Erosions/ulcers 2 Flashcards
Auto immune etiologies
Pemphigus foliaceus ** most common
Cutaneous lupus erythematosus
Pemphigus vulgaris
Subepidermal blistering dermatoses
Uveodermatological syndrome
Cutaneous lupus erythematosus localizing
Discoid LE
Mucocutaneous LE
Vesicular CLE
Exfoliative CLE
Pathogenesis of CLE
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
Discoid lupus erythematosus
In humans there’s a localized and generalized form
Localized in in the head and neck and generalized is everywhere
Canine DLE
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
Skin lesions of canine DLE
Erosions
Ulcers
Depigmentation
DX for nasal DLE
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
TX for mild cases for nasal DLE
Doxycycline or minocycline w niacinamide
Topical GC’s or tacrolimus ointment
Refractory cases - cyclosporine
avoid sunlight
Mucocutaneous lupus erythematosus
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***
Differential for MCLE
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
Initial approach TX for MCLE
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
Vesicular cutaneous lupus erythematosus breeds
Shetland sheepdog
Rough collie
Border collie
VCLE lesions
- Shape - annular, polycyclic or serpiginous
- Location - axillae, groin, concave pinnae
- Lesion type - erosions or ulcers
DX and TX for VCLE
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
Exfoliative cutaneous lupus erythematosus
Common in German shorthaired pointer dog, vizslas
skin AND systemic signs
ECLE - hereditary disease
Autosomal recessive
Common in <1year old
Skin lesions of ECLE
- Generalized scaling
- Thinning of hair —> complete alopecia
- Depigmentation
- Erosion/ulceration
Systemic signs of ECLE
- Periphery lymphadenopathy
- Lameness and hunch-stance
- Infertility
DX, Px, TX of ECLE
Skin biopsy - histo findings are similar to CLE
Prognosis is poor!!
Tx w mild improvement
- cyclosporine
- hydroxychloroquine
- adalimumab
Uveodermatological syndrome
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.
Pathogenesis of UDS
Cytotoxic t lymphocytes attack pigment cells (melanocytes) of skin and eyes
Clinical features of UDS - skin
Depigmentation —> inflammation —> erosions/ulceration
Clinical features of UDS - face
MOST commonly affected region
Mucocutaneous junctions of eyes, nose and perioral
Clinical features of UDS - eyes
Uveitis, retinitis, blindness if severe
Ocular signs can preceded, be concurrent with or follow skin lesion ***
DX and Tx of UDS
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
Autoimmune subepidermal blistering dermatoses
Autoimmune disease
Occurs below epidermis - deepest lesion
Leads to cleft or blister, vesicle - part of skin that doesn’t anchor to the basement membrane
Lesions for AISBD
Vesicles or ulcers
Fluid inside is usually clear and thin
Lesions can occur on ears, paw pads, lips, mouth
AISBD subtypes
Mucous membrane pemphigus**
Most common in dogs
Clinical exam of AISBD
Vesicles or ulcers - distribution can help determine type
Histopathology - subepidermal vesiculation/clefing w variable inflammation
Tx of canine AISBD
This is a chronic and relapsing disease - rare tho
Drugs for mono or combo therapy
- GC’s
- tetracyclines + niacinamide
- dapsone
- azathioprine
- colchicine
- oclacitinb
