1	Whiskey Intro 3 year old Westie Intense Pruritus Severe Dermatitis 2 year duration Sever during last 6 months (Winter) Steroids don't help On Lamb and Rice OTC diet
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6	Problem List
7	A Pattern Approach 10 common patterns Folliculitis Pododermatitis Otitis Yeast Dermatitis Pruritus Nonpruritic Alopecia Autoimmune Skin Disease Keratinization Defects Lumps, Bumps, and Draining Tracts Weirdopathies
8	2 ?s 2^o Infections Pyoderma Allergies Demodex Atopy Dermatophyte Food Yeast Dermatitis Scabies Otitis Pododermatitis Endocrine Hypothyroid Cushing’s
9	Differential Secondary infections Yeast Pyoderma/demodex/RW Primary disease Atopy/food allergy/scabies Endocrine (hypothyroid/Cushing’s)
10	Skin Scrape
11	Cytology Impression Smear
12	Tape Prep
13	CBC/Chemistries CBC Normal Serum Chemistries Normal
14	Biopsy Skin Biopsy Chronic hyperplastic perivascular dermatitis
15	Bacterial Culture Bacterial Cultures Staph., E.coli, Strep. Not ampicillin, tetracycline, erythromycin, clindamycin
16	Wood’s Lamp Wood’s Lamp Negative
17	DTM Fungal Culture
18	IDAT IDAT
19	Food Trial Dietary Food Trial Eukanuba Response FP (fish and potato) 60% improvement + food challenge Food Allergic Lamb diet????
20	Thyroid Testing Total T4 Normal TSH Normal
21	Adrenal Testing ACTH stim Normal LDDST Normal
22	Diagnosis 1 Diagnosis Bacterial pyoderma Yeast dermatitis (Malassezia) Not demodicosis, dermatophytosis
23	Diagnosis 2 Primary diseases? Endocrine Atopy/food allergy/scabies Started at 1 year of age Seasonal – used to be – now year-round Steroids – not responsive Ear margins – ok Lamb & Rice diet - ??
24	Treatment
25	Treatment 1 What can we kill? Infection – pyoderma/yeast Antibiotics for 21days ++ Ketoconazole for 30 days Chlorhexidine/miconazole shampoo
26	Treatments 2 Food Allergy Avoid offending foods Symptomatic Therapy Oatmeal + pramoxine conditioner Antihistamines, essential fatty acids Prednisone???
27	Treatment Summary Killed bugs Staph,yeast, scabies? Treated food allergy Symptomatic tx Atopy? Endocrine?
28	Final Diagnosis Diagnosis Bacterial pyoderma Yeast dermatitis (Malassezia) Food Allergy What about Atopy and Scabies?
29	Summation
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