Your problem list for Wyatt consists of
- Severe pruritus
- Dermatitis (inflammation and secondary infection)
- Bilateral otitis externa
Wyatt's owners approve ear cytology, skin cytology, and skin scrapings. Here are your findings:
- Skin cytology (acetate tape preparation) results (ventral trunk, front feet): Occasional to 2-3+ cocci/hpf, 1-2+ yeast/hpf
- Ear cytology (individual swab smear samples obtained from the right and left ears): 2-3+ cocci/hpf, 1+ yeast in both ears
- Deep and superficial skin scraping cytology (ventral trunk): No evidence of Demodex or Sarcoptes species (in your experience, sarcoptic mange is endemic in your area)
HOW TO PERFORM ACETATE TAPE PREPS FOR SKIN CYTOLOGY
Clear acetate tape (not opaque or frosted) is an easy and effective tool for screening patients for the presence of Malassezia dermatitis. Place a piece of tape over areas of dermatitis and pruritus. The glue on the tape is ideal for picking up yeast organisms. Tape is also ideal for screening places that are harder to reach (such as interdigital areas or facial fold areas) with glass slides to make impression smears. Stain the tape with the second and third set of Diff-Quik (Dade Behring) stains (red and purple—eliminate the first step, which is the fixative). Then place the tape sticky side down on a glass slide, and examine it under the microscope with the 100x objective.
What is the most appropriate plan for Wyatt?
a) Submit a sample for serum ELISA allergy testing to identify whether Wyatt has developed new allergies.
b) Rule out a flare of atopic dermatitis—resolve current ear and skin infections with appropriate medications, and then re-evaluate Wyatt's comfort level and response to therapy.
c) Obtain a skin biopsy and bacterial culture to rule out neoplasia and a resistant bacterial infection.
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