentrations in order to decrease future sensitization.13

 

Establish allergic patient management.

 

A short term, middle and long-term control management for the patient with environmental allergies must be created once we rule out other allergies and pruritic causes (11).

 

Short-term control management of the allergic patient includes:

  • Elimination of secondary bacterial and yeast infections. (identify these by cytology)
  • Short-term control of pruritus with topical or systemic corticosteroids, or oclacitinib administration.
  • Topical therapy with shampoos to control infections or moisturize the skin and coat

 

Middle term control management includes:

 

  • Restoration and improvement of epidermal barrier with essential fatty acids (EFAs) or topical essential oils
  • Prescription diets focused in improving epidermal barrier and diminish pro inflammatory factors
  • Anti pruritic control with Oclacitinib, oral cyclosporine, or corticosteroids (evaluate side effects and monitor the patient)
  • Concomitant use of soft topical steroids like hydrocortisone aceponate (when needed)
  • Topical therapy with moisturizing and epidermal barrier improvement shampoos.

 

Long term control management include:

 

  • Anti pruritic control with Oclacitinib, oral cyclosporine, or corticosteroids (evaluate side effects and monitor the patient)
  • Concomitant use of soft topical steroids like hydrocortisone aceponate (when needed)
  • Topical therapy with moisturizing and epidermal barrier improvement shampoos.
  • Administration of allergen specific immunotherapy based on allergy testing (in vitro or intradermal)
  • Antimicrobial therapy for bacteria and/or yeast (if needed)

 

REFERENCES

 

  1. Hillier, A., & Griffin, C. E. (2001). The ACVD task force on canine atopic dermatitis (I): incidence and prevalence. Veterinary Immunology and Immunopathology, 81(3-4), 147–151.
  2. Mueller RS, Bettenay SV, Shipstone M.. Value of the pinnal-pedal reflex in the diagnosis of canine scabies. Vet Rec. 2001 May 19;148(20):621-3
  3. Griffin, C. E., & DeBoer, D. J. (2001). The ACVD task force on canine atopic dermatitis (XIV): clinical manifestations of canine atopic dermatitis. Veterinary Immunology and Immunopathology, 81(3-4), 255–269.
  4. Saridomichelakis, M. N., Farmaki, R., & al, E. (2007). Aetiology of canine otitis externa: a retrospective study of 100 cases. Veterinary ….
  5. Rybníček, J., Lau-Gillard, P. J., Harvey, R., & Hill, P. B. (2009). Further validation of a pruritus severity scale for use in dogs. Veterinary Dermatology, 20(2), 115–122. Favrot, C., Steffan, J., Seewald, W., & Picco, F. (2010). A prospective study on the clinical features of chronic canine atopic dermatitis and its diagnosis. Veterinary Dermatology, 21(1), 23–31.
  6. Hensel, P., Santoro, D., Favrot, C., Hill, P., & Griffin, C. (2015). Canine atopic dermatitis: detailed guidelines for diagnosis and allergen identification. BMC Veterinary Research, 11(1), 1–13.
  7. Stetina, K. M., Marks, S. L., & Griffin, C. E. (2015). Owner assessment of pruritus and gastrointestinal signs in apparently healthy dogs with no history of cutaneous or noncutaneous disease. Veterinary Dermatology, 26(4), 246–e54.
  8. Olivry, T., Mueller, R. S., & Prélaud, P. (2015). Critically appraised topic on adverse food reactions of companion animals (1): duration of elimination diets. BMC Veterinary Research, 11(1), 1–3
  9. Habil, F. P. G. D. M. V. D., & DVM, S. R. M. (2011). Adverse Food Reactions in Dogs and Cats. Veterinary Clinics of NA: Small Animal Practice, 41(2), 361–379
  10. Ricci, R., Granato, A., Vascellari, M., Boscarato, M., Palagiano, C., Andrighetto, I., et al. (2013). Identification of undeclared sources of animal origin in canine dry foods used in dietary elimination trials. Journal of Animal Physiology and Animal Nutrition, 97, 32–38. Olivry, T., DeBoer, D. J., Favrot, C., Jackson, H. A., Mueller, R. S., Nuttall, T., & Prélaud, P. (2015). Treatment of canine atopic dermatitis: 2015 updated guidelines from the International Committee on Allergic Diseases of Animals (ICADA). BMC Veterinary Research, 11(1), 1–15

Dermatology – Part 1

svetlina

Dr Svetlina Alexandrova DVM, Member of ESVD

Light Vet Clinic, Bulgaria

 

 

1ST THING TO DO IS SKIN SCRAPING!!!

 

derma 14

Slide, mineral oil (lactophenol, glycerin, liquid paraffin), blunted scalpel blade and coverslip

1ST THING TO DO IS SKIN SCRAPING!!!

 

 

 

 

 

 

1.SARCOPTES SCABEI VAR. CANIS    

 

               Even if you don`t see it, treat it!

sarc

SARCOPTES SCABEI VAR. CANIS

sarc2

SARCOPTES SCABEI VAR. CANIS

Some treatment options:

Selamectin spot on 3 x every 2 weeks;

Moxidectin spot on 3 x every 2 weeks;

Ivermectin 0,2-0,4 mg/kg s.c. 4 injections every 7 days (not licensed for this use, heartworms test, MDR1 gene mutations);

Fipronil spray 3 mg/kg at 14-day intervals

 

 

2.DEMODEX SPP

 

 

Important note for all parasites search: closed diaphragm of the microscope and less light; scan the entire slide using 10X objectivederma

demo

DEMODEX SPP

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3.NEOTROMBICULA AUTUMNALIS (skin scrapings)

 

Clinical signs late summer and fall.

Some treatment options:

Fipronil spray

Parasiticidal dips

derma5

NEOTROMBICULA AUTUMNALIS

derma6

NEOTROMBICULA AUTUMNALIS

 

 

 

 

 

 

 

 

4. CHEYLETIELLA SPP. (skin scrapings, tape strip test)

 

Some treatment options:

Selamectin spot on every 14- to 30-day intervals

Ivermectin 0,2-0,3 mg/kg sc 2 injections at 14-day intervals

Fipronil spray

derma9

CHEYLETIELLA SPP.

derma10

CHEYLETIELLA SPP.

 

 

 

 

 

 

 

 

 

 

 

5.TRICHODECTES CANIS (coat brushing)

 

Some treatment options:

Selamectin spot on every 14- to 30-day intervals

Ivermectin 0,2-0,3 mg/kg sc 2 injections at 14-day intervals

Fipronil spray

derma11

TRICHODECTES CANIS

derma 12

TRICHODECTES CANIS

 

 

 

 

 

 

 

 

 

 

 

6.DERMATOPHYTOSIS  (tape strip test, wood lamp, fungal culture)

 

Some treatment options:

Topical therapy: enilconazole rinses, miconazole…

Systemic therapy: itraconazole, ketoconazole

derma13

DERMATOPHYTOSIS

derma 3

DERMATOPHYTOSIS

“Sharing is Caring” . How we exchange experience on The Balkans?

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Romania and Turkey!

One of the goals of the journal Vets on The Balkans is vets from that region to know each other and to find easier and cheaper way to upgrade their knowledge , experience and skills. We have so much good vets at our region and is easier to go from Bulgaria to Turkey, or from Romania to Serbia and learn what you are interested in.13020132_10153846384832935_145849298_n

We are more than happy that is already reality. Dr Onur Catar from Pet Code Veterinary Clinic in Ankara, Turkey visited Dermatology clinic of Dr Rares Capitan , resident ECVD.12992870_10153846383907935_796095468_n

Dr. Capitan graduated in 2006 from the Faculty of Veterinary Medicine Bucharest (University of Agronomic Sciences and Veterinary Medicine of Bucharest).13022364_10153846386352935_862538900_n
He is member of ESVD – European Society of Veterinary Dermatology

Dr. Capitan is passionate about all areas related to veterinary dermatology. His hope is that, in Eastern Europe, veterinary dermatology services be elevated to international standards.
In recent years Dr. Capitan has attended and graduated multiple intensive courses, seminars, and workshops, facilitated by famous dermatologists veterinarians in Europe and the United States, including:
ESAVS (European School for Advanced Veterinary Studies) – Vienna
International clerkship at Ohio State University – Dermatology and Otology

Recently he was accepted and has been participating in a veterinary dermatology residency under the guidance of Dr. Chiara NOLI DVM Diplomate of the European College of Veterinary dermatology.

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Dr Rares Capitan in Bulgaria!

He was as well guest as a consultant in 2 veterinary clinics in Sofia, Bulgaria!

When Dr onur Catar came back home in his daily job, he starts using his knowledge from Dr Rares Capitan.

This is the most important thing in our life, not only professional. “Hand by Hand” we all will be better!

 

Thank you guys for all! You are Vets on The Balkans!

 

Meeting with Dr Rares Capitan, DVM, resident ECVD

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Dr Rares Capitan , DVM, resident ECVD

    1. When and how you decided to be veterinarian?

I was inspired by my mom and she implement this idea in my mind, as early as I was in elementary school. For me it was my one option. It was life a goal to achieve. I studied veterinary high school and the next step was Veterinary Faculty. Another personal motivation was my first dog. When I was 10 years old and he unfortunately  died of Parvovirosis. I was  promised to myself that I will try to save as many animals as I can.

     2.How did you choose Dermatology as your professional?

I think all started by frustration of dealing with dermatological cases in my clinic.      Because if you think about Dermatology, are more less the same. So can you figure it out what is going on with the patient and what is the right diagnosis.Of course, you need to have patience , to have detective way of thinking. I think everything started by attending workshop by Chiara Noli in Bucharest. Then I understood that this is what I wanted to do . The more I got into it, I could not stop. Now, here I am, traveling as a specialist.

3. Tell us ” the price ” to be professional veterinarian?

This a good and hard question. Everybody is first concern about the money. Because the learning in this level is very costly. From my experience , I cannot say is not a financial matter, but is not the most important thing to reach your dream. Time is the most precious thing , because you need to learn, to prepare yourself for the mentor and college expectations. This is far beyond of my initial expectations.

To do residency at european level you need to be 200% motivated , 200% dedicated, 200% willing to succeed  and more less leave everything aside. But at the end I know it will worthy.

4. Tell us about your Dermatology Association in Romania?

I am very proud about our association. I think, the biggest goal is to bring international high level of science and practice of veterinary dermatology, closer to our region. I think SRDV (Romanian Society of Veterinary Dermatology) is starting to do that. We are young society, but we already had our first annual congress with 300 participants, 2 workshops and we plan to do 2 more this summer. We are organizing the second big annual congress in October this year. For future plans we want to spread the knowledge over other countries on the Balkans, where I know, there are vets , who  need to be part of our society. So we are open to welcome any vet from the Balkan to join us, whoever wants to get involve and join our spirit.

5.Which are negative and positive things to be vet on the Balkans?

Let’s start with the negative. We are depending of our countries economically substantial difference between our general practice level and this one in Western Europe. But there are a lot of good enthusiastic people who want to learn more and align the way of practice and knowledge.

6. Would you like to share with us your future plans?

Of course, I want to finish my residency and pass my exam. I want to build first dermatological clinic in our region. Another big dream of mind, is to have my own residents from the Balkans. So they continue this win. I am already looking for highly motivated vets that want to do performance.

7. What do you thin about Vets on The Balkans?

I think is a good interesting idea. I really hope that this project will  continue for a long time and collect many vets as want to share their experience. So the whole community from the Balkans will progress in a good way.

 

Dr Rares Capitan, DVM , resident in ECVD

He graduated in 2006 at Faculty in Veterinary Medicine in Bucharest , Romania. He is member of ESVD- Europian Society of Veterinary Dermatology.

He passionate about all areas related to veterinary dermatology services to elevated to international standards.

Founder member and President of SRDV – Romanian Society of Veterinary Dermatology

He is passionate about all areas related to veterinary dermatology services to elevated to international standards