Skin lesion advice please

RE: Skin lesion advice please

Anthony Todd — Tue, 08 Sep 2015 16:54:42 GMT

Wish you'd clip a foot or two so we can see what the lesions actually look like.....

Can't believe it's bacterial??

RE: Skin lesion advice please

Laura Marshall — Tue, 08 Sep 2015 14:27:27 GMT

Wow, lots of discussion going on here! I'll try and add in the answers to some of this.

Deep skin scrapes were taken, from several affected areas. He has got history of topical hypersensitivity to Advocate, however that said I haven't pursued alternatives yet.

Apoquel is not an option, I do not have enough for my existing patients so cannot give to anyone else.

I have actually started him on a course of cephalexin and will be reviewing next week, so I'll update with where we're at. Interestingly he spent a week at the owners parents and he seemed better...

RE: Skin lesion advice please

Robin Grimmer — Mon, 07 Sep 2015 14:43:55 GMT

[quote user="Anthony Todd"]

[quote user="Robin Grimmer"]Yes[/quote]

Does it look different in older or old dogs though: distribution? appearance?

Should be able to confirm easily in this one with deep scrape.

[/quote]

I don't think so, except usually generalised. Also prognosis poorer as usually something fairly bad going on eg cancer.

RE: Skin lesion advice please

ChrisBVSc — Sun, 06 Sep 2015 22:50:28 GMT

Obviously this is much lower down the list of differentials than everything mentioned above, but has the dog ever been abroad? I'd be asking as we've had a couple of leishmaniasis cases recently that have started off looking a bit like this.

RE: Skin lesion advice please

Martin Atkinson — Sat, 05 Sep 2015 22:49:48 GMT

[quote user="Paul Stevens"]No one interested in demodex secondary to immune insufficiency (liver/ occult neoplasia) ?[/quote]Demodex is usually non-pruritic and easy to find on a scrape which the OP has done so sarcoptes more likely in an older dog which shifted it further down my differentials. But agreed shouldn't rule demodex out and I've seen some cases in older dogs 2ndry to tumours/immunosuppression.

RE: Skin lesion advice please

Anthony Todd — Sat, 05 Sep 2015 13:54:55 GMT

[quote user="Robin Grimmer"]Yes[/quote]

Does it look different in older or old dogs though: distribution? appearance?

Should be able to confirm easily in this one with deep scrape.

RE: Skin lesion advice please

Robin Grimmer — Sat, 05 Sep 2015 13:45:18 GMT

[quote user="Anthony Todd"]

Not being confrontational, just interested, but has anyone ever seen demodex in a very old dog?

Er, but lesions on the foot do look suspicious, and may look different in an immuno-compromised or geriatric animal.

Scrape, which must draw blood, is,IMHO, better, quicker, cheaper and probably more productive, than a biopsy anyway.

PS clipping the feet lesions might give us more visual clues [and make it easier to apply the iodine.....]

[/quote]

Yes, but there is usually something else going on causing immune suppression. (In older dogs)

RE: Skin lesion advice please

Anthony Todd — Sat, 05 Sep 2015 13:40:45 GMT

Not being confrontational, just interested, but has anyone ever seen demodex in a very old dog?

Er, but lesions on the foot do look suspicious, and may look different in an immuno-compromised or geriatric animal.

Scrape, which must draw blood, is,IMHO, better, quicker, cheaper and probably more productive, than a biopsy anyway.

PS clipping the feet lesions might give us more visual clues [and make it easier to apply the iodine.....]

RE: Skin lesion advice please

Paul Stevens — Sat, 05 Sep 2015 12:06:24 GMT

No one interested in demodex secondary to immune insufficiency (liver/ occult neoplasia) ?

Near the top of my list.

Need to do GOOD skin scrapes if biopsy not possible (money).

RE: Skin lesion advice please

Anthony Todd — Sat, 05 Sep 2015 11:42:33 GMT

Vital that we know the outcome please, me anyway, as it's the only way I will learn that modern expensive prolonged treatments and tests have, occasionally, some value.....

[Well, depends on where you place the value I guess.]

Just think of the pleasure it will give the academics and modvets to see a dinovet squashed again.

RE: Skin lesion advice please

Martin Atkinson — Fri, 04 Sep 2015 11:02:02 GMT

[quote user="Laura Marshall"]I performed a skin work up to assess for mites, dermatophytosis and cytology[/quote]As with all these situations, i wouldn't beat myself up if the owner can't/won't pay for further investigation. However, how carefully did you look for sarcoptes? Old pruritic dog puts that top of the list. It can be difficult to find. Common things occur commonly so as others suggest a treatment with an ectoparasiticide wouldn't go amiss if they can't afford a sarcoptes antigen test. The feet look a bit like a deep pyoderma but often in old dogs there is some underlying immuno-suppressive thing going on if its that. Unlikely to be atopy at this age so I would treat it with stronghold and antibiotics for a month and see what happens.

RE: Skin lesion advice please

Emily Rainbow — Thu, 03 Sep 2015 17:49:22 GMT

Have had some success with these sort of cases where further work up not an option and initial work up inconclusive with twice weekly limeplus Dip baths. Malaseb first (leave on for 10mins before rinsing) then sponge over limeplus and leave on to dry. Does smell and stain light colours tho/

RE: Skin lesion advice please

Bob Russell — Thu, 03 Sep 2015 13:04:01 GMT

A dose of Stronghold 'in case'!

RE: Skin lesion advice please

Anthony Todd — Thu, 03 Sep 2015 11:48:49 GMT

Nothing on the ears?

No humans with lesions [neck, chest inner arms? [pretty well confirms negative/positive sarcoptes]

Any other animals involved?

Eurax [crotinonium] is a really effective non steroidal anti pruritic which is also effective against sarcoptes but the pictures don't look "itchy" enough. It is cheap too, and off prescription.

Although it's very rare these days zinc deficiency in a restricted diet [low fat biscuit] does look a bit like the pics. but is non-pruritic.

I can't believe it's bacterial and doesn't look as if it'll be steroid responsive as there seems to be little irritation.

Looks too discrete to be ectoparasitic.

Doubt if full-bloods would add anything at all to the mystery.

Dare I say that, with discrete fungal looking lesions, you've got nothing to lose just applying tincture of iodine daily [cotton bud] to the lesions and often they resolve even without a diagnosis.

RE: Skin lesion advice please

Utlendigur — Wed, 02 Sep 2015 16:53:07 GMT

You said anti-inflammatory steroids don't help but the nose responded to surolan... has he had systemic antibiotics? Just wondering if there is a degree of deep pyoderma in the leg lesions, which would in itself be pruritic whatever the initial cause of the inflammation. If the owners can't afford any further diagnostics you could trial advocate/stronghold plus long course of antibiotics +/- malaseb +/- buster collar, then see what he is like in 2-3 weeks before going down the route of immunosuppressive doses of steroids. Also it looks like the lesions are on the skin rather than nail beds or mucocutaneous junctions which isn't typical of immune mediated.

RE: Skin lesion advice please

mariette asselbergs — Wed, 02 Sep 2015 16:43:58 GMT

Atopic - apoquel patient?

Mariette

RE: Skin lesion advice please

scatty — Wed, 02 Sep 2015 16:42:28 GMT

Hi Laura,

Has he had any spot -on ectoparasite treatments?