How to perform a good physical examination in veterinary dermatology

More information from Anthony Chadwick at The Webinar Vet- a leading provider of veterinary webinars and online veterinary CPD

I always like to start with a general physical examination. I like to check the dog all over. You know, I like to look in its mouth. Because it may have blisters in its mouth, which may be an immune-mediated disease. And if I’ve not looked there, I’ve missed it. It may have a liver tumor in there which is causing hepatocutaneous syndrome. So I palpate its abdomen and I can feel that. It may have enlarged lymph nodes. That may be because it’s got demodicosis or it’s got an infection. Or it’s got some sort of tumor going on as well. So it’s important to do a general physical examination before you launch into the skin. Always listen to the heart and lungs to check everything is ok. You may want to anaesthetise this pet at some point.

I like to look at the distribution of the lesions and see what type of lesion they are. And often by doing that, I’ll get an idea of the various conditions. So cheyletiella is very often a dorsal pruritic dandruff-type disease. So if I’m seeing a younger puppy with lots of dandruff on its back, I need to get the clippers out and look for mites. Otodectes, mainly around the ears.Sarcoptes is ventral, on the points of the elbows. They’re the common areas that I tend to see it. Although sarcoptic mange can be very difficult to find on a scraping, you can also do blood samples and so on. And look at the hair coat. Is the hair being pulled out? What’s happening to it? And then by clipping some of that hair, have a closer look at the skin. Is there scaling, signs of infection, or a papular rash? What’s going on? Are there secondary infections, and so on? And obviously, with some parasites, you can see them with the naked eye, certainly fleas and lice. Also be aware during the clinical examination and the history that you take, that there are different ways of manifesting pruritus between dogs and cats. So quite often I will say to a cat owner, Is your cat itchy? And they’ll say, No, it isn’t because they imagine me to mean whether the cat is actually scratching with its back leg. When I ask the question, Does the cat wash itself a lot? – Oh, it’s always washing itself. And that’s a sign of itchiness in a cat, especially if it’s doing it excessively. So it’s useful to make sure you’re asking the right questions and looking to see if you can see areas of hair loss and so on, which may be due to pruritus, or it could just be falling out.

Next look for the classic lesions of veterinary dermatology

• Papules

• Pustules

• Epidermal collarettes

• Scale

• Alopecia

• Nodules

• Plaques

If you do not recognize these go to any good veterinary dermatology text book to learn how to recognize these lesions