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Dermatology (VEM 5387) > Autoimmune Skin Diseases (Marsella) > Flashcards

Autoimmune Skin Diseases (Marsella) Flashcards

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Dermatology Board Prep flashcards
1
Q

Pemphigus complex

A
  • Antibodies produced against protein (desmogleins) responsible for intercellular adhesion
  • Type II hypersensitivity
  • Detachement of cells from each other (acantholytic cells)
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2
Q

Pemphigus foliaceus location of action

A

Antibodies target antigens in the upper part of the epidermis (right below the stratum corneum)

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3
Q

Pemphigus foliaceus predilections

A
  • Dogs, cats, horses, goats
  • Chow-chow, Collie, Akita
  • Middle-aged to old animals
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4
Q

Pemphigus foliaceus clinical signs

A
  • Primary lesion: pustule
  • Crusting & scaling
  • Distribution: pinnae, face, bridge of nose, hyperkeratosis of footpads, nailbed (cats)
  • Cat distribution (“stripper’s disease”): face, perinipple, nail beds
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5
Q

Pemphigus foliaceus diagnosis

A
  • Cytology from pustule
  • Histopath
  • Biopsy new lesions (when off steroids)
  • R/O pyoderma & demodex
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6
Q

Pemphigus foliaceus therapy

A
  • Long term w/ potential serious side effects
  • High doses of corticosteroids
  • Azathioprine (dogs)
  • Chlorambucil (cats)
  • Gold
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7
Q

Pemphigus erythematosus predilections

A
  • Collies
  • German shepherds
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8
Q

Pemphigus erythematosus pathogenesis

A
  • Cross over between pemphigus & lupus
  • Milder than PF
  • Antibodies
    • Intercellular spaces of epidermis (pemphigus)
    • Basement membrane (lupus)
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9
Q

Pemphigus erythematosus clinical signs

A
  • Pustular dermatitis - face & ears
  • Nasal depigmentation
  • Aggravated by UV light
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10
Q

Pemphigus erythematosus diagnosis

A
  • Cytology
  • Histopath
  • ANA test (antinuclear antibody) is negative
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11
Q

Pemphigus erythematosus therapy

A
  • Mild
    • Topical steroids or tacrolimus
    • Sunscreen
  • Severe
    • immunosuppressive therapy
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12
Q

Pemphigus vulgaris predilections

A
  • Most common type in humans
  • Rare in animals, but usually older animals
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13
Q

Pemphigus vulgaris location of action

A

Acantholysis in lower epidermis

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14
Q

Pemphigus vulgaris clinical signs

A
  • Primary lesion: bulla
  • Ulcerations & erosions
  • Distribution: oral cavity, mucocutaneous junctions, nail beds (sloughing), axillae, groin
  • Lethargy, fever, anorexia
  • 2º infections
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15
Q

Pemphigus vulgaris diagnosis

A
  • Histopath
    • Biopsy fresh lesions
  • R/O more common diseases
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16
Q

Pemphigus vulgaris therapy and prognosis

A
  • Immunosuppression - require high dose to stay in remission
  • Prognosis guarded to poor, fatal without therapy
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17
Q

Pemphigus vegetans

A
  • Very rare
  • Mild form of pemphigus vulgaris
  • Proliferative lesions
  • Scaling, crusting of axillae and groin
  • Diagnose & treat same as pemphigus foliaceus
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18
Q

Discoid lupus erythematosus predilections

A
  • Collie
  • German shepherd
19
Q

Discoid lupus erythematosus pathogenesis

A
  • Benign form of lupus
  • Sunlight triggers expression of new antigens
  • Produciton of antibodies
    • Deposition in basement membrane
    • Type II cytotoxic reaction
20
Q

Discoid lupus erythematosus clinical signs

A
  • Nose
    • Depigmentation
    • Loss of normal appearance
    • Erosions & ulcerations
  • Pinnae, eyelids, lips, footpads (rare)
21
Q

Discoid lupus erythematosus diagnosis

A
  • Histopathology
  • Immunofluorescence
  • ANA test (antinuclear antibody) - negative
22
Q

Discoid lupus erythematosus therapy

A
  • Topical steroids or tacrolimus
  • Sunscreen, vit. E
  • Systemic steroids (low dose) or tetracycline/niacinamide
23
Q

Systemic lypus erythematosus pathogenesis

A

Antibodies produced against different antigens (RBCs, platelets, nuclear antigens…)

24
Q

Dermatological signs of systemic lupus erythematosus

A
  • Seberrhea
  • Vasculitis - necrosis of pinnae and tip of tail, crusting and ulceration of footpads
  • Nasal depigmentation & ulceration
  • Mucocutaneous bullous disease
  • Panniculitis
25
Q

Systemic lupus erythematosus diagnosis

A
  • Presence of multisystemic dz
  • CBC, chem, UA
    • Anemia, thrombocytopenia, proteinuria
  • ANA test (antinuclear antibody test): 90%
  • Suggestive histopath and immunofluorescence
26
Q

Sysemic lupus erythematosus therapy

A
  • Immunosuppressive drugs (high dose)
    • Azathioprine
    • Chlorambucil
  • Gold contraindicated due to renal complications
27
Q

Bullous pemphigoid predilections

A
  • Old animals
  • Collies
  • Dobermans
28
Q

Bullous pemphigoid pathology

A

Antibodies produced against basement membrane

(not a true pemphigus b/c no acantholytic cells and it acts in the basement membrane)

29
Q

Bullous pemphigoid clinical signs

A
  • Primary lesion: bulla
  • Ulcerations
  • Fever & anorexia
  • Distribution: oral cavity, axillae, groin, mucocutaneous junctions, nail beds
  • Paronichia (infection) , sloughing of nailes
30
Q

Bullous pemphigoid diagnosis & therapy

A
  • Histopath
  • Immunofluorescence
  • Immunohistochemistry
  • Tx same as pemphigus foliaceus
31
Q

Erythema multiforme pathogenesis

A
  • Immune mediated syndrome
  • 2º to drugs or infections (cephalosporins, TMP-sulfa, levamisole, gold)
  • Acute, self-limiting
32
Q

Erythema multiforme clinical signs

A
  • Target lesions - peripheral erythema w/ central clearing
  • Macules
  • Plaques
33
Q

Erythema multiforme diagnosis

A
  • Suggestive history and clinical signs
  • Histopathology - biopsy epidermis, not ulcer
34
Q

Erythema multiforme therapy

A
  • ID & tx underlying cause
  • Supportive therapy
  • Abx for 2º infection
  • Steroids (controversial)
35
Q

Toxic epidermal necrosis (general info)

A
  • Severe cutaneous eruption
  • Systemically ill - fever, lethargy
  • Full thickness necrosis and sloughing
  • Mucosal ulcerations
  • Arthralgia

(usually induced by drugs, like Hartz products)

36
Q

Toxic epidermal necrosis diagnosis

A

Histopath of early lesions

37
Q

Toxic epidermal necrosis therapy & prognosis

A
  • ID & tx underlying cause
  • Supportive (fluids, abx)
  • NO steroids
  • Poor prognosis (electrolyte loss, 2º infections)
38
Q

Mycosis fungoides pathogenesis

A

Cutaneous lymphoma (T cells)

CANCER (not a damn fungus)

39
Q

Mycosis fungoides clinical signs

A
  • Erythema, pruritis, seborrhea
  • Depigmentation & ulcerations of mucus membranes & nose
  • Stomatitis & oral ulcerations (animal stops eating)
  • Plaques & nodules
40
Q

Necrolytic migratory erythema (general info)

A
  • AKA: hepato-cutaneous syndrome, glucagonoma syndrome, superficial necrolytis dermatitis
  • Old dogs
  • Associated w/ liver dz, glucagonoma, diabetes mellitus, Cushing’s
41
Q

Necrolytic migratory erythema pathogenesis

A
  • Metabolic defect - nutritional deficiency at epidermis → skin necrosis
    • Aminoacids
    • Zinc
    • Fatty acids
  • Cutaneous lesions may occur months before onset of systemic dz
42
Q

Necrolytic migratory erythema clinical signs

A
  • Erythema, ulcerations, crusting
  • Distribution: pinnae, muzzle, footpads, genitalia
  • 2º bacterial & yeast infections
43
Q

Necrolytic migratory erythema diagnosis

A
  • Histopath
    • “Red, white, and blue”
    • Blue - hyperplasia of basal cell layer
    • White - cellular edema in middle epidermis
    • Red - hyperkeratotic parakeratosis
44
Q

Necrolytic migratory erythema therapy & prognosis

A
  • ID & correct underlying dz
  • Treat 2º infections
  • Aminoacid, zinc, fatty acid supplement
  • NO glucocorticoids
  • Poor prognosis (death in 6 mos after onset of cutaneous lesions)

Dermatology (VEM 5387) (17 decks)

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