additional diagnostic methods in dermatology notes: plenary lectures 2017... · praktische...
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Additional Diagnostic Methods in Additional Diagnostic Methods in DermatologyDermatology
University of Veterinary Medicine,
Department and Clinic of Internal Medicine
Noémi Tarpataki
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
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
� Appropiate method
– For example: if only superficial skin scrape was takenscrape was taken
� Correct evaluation of the results
– the possibility of finding Demodex mites is less.
SamplingSampling
� Appropiate method
� For example: if we are looking for Sarcoptes mites Sarcoptes mites
� Correct evaluation of the results
– 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
Multiple superficial scrapingMultiple superficial scraping
� Sarcoptes scabiei (var. canis)
Multiple superficial scrapingMultiple superficial scraping
� Sarcoptes scabiei (var. canis)
Multiple superficial scrapingMultiple superficial scraping
� Notoedres cati, Otodectes cynotis
Multiple superficial scrapingMultiple superficial scraping
� Linognathus setosus; Cheyletiella yasguri; Neotrombicula� sucking louse (pediculosis);cheyletiellosis; trombiculosis
Multiple superficial scrapingMultiple superficial scraping
� Dermatophytosis
Multiple deep scrapingsMultiple deep scrapings
Multiple deep scrapingsMultiple deep scrapings
� Demodicosis
Multiple deep scrapingsMultiple deep scrapings
� Demodicosis
Multiple deep scrapingsMultiple deep scrapings
� Demodicosis
Multiple deep scrapingsMultiple deep scrapings
� 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)
Cytologic examinationCytologic examination
� Fine-needle aspiration
Cytologic examinationCytologic examination
� Fine-needle „biopsy”
Staining Staining –– DiffDiff--QuickQuick
Cytologic examinationCytologic examination
�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
Methods of biopsy samplingMethods of biopsy sampling
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)
IntraDermalIntraDermal ((allergicallergic) ) SkinSkin Test Test (IDST)(IDST)
IntraDermalIntraDermal ((allergicallergic) ) SkinSkin Test Test (IDST)(IDST)
Blood samplingBlood sampling
� Allergy-serology
Blood samplingBlood sampling
�Sarcoptes: IgG-serology
Blood samplingBlood sampling
� Blood count, biochemistry, hormons
Instruments of clinical Instruments of clinical examinationexamination
� 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
Effect of Effect of earear cleansercleanser ingridientsingridients
� 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!
Effect of Effect of earear cleansercleanser ingridientsingridients
� 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
Effect of Effect of earear cleansercleanser ingridientsingridients
� 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
Effect of Effect of earear cleansercleanser ingridientsingridients
� 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!