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Prefacio
Bienvenido a la séptima edición de Dermatología de pequeños animales, de Muller y Kirk.
En esta nueva edición encontrará grandes diferencias respecto de las anteriores. Karen Campbell se une a esta edición y representa un valioso aporte. Karen es jefa del servicio de dermatología en la Universidad de Illinois.
Cuando comenzamos con la escritura, todos los comentarios que hemos recibido de nuestros lectores a lo largo de los años, nos llevaron a realizar numerosos cambios, algunos estructurales y algunos más filosóficos. En primer lugar, los filosóficos:
en sus primeras seis ediciones, este libro fue “la Biblia” del arte, la práctica y la ciencia de la
dermatología y la dermatopatología veterinaria, e incluyó toda la información necesaria. Las
referencias fueron tan completas como fue posible; desde que publicamos la sexta edición,
se ha experimentado –y continua experimentándose– una explosión de información sobre
todos los aspectos de la ciencia que influyen en la práctica de la dermatología veterinaria. Hay
cambios casi a diario. Por fortuna, los diversos buscadores de la Web en todo el mundo nos
permiten acceso instantáneo a esta nueva información. Nos hemos esforzado mucho para
brindarles una sólida base de los aspectos fundamentales. Hemos incorporado nuevas referencias destacadas para orientar al lector en su estudio.
Por primera vez, advertirán que los autores o coautores de algunos capítulos son expertos
en cada área. Esto es así para ofrecerles la mejor cobertura personalizada de aquellos temas a
nuestro alcance. Como ustedes saben, la práctica de la dermatología es un arte y una ciencia.
Todo el mundo puede leer acerca de la ciencia, pero el arte debe desarrollarse. Los capítulos
han sido escritos por verdaderos expertos y esperamos que puedan enseñarles tanto la ciencia
como el arte de la dermatología.
Estructuralmente, se trata de un libro nuevo. Las ilustraciones son nuevas, y todas a color.
Ya no existen aquellas tablas periódicas de colores con múltiples enfermedades que exigían
recorrer las páginas hacia adelante y atrás para ver las ilustraciones de la enfermedad que se
estaba estudiando. Ahora las ilustraciones están relacionadas directamente con el tema que se
trata. A lo largo de los años, hemos venido escuchando que el aspecto más débil del libro era
la limitada cantidad de ilustraciones clínicas. Para superar esto, quisimos aumentar significativamente el número de ilustraciones.
Agradecemos toda la información y la ayuda que hemos recibido de nuestros colegas, especialmente de Bob, George y Danny, y de nuestros clientes y pacientes. Esto no habría sido
posible sin el apoyo de nuestros esposos y familias.
Es nuestro deseo que disfruten de esta edición.
William H. Miller, Jr.
Craig E. Griffin
Karen L. Campbell
Comprando
todos los meses
llévese la Biblia de la Dermatología
Nueva edición con estructura y fotografías
renovadas en un
100%
Promoción: desde el 25 de septiembre del 2013 hasta el 25 de mayo de 2014.
Compre 90 pipetas mensuales a elección y pídale a su distribuidor
una estampilla
para completar el album (total 720 pipetas).
Aproveche esta oferta que beneficiará a sus clientes con un Fipronil de primera
línea y le permitirá obtener la bibliografía más importante y actualizada
en dermatología a nivel mundial.
Instituto de Dermatología Veterinaria
R. Fulton 2445 - (1618) - Malvinas Argentinas - Pcia. Bs. As. Director Técnico: Dr. Gustavo Castellano Médico Veterinario. Tel.: 03327-457669 / E-mail: [email protected]
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FIGURE 2-16 Crust is formed when dried exudate, serum, pus, blood,
cells, scales, or medications adhere to the surface. Unusually thick crusts
are found in hairy areas, because dried material tends to adhere more
tightly than in glabrous skin. Crust may be primary, as in primary seborrhea and zinc-responsive dermatosis; or secondary, as in pyoderma, fly
strike, or pruritus. Hemorrhagic crusts in pyoderma are brown or dark red;
yellowish green crusts appear in some cases of pyoderma; tan, lightly
adhering crusts are found in impetigo. Vegetations—heaped-up crusts
seen in pemphigus vegetans. Photograph illustrates cat with severe
crusted ulcerative facial dermatitis. Dark crusts imply deeper tissue
damage or hemorrhage and may be seen more with traumatic wounds,
furunculosis, fly strike dermatitis, and vasculitis. Honey-colored crusts are
more commonly infectious in nature; thicker dry yellow crusts are more
typical of scabies and zinc-responsive dermatosis. Tightly adherent crusts
are typical in zinc-responsive dermatosis and necrolytic migratory erythema, and they also occur in some cases of seborrhea.
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MULLER AND KIRK’S SMALL ANIMAL DERMATOLOGY
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Recognition of the different stages of lesion formation is
helpful in formulating differential diagnoses and is also important when selecting areas to sample for diagnostic tests.
FIGURE 2-17 Follicular cast—an accumulation of keratin and follicular
material that adheres to hair shaft extending above surface of follicular
ostia. It is a primary lesion in vitamin A–responsive dermatoses, primary
seborrhea, and sebaceous adenitis. A, Hairs of a dog with sebaceous
dysplasia. B, Closer view of hairs following epilation; clumps of material
at base of multiple hairs are casts. Follicular casts may be secondary
lesions in demodectic mange and dermatophytosis.
PROBLEM LIST AND DIFFERENTIAL DIAGNOSIS
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A problem list should be made based on the information
obtained from the history, physical, and dermatologic examinations. A differential diagnosis list is then developed for each of
the patient’s problems. Comparing key features of the diseases
in the list with findings from the history and physical examination is helpful in prioritization of the differentials. The possible
diagnoses should then be considered in their proposed likely
order of occurrence. This prioritization is helpful in developing
a cost-effective plan.
DEVELOPING A DIAGNOSTIC
OR THERAPEUTIC PLAN
76
Laboratory tests or therapies can be recommended on the basis
of tentative diagnosis and differential diagnosis. If a strong
tentative diagnosis is not established from the history and physical examination, the approach should be directed at the two or
three most likely diagnoses. Client-veterinarian interaction is
critical at this point. The client decides what is going to be done,
but his or her decision is based on the clinician’s recommendations. Therefore, the client needs to know the tentative or possible diagnoses, as well as expected costs and anticipated results
of the diagnostic or therapeutic options proposed.
Diagnostic tests and laboratory procedures are useful whenever a definitive diagnosis cannot be made from the case history
and clinical examination alone.21 Laboratory procedures may
FIGURE 2-18 Comedo—a dilated hair follicle filled with cornified cells and
sebaceous material. It is the initial lesion of feline acne and may predispose skin to bacterial folliculitis. A comedo may be produced secondary
to seborrheic skin disease, occlusion with greasy medications, or administration of systemic or topical corticosteroids. Photograph illustrates comedones of ventral abdomen of dog. When comedones are present,
diseases of hair follicle should be considered, such as infection with
Demodex and dermatophytosis. Comedones may be primary lesions in
feline acne, vitamin A–responsive dermatosis, Schnauzer comedo syndrome, Cushing disease, sex hormone dermatoses, and some idiopathic
seborrhea disorders.
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FIGURE 3-17 Four-month-old Labrador retriever that was burned by boiling oil 4 days prior to presentation. A shows exudative matted fur with erosions
on lateral left hind limb, left flank, and rump extending up to lateral T-L area of trunk. However, with fur intact, is it impossible to evaluate extent of
damage. B, As wound was probed and cleaned, affected area sloughed easily. C, Once area was clipped and cleaned, extent of wound is evident and
clearly affecting 25% of body. D, Wound was then kept moist and protected with calcium alginate dressing. This allowed for continued absorption of
draining exudate while keeping wound clean and decreasing pain. This type of bandage will require a secondary bandage to cover it and frequent
changing.
OXYGEN USE IN WOUND HEALING
172
In the past decade, there has been increased focus on the therapeutic role of oxygen in both the chronic and acute wound. The
role of oxygen in wound healing is not yet completely understood, but numerous studies have demonstrated impaired
wound healing under hypoxic conditions. There are two
methods employed to increase delivery of oxygen to a wound:
topical products that use chemical methods to release oxygen
onto wounds and hyperbaric oxygen therapy. Hyperbaric
oxygen therapy (HBOT) works by fully enclosing a person in a
chamber, increasing the pressure in the chamber, and then
delivering pure oxygen. The entire body and all organs and
tissues in the body are exposed to increased oxygen pressure.
The oxygen is inhaled into the lungs, where it dissolves in the
blood and is distributed to the wound. At sea level, or 1 atmosphere of pressure, the air contains 21% oxygen. This small
amount of oxygen is enough to saturate 98% of the oxygencarrying protein in our blood, the hemoglobin. With hyperbaric
oxygen, the body is exposed to 1 to 3 atmospheres of pure
oxygen, or 100% to 300% oxygen, nearly 15 times the amount
of atmospheric oxygen.
Numerous studies have examined the adverse and beneficial
effects of HBOT in animals and veterinary medicine. Results for
the most part demonstrate some benefit, but these results are
inconsistent. HBOT has not been effective in full-thickness
grafts on horse limbs, but it has been shown to enhance healing
after surgical ulnar repair in cats. As technology becomes more
readily available to clinical practice and more clinical trials are
performed to define its effectiveness, HBOT may be considered
as an additional therapeutic option in many conditions, including problem wounds, spinal cord injury, and cerebral ischemic
injury.542-545,561-566
Topical oxygen therapy is a more practical way to deliver
enhanced oxygen therapy in veterinary medicine and has
been shown to improve wound healing.540 The only current
product available in veterinary medicine is ZoonOx by PetMedicus Laboratories. ZoonOx is a topical hyperbaric oxygen
therapy for dogs, cats, and horses. It is reported to deliver an
intensified penetration of supersaturated oxygen into injured
tissue to stimulate faster healing. It uses an inert organic compound to encapsulate and transport oxygen molecules in an
emulsion dispensed from an aerosol container and applied
directly to injured skin or gum tissue. The resulting hyperoxia
is supposed to promote new collagen and epithelium in
burns, surgical incisions, traumatic injuries, certain dermatitides, and other skin disorders. The oxygen radicals formed
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FIGURE 4-3 Folliculitis. A, Multiple tufted papules and nodules over lateral
thorax. These lesions are often confused with urticaria. B, Multiple areas of
discrete “nonreactive” alopecia caused by follicular inflammation. C, Widespread alopecia due to coalescence of pustular lesions. Dog had been treated
with corticosteroids instead of antibiotics. D, Multiple small crusted follicular
papules over tarsal region. E, Multiple papular and pustular (arrows) lesions
on sternal region. F, Large epidermal collarette associated with coalescence
of multiple pustules in Shetland sheepdog. G, Widespread disease with alopecia and multiple epidermal collarettes surrounding areas of central hyperpigmentation (arrows).
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FIGURE 19-19 A case of Raynaud-like disease in a dog. (Courtesy D.
Carlotti.)
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FIGURE 19-18 Infectious causes of claw diseases. A, Trichophytin infection
with mild onychodystrophy and onychomalacia of affected claw. Note
yellow discoloration of claw. B, Claws of digits 2, 4, and 5 show brown
staining distally, which occurred while all digits had Malassezia paronychia. Dog was treated for 3 weeks with ketoconazole, and normal white
claw formed. Recurrence of Malassezia paronychia can be seen in digit
2 claw fold, where there is also mild swelling and erythema (paronychia
with brown stain occurring on proximal claw). C, Onychogryphosis of
claws in a dog with leishmaniasis. (C Courtesy Chiara Noli.)
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FIGURE 19-20 Symmetric lupoid onychitis. A, Hemorrhage seen in the claw.
(Courtesy of M Boord) B, Purulent exudate over corium after onycholysis
claw was removed. C, Regrown claws in a SLO case on fatty acids, tetracycline, and niacinamide showing onychodystrophy still present.
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