皮肤是猫咪健康状况的标志-全身性疾病的皮肤表现（4）

王帆

皮肤是猫咪健康状况的标志

SKIN AS A MARKER OF GENERAL FELINE HEALTH

全身性疾病的皮肤表现

Cutaneous manifestations of systemic disease

作者：Linda J Vogelnest

翻译：何梦婷  校对：王帆

瘙痒的患猫

The cat with pruritus

猫皮肤病常见明显瘙痒，最典型的是过敏反应（图7）或一部分感染性皮肤病（如细菌性脓皮病、马拉色菌性皮炎、戈托依蠕形螨相关的蠕形螨病、疱疹病毒相关的面部皮炎）。全身性疾病通常不伴有明显的瘙痒，尤其是在没有明显皮肤病的区域。继发性细菌和/或马拉色菌感染可引起明显瘙痒，但是，当与潜在的全身性疾病相关时，这种瘙痒症很少是严重的，并且更典型地表现为轻微舔舐、甩四肢、摩擦或过度理毛。

Feline skin disease with prominent pruritus is common, and most typically associated with hypersensitivities (Figure 7) or a subset of infectious dermatoses (eg, bacterial pyoderma, Malassezia dermatitis, D gatoi demodicosis, herpesvirus-associated facial dermatitis). Systemic diseases do not tend to present with prominent pruritus, especially in the absence of obvious areas of dermatitis. Secondary bacterial and/or Malassezia species infections may cause obvious pruritus; however, when associated with underlying systemic disease such pruritus is rarely severe, and more typically manifests as subtle licking, limb shaking, rubbing or excessive grooming.

图7患有特应性皮炎并发跳蚤叮咬过敏的瘙痒的患猫。就诊时有明显瘙痒表现。注意躯干和四肢毛发的健康光泽，头部有斑片状部分脱毛区。

Figure 7 Pruritic cat with atopic dermatitis and concurrent flea bite hypersensitivity. Pruritus was evident during the consultation. Note the healthy sheen to the coat on the trunk and limbs, and patchy partial alopecia on the head

对皮肤病患病动物进行仔细的病史调查和全面的体格检查，往往能为潜在的全身性疾病提供最有用的线索。许多皮肤病变是非特异性的，各种皮肤病都会表现。

Careful screening of history and complete physical examination in patients presenting with skin disease often provides the most useful clues to the potential for underlying systemic disease. Many skin lesions are non-specific and occur in a wide range of skin diseases.

所有感染性病因的皮肤病都可能是发生了免疫抑制的结果。因此，对于任何感染性皮肤病，筛选可能的感染源和考虑潜在免疫力降低的可能性都是很重要的。

All infectious causes of skin disease may occur as a consequence of immunosuppression. Thus screening for the likely source of infection, and considering the likelihood of underlying immuno compromise, is important with any infectious dermatosis.

诊断方法：瘙痒 Diagnostics: pruritus 不考虑年龄或其他体格检查或病史调查时，猫出现明显瘙痒首要考虑疾病之一是过敏反应。然而，目前还没有一种简单的方法来准确地确认或排除皮肤过敏，诊断依赖于充分的临床支持和病史信息以及排除其他鉴别诊断。在更典型的表现中，对过敏反应的诊断是相当简单的（例如，年轻成年猫间歇性瘙痒，使用糖皮质激素有效），尽管区鉴别不同类型的过敏反应往往更有难度。当面对非典型的表现时，诊断可能会有更困难。 Hypersensitivity is one of the first considerations for a cat presenting with prominent pruritus, irrespective of age or other physical or historical findings. However, a simple means of accurately confirming or excluding cutaneous hypersensitivity is not currently available, and diagnosis is reliant on sufficient supportive clinical and historical data and exclusion of other differentials. In more typical presentations, a broad diagnosis of hypersensitivity is fairly straightforward (eg, young adult cat with glucocorticoid-responsive intermittently flaring pruritus), even though distinction between types of hypersensitivity is often more challenging. Diagnosis may be more problematic when faced with atypical presentations. 过敏反应先发生在年轻成年猫，表现为持续性或阵发性瘙痒，伴随着一系列轻微到严重的自损性皮肤变化。疾病有时会发生在老年动物。猫的常见过敏反应是特应性皮炎（也称为“非食物性，非跳蚤过敏反应”）、食物不良反应（包括真正的食物过敏和食物不耐受），以及在世界不同地区的跳蚤叮咬和蚊子叮咬过敏反应。过敏反应常见并发继发性细菌和酵母菌感染，有时引发严重瘙痒。 Hypersensitivities characteristically begin in young adult cats, manifesting as constant or episodic pruritus, with a spectrum of subtle to severe resultant traumatic skin changes. Disease will sometimes commence at an older age. The common hypersensitivities described in cats are atopic dermatitis (also called ‘non-food, non-flea hypersensitivity’),food adverse reactions (encompassing true hypersensitivity and food intolerance) and, in varying regions of the world, flea bite and mosquito bite hypersensitivities. Concurrent secondary bacterial and yeast infections are not uncommon with hypersensitivites, and sometimes create severe pruritus. 对瘙痒患猫的有效诊断评估包括先对过敏症或寄生虫病的病史调查，随后进行基本的皮肤诊断检查，以筛选原发性和继发性感染。如果初期评估信息相互矛盾或不能帮助诊断，则可能需要进行更详尽的诊断评估。 An efficient diagnostic evaluation for the pruritic cat encompasses initial historical screening for allergic or parasitic disease clues, often followed by basic skin diagnostic tests to screen for primary and secondary infections. A more exhaustive diagnostic evaluation may be indicated if initial assessment provides conflicting data or does not help focus the diagnostic possibilities.

瘙痒患猫病史问诊的重要诊断 <是否以前的证据提示过敏反应？ <是否接触传染性感染病的风险？ <整体健康 感染性病因检查 <胶带粘贴法（细菌和酵母菌感染；非典型皮肤癣菌病） <皮肤浅刮（戈托伊蠕形螨、疥螨、其他外寄生虫） 如果没有明显的感染，过敏反应不典型，或同时有全身症状表现 <全身性疾病筛查

Important diagnostics for the pruritic cat Historical questioning < Previous evidence suggestive of hypersensitivity? < Risk of contracting contagious infections? < General health Tests for infectious causes < Tape impressions (bacterial and yeast infections; atypical dermatophytosis) < Superficial scrapings (D gatoi; Notoedres; other external parasites) In the absence of apparent infection and when less typical for hypersensitivity, or when there are concurrent systemic signs < Screen for systemic disease