Erosions/ulcers 2

Question 1

Auto immune etiologies

Answer 1

Pemphigus foliaceus ** most common
Cutaneous lupus erythematosus
Pemphigus vulgaris
Subepidermal blistering dermatoses
Uveodermatological syndrome

Question 2

Cutaneous lupus erythematosus localizing

Answer 2

Discoid LE
Mucocutaneous LE
Vesicular CLE
Exfoliative CLE

Question 3

Pathogenesis of CLE

Answer 3

Effects basal cells in expressing autoantigenicity
Creates cytotoxic t lymphocytes - destroys viruses
This causes basal cells to die - apoptotic basal cells
The dead cells create space for ulcers
Fibroblasts fill in and create a scar in severe cases

Question 4

Discoid lupus erythematosus

Answer 4

In humans there’s a localized and generalized form
Localized in in the head and neck and generalized is everywhere

Question 5

Canine DLE

Answer 5

Occurs in two forms - facial and generalized
Facial occurs on the nasal region
Generalized occurs on head, neck, trunk and limbs
Chronic lesion lead to ulcers

Question 6

Skin lesions of canine DLE

Answer 6

Erosions
Ulcers
Depigmentation

Question 7

DX for nasal DLE

Answer 7

Biopsy - take from the edge of erosion/ulcer 30/70 erosion to visualize the apoptotic cells
NEVER biopsy an entirely ulcerated lesion
Select multiple lesions to sample - varying stages
Biopsy before starting GC’s therapy

Question 8

TX for mild cases for nasal DLE

Answer 8

Doxycycline or minocycline w niacinamide
Topical GC’s or tacrolimus ointment
Refractory cases - cyclosporine
avoid sunlight

Question 9

Mucocutaneous lupus erythematosus

Answer 9

Predisposed in German shepherds
Common in mucocutaneous junctions
- anogenital (57%)
- perioral (43%)
- Periocular (29%)
- nose (19%)
67% have more than two or more junctions involved***

Question 10

Differential for MCLE

Answer 10

Commonly mistaken for Mucocutaneous pyoderma
1. Distribution - Higher tendency to affect nose or perioral region
2. Region - less extensive erosion
3. TX - complete response to antibiotic therapy

Question 11

Initial approach TX for MCLE

Answer 11

Doxycycline or minocycline w niacinamide
Concomitant oral GC’s = short time to remission
With ^ = 30d
Without ^ = 60d
Refractory cases: cyclosporines - relapses are common upon tapering of Tx

Question 12

Vesicular cutaneous lupus erythematosus breeds

Answer 12

Shetland sheepdog
Rough collie
Border collie

Question 13

VCLE lesions

Answer 13

1. Shape - annular, polycyclic or serpiginous
2. Location - axillae, groin, concave pinnae
3. Lesion type - erosions or ulcers

Question 14

DX and TX for VCLE

Answer 14

Skin biopsy - histo findings are similar to ALL FORMS of cutaneous lupus eryth
TX - similar to all varieties of CLE
Doxycycline & niacinamide +/- steroids
Cyclosporines
Tacrolimus topical therapy
PX is pretty good

Question 15

Exfoliative cutaneous lupus erythematosus

Answer 15

Common in German shorthaired pointer dog, vizslas
skin AND systemic signs

Question 16

ECLE - hereditary disease

Answer 16

Autosomal recessive
Common in <1year old

Question 17

Skin lesions of ECLE

Answer 17

1. Generalized scaling
2. Thinning of hair —> complete alopecia
3. Depigmentation
4. Erosion/ulceration

Question 18

Systemic signs of ECLE

Answer 18

1. Periphery lymphadenopathy
2. Lameness and hunch-stance
3. Infertility

Question 19

DX, Px, TX of ECLE

Answer 19

Skin biopsy - histo findings are similar to CLE
Prognosis is poor!!
Tx w mild improvement
- cyclosporine
- hydroxychloroquine
- adalimumab

Question 20

Uveodermatological syndrome

Answer 20

Uveo- : uvea, pigmented layer of the eye
beneath the sclera and cornea
-dermatologic: involves the skin
Other name: Vogt-Koyanagi-Harada (VKH)- like syndrome
Breed predisposition: Akitas, Malamutes, Huskies, Samoyeds.

Question 21

Pathogenesis of UDS

Answer 21

Cytotoxic t lymphocytes attack pigment cells (melanocytes) of skin and eyes

Question 22

Clinical features of UDS - skin

Answer 22

Depigmentation —> inflammation —> erosions/ulceration

Question 23

Clinical features of UDS - face

Answer 23

MOST commonly affected region
Mucocutaneous junctions of eyes, nose and perioral

Question 24

Clinical features of UDS - eyes

Answer 24

Uveitis, retinitis, blindness if severe
Ocular signs can preceded, be concurrent with or follow skin lesion ***

Question 25

DX and Tx of UDS

Answer 25

Clinical DX of uveitis - biopsy of inflamed skin lesion for Histopathology
Tx
- GC’s +/- cyclosporine
- GC’s +/- azathioprine
Treatment must not be delayed *** severe uveitis = blind

Question 26

Autoimmune subepidermal blistering dermatoses

Answer 26

Autoimmune disease
Occurs below epidermis - deepest lesion
Leads to cleft or blister, vesicle - part of skin that doesn’t anchor to the basement membrane

Question 27

Lesions for AISBD

Answer 27

Vesicles or ulcers
Fluid inside is usually clear and thin
Lesions can occur on ears, paw pads, lips, mouth

Question 28

AISBD subtypes

Answer 28

Mucous membrane pemphigus**
Most common in dogs

Question 29

Clinical exam of AISBD

Answer 29

Vesicles or ulcers - distribution can help determine type
Histopathology - subepidermal vesiculation/clefing w variable inflammation

Question 30

Tx of canine AISBD

Answer 30

This is a chronic and relapsing disease - rare tho
Drugs for mono or combo therapy
- GC’s
- tetracyclines + niacinamide
- dapsone
- azathioprine
- colchicine
- oclacitinb