dermatological history and examination

76
Dermatological History and Examination Natapol Pumipuntu,DVM

Upload: filmnatapol

Post on 16-Jan-2015

2.195 views

Category:

Health & Medicine


6 download

DESCRIPTION

 

TRANSCRIPT

Page 1: Dermatological history and examination

Dermatological History and Examination

Natapol Pumipuntu,DVM

Page 2: Dermatological history and examination

• Contents• โรคผิ�วหนังในัสุ นัข• ข�นัตอนัการตรวจว�นั�จฉัย - History taking - Physical Examination - Differential Diagnosis - Diagnosis Test & Clinical pathology - Tentative Diagnosis & Definitive Diagnosis• การรกษาเบื้��องต�นั

Page 3: Dermatological history and examination

• จ�าแนักตามสุาเหต ของโรคได้�ด้งนั!�

• Parasitic diseases• Bacterial skin diseases• Viral, Protozoal and Rickettsial skin

disease• Fungal skin diseases• Hypersensitivities• Autoimmune dermatoses

Page 4: Dermatological history and examination

• จ�าแนักตามสุาเหต ของโรคได้�ด้งนั!�(ต"อ)

• Endocrine dermatoses• Nutritional dermatoses• Neoplastic dermatoses• Psychogenic dermatoses• Congenital and hereditary dermatoses• Miscellaneous dermatoses

Page 5: Dermatological history and examination

• Parasitic diseases

• Demodex canis• Sarcoptes scabiei• Otodectes cynotis• Cheyletiella spp.• Tick• Flea• Fly

Page 6: Dermatological history and examination

Demodex canis

Page 7: Dermatological history and examination

Sarcoptic mange

Page 8: Dermatological history and examination

Otodectes cynotis

Page 9: Dermatological history and examination

• Bacterial skin diseases

• Staphylococcus intermedius (coagulase-positive & Gram-positive coccus)

Page 10: Dermatological history and examination

• Bacterial skin diseases (cont)

• Surface infections - pyotraumatimatic dermatitis

(Hotspot) - fold pyoderma

Page 11: Dermatological history and examination

• Bacterial skin diseases (cont)

• Superficial infections - impetigo - Superficial folliculitis

Page 12: Dermatological history and examination

• Bacterial skin diseases (cont)• Deep infections - Deep folliculitis - Deep pyoderma - cellulitis - mycobacterial infections

Page 13: Dermatological history and examination

• Viral, protozoal and Ricketsettsial skin diseases

• Viral : canine distemper virus canine viral papillomatosis etc.• Protozoal : canine leishmaniasis etc.• Bacteria : Ehrlichia canis etc.

Page 14: Dermatological history and examination

• Fungal skin diseases

• Fungi - Microsporum canis - Microsporum gypseam - Trichophyton mentagrophytes• Yeast - Malassezia patchydermatis

Page 15: Dermatological history and examination

• Hypersensitivites

• Allergic contact dermatitis• Inhalant allergy• Adverse reaction to food• Drug eruption

etc.

Page 16: Dermatological history and examination

• Autoimmune dermatoses

• Lupus erythematosus• Pemphigus foliaceus• Pemphigoid syndrome• Alopecia areata• Discoid lupus erythematosus• Pemphigus vulgaris

Page 17: Dermatological history and examination

• Endocrine dermatoses

• Hypothyroidisim• Hyperadrenocorticism• Gonadal hormones• Growth hormone etc.

Page 18: Dermatological history and examination

• Nutritional dermatoses

• Protein/calorie deficiency• Essential fatty acid deficiency• Vitamin A deficiency• Vitamin E deficiency• Zinc deficiency

Page 19: Dermatological history and examination

• Neoplastic dermatoses

• Tumors of epithelial origin : Papilloma, Basal cell tumor, Sebaceous gland tumor, Squamous cell carcinoma etc.

Page 20: Dermatological history and examination

• Neoplastic dermatoses (cont)

• Tumors of mesenchymal origin : Fibroma, Fibrosarcoma, Lipoma, Liposacoma, Mast cell tumor etc.

Page 21: Dermatological history and examination

• Neoplastic dermatoses (cont)

• Tumors of lymphohistiocytic origin : Histiocytosis, cutaneous lymphoma, Transmissible venereal tumor etc.

Page 22: Dermatological history and examination

• Psychogenic dermatoses

• Lick dermatitis

Page 23: Dermatological history and examination

• Miscellaneous dermatoses

• Congenital dermatoses• Hereditary dermatoses• Keratinization disorder• Metabolic dermatitis

Page 24: Dermatological history and examination

ขั้��นตอนการวิ�น�จฉั�ยโรคผิ�วิหน�งHISTORY

Physical Examination

Differential Diagnosis

Diagnosis Test & Clinical Pathology

Tentative Diagnosis or Difinitive Diagnosis

Treatment

Page 25: Dermatological history and examination

• การซั�กประวิ�ต� (History Taking)

Page 26: Dermatological history and examination

• การซักประวต�ข�อม&ลพื้��นัฐานั• ข�อม&ลของเจ�าของสุตว* เช่"นั ช่�,อ ที่!,อย&" เบื้อร*โที่ร• ข�อม&ลประจ�าตวสุตว* เช่"นั ช่�,อ พื้นัธุ์ * อาย ประวต�

วคซั!นั ประวต�ที่�าหมนั ฯลฯ

• ซักประวต�ที่ ,วไป เช่"นั อาหาร สุภาพื้แวด้ล�อม ที่!,นัอนั จ�านัวนัสุตว*ที่!,เล!�ยงรวมกนั ฯลฯ

CHIEF COMPLAINT

ซั�กประวิ�ต�เน�นระบบผิ�วิหน�ง

Page 27: Dermatological history and examination

• การซักประวต�เนั�นัระบื้บื้ผิ�วหนัง• วนัที่!,/อาย ที่!,พื้บื้ป1ญหาของผิ�วหนังคร�งแรก• ลกษณะของการเก�ด้เป4นัแบื้บื้ที่นัที่!ที่นัใด้หร�อค"อยเป4นัค"อยไป

• …พื้บื้ในัช่"วงฤด้&ใด้ฤด้&หนั6,งหร�อไม" ฤด้&อะไร• ความผิ�ด้ปกต�ของผิ�วหนังเก�ด้ข6�นัคร�งแรกที่!,ต�าแหนั"งใด้• ลกษณะของความผิ�ด้ปกต�ที่!,พื้บื้ม!ลกษณะเป4นัอย"างไร• สุตว*คนัหร�อไม" คนัอย"างไรตลอด้เวลา/เป4นัคร�งคราว/เฉัพื้าะกลางค�นั

• ต�ด้ต"อไปยงสุตว*ตวอ�,นั/ช่นั�ด้อ�,นัหร�อไม"• สุตว*ตวอ�,นัหร�อคนัเล!�ยงม!ป1ญหาของผิ�วหนังหร�อไม"• … …เคยใช่�ยารกษามาก"อนัหร�อไม" ยาอะไร .ตอบื้สุนัองต"อการรกษาหร�อไม"

Page 28: Dermatological history and examination

• การซักประวต�เนั�นัระบื้บื้ผิ�วหนัง

• เจ�าของค�ด้ว"านั"าจะเก�ด้จากสุาเหต ใด้• อะไร/สุ�,งใด้ที่!,ที่�าให�อาการของป1ญหาผิ�วหนังร นัแรงมากข6�นั

• …เคยพื้บื้เห7บื้หมด้บื้นัตวสุ นัขหร�อไม" ว�ธุ์!ก�าจด้/ป8องกนั

• … การอาบื้นั��า ความถี่!, แช่มพื้&ที่!,ใช่� ลกษณะ ของการอาบื้นั��า ฯลฯ

Page 29: Dermatological history and examination

• History

• Breed• Age• Sex• Environment• Diet• Health status• History of disease• Response to previous treatments

Page 30: Dermatological history and examination

• การตรวจร"างกาย(Physical Examination)

Page 31: Dermatological history and examination

• Physical Examination

• ต�าแหนั"งของว�การ

Page 32: Dermatological history and examination

• Physical Examination

• ร&ปแบื้บื้การกระจายของว�การ - Bilaterally symmetric lesion - Asymmetric lesion

Page 33: Dermatological history and examination

• Physical Examination

• ร&ปลกษณะของว�การ - Single - Linear - Annular

Page 34: Dermatological history and examination

ANNULAR LESION

ARCIFORM LESION

LINEAR LESION

Page 35: Dermatological history and examination

• Physical Examination

• ลกษณะของว�การ - Primary Lesions - Secondary Lesions

Page 36: Dermatological history and examination

• <<Primary Lesions>>• Macules & Patches - Discoloration of the skin - macules less than 1 cm in diameter - patches larger than 1 cm in diameter

Page 37: Dermatological history and examination

***The change is colour may result from pigment loss or excess, erythema or haemorrhage.

Page 38: Dermatological history and examination

• Papules & Plaques

• A circumscribed, solid elevation of the skin

• Papules less than 1 cm in diameter (often pink and red)

• Plaques larger than 1 cm in diameter

Page 39: Dermatological history and examination
Page 40: Dermatological history and examination

• Pustules

• Circumscribed elevations of the superficial layers of the epidemis

• Bacterial infection• The infiltrate will contain

neutrophils, bacteria, debris and perhaps a few free keratinocytes

Page 41: Dermatological history and examination

PUSTULE

**The most important cause is Staphylococcus intermedius

Page 42: Dermatological history and examination

• Wheals• More or less well-defined

elevations of the skin due to edema• Round, oval or plaque-like• Disappears within minutes or hours**angioedema

*Localised mast cell degranulation within the skin

Page 43: Dermatological history and examination

• Vesicles & Bullae• A well-demarcated elevation of the

superficial layers of the skin• Vesicles less than 1 cm in diameter• Bullae lager than 1 cm in diameter

Page 44: Dermatological history and examination
Page 45: Dermatological history and examination

• Nodules• Circumscribed elevations of the

skin that are larger than the 1 cm in diameter (deeper skin layers)

Page 46: Dermatological history and examination

• Tumors• Masses of neoplastic origin

whether benign or malignant• May extend into the deeper

subcutaneous tissue

Page 47: Dermatological history and examination

• Cysts• Cavities within the skin that are

lined by epithelium

Page 48: Dermatological history and examination

• <<Secondary Lesions>>

• Comedones - dilated hair follicle which contains a pigmented impaction of lipid and keratinaceous debris “BLACK HEAD”

Page 49: Dermatological history and examination

• Scale

• Associated with the shedding of large rafts of keratinocytes (accumulation of loose cornified fragment of the epidermis)

Page 50: Dermatological history and examination

• Crust

• Composed of dried exudate mixtd with debris on the skin surface (serum/blood/pus)

Page 51: Dermatological history and examination

• Exocoriation• Areas of epidermal damage

(caused by scratching, biting or rubbing)

Page 52: Dermatological history and examination

• Ulceration• The integrity of the basal layer

(basement membrane) is destroyed• The dermis is involved and healing

is often by scar formation

Page 53: Dermatological history and examination

• Lichenification• A thickening of the epidermis with an

accompanying hyperpigmentation in most instances (elephant skin like)

Page 54: Dermatological history and examination

• Hyperpigmentation• Usually a consequence of melanin

excessHypopigmentation

• Loss of pigment

Page 55: Dermatological history and examination

• Scar• Occurs when the basal layers of the

epidermis have been breached and the underlying dermis is damaged

Page 56: Dermatological history and examination

• การตรวิจวิ�น�จฉั�ยโรคผิ�วิหน�ง

ซั�กประวิ�ต� & ตรวิจร�างกาย

Problem list ?

Page 57: Dermatological history and examination

• Problem list?

• Pruritus• Focal / generalized/symmetrical alopecia• Crust• Hyperpigmentation• Scale• Nodule• Patch• Plaque

Page 58: Dermatological history and examination

•Diagnostic Test• TrichogramIdentification of fur mites, adherent egg

cases, fractured ends to the hair shaft** Trichograms are not a reliable method of diagnosing, or ruling

out, ectoparasite infections

Page 59: Dermatological history and examination

• Method

• Remove a small tuft of hair with fingers or forceps

• Laid onto trasparent adhesive tape

• Laid onto a glass slide

• Microscopic examination

Page 60: Dermatological history and examination

• Adhesive tape stripping

• Allows direct sampling of the coat or skin surface&hair

• Observes squamous morphology, ectoparasites and micro-organisms

Page 61: Dermatological history and examination

• Method• A commercial, clear, adhesive tape is

gently pressed onto the clipped skin surface

removed stained with Diff Quick

Laid acrossA glass slide

Laid across a glass slide

Page 62: Dermatological history and examination

• Skin scraping

• This procedure samples the surface, the epidermis and the upper dermis

• Indication of Demodex spp., Sarcoptes scabiei and Cheyletiella spp.

• Indication of dermatophytosis (spores)

Page 63: Dermatological history and examination

• Method

• Parasites Clip hair

Liquid paraffin is applied to the skin surface & slide

Dragged across the tensed skin repeatedly by the blade

Transfer accummulated sample to the slide

Page 64: Dermatological history and examination

• Method • Dermatophyte

Clip hair

10%KOH applied to the skin surface & slide

Dragged across the tensed skin repeatedly by the blade

Transfer accummulated sample to the slide

Heat fixing

Stained with Lactophenol cotton blue or India ink

Page 65: Dermatological history and examination

•Wood’s light• Indication of Microsporum canis,Microsporum distortum, Microsporum audoinii,

Trichophyton scnoenleinii

• False positive : Pseudomonas spp., Corynebacterium spp., keratin, soap, petroleum and some drugs.

Page 66: Dermatological history and examination

• Wood lamp examination

Page 67: Dermatological history and examination

• Fungal culture

• The scale and hair are inoculated onto a culture plate containing a medium

Page 68: Dermatological history and examination

• Otic sampling

• Indication of Malassezia pachydermatis, bacteria and mites

• Method the sample is collected with a cotton swab

dryfixing

staining

Page 69: Dermatological history and examination

• Impression cytology

• Used to sample cells from the surface of erosions and ulcers or from the orifices of discharging fistulae

• MedthodPressing a cleaned glass slide against the lesion

dry

Staining with Diff Quick

Page 70: Dermatological history and examination

• Aspiration cytology

• Used to sample cells from within lymph nodes, nodules and neplasms

• Method Needle aspiration

smear

dry

Staining with Diff Quick or special stain

Page 71: Dermatological history and examination

• Bacteria Culture

• Indication of aerobic bacteriaMethod the sample is collected with a cotton swab /

aspiration

Page 72: Dermatological history and examination

• Intradermal skin testing

• Demonstrate the presence of allergen-specific IgG on the mast cells at the site of the intradermal injection

• Method

Page 73: Dermatological history and examination

• Punch biopsy

• Obtain samples for histopathological examination

• Method Select site

Local anesthesia

Push biopsy punch through the skin

Remove sample & placed into 10% formaline

Page 74: Dermatological history and examination

• Treatment• หลั�กในการร�กษาโรคผิ�วิหน�ง - ขั้จ�ดสาเหต ขั้องโรค - ปร�บสภาพขั้นแลัะผิ�วิหน�ง - บ$าร งผิ�วิหน�งแลัะขั้น

Page 75: Dermatological history and examination

• ร%ปแบบขั้องการร�กษา• Topical treatment• Systemic therapy• Skin surgery

Page 76: Dermatological history and examination

• THANK YOU FOR YOUR ATTENTION

ถ้�าเรามั�วิแต�โทษคนอ)*น เราก+จะหย ดอย%�แค�น,� แต�ถ้�าเราโทษต�วิเอง เราจะไปได�อ,กไกลั - ส วิก�ต� อมัรพ�นธุ์ /-