Additional Diagnostic Methods in Dermatology notes: Plenary lectures 2017... · Praktische Dermatologie bei Hund und Katze, Chiara NOLI, Fabia SCARAMPELLA, 2004. Clinical Handbook

Additional Diagnostic Methods in Additional Diagnostic Methods in DermatologyDermatology

University of Veterinary Medicine,

Department and Clinic of Internal Medicine

Noémi Tarpataki

[email protected]

Place of laboratory proceduresPlace of laboratory procedures

Diagnosis

�� Additional Additional

examinationsexaminations

�� Clinical examinationClinical examination

�� HistoryHistory

What can be examined?What can be examined?

� parasites, bacteria, fungi

� hair skin

� Other organs (immune-, hormonal system)

Examination of the integumentumExamination of the integumentum� METHODS

- inspection / palpation / smelling / percussion

� ADDITIONAL EXAMINATIONS- flea comb / Wood-lamp / Otoscopy- skin scraping + pluged hairshuft sending to laboratory

--microscopic (parasitology, trichogram: structure of the pluged hairshuft)--microbiological: culture: bacteriology +mycology and resistency--microbiological: culture: bacteriology +mycology and resistency-- +/- taking and sending STERILE SWAB SAMPLE--(cytology (after staining))

-cytology--impression-smear (glass-slide; scotch tape)--aspiration (FNA)--swab smear (from extarnal ear canal)--”cytobrush” (PCR: papilloma/herpes etc.)(--from skin scraping or biopsy sample)

-biopsy sampling (by scalpel blade or biopsy punch, histopathology)-allergy tests: in vivo: IDST; in vitro: serum allergen-specific IgE-blood tests (blood count, biochemistry); hormons, function tests-immunological tests: ANA, immunocomplex, Coombs test, flow cytometry;

--(histopathology: immunfluorescency, immunhistochemistry)

Instruments of Instruments of clinicalclinicalexaminationexamination

FleaFlea comb and comb and flotationflotation

Instruments of clinical Instruments of clinical examinationexamination


Sampling and sending Sampling and sending to laboratoryto laboratory

� Ask: what type of sample is needed for the given examination

� Ordering/ buying of the sampling � Ordering/ buying of the sampling instruments of the given laboratory (sterile swabs/ tubes with test medium/ solutions for biopsy sampling etc.)

� Accompanying documents and sample labeling

Sampling for Sampling for own examinationsown examinations

� If we’ got microscope– Skin scraping

– trichogram

– Cytology– Cytology

� Instruments and materials– Scalpel blade, glass slide

– Paraffinoil

– Diff-Quick for staining

– Immersion oil

SamplingSampling

� Appropiate method

� Correct evaluation of the results

SamplingSampling


– For example: if only superficial skin scrape was takenscrape was taken


– the possibility of finding Demodex mites is less.

SamplingSampling


� For example: if we are looking for Sarcoptes mites Sarcoptes mites


– we will have only 10-50% possibility of finding them even if we took the sample really from huge region

Skin scraping for microscopic Skin scraping for microscopic examination and culturingexamination and culturing

� trichogram, citology

� bacterial and fungal culture

Skin scraping for microscopic Skin scraping for microscopic examination and culturingexamination and culturing

� Method– Superficial / deep

pushing out of hair follicle / pulling out hair shufts– Huge surface / many region /

border of the lesion and healthy skinborder of the lesion and healthy skin– Crusts are not needed but sampling from the str.

corneum

� Evaluation of skin scrape– Sensitive method for ectoparasites,

except Sarcoptes mites– Bacterial culture: the antibiotic resistance is important– Fungal culture: the only sure method for proving

Dermatophytosis

Skin scraping for

microscopic examination

and culture

Instruments Instruments forfor skinskin scrapingscraping

Multiple superficial scrapingMultiple superficial scraping


� Sarcoptes scabiei (var. canis)


� Sarcoptes scabiei (var. canis)


� Notoedres cati, Otodectes cynotis


� Linognathus setosus; Cheyletiella yasguri; Neotrombicula� sucking louse (pediculosis);cheyletiellosis; trombiculosis


� Dermatophytosis

Multiple deep scrapingsMultiple deep scrapings


� Demodicosis


� Demodicosis


� Demodicosis


� Demodicosis

Swab samplingSwab sampling

� In case of pus

SamplingSampling forfor trichogramtrichogram

TrichogramTrichogram

� Demodicosis

� Dermatophytosis

� Cheyletiella

TrichogramTrichogram

� Dd. of alopecia

CytologyCytology

� Method:-impression-smear (glass-slide; scotch tape)-aspiration (FNA)-swab smear (from extarnal ear canal)-”cytobrush” (PCR: papilloma/herpes etc.)-”cytobrush” (PCR: papilloma/herpes etc.)(-from skin scraping or biopsy sample)

Evaluation– Sensitive method: bacterial and Malassezia owergrowth

– Differentiation of inflammatory (septic / non septic) and neoplastic skin lesions:

– Fast, but not always giving exact final diagnosis

Cytologic examinationCytologic examination

� Direct smear

� Impression smear

� Swab smear� Swab smear

CYTOLOGYCYTOLOGYFNA (fine needle aspiration)FNA (fine needle aspiration)


� Fine-needle aspiration


� Fine-needle „biopsy”

Staining Staining –– DiffDiff--QuickQuick


�Scotch tape stains

Cytologic findingsCytologic findings

CytologyCytology

intertrigointertrigo folliculitisfolliculitis

dr Vajdovich Péter

CytologyCytology

Pseudomonas

deep pyodermadeep pyoderma sterile pyodermasterile pyoderma

aeruginosa

Photos of dr Péter Vajdovich

CytologyCytology

� Malassezia pachydermatisyeast

Cytology and/or PCRCytology and/or PCR

� „Cytobrush”

Instruments of biopsyInstruments of biopsy

Instruments of biopsyInstruments of biopsy

Methods of biopsy samplingMethods of biopsy sampling



Diagnostic value of histopathologyDiagnostic value of histopathology

Diagnostic value of histopathologyDiagnostic value of histopathology

IntraDermalIntraDermal ((allergicallergic) ) SkinSkin Test Test (IDST)(IDST)



Blood samplingBlood sampling

� Allergy-serology


�Sarcoptes: IgG-serology


� Blood count, biochemistry, hormons


� Examination of external ear canal

Aim of ear cleansingAim of ear cleansing

� diagnostic – therapy

� ↓↓↓↓ exsudate → ↓↓↓↓ infectious agents

� ▬ foreign body

� ↑ effectiviness of topically usable � ↑ effectiviness of topically usable drugs (ear drops)

� The external ear canal is more visible

Ear clenaser depends on…Ear clenaser depends on…

exsudate:

– if it is ceruminous, fatty → oily ear cleanser

� exsudate:

– If it is purulent→ watery ear cleanser

Effect of Effect of earear cleansercleanser ingridientsingridients

� Solving the fatty mass, degreasing effect of ceruminolytics:

� Organic oils and solvent: propilen-glycol, lanolin, glycerin, lanolin, glycerin, squalene (triterpen, shark oil), butilated hydroxitoluen, cocamidopropil-betain, mineral oils, sodium(Na)-docusate

� Indication: ceruminous otitis externa

� Contraindication: injury of ear drum! X


� Surfactants: solving the mass into emulsion and keep it in

DSS (dioctil-sodium � DSS (dioctil-sodium sulfosuccinate), Ca-sulfosuccinate, urea, urea-peroxidase

� the best ceruminolytics!


� Adstringents (drying the ear canal, preventing macerations by moisture):

� Izopropil-alcohol, boric acid, � Izopropil-alcohol, boric acid, acetic acid, benzoic acid, salicylic acid, sulfur, Al-acetate, silicone-dioxid

� Alone or together with the other ingridients

� For preventing OE (e.g. bath)

www.google.com


� Antimicrobial effect:

� chlorhexidine, Tris-EDTA + 0.15% chlorhexidine, salicylic acid, 2% acetic acid + 2% boric acid, PCMX (parachlorometaxilenol), 2% boric acid, PCMX (parachlorometaxilenol), isopropil alcohol, 2-2.5% acetic acid, acidic NaCl, sacharids

� Use of combinated ear drops can be avoided with these ingridients


� Topical anesthetic effect:– tetracain

� Help the skin barrier function– phytosphyngosine– phytosphyngosine

� Acidic (pH 6)– Lactic acid, acetic acid, NOT together with

aminoglycosid

� Basic (pH 8)– Tris EDTA: Otodine®, after rinsing: fluorokinolons

� Neutral– Epi-Otic®

EarEar cleansingcleansing

� Bacterial OE e.g. twice for two weeks

� Filling the ear canals with ear cleanser (0,5-5 ml in syringes)Filling the ear canals with ear cleanser (0,5-5 ml in syringes)

� Massage for 1-2 minutes� Let the dog shake the head for

10-30 minutes� Drying/clearing the entrance

with a gause � Teach the owner

LiteratureLiterature

� Praktische Dermatologie bei Hund und Katze, Chiara NOLI, Fabia SCARAMPELLA, 2004.SCARAMPELLA, 2004.

� Clinical Handbook on Canine Dermatology, Didier Noel CARLOTTI, Virbac S.A.

� Skin Diseases in the Dog and Cat, D.I. GRANT, 1991.

� Picture of Int. Med.

� www.google.com

Thank you for your attention!Thank you for your attention!

Documents

Additional Diagnostic Methods in Dermatology notes: Plenary lectures 2017... · Praktische Dermatologie bei Hund und Katze, Chiara NOLI, Fabia SCARAMPELLA, 2004. Clinical Handbook