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CFT II > Exam 2 - Autoimmune Skin Diseases > Flashcards

Exam 2 - Autoimmune Skin Diseases Flashcards

1
Q

what is a self marker in regards to the immune system?

A

self marker (MHC) labels the body’s cells as a friend & are tolerated by the immune system

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2
Q

what is an antigen?

A

molecule that the immune system recognizes as foreign (non-self) & treats as a foe

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3
Q

what is the common history of a patient with an immune-mediated skin disease?

A

severe disease with acute/rapid onset with reports that lesions wax/wane in short cycles of 7-10 days

intermittent episodes of systemic illness concurrent with the development of lesions

lack of response to appropriate therapy for non-immune mediated disease

difficulty eating/drinking - may be early sign of oral ulceration

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4
Q

what lesion distribution should make you think of immune-mediated skin disease?

A

involvement of the nasal planum, ear pinnae, or foot pads (non-haired skin)

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5
Q

what part of lesion development may clue you in to an immune-mediated issue seen on physical exam?

A

large numbers of intact primary lesions that are easily found & are in the same stage (all pustules/vesicles/bullae without epidermal collarettes)

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6
Q

what diagnostic test should be considered sooner in a patient’s work up for potential immune-mediated skin disease? why?

A

skin biopsy - best chance for definitive diagnosis

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7
Q

what is the minimum database needed when working up a patient for a potential immune-mediated disease?

A

skin scrapings & cytology - rule out parasites & infections

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8
Q

why not surgically scrub/prep the skin site for biopsy?

A

you can wash away the diagnostic sample

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9
Q

why is the top option for biopsy unacceptable but everything beneath is?

A

including both normal & abnormal in one sample can be misinterpreted by the pathologist depending on how the sample is cut & processed

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10
Q

what is considered to be the mainstay of therapy for immune-mediated skin conditions?

A

glucocorticoids - often used initially to get disease into a rapid remission & then tapered

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11
Q

when is cyclosporine best for treating immune-mediated skin disease?

A

best for t-cell mediated diseases such as lupus & perianal fistulas

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12
Q

what is the MOA of tacrolimus? when is it best used in immune-mediated skin disease?

A

calcineurin inhibitor like cyclosporine that is much more potent - best for localized disease such as discoid lupus erythematous & perianal fistulas

owners must wear gloves

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13
Q

why not use azathioprine in cats?

A

can cause fatal leukopenia & thrombocytopenia

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14
Q

when is azathioprine & chlorambucil best used for immune-mediated skin disease?

A

in combination with other immunosuppressives - most beneficial for glucocorticoid dose sparing effects

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15
Q

when is mycophenolate mofetil best used for immune-mediated skin disease?

A

effective in most cases of pemphigus foliaceus

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16
Q

when is leflunomide best used for immune-mediated skin disease?

A

histiocytic diseases - may be beneficial in other round cell diseases

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17
Q

what is the MOA of pentoxifyline? when is it best used for immune-mediated skin disease?

A

phosphodiesterase inhibitor that allows for more deformability with red blood cels

good choice for vasculitis cases

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18
Q

what is the main goal of therapy when treating immune-mediated skin disease?

A

get disease into a clinical remission with medications & then taper to the lowest dose possible to keep the disease managed

19
Q

this distribution is seen with what immune-mediated skin condition?

A

pemphigus foliaceus

20
Q

what is the pathogenesis of pemphigus foliaceus?

A

immune system makes an attack on the adhesion molecules that hold the skin together

in pemphigus foliaceus - attack is only on part of the desmosome & where the cells are most concentrated is where the lesion target is

as the adhesion molecules separate, a pustule forms

21
Q

what is seen on biopsy that is pretty definitive for pemphigus foliaceus?

A

acantholytic keratinocytes - immature skin cell that has lost its attachment to its neighbors, rounded edges

subcorneal pustules, neutrophils but no bacteria representing a sterile inflammatory process

22
Q

this distribution is seen with what immune-mediated skin condition?

A

cutaneous vasculitis

23
Q

how can you differentiate between erythema on skin & lesions that represent bleeding?

A

erythema will blanch when you press a slide down on it

bleeding doesn’t blanch

24
Q

what are you paying attention to with lesions, lesion locations & symmetry that may indicate an immune-mediated dermatological disease is present?

A

lesions will all be in the same state - all pustules, all crusts, won’t see different stages, & pustules are much larger in pemphigus

immune-mediated diseases can affect both haired & non-haired skin

especially if on the nasal planum & paw pads!!!!!!

symmetry is very common in immune-mediated dermatological diseases

25
Q

what is an example of when you may consider the presence of an immune-mediated dermatological disease in a patient you treated for folliculitis?

A

the patient presents with signs of folliculitis (lesions are affecting haired skin, pustules are seen) , so empirical therapy is administered but the patient has no response to it

consider pemphigus - autoimmune disease that features pustules!!!

26
Q

why is biopsy pursued earlier in immune-mediated dermatological diseases?

A

gives you the most bang for your buck - especially if lesions are present on nasal planum/paw pads

gets you a definitive diagnosis quicker

27
Q

T/F: cats with pemphigus respond well to cyclosporine as treatment while dogs do not

A

true

28
Q

why should you not give a cat azathioprine for an immune-mediated dermatological disease?

A

causes myelosuppression (and maybe liver toxicity?)

29
Q

T/F: many general practitioners fail at treating immune-mediated skin diseases because they taper immunosuppressive drugs too quickly

A

true

30
Q

what is the schedule used for tapering immunosuppressive drugs for autoimmune skin diseases?

A

tapering is extremely slow - decrease of about 20% every 10-14 days

31
Q

what is the most common dermatological autoimmune disease seen in companion animals?

A

pemphigus foliaceus

32
Q

how can pustules on the skin of a dog help clue you in to an immune-mediated disease?

A

pustules in pemphigus are huge & span multiple hair follicles

in folliculitis - pustules are smaller because individual follicles are affected

33
Q

what is shown here that concerns you for an immune-mediated disease?

A

pustule is present on the actual paw pad

34
Q

what cell types are shown on this biopsy sample of the nasal planum of a dog? what do you think the dog has?

A

acantholytic keratinocytes

pemphigus foliaceus

35
Q

T/F: the concave surface of the pinna is a common site for lesions in immune-mediated dermatological disease

A

true

36
Q

the lesion distribution shown is for what disease in cats?

A

pemphigus foliaceus in cats

37
Q

will you scrub a crust before taking a biopsy sample when looking for immune-mediated skin disease? why? what should you do?

A

NO - you will literally wash away your evidence you dummy

biopsy through the crust!!!

38
Q

will you see pustules on cats with pemphigus? why?

A

not really - they suck at making them

you’ll probably see crusts instead

39
Q

what disease has the lesion distribution shown in the photo? why?

A

cutaneous vasculitis - lesions are on the distal extremities because of smaller vessels & how they are affected

40
Q

because cutaneous vasculitis has a lot of triggers associated with its cause, where can you start after taking a biopsy?

A

run a 4DX

41
Q

what is the pathogenesis of cutaneous vasculitis?

A

type III hypersensitivity reaction - antigen-antibody complexes are deposited inside vessel walls & the body can’t effectively clear them

complexes result in lymphocyte recruitment & complement fixation. Damage is believed to be mediated by the cleaved complement anaphylotoxins, C3a (initiates mast cell degranulation) & C5a (encourages inflammatory cell recruitment in tissues resulting in massive damage to the blood vessel wall)

fibrin deposition enables thrombus formation - tissue necrosis & movement of red blood cells outside the vessel wall (extravasation) are the ultimate outcome

42
Q

what is seen on biopsy that is supportive of cutaneous vasculitis?

A

bubbling on the basement membrane, separation at the basement membrane

when active - lesions will show up as erosions/ulcers (especially at the ear margin because of those teeny tiny vessels)

43
Q

what immune-mediated disease do you think is going on?

A

cutaneous vasculitis - little hole punch looking things

44
Q

what is the only way to definitively diagnose cutaneous vasculitis?

A

histopathology - lesions without marked ulceration and necrosis are preferred

extravasation of red blood cells is common

fibrinoid necrosis is the end point of immune-mediated blood vessel wall destruction

in some cases, only changes associated with vasculitis (i.e. necrosis, fibrinoid change, endothelial swelling, thrombosis) are seen

CFT II (28 decks)

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