C10005410 / invoice 10000

09/03/2026 Presented for itchy tummy and lumps on head

HISTORY: O noticed little lumps on head a few weeks ago that come and go, Noah doesn't seem to bothered by them. Tummy pink and itchy from wet grass, rubbing her belly a lot. Ears seem comfortable, otitis resolved previously. Licks feet a lot, usually feet are the first thing to get itchy, but this time they're not really affected. 
Cytopoint seemed to work, reduced itching significantly for approx a month. 
O washes every 2 weeks with alloveen shampoo, no conditioner. Cleans her tail fold regularly and sometimes uses sudocrem, has a screw tail. 
EDDU normal. No V+ or D+. no coughing or sneezing. 
UTD nexgard spectra.

PHYSICAL EXAM: 
Attitude: BAR, FAS shaking nervous, good for exam
BCS: 3/5
Heart/lungs: Clear, no murmurs or arrhythmias. HR 120. RR wnl. 
MM: pink and moist
Skin Tent: normal
Dental Score: 0
Abdomen: comfortable and soft
Skin: Multiple erythematous small nodules on top of head. Ventral chest moderate erythema and scabbing. mild erythema at inguinal ventrum and interdigitally on all feet. 
Eyes: clear
Ears: clear
Temp: //
Lymph Nodes: wnl
MSK/Neuro: normal

DIAGNOSTICS:
Cytology sticky tape head nodules - neuts ++, cocci +
Chest and ventrum - neuts ++, cocci ++
Tail fold - neuts +++, cocci ++

ASSESSMENT: Superficial bacterial pyoderma. Possibly secondary to atopy or contact allergy

PLAN: Cytopoint 20mg given SC. Cephalexin PO BID. Recheck skin in 10 days. Start using conditioner after washing, and adv can use topizole on feet during flares with contact time, every 2-3 days, followed with conditioner. 
Adv if still itchy after cytopoint within next 24-48h, can call for some apoquel. 

JR/KC