Hi, and welcome to this talk on reptile skin disease. We're gonna, obviously a very broad rending talk where a lot of reptile species we see, and accordingly, a lot of, skin disease. So we can look at some basic some generalities and things.
I'm obviously gonna start with how to, investigate, the problem. And basically start like everything else, history, and very importantly, every time we deal with with reptiles, a husbandry review. A dermal examination, full clinical examination, and sampling, and again, we're gonna look at some specific, if you like, patterns and types of disease we're going to see and some examples of.
Again, important to remember these are very, you know, reptile medicine is really new. A lot of things we're finding out as we go along as well. So, you know, if you investigate these, you're gonna find some new diseases as well.
So why don't take a history, . Because it's gonna tell us a lot, and very often it's gonna give us a major clues to what type of things we're gonna see, whether infections are more likely, where the damage is more likely, you know, how long it's been going on for, if nothing else. And so certainly important aspects of how long the owners had the animal for, what it is, you know, species, signalment, you know, something you just telling what sex is can be important, but it can be quite difficult to do.
Has there been any mixing, so has it just been purchased to come from a dealer, mix other species too? Has it been mixing within the collection? Does the have a mixed collection of reptiles?
And we're gonna see one where, be mixing of Euromastics and bearded dragons in the same area can lead to, to, to, to transfer an infection. Because what might be a, a commensal or non-pathogenic 1 may be really quite significant in another. And most, most people who keep them, keep them in separate fibs, they're not necessarily barrier nurses between them.
Always with skin disease, really find out how the disease started and where it started as to how it's now presenting now, because there will be changes and they can be quite significant. And secondary changes may swamp what originally was there. Is it spreading on the body?
Is it spreading between animals? And really importantly, are animal, other animals if they're present or affected. And of course, the husbandry.
A husband review is absolutely critical. And we're gonna look at things like heat, obviously, light levels, humidity can be important with skin disease. And we're gonna look at some other things too, so substrate, you know, have we got a really nasty sort of a, build up of material in the subject area.
Glass too, and we're going to see issues that come from that. So here we got hospital bibs, here's a water dragon. These may very typically present, this has got perdony on here, but you can see the rubbing on my nose here.
This is a species often does not recognise barriers. And so we see these nose rubs, where they try and walk through the glass the whole time. This is snake.
It's done just that, and you see it's batting its nose and damaging that we're getting skin disease from that. That pattern's quite distinctive, and we can, you know, we can obviously treat it topically. We can, we can maybe systemic antibiotics need to, but really above all, we need to put some like brown paper or saying covering that, so it has a visible barrier.
It doesn't try and walk through the whole time. He was saying very simple to someone is like putting like plastic plant across it. We know what cleaning materials have got present because we may have an irritation from overuse or from, from a wrong material being used, or even a wrong concentration material being used or something we left in contact should be removed.
We don't know about diet, because we may see issues with maybe low protein, maybe with incorrect protein, and of course if people putting live food in, don't forget that the live food may get desperate and actually eat the reptile, if, if just just left for good, and we will see prey bites reasonably commonly. So heat can important depending on species. Do we have overhead heat?
Do you have heat mats placed either on a side wall or underneath? Underneath it, very few species actually get the heat from underneath. They're used to sitting in the sun and basking.
And certainly they're cold, and we'll see some burns later on, that might be a reason for it. But all species have a thing called a pot, a preferred optimum temperature zone where they want to be at a certain temperature a certain time. And we therefore have to provide a range, so they can choose.
Temperature. Now, to do that, we need to, to control the temperatures to make sure it's kept within that preferred range. But we did do that, we have to measure.
It's really important that when we say to people, what temperature you're keeping up, so temperature are OK. They think that it is OK. They're not doing things wrong on purpose.
And also it may once upon a time be right, but they're not measuring and checking when the valves broken or the heat mats no longer working as well as it did, that may no longer be appropriate. So we need to measure and generally recommend that, yes, they can do heat guns, they can do . Thermo imaging, all that kind of stuff.
But if they really want to measure properly, want continuous measurement, so things like maximum minimum thermometers, always one of the hot end, one of the cool end, and keep monitoring and measuring with those, and keep checking and keep recording. If they're not recording what they're getting, it's very difficult, . And again, you can fix alarm says if you want to, and that's great.
And 11 breeder we work with, a very high level building, he will have this type of measurement in each vivarium, in each room, and also in the building overall. So he's getting 3 levels of alarm of flagging as a problem. And I always think it's good enough for him, it's probably good enough for all of us.
So looking at light as well, the skin disease is probably one of the lesser areas, probably more important for things like eyes and stuff, where there's one area that is important, we'll talk about at the moment. So we do want, most species want UV, for some, where certainly carnivorous species like snakes, chameleons, stuff like that. There's a little bit of, some patients showing that you can have a trade-off.
If you're putting good levels of, of activated D3 in the diet, they need less, UV exposure. So again, you, you do the dietary history alongside this, and again, that's a good way of assessing we've got, got good UV. But overall, we need a full spectrum UV, make sure it's not too, high.
So typically 5.0 UVB is perfectly OK, otherwise you may see eye damage and that type of thing. For fluorescent tubes, you need to have it within 10 inches of the animal, because the, UV doesn't penetrate that far.
And you're also gonna have to replace them every 6 months. For the Mercury vapour lamps, they probably will last a lot longer. But ideally, what we should be doing is doing a elimter and measuring, on a regular basis and seeing when that bulb needs replacing or not based on that.
I want to get in the first place. Again, it was a lady called Frances Bain. She has an excellent, website.
Go on there. She checks them every year and produce recommendations, which ones are the best ones to get the time, because it does vary. Now, where this really comes into effect with with skin disease is actually, some of the, crepusca species a good example of that is leopard geckos.
Now these guys only sort of bask morning and or evening. It can vary between species too. And they're really sensitive to UV, and they can sort of give you like get a daily ration very quickly that way.
But it has been shown that if you, overexpose leper geckos to ultraviolet, you'll get an increased shedding rate, and almost like a low level skin burn in stimulating that shedding, and that can be a promoter for dysectiasis. And we're going to see that in a moment the leper geckos particularly overrepresented that. So again, a good thing to find out.
And typically what you want with these guys is 2 hours of UVB in the morning, 2 hours in the evening, and no more than that. There's no additional advantage, even measuring calcium levels no additional advantage. Humidity is also important.
Bear in mind with humidity, let's include water quality with that. We do, and they treat to put a little picture there, but we do deal with some aquatics and semi-aquatics. Semi-aquatics think, well, how we get out of the water, so why do we need to worry about that?
Well, if the air temperature is wrong, they may be forced into the water, or if that's warmer, and so that may put me into contact with, with, with nasty conditions for a bit longer. Someone may want to spend more time in the water, but they don't want to. They don't do get going enough because it is not a nice environment.
So water quality is important, and very often, for certainly for a semi-aquatic, turtles can be, can be quite bad. So how we're gonna assess it, we again, we use measuring devices. Again, typically we recommend using maximum minimum type hygrometers, one of, one of the wet end, one of the the dry end, and again, try and create zones, try and create gradients and create choice.
And here's an example of the tortoise when we think about Mediterranean tortoise, particularly of needing, any humidity, but create a zone because they can choose them. And typically we use a wet towel just at one end of a tank, and then we have a dry end, we have a wet end, and we have a, we have, have, have, . And we don't have a whole of one end being dominated by by the wetness.
So we create a gradient for them. And typically it's a nice little micro zone. Again, bear in mind where the reptile actually is.
So often you'll see things like temperature, humidity measured high up in the viiv. While the reptile is there, if it's down at ground level, it's not there, it's no relevance to it. And here's a good example.
The tortoise micro zone and uses its humidity is just above the substrate surface. So we've got a towel there and so our humidity zone is just above the surface where the tortoise knows is. So really important.
Substrate itself is quite relevant with this too, because some will retain that moisture. Of course, reptiles do urinate. There's some liquid in that too sometimes.
And of course they can really hold that, depending on what it is. So certain thing like bark chip can really hold that together. And, so, you can end up with these really quite nasty environments, and some of these sort of scale rots and snakes and stuff can be linked into these very unhygienic things.
So one test you can do is the squelch test. So anybody who's done farm work, this is something we always used to do with calf pneumonias, we go in the barn and we'd step on the, on the bedding and feel a bit squelched or not, which was a sign it wasn't very nice underneath there. The other opposite end is also true, we can do the dust test as well.
And so again. Again, chippings can be another thing too, they get that to dry out. That little micro zone just above can be very dusty, and that can be leading to respiratory problems, eye problems, and of course skin irritation as well.
And again, importantly, you know, with reptiles biology, what sort of area does it live in? And not only what area does it live in, but what sort of micro zone does it live in? And that's important.
So I hope you don't know that. We don't we do our skin examination. We're gonna check the whole body.
We look at lesion distribution. We're going to describe those lesions. So we're going to colour changes, we've got crusting, we got ulceration, we've got masses of swellings.
Have we got like shed retention? Can we see parasites? Now, this is something which With age, you use more and more and more.
And I really, well, when you start using it, you really think I should have done this a while ago. Magnification is really important, especially in smaller spaces, especially small lesions, but magnification really, really is good. Do start using it, don't feel proud.
Get the magnifying glasses or, devices out there too. It's just an optic car, and, I find it very useful to put its light and magnification together. So within the actual examination of a whole animal, again we can talk about skin in a moment as reflecting systemic disease.
And sometimes even progressing into systemic disease. So what can we actually do? Reptiles are difficult to examine in fairness, but we can do a good base examination.
We can assess demeanour and strength, even something like a tortoise, with a big shell around it, which should preclude a lot of examination, pull the legs out, see how strongly it resists. You know, if it's a really strong animal, it's probably quite a well animal. If it's very weak and just flops about.
And there's no resistance or tone to the muscles, that's not a sign of of one animal. We can do condition scoring, or we can compare that to to body weight. So, you know, we, we can get some idea of a fat animal, or a thin animal, chronic disease, acute disease, that type of thing.
We can palpate, so lives in snakes. We can have a good palpate the salamic cavity. We can pick up swellings and masses, snakes constipation, that type of thing too.
Less so in tortoise, we can still palpate in the prefemoral fossa, and the females, we can feel aches rocking about in there too sometimes. We can auscultate, but not with, not with, with, with, with a stethoscope because it doesn't work well on the scales and the very quiet noise they have. But we can certainly use an 8 megahertz Doppler, so like we use for cat blood pressure, and we can listen to the heart, we can pick up murmurs, rates and rhythms that way as well.
We can do mouth and ear examinations. It can be really important, and we can do cloacal checks and in bigger animals, particularly snakes, we can actually do percloacal examination. Big lizards too, so like iguana actually palpating the kidneys can be as sensitive as taking blood and blood sampling too, if we're suspicious of systemic illness or we just want to check how well the animal is, a blood sample for a full panel haematology and biochemistries is really, really useful.
So what are we gonna see? Well, here's a starter. Don't forget that the shell is part of the dermal system, part of the skin really.
And we're gonna have to assess that we do shell disease much later on. But, you know, we're gonna see growth defects and things in, in these, these colonia. We're gonna see pyramidding.
Now this is really interesting. The one real paper that's really shown much was insular, the African spurd, that seem to show that humidity was involved. But again, humidity probably for these guys a bit of a driver towards growth, because of course, you know, we're gonna grow mainly and feed mainly in the wet, wet, wet times of the year.
But certainly, in general, in tortoises, this pyramidding with this change of the shell, Are, really, linked into growth rates, and whether the, protein matrix is being laid down too quickly to allow proper calcification. So in other words, you get a very soft shell which sinks and forms these pyramids, where it sinks in between the growth zones, and they calcify, just a little bit too slowly. So really slow down the growth rate.
Now that may be linked into humidity, may be linked to temperatures as well, the sun linked into feeding, with too rich a food, too much food. And I always say to people when they don't grow, it's not a race to get the biggest tortoises as quick as possible, you know, for the long run, races to get the best shaped tortoise. And to get these two.
The other thing to remember too with colonia is that, they, when they shed, now the, aquatics will actually produce layers of skin off the or or layers of shed off the shell and shed them in the water. Again, another thing that maybe indicator of poor water quality is retained shed on the shell of a terrain, because, they're not, not going to get rid of it. But certainly in tortoises, you'll see these rings, and each one is a retained shed.
That's perfectly normal to retain on land colonia. It can give you some idea of roughly how old or how many growth zones they've got, but just watch out for that, and you'll see those growth areas there too. And as mentioned too, we're doing systemic checks because skin can reflects systemic disease.
And in some cases, maybe things like parasites spread. So you can get parasites enter through the skin and then go into internal organs, or you can get parasites through internal organs, and they're actually, shed, out to the skin and, and, and, and actually shed out through ulceration of the skin. We see bacterial spread in septicemia from reddening of the skin here, maybe linked into septicemia.
We'll talk show that again later. We may see immunodeficiencies and malnutrition problems. And this is, a snake which we operate on, removed, a malignant bowel tumour from.
And one of the consequences, we do have some malmabsorption. And we do see these, these, these blisters, these large areas of fluid building up, which are more subcutaneous, edoema, because of now accordingly low protein levels from malabsorption. So, skin reddening talks a lot about this is a really important thing to pick up on.
Typically we always linked to septicmia, and we do this thing called a blanche test where we basically just press the shadow a skin, and because it's it's representing end artery engorgement, we'll see it's blanching, and then immediaterefill when we let the pressure go again. But actually, we can see that with other reasons for picking up as well. I mean not Septicaemia.
But certainly if you see this situation and, and if you want to see skin reddening, you know, do go and have a look at at a terrapin or a semi-aquatic turtle, and we'll see it quite well. If you see reddening of the skin and reddening of a shell, in particular, where you've got reddening all over the shell here you can see on the sides, you can see underneath there. That's really is typical of septicemia, and we need to worry a lot.
If the animal should be ill as well. Because, you know, septseia is a serious condition. It's very unusual to see sepsse in an animal's absolutely perfectly well.
It's not impossible, but. We'll see for other reasons too, we may see it in in associated with like a soft shell, where the shell is bruising very easily. This is picornavirus in a very young tortoise, and we can see the reddening of a shell there, basically where idiot pets are gone and press their thumbs and see how soft the tortoise is.
We may see it as normal, and some of these is the box turtle things, may actually have a reddened skin as part of a normal coloration, and it can vary with season as well. So just be careful, always these guys know what normal is. And one thing definitely watch that, we see a lot of is reddening of land colonia underneath.
And only vent a well animal, it's only redden underneath there. And very typically, we'll see this where they're kept on concrete, where they may be scraping along that and traumatising and bruising. And of course, in summer, where the the light might be on that, sort of a concrete slab, really heats it up.
Yeah, if you walked on a patio and bare feet, you know how hot that can be, they're actually sat on that, and they get a low level burn from that. And that can happen too if they're exposed to heat mats, and they're sitting on that a cold viv, they're sat on a heat mat, you get these chronic burns. And also, there seems to be more a trend at the moment to feeding clo, tortoises in Bavaria on slate.
Again, we get a syndrome where you got this light shining on them the whole time. Slates are really hot and they're going to feed and they get these low level burns. And so we'll see this, and it's just underneath there.
So when animal we've got the burns in a very or reddening in a very particular pattern or a ventrum, then you, you can be thinking about burns quite a lot. We see other discolorations as well. Some of these can be iatrogenic, so this is, injection of refloxacin in, in an iguana, and we get with some irritation, we get colouring there too.
And chameleons are brilliant for that too. So here's another post-injection one. And also, if you take blood sample of a comedian, do warn the owner that everywhere, distal to the blood sampling site is probably gonna turn black for a few days, where you've interrupted blood supply.
And the reason for that is that, The colour in these skins is produced by blood flow through different types of cell. And the default is if there's no blood supply, they go black. And that's why you can sometimes see that as being a prognostic sign as well.
Don't forget it can be seasonal two, so in bearded dragons, they'll blacken the beard too in certainly in reproductive condition as well. We may see that too in, in animals which are dying. So here's a .
The dead, such dying bearded dragon, and again, when they went into shock, when the blood supply is being withdrawn from the extremities, you may see all the skin go black, and that's a really poor prognostic sign. We some time see reduced colour as well, where we've got scarring, where we've got areas which are damaged and nothing can enter at all. And other colour changes happen as well.
So some of the normal, this is, by the way, is, a terrapin shell. This greening, especially in a lot of time water, is actually pretty normal. It's algae growth on there.
It's not a disease, as as long as the animal's well, it's not the obvious problems there, that can be pretty OK. We can see inside of them too, so very thin skinned animals like especially, amanistic geckos and stuff. We can see black spots in the liver and stuff which may be linked to these, may not be, and we can actually look at organs through there as well.
So colour changes may not be skin, they may be underneath. We'll see kind of changes some associated with certain infections, so fungal bacterial, as on this, comedian skin where we're getting areas of darkening and areas of hyperpigmentation within those areas as a scarring. And sometimes we'll see it linked into, infection.
So here we've got a beta dragon with a 10 infection. This area here is actually died back. We see demarcation line.
Here's where the infections spreading upwards. We've got this inflamed area, and again, another demarcation line where that area is dying back to your body's trying to wall this off and trying justcast off the infection. What we do typically these, we give them antibiotics, try and reduce that zone there, they would probably amputating just above the demarcation zone.
We will see parasites as well. The most common one we'll see is the snake mite. This is Oinusisnatrichus, .
It has a long life cycle, that does actually primarily off the animal where you hop on to, to sucks and feed, and they go under the scales, and, and fairly obvious from there. They will spread remain significance apart from irritation. They may also cause shedding problems because they're irritating the skin so much is they will actually spread certain infections.
Most important, which is arena virus, which is the cause of inclusion body disease in the boids. And so it's really important to control these mites, especially in animals entering a collection. And they're pretty mobile.
You see nice long legs. They can transfer between snakes, they can transfer between Bavaria. And if you have got something with a, with a sort of snake groom and lots of herbs, it's important that they actually do treat every single bavarian and they actually, treat all the animals and monitor the whole thing.
Again, we can get localised infection linked into this as well. So some little areas here. This is special we have got had a mic problem, and that the snakes rubbed and we've got some, some localised infection.
Lizards get these as well. Typically, these will be clustered around the eyes. Again, always with both li and snakes, look around the, the holes around the nostrils, look around the eyes, and you can see these very distinctive mites.
Now, how we treat them, you can use ivermectin, which will, injected, into these, which will obviously kill anything that's feeding cause they're bloodsucking. Personally, I tend to use fitreil spray. And what we'll do with the animal is we will put this onto cotton wool, wipe the animal down, pay attention around the eyes.
Of course, snakes doesn't matter because they've got a spectacle, so into the eyes, but if you've got a lizard, then obviously make sure you don't get into the eyes and use a cotton bud to go carefully around there. We do need to treat those areas. Then put the animal to dry in a well-ventilated area.
I have had somebody with baby snakes, where they put them into a closed box and we had animals succumbing to the alcohol fumes from the spray, so be careful with that. . You need to treat the environment as well, so remove all the material from there.
Organic material needs to be chucked away which you simply cannot clear the mites out of it. Clean everything, really wash it down well. Plastic stuff can be washed in hot soapy water, and then, spray everywhere with the footprint again.
Leave to drive half an hour before you put the animals back into it. And repeat that monthly. So don't put loads and loads of organic material back again.
Just use a few plastic things for hiding, they can be washed in a month's time when you repeat the treatment. That seems to work quite well. In terms of control, quarantine is really important for people reptile collection, they bring new animals in very rarely observed, but really, really important.
And during that quarantine period, they can treat once or twice, with fipronil and try and reduce mite numbers on the new animals. We see ticks occasionally, typically in poor animals, they can cause reactions, they're not very common, but do watch out for them. One problem we do see from time to time, especially in tortoises, is my ISS.
It's not nice, it's a sign of extreme debability. It's a dreadful prognostic sign. It's really difficult to treat as well.
Now bear in mind that ivermectin is toxic to colonia. Do not use ivermectin colonia. So this makes it even more difficult to treat.
So you do have to often have sedate, you have to physically clean, these, . These, these out there because you can't give a shot of ivermectin to kill them. What you can use is the F10 insecticide spray, and that's quite useful, .
So that we can drive that holes and things, but this is a really poor sign because if we taught to be, be debilitated enough to allow this to happen, it's in a bad, bad way. So moving on, we see swellings and masses, and again we're seeing this, you know, how many have we got, where are they, what size are they? What do they look like?
Are they growing? I always important that are they spreading are more appearing. Again, check how the animal is.
And we see a range of things. We see abscesses, we see granulomas, and we see tumours. Some may be very benign.
This is a very typical thing in snakes, typically corn stakes one of these guys, but you'll get these fat bodies appearing just . Bilaterally above the tail of the vent, can typically saying if it's bilateral and symmetrical, very often these are quite benign. But you will, so many cortexs get, get, asymmetric swellings, do need larates they often find these simply lipomater, and it's a case of addressing diet, but just watch out for them.
A big syndrome we see in chameleons now is that, skin carcinomas. We see a lot of theses especially may be viral linked, but we can see them crop up all over the place. And these are definitely worth doing an FNA, or removing one as a trial rather than continuously moving some more and more will crop up and very difficult to prevent.
So watch out for that. They are, they are really quite common. So, investigating the swellings, what can you do?
Examine them, obviously, biopsy. FNA is an easy one, of course, you are gonna get some that don't exfoliate. You are gonna get some that don't, don't give a diagnostic, sample.
You can do wedge smears, impression smears, you can excise a small mass and see what comes up from there. And, and that, that can be useful. If you're going to do those again, what, what, what level of sedation do you need?
Depends how deep it is, depends how extensive your biopsy is gonna be or remove the whole thing. You may require general anaesthesia, sometimes you can sedate and use local anaesthetic, and in some instances certainly debit animals, you might just want to use local alone, and just block a small area if that's possible for a very small sample. In terms of therapy, these again dictated by diagnosis.
It is probably true to say that most masses in reptiles are malignant, generally locally invasive rather than than systemically, but it can be very, very hard to get a good margin of removal. So in some cases, therapy may not actually be possible. Sometimes cases of leaving it to quality of life deteriorates, and then considering euthanasia then.
And part of that timing is going to take you where the masses are, you know, if around the body, probably things can go along a lot better than if you've got a mass on the mouth or the eyes or something. If you excise, do excise. Sometimes you've got granulomata, you might want to be doing intralesional therapy, so intralesional antibiotics and stuff, maybe these reduced size, make removal easier later.
Another type of swaying we see, we do see abscesses, again, look for how many there are, how, how accessible they are, how deep they are. So, contrasting examples here, you know, here's, tortoise neck got these very superficial abscesses. These are easy to remove the superficial.
We can clean underneath and we get good results from that. This, turtle here, we've got, this abscess. You know that one there, but actually when we do some imaging, we can actually see they're actually linked.
We can also see that the, the abscess of invading deep. It was bursting through a shadow. It's going through the spine, and this is absolutely unremovable without taking the whole back end.
And so this was a euthanasia case because we simply could not treat it. So, you know, then they they do they have to go find information before you just go plunging in, rather than simply just clean out something like that. In terms of sampling, again, you don't want to, if you're taking back sample, it is a logical thing to do.
Try not to just take a swab from the top because it's going to give you surface contaminant. You actually want to lift these, ideally even take a little pinch biopsy from the abscess wall that's going to give you the best type of sample results possible. And eventually we see dissectiasis.
Bear in mind that, you know, we know that snakes, sheds a whole skin in one go, but things like colonia, and lizards will shed piecemeal. And so we will see these small bits coming away from there. And so it can be a little bit difficult deciding whether it's too much of that excessive shedding, we've got disc dios, or have we got just generally, an animal shedding in paranormal shed bit by bit.
The species we see most often in is, the leopard gecko. And very often we'll see, retention on the feet. My feeling is it's very much linked into heat mat usage, and where they sort of a bit cold, they sit on the heat mat and basically, they dry out their feet.
We'll also see it in my eyes. This is the gecko specta doesn't have, doesn't have, spectacles, and they do have skin though inside the eyelids. And so it's not the greatest position to lose shed from.
And certainly if there's a marginal lack in their environment, they will often show the eye, shedding problems first of all. These will irritate, we get build up a shed of mucus, of, of infected material within that we have to remove. And once it's started, it's very hard to control.
We sometimes scarring the lids, and we get disice every single shed afterwards. Again, we'll see which snakes they don't always should properly, it build up to dry skin too. And typically, these are, The these are husbandry links, so maybe heat, maybe, I mentioned with the leper geckos has like light levels.
Humidity too, and again, the leper gecko is a great example of this. They're desert species, so very often they have a dry, hot viv. Actually, where they live is under rocks.
Those will have a 100% humidity, where the water accumulates and, and is there. So within the epic gecko enclosure, you need to put a humidity chamber, very simple, say like a margarine tab, with the sort of the lid on, but whole cutting side walking out there, fill it with damp sphagnum moss, change the moss regularly so it doesn't become manky, and then they can walk in, walk out. I know we put a middle temperature zone, so they're more likely to use it.
And then that's really good for they come shedding time. They've got a high humidity zone and starting to rub it. When you have got those, eyes affected, you know, obviously keep clean out there, we use, we use liquid drops to try and moisten and just trying to clean.
And actually, that's a real point with the whole therapy, really. Don't just try and heave everything up. It's very tempting to pick it away and stuff, but actually, you're often going to do some damage to where we can with these guys, you can lose toes and things.
So just really just treat it gently and Correct the environment, to treat the whole animal, treat the whole environment, and we don't tend to just pull things off. We tend to just, I generally recommend what people do is they get like a turn it upside down either a towel or a face cloth. You bathe the animal in warm water once a day.
When it comes out of there, you soak the the towel face cloth in warm water and you just hold it and let it wriggle through and rub. And so basically you're just gently lifting it away, and maybe you actually leave that retained shed on until the next shedding, when it can come off properly. Now, as I mentioned in the thing too, we see we actually have, eye caps.
Don't forget that many of these species do have, spectacles where the eyes are fused over the top of the eye. And so this is part of the skin system, not the eye system really. So this is a normal shed.
You often see it bluing of the eye, before you shed because basically you get fluid produced under the skin before it comes away. And again, this is another reason why systemic illness may be involved sometimes. If they're marginally dehydrated, it's very hard to produce this, this, this, this fluid, and that means they can't always shed correctly, so again.
Assess the whole animal, look after the whole animal. If it doesn't come away, you'll see this bit of skin around there, but I think it's very dry, crinkly skin over the top. Again, do not remove an old technique to put 3 bar and pull it away.
You'll damage if it's attached to a cornea, you'll damage the whole eye and really cause problems. Simply moisten it, rub it, just if things lift away gently and naturally, let it happen. Otherwise, just let it happen with the next shell and come away in one go.
Occasionally we get other sort things with spectacle. This is Cresta Gecko, which has got . Sub-spectacular fluid.
It's usually linked into something happening along the tear duct here, and where we treat these actually we we obviously correct anything in here, but we open up the spectacle, let it drain, and then you cover the cornea with eye drops until, until the next shed happens. We'll see wounds as well, and very rarely will we get, apart from surgery, will we get a nice wound, we can treat my first intention with suturing. Obviously, there's any reasons for it, we're going to have to check those out.
Typically, aggression from others. So aquatics really do bite each other quite a lot. And so if you've got bullying going on, that's, we've got to split them up.
They're not social species, so you've got to keep them away from each other. And just try and try and let them correct. Again, you know, here we've got a wider range of skin changes, got real pus formation, so this is gonna need a lot of antibiotic therapy as well.
. With the land colonia, very often you've got, if you've got an overactive male, one way they'll stimulate the females in certain species to ovulate is to bite them, and this can go too far sometimes, they can really cause a lot of damage by continually harassing, and there's only one thing you've got to get the male away from the female and give her some break. And most of these are in fact you have to do some, do some antibiotic. This, you have to do second intentional healing.
So typically we'll be cleans each day. We'll be putting on, I favour, a combination of insight gel, this hydrophilic gel, mixed with flamaine, which makes us all like almost like meangi mixture. And it's really good to got a combination of barrier cream, sil subidizing cream with, with, with, with, with, with, with the hydrophilic gel that works really nicely.
We'll see shell rubs too. Again, if you've got, the shells malformed, or if you've got, metabolic bones and the pelvis is flattening, you may start seeing rubs onto the legs and things. And, again, here, we can treat those in the same way as wounds.
We can, we can put gels on them, we can. Heal by second intention, but we're gonna have to do something about the shell, and typically something like this would actually would actually cut away under anaesthesia, an area of shell, put an epoxy layer on it just to keep it smooth and while it heals, and get that away from the leg, so that it can, it can heal properly. We'll see rat bites in tortoises as well, and mouse bites, these are typically occurring in hibernation, .
And they've usually found in the spring, having been attacked while they're, while they're inactive, and we get these deep, Because of metabolic inactive, ungranulating, damaged, often dry necrotic, wounds. They can be very extensive, obviously incredibly extensive. We have whole limbs removed occasionally.
There's nothing you can do for that apart from tidied up and amputate the part remaining stump. It's obviously not beyond the wound at that stage. But actually, even with some of these, they look severe, there's often bone exposed.
These can do really, really well, and you can get quite a good success rate. So, What can you do? Well, number one thing, again, look after a whole animal.
It's coming out of hibernation, recover it's likely to have had a pretty bad hibernation, being attacked by rats and mice. So recover it, support it, make sure it is going back to full activity, and it's a well taught us fundamentally. And then under anaesthesia, you can debride this, and, and encourage granulation.
Again, back to this is the Flamazine, insight mix applied, and we'll do this for a period until we've got a good granation bed going. And then typically what I would do is I use this dressing called granny flex, which, I will suture over the, over the wound. And every couple of weeks, we'll re-sedate, remove, clean, and put a new pad on.
And typically we do about 3 or 4 times, and usually it will heal, in about 6 to 8 weeks and then back on to topical therapy and just cleaning, and they can do very, very well indeed. Well at time, we'll often use antibiosis depending on how the granulation bed looks, and support the whole animal as needed. Again, mentioned already with this is skin burns, and again depends on what heating system as the major clue as to whether it's actually happening.
So, you know, if we've got a heat map, we're gonna see these problems, underneath. So here's a typical one in a snake, quite a deep burn here. Some people see snake ones on the side, if they've got like, a, an overhead heater with a cage around it, they'll wrap around it and burn their sides.
. This again is often a sign, it sounds weird. This is often a sign not the heat is too hot, but the vivarium is too cold. And so we're really trying to get hot and we're trying to warm into there.
This is as I mentioned before about the tortoises with the slates, these low level burns. Here we have removed the scoot, and we can see just how deep some of those burns can go over a long period of time. It's into a bone that's underlying there.
And that's where we start getting the crows, we start getting shell infections as well. And here is a comedian again cold with problem, comedians getting closer and closer to the overheater, and it's burnt along its back there. And how we treat these very like we do with the rat bits things, we're going to, obviously correct the environment.
We're going to try and make it better, for the reptile, so it doesn't have to get so close to the heater. We're gonna guard the heater better, hopefully. It's a heat map we're gonna put on the side wall so it can't sit on it.
Maybe you have a better style of heating as well. And we're gonna use antibiosis where we need to, and we're gonna use this, this. Combination of sulphur sulfadiazine and in site just to try and heal that in, allow those burnt areas to slough off there, and to heal, heal naturally underneath it.
And that can work pretty well. Just a side thing, this isn't skin disease, but it's a reptile. It's really cool, but it is a burn.
Syndrome of crocodilia, they're very often given water tank heaters, so those long thin glass tubes. And I've seen this a couple of times now where they bite them, and I think it's one of those things where they move and the the tube catches the light and flashes like a fish, and they just programme. The crocodiles don't think too about life too deeply and bite them, and they explode.
And this is a tick burn this, this, this, this crocodile basically stuffed this entire palate, and so some of these bones you see can be quite severe. Sorry, it's cool picture time. OK, we'll see ulceration as well.
This can be trauma. This can be primary, very rarely primary infection. This is a very weird one.
This is in a group of, colonial, we actually had a leptos virus that did genuinely appear to be a primary infection. But very rare. Normally it's a secondary infection to you like squelchy substrate, or hygiene problems or just just wrong environment and, and skin softening and problems there.
And some is also again very dermal thing, but did it start as an ulcer? Is that the primary lesion or is it a secondary lesion? Because some of these may have started with blisters that have burst, just like in dogs with bullet watch.
In aquatic species, again, like in this, fly river turtle, we are fully aquatic, you know, what's the water quality like? Really check that out, just like we do in a fish. We want to check the water quality because bad water quality can lead to skin damage, can lead to invasion from, bacteria and stuff, and problems from there too.
So again, what we can do with this, we're going to distribute liquid distribution, you know, is it ventral, is it all over, which bits are affected? We're gonna take samples, biopsy is very effective, but for both, histo and for culture, and we're gonna talk about that more because this leads us into our infectious diseases. Here, we may be looking at bacteria, fungi, parasites, sometimes even viruses, that can cause problems in these guys, they're a mixed bag.
But Here's a piece of reptiles, what is an infectious disease? And this isn't that well defined in reptiles, because they don't fulfil coxs postulates, and that's because of a role in the environment and because they're ectotherms, and coxs postulates redesigned over endotherms. So here we have this argument between what are primary pathogens and water are opportunistics, and whereas a sliding scale of pathogenicity, in other words, just how opportunistic are some of these, some need a lot more help than others to become, to cause a disease.
And similarly with bad conditions, some which are quite pathogenic become more pathogenic, so some dermatoses may become systemic infection. I'll show you one good exampleelectron. Similarly, reptiles, you see a lot of animals affected, sounds like an outbreak of infectious disease.
But actually it's not always. They're sharing husbandry, it may be the fact that husbandry the underlying factors of what is a common factor, not the organism you'll find within there. So we always consider primary factors, and these things we must correct.
Secondary factors that usually need therapy, and tertiary factors that may or may not require therapy. And here's an example, the yeast dermatitis, . Not a pathogenic fungus, just a yeast.
What was causing it? Well, we had trauma from another lizard. So it started with a bite.
So the problem of primary problem is really down to that we had a bad social grouping, guess that two. Secondary problem is a trauma, we could treat that with with secondary intentional healing, and the tertiary problem is the overgrowth of the yeast, and actually with the cleaning, we didn't have to specifically treat that. So, how do we diagnose skin infections?
We do that again, we, we talk about we do history examination, clinical signs, histories. Now, here's the big thing, do we take swabs and stuff, or do we do biopsies and tissue culture? And actually I really will push people onto biopsy and tissue culture.
Why do we do that? Firstly, because we want to combine the histopathology, and that puts a culture in perspective. So let's say you culture, a nice gram-negative rod, we take a, we take a histopath sample, we can see white blood cells there, which are, phagocytosing, gram-negative rods.
Fantastic. It all fits together and you really have got the significance of the organism you're growing. Let's say we culture some nice gram-negative rods, and actually what we see are white blood cells, phagocytosing a fungus.
We know there's a fungus there too. So, again, important, we, we culture both bacteria and fungi. Very often you'll hear about people saying, oh, it's crusty, it must be a fungal infection.
It's actually quite unusual compared to some of the other things. So beware of overdiagnosis by just looking. You want to really be careful overdiagnosing.
The significance of superficial environmental invaders, which are coming on the outside too. So biopsy, definitely worth the expense, definitely worth the extra trauma, and of course, the need for sedation, and or anaesthesia to take the samples. Again, important culture about temperature culture, typically, they should be cultured both at about 35 degrees, which is more normal, and also about 21 degrees because many of these, these reptiles affected are at low temperature, and, .
Also, They're low temperature and also it means it's more favouring the bacterial growth than the reptile's defences. So it's quite easy to see what grows at different temperatures. When it's in shell lesion, again, we'll see those later on too, treat them the same way.
The difference is you're gonna need to use a bone biopsy needle rather than the standard, standard biopsy gear, but cut of a biopsy and culture from deep and not the superficial tissue. Again, big thing with these things, don't just give them menro. Don't just go for that reflex.
So here's a snake. These got some nice little blisters all over it. We actually have a different.
This could be bacterial infection. It could be all kinds of other things too. And a very simple technique, we just put a needle in here, we aspirate out some fluid, do some cytology, and hey presto, we found lots of yeast, and this is actually a fungal infection.
So what we did treat with systemic antifungals. It was linked into, environmental issues, so we create to the environment. Again, why not just give NRA to everything else, some specific infections where it's not gonna work.
So here's one to start with too. And this is back to our swellings and lumps and things is do consider mycobacteriosis in reptiles. And these are referred to as mots, mycobacteria other than tuberculosis, and they should be considered all granulomas reactions.
And sadly for our own purposes, granulosis reactions are quite common in reptiles. There's no real therapy. It's often poorly effective, and of course, this is a zoonosis.
So very often, of course, other reptiles be affected too. This is something where disease controls be very difficult. And so if we do diagnosis, then probably euthanasia is going to be indicated in a lot of the cases.
We should And again, it's another driver for if we're seeing things like this, is we should be taking biopsy samples and checking this out and making sure we've got the right things, or very least doing cytology. Another organism we'll come across this thing called Debrecia agamarum. It's typically seen in uromastics lizards.
We see a dermatitis, chilitis, and if they're really run down, we'll see septicemia from it. It can be found on bearded dragons as, a commensal. It doesn't seem to cause these those, and certainly people keep both.
This is where we really will start to see it. So, what do we do with it? Well, we can do surgery.
We'll show you a leash in a moment. You can see why you might need surgery. And fluoroquinolones just don't work, even though it's bacterial fluoroquies don't work.
So this is why we use a drug called Kefir. Dose rate is 5 meg per kg, intramusy once, once a day for 2 weeks. So it takes a little bit of treating as well.
And this is why it's a real deep lesion. You can see why it always is, is crushed here too, so minor surgery just remove that, take it down a bit, will really help penetration and really, really help with cleaning, and, and getting rid of that. Big one we see a lot is it's called a Nannisioycosis.
It does change its names most, most years. So do watch out. It's been previously known as CANV, and yellow fungus disease.
It's found in many lizard lizard species, but especially bearded dragons, and it's related, so you may have read about, which is the white-nose disease in snakes. It does appear to be a primary pathogen in many situations. So certainly one that doesn't need much help to become a problem.
If you have got, underlying facts, you have got an ill animal, it can go septicaemic, and the prognosis once the septicaemic is very, very poor indeed. Cytologically, it can be confused with ringworm, which is much less pathogenic in reptiles. So therefore, again, very important to go going for the culture, we're going for the, histopathology, and making sure you get that distinction correct.
And this is what it looks like we get these very deep crusting lesions, . Often all over, but certainly in body cracks limbs and stuff can be be be quite important. And again, can be extensive around the eyes and around the mouth.
This can hinder feeding and so the animal become even more debilitated linked into the disease. So what about treating? Well, environment's really important too, partly because obviously you want to correct any underlying factors and make your life better for it, but also because you're gonna have to treat that environment too.
This is a fungus can be releasing spores. If the animals are continually reinfected from an environment spores, then, you're going to, you know, you're gonna have, have much more difficulty treating. So you want to basically clean everything out, they have a very minimal environment, so you're cleaning every single day and reducing that spore count while you're treating.
We can do topical therapy, iodine baths, and cleaning, really useful. Again, reducing spore shedding, if nothing else. Its antifungals, itchcono has been used, but doesn't seem to be very useful.
Fortunately our voriconazole is much cheaper than it was, and so therefore is much more accessible. So therefore, that's probably our mainstay of treatment. And, but bear in mind, this takes months, and they will typically be on the voriconazole for 6 to 12 months.
And even then, the prognosis is fairly guarded. We do have some successes where it sort of minimal invasion of fundamentally healthy animal and environmental facts to be put right quite quickly and very compliant owners are prepared to go through all this, but overall prognosis is poor if it's any deeper than that. And if it's systemic, it's almost hopeless.
So we're gonna finish up we're looking at shell, again, don't forget it's part of a skin system, it's probably the finishing obviously is probably my favourite area to work with. And further from infections, we also have this thing called shell rot, . And shell rot is not a single disease.
It's more again, more of a syndrome. We've got a contrast where it's just straightforward damage, but very often shell rot can come from damage. So if you have, a male tortoise who tends to butt rather than bite, you can make can damage the shell.
If you've got burns, this needs a necrosis of the underlying bone, and therefore, infection from there too. Again, you can see, you often wonder what you get. You see damaged shells like here, you know, is this superficial or deep?
I do a fingernail test, if I can get my finger under here and lift the scoot, then it's probably a bit deeper. I need to do that. I treat it like a horse's hoof, where I basically peel back the layers and see how deep it goes and see where, where the infection runs out.
Obviously, once you start doing anything more very, very external, scoot, debridement, you have to be under anaesthesia for this. Once, You've done that, you really start treating this like a skin infection. Except it's hard skin, not soft.
You debride it. You put wet to dry dressings on, you bandage it, you're allowed to granulate and you carry on with systemic therapy during all this. I can take a little bit longer because it's boning.
Here's an example. It's a marginate tortoise, a very superficial area here. This is where it was kept, marginate males bite, so marginate females have very thick skin.
This was kept with a spurth-eyed male who butted, and he basically bruised her, and infection set in from there. So in anaesthetize, we start debriding with scu. Now we can start seeing just how extensive this is, go a long way underneath there.
We have to remove that. Debride, we're using bone tools, we're using drills, and we're taking that down. Again, we're around the back as well, we attacked there as well.
And again, see how deep this is going. This is going through full bone thickness in this place here. And then we cover with wear wet dry dressings.
These are gauze swabs soaked in hippy scrub, and then basically we just treated it and treat it. And this is a picture of 6 to 9 months later, where we're getting good bone granulation from there. So it can heal even the deep lesions very, very well indeed, and often a lot quicker than people think, again, the other side as well.
In terms of damage, we see all sorts of things. We see bites, especially from dogs and stuff. We see moa injuries, we see RTAs, people driven over their horses often get cracked shell from that or dropped, and we treat them in many ways just the same, except in some cases maybe sort of increased, emphasis on.
Stabilisation. So this was a garden fork injury. Again, it's gonna be deep injuries.
It's gonna be going into soft tissue underneath there. We have to try and assess that at some point, and typically gonna have the shell pushed inwards, so we have fragments going in deep as well. At some point, we have to go in there and remove them before they form a knives of infection inside the abdominal cavity.
This is post-dog bite again, assessed prognosis. You know, this tool actually was really bright, it actually moved about in it while on on the consult room table, but we can see here, we're not gonna put this back together again. There's such deep damage here too, and we can't, even though the tors looks OK, we can say, look, really, we're gonna have to look at euthanasia here because there's too much damage.
Opposite spectrum, this is, an aquatic, semi-aquatic rather, and it's been bitten by one of its friends and it's taking nice fee out of here again, really clean bite, clean removal. Again, probably just very topical therapy. Maybe not even need, we don't think we've used systemic antibisis here.
We'll actually treat this very effectively indeed, it'll heal in its nice fee. This tour here had . A mole injury, using a sort of rotary device, and it's simply just, it was hiding in a hedgerow.
Please get people to check their hedgerows before we do that, start strimming and stuff. And this one actually got, go deep, got superficial areas in the slash across it. Again, stabilising very often.
Just latoplast. Do some very fancy stuff in my time, but you know, certainly where I've got an RTA usually I'll crack along the shell, and I just put everything together, laster plasts, where areas, areas have gone, been pushed inwards. I'll hook them out, line them up and just hold them in place of lasterplast for a week or two while everything stabilises.
And then very often actually my repair I have to is minimal because it's already started fibrosing. In this case here we had deep injury, we had your liver exposed here, and we had damage that we had to stabilise that before we could start addressing the shell. So can beware of those deep injuries sometimes.
And this is a very typical thing in a drop tortoise, where you get the front part of a shell, it's a bit less supported, will just break away. And these areas where where you do have to put some stabilisation on more than tape, because often just flapping around, you don't want to use, lose that much shell. So here we're actually doing, putting screws in place and we're doing sort of, figure eight wires around just to, to keep in place and that worked really well.
So when we have got basic damage, and these are, this is a couple of dog bite cases, what are we gonna do? Well, typically what we'll do is we will treat them with antibiotic, anti-inflammatory, wet to dry dressings for a couple of weeks, up to a couple of weeks, 70 to 14 days before we do anything else. And so we're waiting for the areas that were bruised, to demarcate to become obvious, and so we know what's healthy and what's not healthy.
Then once that was over we'll anaesthetize and we will drill away with, this is hard tissue, remember, we'll drill out the the, the areas that appear to be non-vital, whether it be bits like this or whether it be like scrape wounds along here. After we've done that, we'll scrub down, do a deep scrub of those areas, dry off there, and then we can place epoxy resin. Don't think this is, this is after two weeks of wet to dry dressing of antibiosis, of supportive care.
So don't rush straight into this, otherwise you may find you've missed areas that are, which appeared healthy, but were bruised and devitalized, and you're gonna have to do it all over again. One area with just to show a specific case here too. This is a typical sort of terrier bite, where they've been chewing away to withdrawn inside, so the terrier from work it just eating its way through.
We see the tooth scratched along here. We can see we've got a lot of area of front end of shell here and open area skin. What we can do with these is again, back to about 2 weeks, we're wet to drying here, we're trying to keep all tissues as vital as possible.
We're then debriding back, you see here we've removed some of its dead stuff here, back to so if you like, nice dermis here. And then what we've done is we've simply drilled a few step holes along here, and then we can suture the skin to the, to the shell edge there too, and then we can place epoxy over here. And again, those can heal really nicely at that point.
So, in summary, these reptiles suffer from a range of diseases that may present as dermal, and these may be infections, and may be systemic disease, and it has been related. It can even be all three of those. So as a result, you're looking at a very thorough holistic investigation and regard the environments being part of the animal these.
Investigated too, and a lot of patients. I got the ideas, these are not going to be better in 1 to 2 weeks. Manage the expectations of a client.
If you say, I'll come back in 5 days, they'll be expecting something to change, it won't have done. So really, you're gonna have to manage expectations. It can take weeks to months to treat.
Thank you.
