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Dermatology > Dermatology allergic and autoimmune > Flashcards

Dermatology allergic and autoimmune Flashcards

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1
Q

Why are cats with fleas often the cause of dogs getting FAD

A

Because they can tolerate large burdens of fleas without showing signs

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2
Q

Signs of flea allergic dermatitis in dogs

A

Pruritis of caudal dorsum, medial thights

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3
Q

Signs of flea allergic dermatitis in cats

A

Pruritic miliary dermatitis of crusted papules, alopexia, head and neck greatly affected

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4
Q

What type of antibodies are associated wtih atopic dermatitis

A

IgE

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5
Q

Favrot’s criteria for atopic dermatitis

A

i) Early onset <3 years of age
ii) Indoor lifestyle
iii) Glucocorticoid responsive
iv) Pruritus sine materia at onset i.e itchy but nothing to see when it started  THEN get changed associated with pruritis and scratching
v) Affected feet and/or ears
vi) Non-affected ear margins and/or dorsal lumbar [distinguish from FAD]

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6
Q

What must we remember to do in relatino to other diseases and Favrot’s criteria for atopic dermatitis

A

Treat other issues that are superimposed on top/mimic this condition e.g fleas, pyoderma
Then get a better specificity of the criteria

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7
Q

Infestation with what might give positive allergy testing to house dustmite

A

Sarcoptes scabei

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8
Q

How is atopic dermatitis treated basic

A

Steroids; should respond fully!! if not then suggests something else going on

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9
Q

How does intradermal skin testing work

A

Injecting antigen solution into skin; including positive (histamine) and negative control
Compare wheal size with positive control

Get a reaction where there is IgE cross linking and mast cell degranulatoin

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10
Q

What is atopic-like dermatitis

A

Where we have all the signs of atopic dermatitic but no evidence of an IgE response on intradermal skin testing or in-vitro allergen testing

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11
Q

Treatment options fo atopic dermatitis

A

Glucocorticoids
Calcineurin inhibitors (tacrolimus, ciclosporin)
Could do allergen specific immunotherapy
Shampoos
Janus kinase inhibitors e.g oclacitinib
Lokivetmab m-Ab against IL31 (cytopoint)

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12
Q

What is lokivetmab directed against

A

IL-31
Licensed for use in atopic dermatitis

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13
Q

When to go for allergen-specific immunotherapy and what are the success rates

A

Do it is the intradermal skin test allergy results make sense with lifestyle of animal etc

33% do very well, 33% have some improvement,, 33% no better

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14
Q

What is food induced atopic dermatitis/cutaneous adverse food reactions

A

= clinically very similar to atopic dermatitis but the reaction is triggered by food not external allergens

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15
Q

What is the classic signs of food induced atopic dermatitis

A

Any age
Classically non-seasonal pruritis
May see GI signs

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16
Q

What must we remember about in vitro allergen testing and food-induced atopic dermatitis

A

It is NOT reliable for this

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17
Q

How can we diagnose/treat food induced atopic dermatitis

A

strict diet trial for minimum of 1-2 months

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18
Q

What is feline atopic syndrome

A

variety of allergic diseases that may be associated with a hypersensitivity to environmental allergens and foods +/- FAD

Involves allergic dermatitis, asthma, GI disease

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19
Q

What cutaneous reaction patterns might a cat with feline atopic syndrome present with

A

1) Head and neck pruritis
2) Self-induced alopecia/hypotrichosis
3) Miliary dermatitis
4) Eosinophilic granuloma complex

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20
Q

Treatment for feline atopic syndrome

A

Systemic glucocorticoids and cyclosporins
Could try off licence oclacinitib

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21
Q

Options to deal with feline food allergy

A
  • Can try hydrolysed diets
  • Novel protein
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22
Q

WHat medication can cause contact dermatitis in cats

A

Otic medication

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23
Q

How common is allergic contact dermatitis in cats

A

Rare
Gets overdiagnosed

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24
Q

What drug can we use to spare steroids in feline atopic skin syndrome

A

Cyclosporine

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25
Q

Skin histopath with mast cells, lymphocytes and eosinophils may be indicative of what on a cat

A

Feline atopic skin syndrome

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26
Q

What drugs can we use to treat auto-immune skin disease

A

Immunsuppressive: Prednisolone, cyclosporine, azathioprine, chlorambucil, mycophenolate mofetil

Immunomodulating: tetracycline, niacinamide
Topical agent: tacrolimus

27
Q

What topical drug might we use for autoimmune skin disease

A

Tacrolimus

28
Q

WHat immunosuppressive drug should we not give to cats

A

Azathioprine

29
Q

What is the new classification of autoimmune skin disease and which things fit under these groups

A

Antibody mediated AISDs: pemphigus/pemphigoid
Lymphocyte mediated AISDs: CLE

30
Q

What are the three autoimmune diseases in the pemphigus group

A

Pemphigus foliaceous
Pemphigus erythematous
Pemphigus vulgaris

31
Q

Signs of pemphigus foliacus

A

Pustules; Face and feet often worst affected + nail beds in cats; pustules etc
May see pyrexia, lymphadenopathy due to immune system activation

32
Q

What is the aetiology of pemphigus foliaceus

A

Antibodies formed against desmosomes in stratum spinosum causing decoalescence to form pustules

33
Q

Target antigens in pemphigus group dseases

A

Desmosome components which hold epidermal cells together

anti-desmogleins/desmo-collins

34
Q

Which breeds are at increased risk of pemphigus foliaceous

A

Akita
Chow

35
Q

What is the Tzanck test

A

Where a pustule is ruptured to do cytology

36
Q

What might we see on cytology of a pustules with P foliaceous

A

Mature hypersegmented neutrophils with acantholytic cells (large and basophilic) which are from the stratum spinosum

37
Q

Which epidermis layer is targeted in P foliaceous

A

Stratum spinosum

38
Q

What medication can trigger p foliaceous in dogs

A

Spot ons

39
Q

What does P erythematous look like and which animals are predisposed

A

Dogs, very rare in cats; GSDs, collies, shelties
Pupules/lesions limited to bridge of nose, eyes, ear pinnae

40
Q

What is the most severe form of pemphigus

A

P vulgaris

41
Q

How does pemphigus vulgaris PRESENT

A

Skin on axilla/ingiunum affected + mucocutaneous junctions, and MMs
Get haemorrhagic ulcerative crusting

Also see pyrexia, depression, halitosis

42
Q

What happens in AISBD (bullous pemphigoid)

A

Formation of auto-antibodies against basement membrane causing separation of the dermis from the epidermis and bullae formation

Affects skin, mucocutaenous junctions and MMs; ulcerative

43
Q

What other auto-immune disease does AISBD (bullous pemphigoid) resemble and how do we tell them apart

A

P vulgaris
Use biopsies

44
Q

Treating AISBD

A

High dose preds + cyclosprone
Can add other immunosuppressives in if needing to reduce steroids

45
Q

What is cutaneous lupus erythematosus

A

Lymphocyte rich dermatitis with prominent basal keratinocyte death

46
Q

What is the most common form of cutaneous lupus erythematosus

A

Discoid lupus erythematosus

47
Q

Signs of discoid lupus erythematosus

A

Nasal depigmentation, erythema, ulceration

48
Q

What might we need biopsy to distinguish discoid lupus erythematosus from

A

Epitheliotrophic T cell lymphoma

49
Q

Treatment of discoid lupus erythematosus

A

Avoid sunlight
If severe use immunosuppression
Try topical agents e.g tacrolimus
Can use immunomodulating effects of niacinamide if less severe

50
Q

What does vesicular lupus erythematosus look like

A

Axillary and inguinal ulceration, alopecia and erytehma
Rare

51
Q

Diagnosis of systemic lupus erythamtosus

A

Anti-nuclear antibody positive + anti-histone antibody positive
Biopsy of skin lesions can be helpful if they are rpesent

52
Q

What signs might we see with systemic lupus erythematosus

A

half have skin lesions
Most have joint disease
Half have haematological changes due to bone marrow being targeted e.g anaemia, thrombocytopaenia, proteinuria
Some also show glomerulonephritis; would get marked proteinuria

53
Q

How many biopsies should we take when assessing skin disease

A

Up to 6 probably; 1 not enough

54
Q

Histology of atopic dermatitis

A

Superficial perivascular dermatitis with mast cells, eosinophils, lymphocytes and histiocytes

55
Q

What type of hypersensitivity is allergic contact dermatitis

A

Type IV hypersensitvity mediated by cytotoxic CD8+ T lymphocytes

56
Q

How is atopic dermatitis mediated

A

IgE response to environmental allergens
Because there is inflammation and IL4 production whcih causes shift from IgM to IgE

57
Q

Histology of flea bite hypersensitity

A

Superficial perivascular eosinophilic, lymphocytic, histiocytic dermatitis

58
Q

What is the target of pemphigus foliacus vs vulgaris (specifically)

A

P foliacus: desmoglein 1
P vulgaris: desmoglein 3; more present in mucocutnaeous junctions hence the clinical signs here

59
Q

Histology of pemphigus

A

 Superficial dermatitis with eosinophils, neutrophils, lymphocytes

60
Q

Histology of discous lupus erythematosus

A

basal cell degeneration, infiltration of lymphocytes and plasma cells at the epidermal dermal interface (becomes very thick), with pigmentary incontinence (because melanocytes are in stratum basale and get damaged so release melanin and then macrophages phagocytose this) and crusting

61
Q

Which dogs get bullous pemphigois most

A

Collies

62
Q

HIstology of bullous pemphigoid

A

vesicles or bullae within basement membranes (between PM and stratum basale), eosinophils

On immunofluorescence see IgG etc at dermoepidermal junction

63
Q

What immunosuppressive drugs could we use for autoimmune conditions

A

Prednisolone
Cyclosporine
Azathioprine (not in cats)
Mycophenolate mofetil
Chlorambucil

Dermatology (8 decks)

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