Clinical techniques in veterinary dermatology: Dermoscopy.

Dermoscopy is a noninvasive, painless, easy-to-perform technique used in human and veterinary medicine for rapid and magnified in vivo observation of dermatological lesions and disease. Dermoscopy can lead to a swifter diagnosis and may eliminate the need to perform more invasive diagnostic testing such as skin biopsies. To perform dermoscopy, the clinician needs a dermoscope and a software program equipped with image capture for pattern identification. Two techniques exist for dermoscopy: standard contact, where the dermoscope is applied directly to the patient's skin with the use of a liquid interface, or noncontact, where there is no direct contact between the skin and the dermoscope. The most important criteria to be considered when using dermoscopy are the morphology/arrangement of vascular structures, scaling patterns, colours, follicular abnormalities and specific disease features. Application of dermoscopic findings should always be correlated with the patient's history, clinical signs and the morphology of the skin lesions. Dermoscopy does require an initial financial and time investment by the clinician, yet this technique can quickly and easily help to identify patterns of disease that correlate with clinical diagnosis of dermatological disease.

La dermoscopie est une technique non invasive, indolore et facile à réaliser utilisée en médecine humaine et vétérinaire pour l'observation in vivo rapide et agrandie des lésions et maladies dermatologiques. La dermoscopie peut conduire à un diagnostic plus rapide et peut éliminer la nécessité d'effectuer des tests de diagnostic plus invasifs tels que des biopsies cutanées. Pour effectuer une dermoscopie, le clinicien a besoin d'un dermoscope et d'un logiciel équipé d'une capture d'image pour l'identification des motifs. Deux techniques existent pour la dermoscopie : contact standard, où le dermoscope est appliqué directement sur la peau du patient à l'aide d'une interface liquide, ou sans contact, où il n'y a pas de contact direct entre la peau et le dermoscope. Les critères les plus importants à prendre en compte lors de l'utilisation de la dermoscopie sont la morphologie/l'arrangement des structures vasculaires, les schémas de desquamation, les couleurs, les anomalies folliculaires et les caractéristiques spécifiques de la maladie. L'application des résultats dermoscopiques doit toujours être corrélée avec les antécédents du patient, les signes cliniques et la morphologie des lésions cutanées. La dermoscopie nécessite un investissement initial en argent et en temps de la part du clinicien, mais cette technique peut rapidement et facilement aider à identifier les schémas de la maladie en corrélation avec le diagnostic clinique de la maladie dermatologique.

La dermatoscopia es una técnica no invasiva, indolora y fácil de realizar utilizada en medicina humana y veterinaria para la observación in vivo rápida y ampliada de lesiones y enfermedades dermatológicas. La dermatoscopia puede conducir a un diagnóstico más rápido y puede eliminar la necesidad de realizar pruebas de diagnóstico más invasivas, como biopsias de piel. Para realizar la dermatoscopia, el clínico necesita un dermatoscopio y un programa de software equipado con captura de imágenes para la identificación de patrones. Existen dos técnicas para la dermatoscopia: contacto estándar, donde el dermatoscopio se aplica directamente a la piel del paciente con el uso de una interfase líquida, o sin contacto, donde no hay contacto directo entre la piel y el dermatoscopio. Los criterios más importantes que deben tenerse en cuenta al utilizar la dermatoscopia son la morfología/disposición de las estructuras vasculares, los patrones de descamación, los colores, las anomalías foliculares y las características específicas de la enfermedad. La aplicación de los hallazgos dermatoscópicos siempre debe correlacionarse con la historia del paciente, los signos clínicos y la morfología de las lesiones cutáneas. La dermatoscopia requiere una inversión financiera y de tiempo inicial por parte del médico, pero esta técnica puede ayudar rápida y fácilmente a identificar patrones de enfermedad que se correlacionan con el diagnóstico clínico de la enfermedad dermatológica.

A dermatoscopia é uma técnica não invasiva, indolor e de fácil execução utilizada na medicina humana e veterinária para observação in vivo rápida e ampliada de lesões e doenças dermatológicas. A dermatoscopia pode levar a um diagnóstico mais rápido e pode eliminar a necessidade de realizar testes diagnósticos mais invasivos, como biópsias de pele. Para realizar a dermatoscopia, o clínico precisa de um dermatoscópio e um programa de software equipado com captura de imagem para identificação do padrão. Existem duas técnicas de dermatoscopia: contato padrão, onde o dermatoscópio é aplicado diretamente na pele do paciente com o uso de uma interface líquida, ou sem contato, onde não há contato direto entre a pele e o dermatoscópio. Os critérios mais importantes a serem considerados ao utilizar a dermatoscopia são a morfologia/arranjo das estruturas vasculares, padrões de descamação, cores, anormalidades foliculares e características específicas da doença. A aplicação dos achados dermatoscópicos deve sempre ser correlacionada com a história do paciente, os sinais clínicos e a morfologia das lesões cutâneas. A dermatoscopia requer um investimento inicial financeiro e de tempo por parte do clínico, mas esta técnica pode ajudar rápida e facilmente a identificar padrões de doenças que se correlacionam com o diagnóstico clínico de doenças dermatológicas.

Treatment of indolent cutaneous T-cell lymphoma with hypofractionated radiation therapy in three cats.

BACKGROUND: Feline indolent cutaneous T-cell lymphoma (ICL) is an uncommon neoplastic disease. There is currently no consensus on treatment recommendations for ICL. OBJECTIVE: To report the clinical outcome of three cats with ICL treated with hypofractionated electron-beam radiotherapy (RT). ANIMALS: Three privately owned cats with ICL. MATERIALS AND METHODS: Medical records and client surveys were reviewed. A diagnosis of probable ICL was based on history, clinical presentation and histopathological findings, and confirmed using CD3 immunohistochemical analysis and PCR for antigen receptor gene rearrangement (PARR). All cats were treated with hypofractionated RT (four fractions of 8 Gy). RESULTS: All cats presented with skin lesions characterised by erythema and alopecia that were refractory to previous treatment with systemic glucocorticoids. Before hypofractionated RT treatment, lesions were histologically described as having diffuse infiltration of the dermis with CD3+ T cells. Molecular clonality analysis revealed clonal T-cell receptor gamma gene rearrangement. After RT, two cats showed histological improvement defined by decreased infiltration of lymphocytes, with cellular infiltrate present only in the deeper dermis; one cat had near complete histological resolution of lesions with only minimal residual lymphocytes. One cat was determined to have a complete clinical response while the other showed partial responses. No acute adverse effects of radiation were observed; chronic effects included leukotrichia, partial alopecia and mild fibrosis. All clients reported improvement in quality of life for their cats. CONCLUSIONS AND CLINICAL IMPORTANCE: Clinical and histological improvement in these cats suggests that hypofractionated RT can be a useful treatment modality for cats with ICL.

Is low-level laser therapy useful as an adjunctive treatment for canine acral lick dermatitis? A randomized, double-blinded, sham-controlled study.

BACKGROUND: Conventional therapy for canine acral lick dermatitis (ALD) consists of systemic antibiotics and anti-anxiety medications. Low-level laser therapy (LLLT) is a noninvasive therapy used to treat inflammatory and painful conditions. HYPOTHESIS/OBJECTIVES: The primary objective was to determine whether LLLT with conventional therapy would be beneficial as an adjunct treatment for ALD. We hypothesized that LLLT and conventional therapy combined would result in a greater reduction in licking Visual Analog Score (LVAS) compared to conventional therapy alone. Secondary objectives were to assess change in lesion/ulcer size, thickness and hair growth. ANIMALS: Thirteen dogs with a skin lesion consistent with ALD. METHODS AND MATERIALS: Dogs were randomly assigned to two groups. All dogs received systemic antibiotics and trazodone. The treatment group (TG) received LLLT by laser (130 mW, 2 min) with blue and red light-emitting diodes (LEDs), while the control group (CG) had sham therapy (laser/LEDs off). Treatments were administered three times weekly for two weeks, then twice weekly for two weeks for a total of 10 visits. Descriptive statistics were performed (mean, median); primary and secondary objectives were assessed with nonparametric ANOVA (Kruskal-Wallis test), with significance set at P < 0.05. RESULTS: Thirteen dogs (six CG, seven TG) were enrolled. There were no significant differences in median LVAS, lesion/ulcer size or thickness of the ALD lesion between TG and CG. There was a significantly greater increase (24%) in hair growth in TG (P = 0.0081) compared to CG. CONCLUSIONS AND CLINICAL RELEVANCE: Treatment of ALD requires multimodal therapy. Although combining LLLT with conventional therapy did not result in a significantly greater reduction in LVAS, there was a significant increase in hair growth compared to conventional therapy alone.

An evaluation of veterinary allergen extract content and resultant canine intradermal threshold concentrations.

BACKGROUND: Limited information is available for dogs on threshold concentrations (TCs), and the protein composition of common allergenic extracts produced by different manufacturers. HYPOTHESIS/OBJECTIVES: To characterize the protein heterogeneity of tree, grass, weed and mite allergens from different lots of allergenic extracts, and to determine intradermal TCs for healthy dogs using extracts from two manufacturers. ANIMALS: Twenty five privately owned, clinically healthy dogs and ten purpose-bred beagle dogs. METHODS AND MATERIALS: Protein concentration and heterogeneity of 11 allergens from two manufacturers were evaluated using a Bradford-style assay and SDS-PAGE. Intradermal testing was performed with 11 allergens from each company at four dilutions. Immediate reactions were subjectively scored (0 to 4+), and objectively measured (mm) and their percentage concordance evaluated. Model-based TCs were determined by fitting positive reactions (≥2+) at 15 min to generalized estimating equations. RESULTS: Allergen extract protein quantity and composition varied within and between manufacturers despite sharing the same PNU/mL values. Model-based TCs of one weed, five trees, two grasses and a house dust mite were determined for extracts from Manufacturer 1 (M1), and for extracts of three weeds, three trees and two grasses from Manufacturer 2 (M2). Receiver operating characteristic curve analyses determined a percentage concordance of the objective and subjective measurements of 77.3% for M1 and 75% for M2 allergens. CONCLUSIONS AND CLINICAL IMPORTANCE: Veterinary allergen extracts labelled as the same species and PNU/mL are not standardized; they show heterogeneity in composition and potency within and between manufacturers. Variability in extract content may require adjustment of intradermal testing concentrations.

Ischemic necrosis of the digits and hyperlipidemia associated with atherosclerosis in a Miniature American Shepherd.

CASE DESCRIPTION A 2.5-year-old 12-kg (26.4-lb) castrated male Miniature American Shepherd was referred because of a 3-week history of a localized crusted skin lesion on the digital pad of digit 3 of the right hind limb. CLINICAL FINDINGS Skin lesions were noted on the digital pads of the right hind limb. Serum biochemical analyses indicated severe hypercholesterolemia and hypertriglyceridemia. Ultrasonography of the terminal portion of the aorta and other major arterial vessels revealed substantial arteriosclerotic change. TREATMENT AND OUTCOME Medical treatments included administration of atorvastatin calcium, a low-fat diet, and omega-3 fatty acids to reduce serum lipids concentration; clopidogrel to prevent thrombosis; pentoxifylline to improve microcirculatory blood flow; clomipramine hydrochloride and trazodone hydrochloride to help with the behavioral problems; and gabapentin to help with pain management and behavioral problems. Surgical management included amputation of the initial digit involved, then eventually the entire initial limb involved. The response to treatment was poor, and euthanasia was elected. Postmortem findings revealed severe, widespread, and chronic intimal atherosclerosis; mild, widespread, and degenerative changes in the cerebral cortex; and edema and vascular congestion in the meninges. CLINICAL RELEVANCE To the authors' knowledge, this was the first report of skin necrosis secondary to atherosclerosis in a dog. Although the incidence of atherosclerosis has been considered very low in dogs, it should be investigated in dogs with severe hyperlipidemia. Primary hyperlipidemia has not been previously described in Miniature American Shepherd dogs but was the suspected underlying metabolic disorder.

In vitro bactericidal activity of blue light (465 nm) phototherapy on meticillin-susceptible and meticillin-resistant Staphylococcus pseudintermedius.

BACKGROUND: Staphylococcus pseudintermedius is the most common cause of bacterial skin infections in dogs. Meticillin-resistant infections have become more common and are challenging to treat. Blue light phototherapy may be an option for treating these infections. HYPOTHESIS/OBJECTIVES: The objective of this study was to measure the in vitro bactericidal activity of 465 nm blue light on meticillin-susceptible Staphylococcus pseudintermedius (MSSP) and meticillin-resistant Staphylococcus pseudintermedius (MRSP). We hypothesized that irradiation with blue light would kill MSSP and MRSP in a dose-dependent fashion in vitro as previously reported for meticillin-resistant Staphylococcus aureus (MRSA). METHODS: In six replicate experiments, each strain [MSSP, n = 1; MRSP ST-71 (KM1381) n = 1; and MRSA (BAA-1680) n = 1] were cultivated on semisolid media, irradiated using a 465 nm blue light phototherapeutic device at the cumulative doses of 56.25, 112.5 and 225 J/cm2 and incubated overnight at 35°C. Controls were not irradiated. Colony counts (CC) were performed manually. Descriptive statistics were performed and treatment effects assessed using the Wilcoxon-Mann-Whitney rank-sum test. Bonferroni-corrected rank-sum tests were performed for post hoc analysis when significant differences were identified. RESULTS: There was a significant decrease in CC with blue light irradiation at all doses for MRSA (P = 0.0006) but not for MSSP (P = 0.131) or MRSP (P = 0.589). CONCLUSIONS: Blue light phototherapy significantly reduced CC of MRSA, but not of MSSP or MRSP. The mechanism for the relative photosensitivity of the MRSA isolate is unknown, but is hypothesized to be due to an increased concentration of porphyrin in S. aureus relative to S. pseudintermedius, which would modulate blue light absorption.

Efficacy of imiquimod 5% cream in the treatment of equine sarcoids: a pilot study.

Imiquimod is an immune response modifier with potent antiviral and antitumour activity. The objective of this pilot study was to evaluate the efficacy of an imiquimod 5% cream (Aldaratrade mark: 3M, Saint Paul, MN, USA) as a topical treatment for equine sarcoids. Fifteen horses with a total of 19 tumours were enrolled, including mixed (7), fibroblastic (5), flat (3), verrucous (2), and nodular (2) types. Baseline data included history, physical examination, tumour location, measurement and digital photography. Imiquimod was applied by the owners three times a week until complete resolution of the tumour or 32 weeks, whichever occurred first. Tumours were measured and photographed every 4 weeks. Treatment efficacy was defined as 75% or greater reduction of tumour size by the end of the trial. Four sarcoids were withdrawn from the study. Twelve of the remaining 15 tumours (80%) showed more than 75% reduction in size and nine (60%) totally resolved between 8 and 32 weeks. The most common adverse effects of exudation, erythema, erosions, depigmentation and alopecia were limited to the tumour and adjacent areas. The results suggest that topical imiquimod is a therapeutic option for the treatment of equine sarcoids, although more detailed studies are required to corroborate these initial findings.

The impact of body site, topical melatonin and brushing on hair regrowth after clipping normal Siberian Husky dogs.

The aims of this study were to determine the impact of body site, vigorous brushing and topical melatonin treatment on hair regrowth after clipping normal dogs. Siberian Husky dogs were randomly assigned to three groups of eight dogs each. All dogs had the lumbosacral region and both lateral thighs clipped. The left thigh and lumbosacral area received no treatment and were compared in all 24 dogs. Eight dogs had the right thigh treated with 0.1% melatonin twice daily for 2 months, and hair regrowth was compared with the left thigh. Eight dogs had the right thigh brushed twice daily for 2 months, and hair regrowth was compared with the left thigh. Eight dogs had neither thigh treated. Hairs were plucked before and 2 months postclipping, and the proportion of hair growth from the original length was calculated and compared as described above. Biopsy samples were collected before and after treatment to determine if brushing induced dermal inflammation and melatonin increased the proportion of anagen follicles. Proportionally, left thigh hairs were significantly longer compared to lumbosacral hairs 2 months postclipping. No significant differences in hair regrowth were noted between the nontreated thigh and the thigh treated with melatonin or brushed. No significant difference in dermal inflammation was noted before and after brushing. No significant differences were observed in the proportion of anagen follicles before and after topical melatonin treatment. Our results showed that the hairs in the lumbosacral region were proportionally shorter than lateral thigh hairs 2 months postclipping. Moreover, topical melatonin and brushing had no impact on hair regrowth after clipping normal dogs.

Frequency of urinary tract infection among dogs with pruritic disorders receiving long-term glucocorticoid treatment.

OBJECTIVE: To determine frequency of urinary tract infection (UTI) among dogs with pruritic disorders that were or were not receiving long-term glucocorticoid treatment. DESIGN: Observational study. ANIMALS: 127 dogs receiving glucocorticoids for > 6 months and 94 dogs not receiving glucocorticoids. PROCEDURE: Bacterial culture of urine samples was performed in dogs receiving long-term glucocorticoid treatment, and information was collected on drug administered, dosage, frequency of administration, duration of glucocorticoid treatment, and clinical signs of UTI. For dogs not receiving glucocorticoids, a single urine sample was submitted for bacterial culture. RESULTS: Multiple (2 to 6) urine samples were submitted for 70 of the 127 (55%) dogs receiving glucocorticoids; thus, 240 urine samples were analyzed. For 23 of the 127 (18.1%) dogs, results of bacterial culture were positive at least once, but none of the dogs had clinical signs of UTI. Pyuria and bacteriuria (present vs absent) were found to correctly predict results of bacterial culture for 89.9% and 95.8% of the samples, respectively. Type of glycocorticoid, dosage, frequency of administration, and duration of treatment were not associated with frequency of UTI. None of the urine samples from dogs not receiving glucocorticoids yielded bacterial growth. The frequency of UTI was significantly higher for dogs treated with glucocorticoids than for dogs that had not received glucocorticoids. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that dogs receiving long-term glucocorticoid treatment have an increased risk of developing a UTI. On this basis, we recommend that urine samples be submitted for bacterial culture at least yearly for such dogs.

The effect of body region on the canine hair cycle as defined by unit area trichogram.

The impact of anatomic location on trichogram analysis of the hair cycle phases was evaluated in 15 clinically normal dogs. The purposes of this study were to determine if the number of hairs in anagen and telogen vary among anatomic sites within a dog and to see whether there is an optimal region to sample hairs for canine trichogram evaluation of the hair cycle phases. In each dog eight sites were sampled. Four (26.7%) of the 15 dogs had no significant differences in the number of hairs in anagen and telogen among the eight body sites examined. Nine (81.8%) of the remaining 11 dogs had only one site that revealed significant differences in the number of hairs in anagen or telogen. In seven (77.8%) of these dogs only the anagen differed significantly, and in two (22.2%) dogs both phases differed significantly. Two (18.2%) dogs revealed two sites with significant differences in the number of hairs in anagen. The number of hairs in anagen and telogen in the shoulder area did not vary significantly in any of the dogs. This observation, coupled with the ease of sampling at this site, indicates that the shoulder is the site of choice when studying variations in ratios of hair cycle phases using unit area trichogram. Our results also suggest that numbers of telogen and anagen hairs from body regions with different hair shaft lengths do not vary significantly, and the occasional inconsistent results noted at some body sites might be due to sample collection technique.

An analysis of canine hair re-growth after clipping for a surgical procedure.

Hair growth and replacement have been studied extensively in humans, sheep and laboratory rodents, but in dogs and other mammalian species few studies have been published. The objectives of this study were: (1) to determine the time required for the hair to re-grow in dogs after clipping for a surgical procedure; (2) to define whether the season of the year influenced the period of time required for re-growth and; (3) to determine if season might influence the telogen: anagen ratio. Eleven Labrador retrievers were recruited during spring, 10 during summer, six during autumn and 10 during winter. Hairs re-grew to their preclipped length in 14.6 weeks, 14.5 weeks, 13.6 weeks and 15.4 weeks when shaved in the spring, summer, autumn and winter, respectively. The differences in these values were not significant suggesting that season has no effect on the rate of hair re-growth in Labrador retrievers housed indoors (P = 0.12). The mean values for the telogen: anagen ratio in each season were: 5.2 (spring), 6.1 (summer), 9.5 (autumn), and 5.3 (winter). The differences in these values also were not significant (P = 0.89). The percentage of hairs in telogen was over 80% in all four seasons.