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Clinical Updates on Juvenile Dermatopathies 幼犬皮肤病的临床进展 翻译：马丽（沅宝） 校对：刘欣 Skin disease remains one of the most common ailments for both puppies and adult dogs, with dermatologic conditions being 4 of the top 10 most common reasons for veterinary visits. Puppies in particular are predisposed to skin disease because of an immature immune system and an immature dermal protective barrier function. Encompassing both infectious and noninfectious causes, skin disease can be extremely frustrating for both owners and veterinarians alike. While a variety of treatment options are available for each dermatopathy, it is important not to assume a “one-size-fits-all” approach for each patient. 皮肤病一直是幼犬和成年犬最常见的疾病之一，占据兽医就诊的十大最常见原因的前四位。幼犬尤其容易患皮肤病，因为幼犬的免疫系统不成熟，皮肤保护屏障功能不成熟，不管是传染性还是非传染性的皮肤病，都会令宠主和兽医有同等的挫败感。虽然每种皮肤病都有多种治疗方案，但重要的是不要对每个患者采取“一刀切”的方法。 Demodectic Mange 蠕形螨 Demodectic mange is caused by skin mites that are a ubiquitous part of the normal flora of healthy dogs. The mites reside deep in the hair follicle, and as long as the immune system is working normally, the mites do not cause disease. Puppies acquire the mites from their mother shortly after birth, typically during nursing or other times of close contact. Because these mites are found on virtually all dogs, they are not considered contagious. 蠕形螨病是由健康犬的常在皮肤螨虫引起。蠕形螨定居于毛囊深处，只要免疫系统正常工作，就不会导致发病。幼犬通常是在出生后不久，在哺乳期或其他密切接触的时候，从母亲那里获得螨虫。因为这些螨虫几乎在所有的犬身上都能找到，所以它们是不传染的。 Unlike adult dogs, puppies do not have a mature immune system, which can result in an overgrowth of the mites deep within the skin. Certain breeds—such as the Afghan hound, American pit bull terrier, American Staffordshire terrier, Boston terrier, boxer, and English bulldog—are particularly predisposed to developing demodectic mange. 与成年犬不同，幼犬没有成熟的免疫系统，这会导致螨虫在皮肤深处过度生长。某些品种，如阿富汗猎犬、美国斗牛犬、美国斯塔福德郡㹴、波士顿㹴、拳击犬和英国斗牛犬等，特别容易出现蠕形螨病。 There are 2 forms of demodectic mange, localized and generalized. The localized form results in a region of focal hair loss, commonly on the face or legs. Clinical signs are typically mild or even nonexistent, and the infection is often self-limiting as the immune system matures. When the localized form spreads to involve multiple regions of the body, it becomes the generalized form of the disease. This form often results in large areas of hair loss, inflammation, and secondary infections. 蠕形螨病有两种形式，局部性和全身性。局部性会导致局部脱毛，通常发生在面部或腿部。临床症状通常是轻微的，甚至不存在，并且随着免疫系统的成熟，感染往往是自我限制的。当局部扩散到身体的多个区域时，它就变成了全身性。这种形式经常导致大面积脱毛、炎症和继发感染。 Although the localized disease form is typically self-limiting, the generalized form can be extremely frustrating and challenging to treat. Common therapeutic options include ivermectin, milbemycin, and moxidectin, all of which are extra-label uses. These medications must be given repeatedly for long periods of time and require high owner compliance to be fully effective. A newer class of drugs, the isoxazoline parasiticides, has recently been demonstrated to be highly effective against generalized demodicosis. With a longer lasting active ingredient, this class of drug has the potential to provide sustained control of infestation for at least 3 months after a single treatment; this usage is also extra-label. 虽然局部性通常是自限性的，但全身性蠕形螨病的治疗非常令人挫败和具有挑战性。常用的治疗方法包括伊维菌素、米尔贝霉素和莫西替丁，这些都是标签外用药。这些药物必须长时间反复服用，并且要求主人服从性高才能完全有效。一种新的药物，异恶唑啉杀虫剂，最近被证明对全身性蠕形螨病非常有效。这类药物有一种更持久的活性成分，在一次治疗后至 少有3个月能够持续控制感染；这种用法也是标签外用药。 Sarcoptic Mange 犬疥螨 Sarcoptic mange is also caused by skin mites; however, there are several important differences between these mites and the mites that cause demodectic mange. Sarcoptic mites reside in the superficial surface of the skin and often cause intense pruritus. It is common to find no evidence of mites during a superficial skin scrape because significant disease can result from only a small number of mites. The pinnal-pedal reflex has been shown to be a valuable diagnostic tool for identifying sarcoptic mange, even when no mites are found on a skin scrape. The intense pruritus seen with infestation can often lead to self-induced excoriations and secondary bacterial infections. Another important feature of sarcoptic mange is its zoonotic potential. This disease can not only be transmitted to humans but also is highly contagious between dogs. Macrocyclic lactones are among the common therapies for sarcoptic mange; however, recent studies have found some drugs in the isoxazoline class to be effective at both eliminating mites as well as addressing clinical signs in dogs with sarcoptic scabies. Use of these drugs for this purpose is also extra-label. 犬疥螨病也是由皮肤螨虫引起的；然而，这些螨虫和引起蠕形螨的螨虫有几个重要的区别。疥螨寄生于皮肤浅表，常引起剧烈瘙痒。在浅表皮肤刮片中没有发现螨虫的迹象是很常见的，因为仅少量的螨虫就会导致严重的疾病。即使在皮肤刮片中没有发现螨虫，耳足反射也被证明是鉴别疥螨的有价值的诊断工具。螨虫感染带来的瘙痒往往会导致自损和继发细菌感染。疥螨的另一个重要特征是它的人畜共患的可能。这种疾病不仅可以传染给人类，而且在犬之间也具有高度传染性。大环内酯是治疗疥螨的常用疗法之一；然而，最近的研究发现，异恶唑啉类药物既能有效地消除螨虫，又能解决疥螨患犬的临床症状。这些药物在治疗疥螨上也是标签外用药。 Ringworm 癣菌 Ringworm is caused primarily by the dermatophyte Microsporum canis, which feeds on keratin found on the surface of fur, nails, and skin. Compared with older dogs, puppies are at an increased risk for developing ringworm infection secondary to an immature immune system. The disease is highly contagious to both animals and humans and is one of the most common causes of tinea capitis (ie, ringworm of the scalp). Infection is spread both by direct and indirect contact (fomites), and spores can survive for months in the environment, making reinfection possible if appropriate environmental decontamination is not performed. A Wood’s lamp can be used to screen patients for ringworm infection; however, false negatives are common. Fungal culture, direct examination of hairs to document active infection, and even biopsies can be used to diagnose infection, as can monitoring empirical therapy. 癣菌病主要由犬小孢子菌引起，它以毛皮、指甲和皮肤表面的角质为营养来源。与年龄较大的犬相比，幼犬因不成熟的免疫系统患癣感染的风险增加，。这种疾病对动物和人类都具有高度传染性，是头癣（即人头皮癣）最常见的病因之一。感染通过直接和间接接触传播（污染物），孢子可以在环境中存活数月，如果不进行适当的环境净化，就有可能再次感染。伍德氏灯可用于筛查患者是否感染癣菌；然而，假阴性也很常见。真菌培养、毛发直接镜检可以证明活跃感染，乃至活检可用于诊断感染，也可用于监测经验性治疗。 Successful treatment requires use of systemic oral antifungals in addition to topical disinfection of the hair coat. Although there are several systemic antifungal therapy options available, not all medications are safe for use in pediatric patients. Once a patient is diagnosed with ringworm infection, it is crucial to treat all household pets and quarantine those pets not showing clinical signs. 成功的治疗需要使用口服抗真菌药物全身治疗，此外，使用皮肤外用药。虽然有几种全身性抗真菌治疗方法可供选择，但并不是所有的药物对幼犬都是安全的。一旦患犬被诊断为癣菌感染，治疗所有家庭宠物，并隔离那些没有临床症状的宠物是至关重要的。 Allergic Dermatitis 过敏性皮炎 Allergic dermatitis is the result of an inflammatory and pruritic allergic skin disease. There are multiple causes of allergic dermatitis, the most common being flea allergies, food allergies, and atopy. Flea bite allergy is the most common cause of canine dermatologic disease, and it is therefore recommended to maintain year-round preventive therapy in pruritic patients. 过敏性皮炎是一种炎症和瘙痒性过敏性皮肤病。过敏性皮炎有多种原因，最常见的是跳蚤过敏、食物过敏和特应性皮炎。蚤咬过敏症是犬类皮肤病最常见的病因，因此建议对瘙痒病患维持全年的预防性治疗。 Although both flea allergy dermatitis and food allergies are common causes of dermatitis in puppies, true atopic dermatitis is much less likely in the pediatric population. Although no single therapy is 100% effective, immunotherapy, canine atopic dermatitis immunotherapeutic (CADI), and oral medications (eg, glucocorticoids, cyclosporine) are cornerstones of medical management. Successful treatment of allergic dermatitis involves not only medical management but also environmental modifications based on the underlying disease trigger, and a multimodal approach is recommended for an optimal treatment outcome. Parasite prevention is also a crucial component of multimodal therapy, particularly in patients with insect-specific allergens. 虽然跳蚤过敏性皮炎和食物过敏都是引起幼犬皮炎的常见原因，但真正的特应性皮炎在幼犬群体中的可能性要小得多。虽然没有单一疗法是100%有效，免疫疗法，犬特应性皮炎免疫治疗（CADI），口服药物（如糖皮质激素，环孢素）是医疗管理的基础。过敏性皮炎的成功治疗不仅涉及医疗管理，还涉及基于潜在疾病诱因的环境改变，建议采用多模式方法以获得最佳治疗效果。寄生虫预防也是多模式治疗的一个重要组成部分，特别是对昆虫过敏的犬。 Conclusion 总结 Dermatologic diseases are extremely common in the canine population, and puppies in particular are at an increased risk because of their immature immune system. There are many reasons for a puppy to be itchy, and regardless of the underlying cause of pruritus, secondary bacterial infections are common. 皮肤病在犬中极为常见，尤其是幼犬，由于免疫系统发育不成熟，患病风险更大。幼犬瘙痒的原因有很多，不管瘙痒的根本原因是什么，继发性细菌感染是很常见的。 Most cases are best treated with a multimodal approach, using both medical management and environmental modifications. Although a combination of both topical and systemic therapies has been suggested for management of the more common dermatologic diseases discussed here, not all of these medications have been proven safe for use in pediatric patients. 大多数病例最好采用多模式治疗，同时使用医疗管理和环境改变。虽然在这里讨论的更常见的皮肤病的治疗中，外用和全身疗法的结合已经被提出，但并不是所有这些药物都被证明是安全的用于幼犬。 Additionally, many topical treatments, such as lime sulfur dips, are time-consuming and require a high level of owner compliance. The isoxazoline drug class is a newer option for treatment of many juvenile skin diseases and may also improve owner compliance due to the need for less frequent dosing. 此外，许多外用药，如石硫合剂浸泡，耗时且需要宠主有高的依从性。异噁唑啉类药物是治疗许多幼犬皮肤病的一种较新的选择，由于给患宠用药频率低，也可能提高宠主的依从性。
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发表于 2021-2-3 15:19:43
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