The dermatology consultation

1 The dermatology consultation



INTRODUCTION


The initial, most important step in achieving a satisfactory consultation and management of any dermatological condition is to obtain a thorough history. Taking short cuts in this step can lead to a misdiagnosis, affect the welfare of the animal, and add a lot of unnecessary expense and dissatisfaction for the owner.


The history should be obtained in a logical fashion, with the view of building up a picture of the condition and a list of differential diagnoses, while examining the patient. This book shows how to work up a case in this manner.


With computerized records in most practices, the age at onset, breed and sex of the individual animal should be readily available. This information provides some useful clues when formulating a list of differential diagnosis.


Age at onset:


• Parasitic problems such as pediculosis, otoacariasis, cheyletiellosis and demodectic mange are more commonly seen in puppies and adolescent animals.

• Genodermatoses can become progressive and, in some cases, are more apparent with age. They are usually established by 3 years of age.

• Of the allergies, atopic dermatitis has an age of onset of more than 6 months and below 3 years, and flea allergic dermatitis is more common in animals older than 5 years of age.

• Hormonal problems tend to manifest after the age of 6 years.

• Neoplastic conditions generally occur in older animals.

Breed predispositions:


• Demodicosis in Staffordshire bull terriers, Scottish terriers.

• Atopic dermatitis in Labradors, West Highland terrier and other terrier breeds, German shepherd dogs, whereas flea allergic dermatitis can occur in any breed.

• Dermatophytosis is more prevalent in Persian cats.

• Dilute coat colour in certain breeds, i.e. blue coat in Dobermanns may be responsible for colour dilution alopecia.

Sex: Note whether the individual is entire or neutered. This is of particular interest when dealing with skin conditions associated with sex-hormone imbalance. There are few other skin conditions where sexual predispositions are recognized.



HISTORY TAKING


History taking is divided into those enquiries that relate specifically to the skin’s condition and those about the general history and management of the animal. In general practice, because time is limited, you could combine some of the questioning with the examination of the animal. If the condition is recurrent, much of the history will already be available on records and will just need confirmation from the owner.


Specific history – key questions:


• Date of onset?

• Is the condition seasonal or non-seasonal?

• If non-seasonal is it continuous and progressive or is it intermittent?

• Is the condition pruritic or non-pruritic? This should include licking, biting, scratching or rubbing. If pruritic, we need to know whether initially non-pruritic and subsequently changed or has always been pruritic.

• Distribution of the lesions now, and initially, and how they have progressed?

• Is there a smell associated with the condition?

• Are there any in-contact animals in the house or casual contacts and if so are they affected?

• Are any people in the house affected?

• Did the condition start following a visit to the grooming parlour, or to boarding kennels?

• Are there any fleas on any of the pets in the house?

Non-specific history: You should include questions relating to the animal’s general health and management, and you may need to ask more specific questions as you build up a picture of the condition.


General health – key questions:


• Is the appetite affected and, if so, has it increased or decreased?

• Has there been any change in water intake?

• Has the exercise tolerance changed?

• Is there any cough, sneezing or breathing difficulty?

• Have there been signs associated with gastroenteric disorders?

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Sep 3, 2016 | Posted by in SMALL ANIMAL | Comments Off on The dermatology consultation

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