Canine Dermatology Case study module 2

1. CASE STUDY:
MODULE 2
By Anita Patel

2. THIS CASE IS PRESENTED
TO YOUR CLINIC THE FIRST
TIME
Short history to follow

3. History
■ 5 year old West highland White terrier
■ Neutered male
■ Long standing history of pruritus
– At presentation 9/10 on numerical scale
■ Initial response to oclacitinib but no further response
■ Intermittent prednisolone given in the past
■ No zoonosis
■ Fed on commercial kibbled diet and dog treats (previously vets prescribed a hypoallergenic diet)
■ Advocate used intermittently

4. CLINICAL PRESENTATION

5. Clinical presentation

6. Case study: Module 1
■ List your differential diagnosis
■ List the most appropriate tests you would do at the first visit
■ List what you would consider on follow up visits
■ What would be an appropriate long term plan for a case like this?

7. List differential diagnosis
■ Based on clinical presentation
– Malassezia dermatitis
– Bacterial overgrowth syndrome
– Demodicosis
– Sarcoptic mange
■ Based on long term history
– Adverse food reaction
– Atopic dermatitis
– Malassezia hypersensitivity
– Contact allergic dermatitis

8. List of the most appropriate tests: First visit
■ Tape strips
■ Skin scrapings
■ Culture and sensitivity +/- depending on previous antibiotics and
cytological findings
■ Consider response to trial treatment if suspect sarcoptic mange

9. Findings in this case
■ First visit
– Tape strips – Malassezia organisms
seen
– Skin scrapes – Demodex injai mites
found on the dorsum
■ Treatment
– 2% miconazole 2% chlorhexidine
shampoo 3 times a week
– Sarolaner every 28 days
– 10 days of itraconazole 10mg/kg
q24h
– Stop Oclacitinib

10. List what you would consider on follow up
visits
■ Repeat food trials
■ Manage pruritus
■ Infection control
■ Maintain ectoparasitic treatments
■ Allergy testing if considering immunotherapy

11. Case follow-up
■ Second visit 3 weeks later
– Less pruritic score 6/10
– Repeat skin scrapes – negative for
Demodex mites
– Tape strips negative for Malassezia
– Repeat food trial start with RCW
anallergenic (no treats allowed)
– (more on this diet will be discussed
in the next module)
■ Third visit 6 weeks from first consultation
– Less pruritic score 4/10
– No response to diet so
– Malaseb washes reduced to 2 times
a weeks
– Sarolaner every 28 days
– Tape strips and skin scrapes still
negative
– This time good compliance with
food so far

12. Case follow up 9-weeks from first consultation
■ Pruritus 4/10 on numerical scale
■ Challenge with original kibble and treats
■ No change on level of pruritus
■ Final diagnosis Atopic dermatitis

13. Next step for management of atopic dermatitis
■ Case like this requires management for chronic atopic dermatitis
– Management of pruritus
– Management of ectoparasitic problems
– Management of infection
– Prophylactic measures long term
– Proactive treatments
■ Individualise the management protocol and change plan according to
finding
■ Owner compliance is necessary

14. 12 WEEKS POST-
TREATMENT

15. Long-term management for this case
■ Weekly Malaseb washes
■ Twice weekly topical application of hydrocortisone aceponate on inguinal
area as a proactive treatment
■ 4-weekly sarolaner
■ Immunotherapy for house dust mite associated atopic dermatitis
■ Apoquel for 3-5 days to stop itch scratch cycle when needed.
■ Monitoring by vet 2-3 monthly for early intervention (sooner if owner feels it
necessary)