Page 1437 - Clinical Small Animal Internal Medicine

1375

VetBooks.ir

157

Approach to the Patient with Dermatologic Disease
Lisa V. Reiter, DVM, DACVD

McKeever Dermatology Clinics, Eden Prairie, and Inver Grove Heights, MN, USA

Skin and ear diseases are among the most common rea- form or questionnaire made available to the client to be
sons why clients seek veterinary consultation. Not only completed either in the reception area or, ideally, emailed
are diseases such as hypersensitivity disorders and skin or mailed to the client prior to the consultation. There
and otic infections very common, the skin is the most are several examples of dermatologic history forms avail-
accessible organ of the body, making it readily visible to able from multiple textbooks (included in the Further
owners. Thus, owners can easily detect abnormalities in Reading section at the end of this chapter), online
the appearance, odor, and feel of the skin and haircoat, through the Veterinary Information Network (www.vin.
as well as appreciate how the disease is impacting their com), and through various veterinary pharmaceutical
pet’s quality of life along with their own. Because derma- companies. These forms can be adapted and modified to
tologic problems are usually multifactorial, chronic, the clinician’s own preferences.
recurrent and noncurable, and often involve several der- The previously completed dermatology history form
matoses occurring simultaneously, owners and veteri- can be quickly reviewed with the client before or during
narians alike can easily become overwhelmed. the consultation, which decreases the time needed to
It is the goal of this chapter to make the diagnosis and extract a good history, and should begin with the client’s
management of dermatologic disease more rewarding by primary complaint. Neglecting this can quickly result in
guiding veterinarians toward a more methodical and a dissatisfied, “unheard” client, especially when the
efficient approach to the dermatologic patient. This will veterinarian’s concerns do not immediately reflect the
be accomplished by emphasizing the recognition of cru- primary concerns of the client. Addressing the chief
cial lesions and their distribution, and assimilating these complaint will often result in an immediate list of differ-
findings and other physical exam abnormalities with the ential diagnoses aimed at identifying the etiology of the
history such that a comprehensive list of systematized underlying disease process. During review of the derma-
differential diagnoses will be formulated and the most tologic history form, additional questions can be asked
appropriate diagnostic tests selected. Finally, the chapter or posed in different ways to help extract pertinent infor-
will end with a discussion of the common diagnostic mation that pertains to specific problems. This is an art
tests utilized in the dermatologic patient, including indi- and takes practice!
cations, techniques, and interpretation. The patient’s signalment can further assist with for-
mulating and ranking differential diagnoses, as there
are some skin diseases that are more likely to occur in
History specific age ranges, sexes (including neuter status), and
in certain breeds. The age of onset of the dermatologic
Despite its complexity, the skin has limited means by disease can be particularly helpful in the very young
which it “reacts” to indicate the presence of an underly- and very old patient. For instance, younger animals
ing disease process, and because numerous skin diseases are more commonly afflicted with diseases such as
will manifest clinically in a similar way, the patient his- demodicosis, otodectes, and dermatophytosis, as well
tory is vital. Not uncommonly, obtaining a thorough and as congenital and hereditary diseases, whereas middle‐
complete history will take longer than the examination aged to older animals are more commonly diagnosed
itself. This process can be expedited by having a history with autoimmune dermatoses, neoplastic conditions,

Clinical Small Animal Internal Medicine Volume II, First Edition. Edited by David S. Bruyette.
© 2020 John Wiley & Sons, Inc. Published 2020 by John Wiley & Sons, Inc.
Companion website: www.wiley.com/go/bruyette/clinical