中文esavs9deboer behavioral道格拉斯兽医学

BehaviorandSkinDouglasJ.DeBoer,道格拉斯J.德波，兽医学SchoolofVeterinaryMedicineCanineLickFelinePsychogenicLickGranuloma(AcralLick舔舐性肉芽肿（舔舐性肢端皮炎Multifactorialcause;typicallyseveralelementsarepresentineachpatient.多种病因AcralLick舔舐性肢端Beginswithastimulusto开始刺激Progresses 过程–SecondarystaphinfectionDevelopmentofa“habit”oflicking养成舔舐的习惯Formationofg Developmentofa“habit”oflicking养成舔舐的习惯Formationofg ViciouscircleLickGranuloma-Causesto考虑舔舐性芽肉肿的病Bacterialinfection细Staphylococcus‘always’apartofthe»Primarydeep »Secondarysurfaceorsuperficialinfection –Unusualbacterialinfectionordeepmycosisispossiblebutmuchlesslikely LickGranuloma-Causesto考虑舔舐性芽肉肿的病Habit!!Often(usually?)apart经常（一直？)SomedogscreatelesionsONLYforbehavioralInothers,followingpersistence,thehabitoflickingdevelops(morecommon) –Don’tbetooquicktoblamethisdiseasecomple onhabit!!LickGranuloma-Causesto考虑舔舐性芽肉肿的病Underlyingpruritus潜在瘙AtoicDermatitisFoodDifficulttodetermineiflickingispruritusvs.»Predisposedageandbreed?易患病 Otherbodylocations? lvs Recurrentotitis?AnyGIsigns?Responsetocorticosteroids?LickGranuloma-Causesto考虑舔舐性芽肉肿的病Priorinjury之前Woodsplinter,grassawn,etc.Underlyingpain隐藏的疼Asfromosteoarthritis,orthopedic smSuamouscellcarcinomaParesthesia 感觉异常/神经Howcanwedoabetterjob?我们怎样才能做得更好呢LickGranuloma-ATreatmentLevelIDiagnostics一级诊–Historyandexamination“Obviousunderlyingcause“明显的”病Inurforeinbod»Socialhistory–behavioral–Cytologyif»Confirmpresenceof»ConfirmabsenceofunusualLickGranuloma-ATreatmentLevelIDiagnostics一级诊CultureandsusceptibilityIfdraining»Ifhistoryofmultipleantibioticsor»For»ForunusualLickGranuloma-ATreatmentLevelI ticsand一级诊断：抗Antibiotics抗生»Ofgreatbenefitifdeeppyoderma»Secondarysuperficialorsurfaceinfectionsseemtobenefitfrom“decontamination” »Beneficialeffectsonwound» sdi »Verylongcourse!!Untillesionshrinks ally,thenat least2weekslonger…4to12weeksLickGranuloma-ATreatmentLevelITreatment:Antibioticsand一级诊断：抗生素和防止舔舐Restraint防止舔»Criticalto andoftenne»Continueafterantibioticsstop,waittoseeif»Relapseduringrestraintonly=primaryunderlyingproblem,notjustself-trauma在防止舔舐期病情复发 »BandageHA!)»Bittersubstance»BandageHA!)»Bittersubstance(HAHA!)LickGranuloma-ATreatmentLevelIIDiagnostics:if–Biopsywithhistopathologyand活检，组织病理学和»Cautionifrestraintisnot–ImagingRadiography–bonychangesUltrasoundforeign CTfistulogramforeign CT-“Bandit”5yrGreat5岁的大丹 “Bandit”5yrGreat5岁的大丹 LickGranuloma-ATreatmentLevelII二级诊–Empiricaltopical经验局部治疗»Topicalsteroid局部类固醇加»Noneshowntobesuperiororparticularlyeffective»Somepatientsmay»ContinueLickGranuloma-ATreatmentLevelIITreatment二级Behavior 行为矫 63dogswithALD,DBPC对63只患有ALD的狗进行DBPC检Fluoxetine20mgoncedailyforsix服用氟西汀20毫克一次/一天，持续六个星SinificantP<0.0001differenceinlesiona earanceandlickingbehavior病变表面和舔舐行为的明显不同Wynchanketal,DepressAnxiety1998;8:21-LickGranuloma-ATreatmentLevelIITreatment–Behaviormodification行为矫 Clomipramine12dogs,DBPCcrossovertrial对12只犬进行DBPC交叉实验Clomipramine3mg/kgBIDfor4weeksMoreeffectivethan ceboatreducingcompulsivebehavior, howevernotcurative. SomesedationandreducedHewsonetal.,JAVMA1998;213:1760-LickGranuloma-ATreatment–Behaviormodification行为矫Naltrexone(narcoticantagonist)纳曲酮11dogs,opentrial,1mg/kgorally,oncedailyCessationoflickingwithhealingin7dogs11dogs,opentrial,1mg/kg11只犬进行公开实验，服用1mg/kgSQtapebeforeandafterWhite,JAVMA1990;196:1073-Dodmanetal;,JAVMA1988;193:815- toryor ManagingUnresponsiveSelf-TraumaandAlopecia管理治疗没有效果的自 和脱治疗没有效果的自-

ermatitis源于异位性皮炎-Fromatopic-like源于类似异位性皮炎 tory/pruritic ondtoconventionaltherapy-Other ruledUnresponsive治疗没有效Diseasedidrespondtoanti-infl torymedicationinpast,nowresistant过去对抗炎药有反应的疾病现在却对抗炎药起耐versusDespiteyourbestefforts,thediseaseneverhasrespondedconventionaloraltherapiessuchascorticosteroidsorcyclosporineA#1:Whatcanwedo?情况#1：我们可以做什么？治疗没有Diseaserespondedtoanti-infl medicationinpast,nowresistant在过去对抗炎药起反应的疾病 –»Checkbyclinicalsigns,cytology,–Adversefoodreaction/foodallergy不利的食物反应/ScabiesChecktreatedempiricallyCorticosteroidtachyphylaxis糖皮质激素的»ScabiesChecktreatedempiricallyCorticosteroidtachyphylaxis糖皮质激素的»ChoosealternatecorticosteroidMalasseziaYeastFrequentlyunrecognizedinsmallanimal在小动物中经常被漏Primarilyadiseaseofdogs(esp.Westie,Basset 主要为犬疾病（尤其是西高地犬，巴吉 易患该病酵母菌过度生长 色菌皮炎 YeastDermatitis酵母皮UnresponsiveSituation#2:FelineOver治疗没有效果的皮 情况#2：猫类过度理Psychogenicalopeciaexistsincats,itisMUCHlesscommonthaninfl toryDonotquicklyblameVentralsymmetricalalopecia(BaldFlankalopeciaAlopeciaonmedialforelimbsIscatremovinghair?是猫Removinghairintentionallyvs.hair“fallin outb VS毛发自己脱落 rselfandtheBroken,“square”hairTaperedhair“BaldBelly”incats猫Ventralsymmetricalalopeciaof猫腹部对称Aclinicalsyndrome,nota只是临床症状，不是 beunderl 也许是潜在的炎症引Maybeunderlyingpsychogenic也许是心理性因素Isit toryor 炎症还是心理性IsitPsychogenicor是心理问题还是瘙痒引起的Psychogenic:catstendNOTtodamageskinResponsetosteroids=notOwnermaybeawareofchangeinsocialenvironment Ventralsymmetricalalopeciaof 猫腹部对称脱毛：评Makesureit’snotaninfl 确定猫腹部对称脱毛不是炎症引起的 –Skin s皮肤刮EmpiricaltreatmentforFungalcultureShort-termprednisonetrial?Skinbiopsy?Ventralsymmetricalalopeciaof猫腹部对称心理性因素引起的猫腹部对称脱毛的Environmental ent丰富Foodpuzzlelim fr BirdfeederinwindowMoretimewith Vent