C09998102 / invoice 10000

PATIENT: LokiDATE: 2026-03-06S:- Hair loss and rash on face (L side particularly affected) - ongoing for months- Licking paws constantly- Scratching face- Self-trauma to affected areas despite bandaging - removes bandages, rubs face against cones/edges- Previous nail removal left fore- Multiple interventions trialled over months with no consistent improvement-abs, cytopoint- O reports bandaging paw - heals when covered but returns to self-trauma when removed- Previous tx: Cytopoint (2 months ago), antibiotics, bandaging, Neocort cream- On parasite control (Bravecto)O:- Dermatological: Dermatitis L face, pododermatitis left front paws, alopecia, skin changes- Previous histopathology (nail and digit): Onychitis with regional dermatitis (lymphoplasmacytic, neutrophilic), intralesional bacteria present - interpretation: secondary infection, underlying problem likely primary issuetape prep- cocci seenskin scrape negA:- Chronic pruritic dermatitis (face and paws)- ?Allergic dermatitis (Cytopoint trial - inadequate response)- Secondary bacterial infection- Self-trauma/excoriation- DDx: Parasitic, bacterial, allergic, other dermatological conditions requiring biopsyP:offered biopsy but declined for now as just had nail biopsy- In-house diagnostic tests: Tape preps and skin scrapes (check for bacteria and parasites) prior to immunosuppressive therapy- Pending diagnostics: Consider Apoquel trial if no parasites/significant bacterial infection identified- Alternative: Corticosteroids (cheaper, effective but more side effects)- Recommended: Skin biopsies (face and foot) for definitive diagnosis if condition persists- Continue management of self-trauma/bandaging as neededDermatological: L facial dermatitis with alopecia, bilateral pododermatitis with self-trauma, previous histopathology showed onychitis with regional dermatitis and intralesional bacteria    Vital Signs