Underlying Skin Disease Research Articles

Effective Nano carriers used as a Targeted drug delivery in Mycosis: A Comprehensive Review

Candida infections, particularly C. albicans, infect the skin, nails, mucous membranes, and gastrointestinal tracts. Cutaneous and mucosal manifestations can be divided into clinical syndromes. The incidence of superficial and systemic fungal infections has increased due to severe diseases and immunosuppressant therapies. Obesity and diabetes mellitus are leading predisposing factors for cutaneous candidiasis. Cutaneous mycoses are a severe skin and underlying skin disease endemic in tropical countries, causingsevere medical and socioeconomic impacts on patients, communities, and health services. Fungal infections have surged in recent years, especially in humid and industrialized regions, with severity ranging from mild to life-threatening systemic infections. Certain drugs, such as polyenes, azoles, and echinocandins, are approved for treating infections, but some fungi have developed resistance to these drugs. Large-scale studies on novel targeting strategies and formulations are being conducted to counter drug resistance, gaining momentum in recent times. Conventional formulations have limitations like high doses, frequent dosing, and various side effects. The emergence of nanotechnology and its applications has been facilitated by overcoming these limiting factors. Formulation scientists can now encapsulate potential drug moieties into nanocarriers, allowing for prolonged release and improved permeation in gels or creams, for targeted effect. This review explores new targeting strategies and the use of nanocarriers for topically administered for the treatment of fungal infections like mycosis, skin allergy etc. This approach provides new opportunities for continuous and sustained research in pharmaceuticals, resulting in more effective outcomes.

Understanding patient perspectives on vaccine decision making in adults with autoimmune bullous diseases: a qualitative study.

Patients with autoimmune bullous diseases are at an increased risk of infection, both from the underlying skin disease and from immunosuppressive treatments. Limited information is available on vaccine beliefs and behaviors in dermatology patients and adults with autoimmune bullous diseases in particular. To understand vaccine decision making, identify perceived risks and benefits of vaccinations, and discuss individual experiences in patients with autoimmune bullous diseases in the United States. A qualitative study was performed utilizing semi-structured interviews, and analysis was conducted on NVivo. Patterns were identified in the coded data, and representative quotations were recorded for each major theme. Interviews were conducted between February 15, 2022 and September 15, 2022. Twenty patients with a diagnosis of bullous pemphigoid, mucous membrane pemphigoid, pemphigus vulgaris, or pemphigus foliaceous were interviewed. Of the 20 participants, 14 (70%) were female, with a mean (SD, range) age of 64.8 (13.2, 34-83) years. Key themes that emerged from qualitative analysis of the interviews included patient concerns regarding their increased susceptibility to infection, potential exacerbation of skin disease following vaccination, and the effect of immunosuppressive medications on humoral response to vaccines. Lack of appointment availability, difficulty accessing vaccines, and cost were commonly identified barriers to vaccination. These findings provide valuable knowledge for dermatologists in regard to providing counseling specific to patient concerns and to improve communication surrounding vaccination in the dermatology setting.

Rosacea: The eyes have it

Rosacea is a chronic inflammatory dermatosis typically affecting the facial skin but also the eyes. With its chronic course with fluctuating episodes of flashing, redness, papulopustules, and nodules it poses a severe psychologic burden to the affected individuals. In addition to the facial changes, more than half of the patients have ocular involvement ranging from blepharitis and conjunctival hyperemia to more severe ophthalmic damage, and even blindness. Clinically, the ocular involvement in rosacea includes meibomian gland dysfunction with relapsing hordeola and chalazia, diffuse hyperemic conjunctivitis, photophobia, episcleritis, or kerato-conjunctivitis, and in rare cases, corneal ulcers. These are mainly observed in adult patients but can also occur in children. Depending on the degree of cutaneous or ocular findings, patients with rosacea may present first to the dermatologist or to the ophthalmologist. Both specialists should be aware of the potential oculocutaneous involvement. Any ocular complaints expressed by the patient in the setting of a dermatologist's office should be referred promptly for an ophthalmologic examination. Conversely, signs suggestive of rosacea in the eye should lead the ophthalmologist to consider underlying skin disease. A timely interdisciplinary collaboration is paramount for the earlier diagnosis and treatment, thus preventing permanent eye impairment in this chronic dermatosis.

Psychiatric comorbidity and psycho-emotional status of patients with acne

Acne is a very common skin disease that has a significant impact on the psycho-emotional status of patients. This disease affects various areas of patients’ lives, leading to problems in body image, socialization, and sexuality. The change in appearance and the psycho-emotional stress associated with the development of acne can also affect other aspects of patients’ lives, including educational attainment, social activity, and a decline in academic performance and ability to work. Interpersonal problems in acne patients can occur not only with acquaintances and colleagues, but also within the family. The presence of a pronounced cosmetic defect, along with acute psycho-emotional problems, leads to a sharp decrease in quality of life, which is often exacerbated by comorbid psychiatric pathology: anxiety, depression, dysmorphophobia, self-injurious behavior, which certainly requires timely, effective and safe therapy for the underlying skin disease. Isotretinoin is an effective medication for the treatment of severe and treatment-resistant forms of acne. This drug has an effect on all four pathophysiological factors of acne development. Isotretinoin reduces sebum production, regulates hyperkeratosis in the estuaries of sebaceous follicles, reduces the number of Propionibacterium acnes on the skin and is thought to have certain immunological and anti-inflammatory effects. This is why the introduction of this drug into clinical practice has been recognized as an incredible triumph in the treatment of vulgar acne. However, the presence of some undesirable side effects may limit its widespread use. In 1982, for example, the FDA issued a warning about the possible risk of depression and the occurrence of suicidal thoughts and attempts while using isotretinoin. However, this warning was not subsequently confirmed.

Recognizing Multiple Diagnoses: Von Zumbusch Generalized Pustular Psoriasis Flare and Adverse Drug Effect

Von Zumbusch generalized pustular psoriasis (GPP) is a rare and severe type of psoriasis that presents as superficial pustules which coalesce into lakes of pus with erythema and scaling, with associated fever and life-threatening complications including sepsis. Here we describe a patient with a history of von Zumbusch GPP who presented with erythroderma, neutrophilic leukocytosis, and hyperbilirubinemia in the setting of missed medication dose and hip surgery. While her laboratory abnormalities were initially attributed to a flare of her underlying skin disease, when treatment of her psoriasis flare failed to correct the laboratory abnormalities, review of her biopsy showed evidence of a concomitant adverse drug effect and the patient ultimately expired due to sepsis.

Nonsteroidal anti-inflammatory drugs hypersensitivity in chronic spontaneous urticaria in the light of its pathogenesis.

Up to 15% of patients with chronic spontaneous urticaria (CSU) experience severe exacerbations of their baseline cutaneous disease after taking nonsteroidal anti-inflammatory drugs that inhibit cycloxygenase-1 (COX-1) enzyme. These subjects are defined as having a NECD (NSAID-exacerbated cutaneous disease). The way NSAID hypersensitivity correlates with the different pathogenic mechanisms of CSU has not been investigated so far. 235 adults with severe CSU submitted to omalizumab treatment were studied. A rapid omalizumab response was considered as a marker of auto-allergic (Type I) CSU whereas patients showing a slow response or not responding at all were regarded as having a type IIb autoimmune disease. At the first visit medical history of tolerance to aspirin and/or other COX-1 inhibiting NSAID was ascertained. Duration of disease, atopic status, thyroid autoimmunity, CRP, D-dimer plasma levels, and total IgE were assessed appropriately. 23 (10%) were hypersensitive to NSAID. Patients with or without did not differ in any of the variable considered, and a similar proportion in the two groups showed type I or type IIb CSU. The study suggests that in CSU hypersensitivity to NSAID represents a phenomenon that is independent on the pathogenesis of the underlying skin disease.

Immunocompromised Patients with Therapy-Refractory Chronic Skin Diseases Show Reactivation of Latent Epstein‒Barr Virus and Cytomegalovirus Infection

Reactivation of latent Epstein‒Barr virus (EBV) and/or Cytomegalovirus (CMV) infection is a dreaded complication in immunocompromised patients receiving hematopoietic stem cell transplantation. Evidence is sparse on whether subclinical reactivation of viral infection may also be of clinical relevance in dermatological patients. We screened patients (N= 206) suffering from chronic skin diseases for subclinical reactivation of EBV and CMV infection. We found that immunocompromised patients with therapy-refractory chronic skin diseases showed higher rates of subclinical reactivation of CMV and EBV infection (6.7% vs. 0% for EBV and 16.7% vs. 5.6% for CMV) and a higher prevalence of virus-specific DNA in skin tissue (30.8% vs. 0% for EBV and 21.4% vs. 0% for CMV) than nonimmunocompromised patients with chronic skin diseases. T cells isolated from lesional skin exhibited up to 14-fold increased proliferation with production of T helper type 1 and T helper type 17 cytokines on stimulation with viral proteins, providing evidence for possible aggravation of the underlying skin diseases by viral infection. Improvement of skin lesions in patients with reactivation of CMV infection (n= 4) was observed on antiviral treatment. Our data suggest that subclinical reactivation of EBV and/or CMV infection is an under-recognized condition in the dermatological patient population with chronic skin diseases.

Knowledge about, attitude toward, and practices in skin care among Thai adolescents.

Skin care for maintaining skin integrity includes cleansing, skin product use, and photoprotection. Inappropriate skin care can lead to skin problems. To evaluate the knowledge, attitude, and practices in skin care among Thai adolescents. Questionnaire-based, descriptive, cross-sectional study. A total of 588Thai adolescent students (mean age: 15.6 ± 1.8years, 50.5% female) were included. Of those who responded, 99.5% knew the benefits of cleansing, and 95.9% knew the benefits of skin care products. Skin products, moisturizer, and sunscreen were used by 87.8%, 80.8%, and 71.5% of students, respectively. Female teenagers used moisturizers, cosmetics, and sunscreen significantly more than males (p = 0.001, p = 0.001, and p < 0.001, respectively). High school teenagers applied cosmetics more than junior high school teenagers (p = 0.004). Ninety-three percent of adolescents knew the effects of sunlight, but only 27.4% regularly applied sunscreen. The sources of knowledge were from person, online social media, print media, and television/radio in 88.5%, 77.5%, 30.7%, and 26.1%, respectively. Data from physicians and parents were trusted by 65.3% and 64.2%, respectively. Most (74.1%) adolescents searched for data from more than 1source. Adolescent females and high school adolescents demonstrated significantly more accurate knowledge and practice in cleansing and photoprotection (p < 0.001) compared with adolescent males and junior high school adolescents. Knowledge and practices did not significantly correlate with underlying skin diseases or monthly allowance. Gender and education level were found to significantly influence knowledge and practice in skin care among adolescents in Thailand.

A retrospective study of comparison of collagen dressing versus conventional dressing for skin graft donor site

Background: Split-skin grafting is commonly employed for covering skin defects in case of ulcers, deep burns and following trauma. It involves harvesting of the epidermis and upper 1/3rd of dermis resulting in a wound called donor site wound (DSW). These wounds pose a kind of burden to patients during the process and after the process of wound healing. These wounds tend to cause pain, are at risk of getting infected, pruritis and cosmetic inconvenience. DSW has been managed with closed or open dressings. Out of many methods, we aim to compare the efficacy of collagen dressing with that of conventional dressing in this study.Methods: A retrospective study including 30 subjects were stratified into 2 groups; group A-collagen dressing and group B- conventional dressing. Patients aged between 18 to 60 years undergoing split thickness skin grafting were included. Patients who are immunocompromised, diabetic, with underlying skin disease and infected wounds were excluded. The outcome was compared in terms of pain, pruritis and scar assessment using Vancouver scar scale.Results: In the present study there was significant difference in median pain score, pruritus and median Vancouver scar score in collagen group compared to conventional group at all the intervals. Also, the incidence of surgical site infection was lower in the collagen dressing group.Conclusions: Collagen dressing is superior compared to conventional dressing in terms of lower pain score, pruritus score and Vancouver scar score.

Yeast fungi of the genus Malassezia in dermatological diseases in animals

The relevance of a comprehensive study of yeast fungi of the genus Malassezia and the development of modern methods for the diagnosis of diseases caused by small domestic animals. Infectious diseases of small domestic animals caused by yeasts have become a high priority in recent years among the problems of veterinary mycology. However, issues of diagnosis, therapy and prevention of yeast infections in small pets remain poorly understood. Difficulties in diagnosing Malassezia infections lead to the fact that in most cases these diseases remain undiagnosed, sick animals do not receive adequate therapy. Therefore, there is a clear need to develop affordable and practical diagnostic algorithms. Depending on the severity and location of the lesion, systemic or local antifungal drugs are used in combination with symptomatic treatment: antihistamines, antipruritic drugs. If necessary, antibiotic therapy is used and in case of using systemic antifungal drugs, hepatoprotectors are prescribed. Malassezia-associated dermatitis in animals is usually a secondary problem due to an underlying skin disease, such as allergic dermatitis (including atopic canine dermatitis and flea dermatitis), recurrent bacterial pyoderma, and endocrine diseases (especially hypothyroidism). The diagnosis of Malassezia-associated dermatitis should be based on a combination of clinical manifestations and microbiological analysis. Treatment is usually selected depending on such factors as: form (localized or generalized), general state of health of the animal, the main primary disease. A review of literature sources on this issue. The characteristics of different species of the genus Malassezia, which are present on the skin of domestic animals and have an etiological significance in the occurrence of diseases of small domestic animals. The localization of yeast fungi on the body of sick animals is described. In Ukraine, these diseases have not been purposefully studied, and the awareness of veterinarians and humane physicians about them remains unsatisfactory. Key words: yeast, fungi of the genus Malassezia, dermatitis, otitis, infection.

Main Causes of Skin Traumas and Damage in Patients with COVID-19

COVID-19 can affect multiple organs including heart and blood vessels, kidneys, gut, and brain. This study aimed to assess all aspects of skin traumas and damages in COVID-19. The main causes of skin trauma in COVID-19 and its consequences can be examined in four parts, including cutaneous manifestations that appear during COVID-19, drug reactions that occur during hospitalization or outpatient treatment of patients, skin damages caused by over-washing or rinsing with inappropriate detergents, or inappropriate use of personal protective equipment (mask, gloves,.), and changes the duration of COVID-19 in patients with autoimmune, chronic and inflammatory underlying skin diseases. The rate of skin manifestations in patients with COVID-19 in the range of 1.8%-20.4%, including vascular lesions (petechiae, purpura, livedo reticularis, pernio, and chilblain lesions), urticaria and maculopapular rash, and other less common skin manifestations such as erythema multiforme, pityriasis rosea, suite syndrome. These skin manifestations were commonly seen in men aged 45-89 years. The most lesions distribution ( 69.4%) was in the body, but in 19% of cases, lesions were observed in the hands and feet. Patients with COVID-19 receive multiple viral treatments, antibiotics, and various anti-inflammatory drugs. Receiving these drugs has led to cutaneous manifestations in some patients. Medical staff is prone to various traumatic skin conditions, due to the long-term use of personal protective equipment. These conditions include itching, redness, skin irritation, contact dermatitis, and worsening of underlying diseases. The effects of COVID-19 on the skin system can be serious and long-lasting. Adequate treatment and supportive therapy can prevent the long-lasting consequences and disability of the patient.

63230 Quantifying Heavy Metals in Interstitial Fluid for Remote Monitoring of Chronic Exposures

ABSTRACT IMPACT: We present a minimally-invasive approach to monitoring heavy metal exposures in geographically disperse populations; this framework may encourage and facilitate greater participation in a broad range of related clinical studies that require biosampling. OBJECTIVES/GOALS: We hypothesize that microneedle array (MA) extraction of interstitial fluid (ISF) will enable minimally-invasive quantitation of heavy metal (HM) exposure. We establish analytical parameters for ICP-MS analysis of HMs in ISF, quantify baseline HM content in ISF vs other fluids, and characterize a mixed HM exposure model. METHODS/STUDY POPULATION: Recent advances in ISF extraction and analysis suggest a minimally-invasive to monitor HM exposure longitudinally in both urban and dispersed communities. ISF can be collected with MAs and is a rich source of disease and exposure biomarkers. To refine analytical methods, Human subjects with no underlying skin disease were recruited into the IRB-approved study. Each subject had blood and urine collected. ISF was also collected using 3D-printed MA-holders. The fluids were analyzed, using ICP-MS, to quantify the levels of uranium (U), cadmium (Cd), vanadium (V), and arsenic (As). Additionally, we analyzed 2,770 subjects from the public NHANES dataset from 2018-2019. Python and Scikit-learn were used to analyze the demographics, survey responses, and metal concentrations for these individuals. RESULTS/ANTICIPATED RESULTS: While several studies have described the surface water and sediment content of toxic metals, determining biological loads remains challenging due to the need to collect blood or urine from a dispersed rural population over time. Our preliminary results suggest similar HM concentrations in ISF, compared with blood in a small unexposed population. Analysis of subjects from the NHANES public datasets suggest similar baseline blood HM concentrations in diverse subject populations with some differences in Cd depending on smoking and e-cigarette usage. Correlation maps also suggest possible synergy between different metals with cobalt and chromium showing the highest correlation. The initial results from this study have been applied to develop a mixed HM exposure model in rats for further translational testing. DISCUSSION/SIGNIFICANCE OF FINDINGS: We present a minimally-invasive HM monitoring approach. Exposure to multiple HMs is suspected to have additive or synergistic harmful health effects. We ultimately envision a wearable microneedle patch that could be mailed to individuals or distributed through community centers, worn for a few hours, and returned to a central laboratory.

The characteristics and impact of pruritus in adult dermatology patients: A prospective, cross-sectional study

Pruritusoften accompanies chronic skin diseases, exerting considerable burden on many areas of patient functioning; this burden and the features of pruritus remain insufficiently characterized. To investigate characteristics, including localization patterns, and burden of pruritus in patients with chronic dermatoses. We recruited 800 patients with active chronic skin diseases. We assessed pruritus intensity, localization, and further characteristics. We used validated questionnaires to assess quality of life, work productivity and activity impairment, anxiety, depression, and sleep quality. Nine out of every 10 patients had experienced pruritus throughout their disease and 73% in the last 7days. Pruritus often affected the entire body and was not restricted to skin lesions. Patients with moderate to severe pruritus reported significantly more impairment to their sleep quality and work productivity, and they were more depressed and anxious than control individuals and patients with mild or no pruritus. Suicidal ideations were highly prevalent in patients with chronic pruritus (18.5%) and atopic dermatitis (11.8%). Pruritus prevalence and intensity are very high across all dermatoses studied; intensity is linked to impairment in many areas of daily functioning. Effectivetreatment strategies are urgently required to treat pruritus and the underlying skin disease.

An Interesting Case of Cellulitis Caused by Shewanella

Shewanella species are opportunistically pathogenic, gram-negative bacilli that are part of marine microflora. Infection caused by Shewanella species in humans is rare and mostly acquired after direct contact with seawater or ingestion of raw seafood. The exact pathogenesis remains unclear. Cutaneous infections are among the most common manifestation with underlying skin diseases and immune-compromised states; however, bacteremia from lungs, abdominal, and biliary sepsis has also been reported. These infections are difficult to diagnose due to limited physicians' experience and scarce microbiological data available. Hence, delayed diagnosis and treatment could be fatal and may result in sepsis with multi-organ failure. Our case report reiterates the fact that careful attention should be devoted to unusual circumstances in history and atypical pathogens on cultures if there is no or minimal clinical improvement after antibiotics.

Consensus of Chinese experts on protection of skin and mucous membrane barrier for health-care workers fighting against coronavirus disease 2019.

Health professions preventing and controlling Coronavirus Disease 2019 are prone to skin and mucous membrane injury, which may cause acute and chronic dermatitis, secondary infection and aggravation of underlying skin diseases. This is a consensus of Chinese experts on protective measures and advice on hand‐cleaning‐ and medical‐glove‐related hand protection, mask‐ and goggles‐related face protection, UV‐related protection, eye protection, nasal and oral mucosa protection, outer ear, and hair protection. It is necessary to strictly follow standards of wearing protective equipment and specification of sterilizing and cleaning. Insufficient and excessive protection will have adverse effects on the skin and mucous membrane barrier. At the same time, using moisturizing products is highly recommended to achieve better protection.

Can pyoderma in dogs be treated with fewer antibiotics?

Staphylococcal skin infections, generally referred to as pyoderma, are a very common reason for the prescription of antimicrobials for pet dogs.1-3 These infections, usually involving Staphylococcus pseudintermedius , vary in...

Blepharitis in dogs: a clinical evaluation in 102 dogs.

Blepharitis is a common finding in many dogs with various skin diseases. To establish a definition for canine blepharitis versus periocular dermatitis (POD), to evaluate the clinical findings and underlying skin diseases of blepharitis, and to document the effects of blepharitis on tear production in dogs. One hundred and two privately owned dogs with clinical signs of blepharitis and a definitive diagnosis of skin disease. Prospective evaluation of clinical signs and underlying diseases in dogs with blepharitis alone compared to dogs with blepharitis and POD. Brachycephalic dogs were significantly more likely to present with blepharitis than other breeds. Twenty five dogs had blepharitis alone [three dogs (2.9%) without and 22 dogs (21.5%) with cutaneous lesion beyond the periocular skin]. Seventy one of 102 (69%) presented with POD in addition to blepharitis. In six cases a differentiation between blepharitis and POD was not possible. Typical lesions included alopecia/hypotrichosis (97%), erythema (93%), eyelid oedema (50%) and crusts (39.2%). Allergic skin disease (52%) was the most common underlying cause of blepharitis, followed by infectious/parasitic diseases (21.5%), autoimmune disorders (17.7%) and neoplasia (4.9%). Four dogs could not be allocated to any of these disease groups. A diagnosis of parasitism was always accompanied by POD. Reduced tear production was detected in ten of the 53 dogs tested (18.8%). Blepharitis occurring in the absence of other skin lesions is rare. The most common underlying cause of blepharitis is allergic dermatitis. Measurement of tear production should be recommended in all cases of blepharitis.

The rash that becomes an erythroderma

Erythroderma is a dermatologic emergency with potentially serious consequences. Several diseases with different etiologies characteristically appear as erythroderma. Depending on the age groups, congenital ichthyosiform disorders, infections, preexisting dermatoses, drug eruptions, and internal malignancies commonly present with, or progress to, erythroderma. The course, prognosis, and management strategies also vary depending on the cause of erythroderma; hence, an accurate diagnosis is essential in minimizing associated morbidity and mortality. The generalized erythema and scaling often obscure the classic clinical features of the underlying skin diseases, posing a diagnostic challenge to dermatologists. Awareness and elicitation of subtle signs and clinical manifestations are crucial. A step-wise approach ensures completeness of clinical evaluation and avoids missing any relevant clinical data. The initial clinical presentation, cutaneous examination findings, and systemic clues reveal important information regarding the diagnosis, course, and prognosis of erythroderma. The age at onset, symptomatology, duration of illness, initial lesions, initial site of onset, clinical course, family history, types of scales, changes in cutaneous integuments and systemic clues will assist in delineating the nature of underlying disease.

Development of Individualized Induced Pluripotent Stem Cells From Fibroblasts of Keloid Lesions in Patients

ObjectivePresently, interesting research related to induced pluripotent stem cells (iPSCs) is emerging. However, the development of new therapies and techniques for treatment of refractory diseases is still required in dermatology. We are exploring novel methods to provide stem cell therapy and elucidate research mechanisms underlying troublesome diseases by reprogramming iPSCs from the fibroblasts of keloid lesions from patients in vitro. MethodHere, we identified the expression of fibroblastic genes in the fibroblast derived from diseased individuals. Corresponding iPSCs were then produced by transfecting patient fibroblasts with non-modified RNA cocktails, expressing OCT4, SOX2, KLF4, cMYC, NANOG, and LIN28 reprogramming factors. The pluripotency of these patient-derived iPSCs was identified by immunocytochemistry, real-time quantitative polymerase chain reaction, and teratoma formation in vivo in non-obese diabetic/severe combined immunodeficiency mice. ResultsAll iPSCs derived from patients significantly expressed the pluripotent transcription factors and could be expanded in vitro. Furthermore, induction of terminal differentiation in long-term culture and the capability of forming embryonic bodies to differentiate into all 3 germ layers in vivo were confirmed in immune-deficient mice. ConclusionFibroblasts from a keloid patient were successfully reprogrammed to iPSCs in vitro. This reprogramming may provide a basis for the production of individualized modified artificial skin to prevent rejections after xenogeneic skin transplantation and trauma through autologous skin transplantation. These cells can also offer a new platform for research on mechanisms underlying skin diseases and personal medical applications.

Otitis externa in the dog and the eat

Otitis externa is the most common disorder of the cat ear canal in small animals, with a higher incidence in dogs than in cats. It has a multifactorial etiology comprising of numerous predisposing, primary and perpetuating factors. The most important primary causes are atopy, food allergy, otodectic mange, foreign bodies, endocrinopathies and keratinisation disorders. Bacteria and yeasts residing in the ear canal usually complicate the initial lesions thus leading to the establishment of ceruminous or suppurative otitis externa. Otitis media and chronic hyperplastic changes of the ear canal are hold responsible for the perpetuation of the disease. A diagnosis is easily made from the history, the cleaning of the ear canal and otoscopy, the cytologic and parasitologic examination of ear exudates, the bacterial culture and sensitivity testing and the radiography (cartilage mineralization, otitis media). Evaluation and treatment of the underlying skin disease is always necessary. Therapy of otitis externa depends on identifying and controlling the predisposing and primary factors, whenever possible. Medical treatment includes cleaning of the ear canals and the middle ear, applying topicals and/or administering systemic medications (acaricides, antifungal agents, antibiotics, glucocorticoids). Corrective surgeries are indicated in the refractory to medical treatment cases.