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Clinical Dermatology > Immune-Mediated and Autoimmune Diseases > Flashcards

Immune-Mediated and Autoimmune Diseases Flashcards

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Dermatology Board Prep flashcards
1
Q

what are the autoimmune diseases?

A

pemphigus
pemphigoids
lupus erythematosus

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2
Q

what are the types of pemphigus?

A

pemphigus foliaceus
pamphigus erythematosus
pemphigus vulgaris
paraneoplastic pemphigus

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3
Q

what three protein types do desmosomes have?

A

plakins
armadillo proteins
cadherins

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4
Q

what is the pathogenesis of pemphigus foliaceus?

A

IgG autoantibodies to desmocollin-1 in 75%

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5
Q

what is the most common autoimmune disease?

A

pemphigus foliaceus

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6
Q

which dogs may be predisposed to pemphigus foliaceus?

A

chow chow
akitas

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7
Q

what are the etiologies of pemphigus foliaceus?

A

spontaneous most common
can be drug-induced/triggered
can be disease-induced/associated?

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8
Q

what is the major autoantigen in dogs with pemphigus foliaceus?

A

desmocollin-1

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9
Q

what is the primary type of lesion in pemphigus foliaceus?

A

pustule

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10
Q

what are the most common and early affected areas in pemphigus foliaceus?

A

pinnae
head and face
nasal planum
cats: claw folds
cats: skin around nipples
footpads

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11
Q

what is the primary differential diagnosis with pemphigus foliaceus?

A

pyoderma

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12
Q

what is the history like with pemphigus foliaceus?

A

non pruritic pustules/crusts
pruritus in 31-73% of feline cases

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13
Q

where should you collect samples for cytology in pemphigus foliaceus?

A

intact pustule: best
under superficial crust
from claw fold pus

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14
Q

what is the goal in the induction phase of treating pemphigus foliaceus?

A

suppress immune system enough for lesions to stop spreading and start healing
1-8 weeks

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15
Q

what is the pulse therapy for pemphigus foliaceus in dogs?

A

10 mg/kg SID prednisone or prednisolone for 3 days, then 1 mg/kg SID

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16
Q

what are the drug options for pemphigus foliaceus in the induction phase for cats?

A

prednisolone
triamcinolone
prednisolone and chlorambucil
prednisolone and cyclosporine
oclacitinib

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17
Q

what should you do with drugs in the maintenance phase of pemphigus foliaceus?

A

decrease does of predniso(lo)ne, every other day, withdraw slowly if possible
decreases doses of other drugs
consider topical if lesions are few

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18
Q

what is pemphigus vulgaris?

A

very rare, very severe vesicular and ulcerative disease
affects mucus membranes and haired skin

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19
Q

what are pemphigoids?

A

bullae and clefts between dermis and epidermis
autoimmune subepidermal blistering diseases

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20
Q

what is a skin biopsy for in pemphigoid?

A

necessary for confirmation
cannot differentiate one pemphigoid from another

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21
Q

what do lymphocytes do in lupus erythematosus?

A

damage basal cells: basal keratinocyte apoptosis

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22
Q

what lesions are primarily seen in facial discoid lupus?

A

depigmentation
erythema
scales
loss of nasal planum architecture

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23
Q

what should you rule out with facial discoid lupus?

A

mucocutaneous pyoderma

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24
Q

who has a genetic predisposition to uveodermatologic syndrome?

A

akitas
samoyeds and huskies also

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25
Q

what happens in uveodermatologic syndrome?

A

autoimmune attack to melanocytes or melanocyte-associated antigens

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26
Q

what are the skin lesions like in uveodermatologic syndrome?

A

always face (nose) or head
depigmentation
erosions, ulcers

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27
Q

what is needed for diagnosis of uveodermatologic syndrome?

A

clinical presentation and breed
histological examination

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28
Q

what is the prognosis of uveodermatologic syndrome?

A

cautious: lifetime treatment may be required, changes in eyes may be irreversible, no spontaneous remission

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29
Q

how is uveodermatologic syndrome treated?

A

systemic aggressive immunosuppressive treatment: predniso(lo)ne or predniso(lo)ne with azathioprine or cyclosporine
topical eye treatment

30
Q

what dogs are predisposed to canine perianal fistulas/anal furunculosis?

A

german shepherd dogs
middle-aged

31
Q

are canine perianal fistulas/anal furunculosis related to anal sacs?

A

no

32
Q

what are the clinical signs with canine perianal fistulas?

A

painful defecation
bloody discharge
tenesmus
painful while manipulating/getting cleaned
odor

33
Q

is surgical management effective for canine perianal fistulas?

A

no

34
Q

what is the main treatment for canine perianal fistulas?

A

cyclosporine

35
Q

what are the other names for juvenile cellulitis?

A

sterile granulomatous dermatitis and lymphadenitis
puppy strangles

36
Q

what are the clinical signs of juvenile cellulitis?

A

deep papules, pustules, nodules, draining tracts
lymphadenitis, abscesses
purulent otitis
joint pain/lameness
fever

37
Q

how can juvenile cellulitis be treated?

A

prednisone 2mg/kg SID
wait with vaccination
systemic antibiotics only if cytology shows secondary infection

38
Q

what is lupoid onychodystrophy/symmetrical idiopathic onychomadesis like?

A

nail/nailbeds inflammation: dystrophy and sloughing of nails
syndrome, not single diagnosis

39
Q

what is the treatment for lupoid onychodystrophy?

A

fish oil
doxycycline and niacinamide
cyclosporine
steroids
pentoxifylline
apoquel?
nail removal
3rd phalanges amputation

40
Q

where are ischemic skin lesions due to vasculitis seen?

A

ear pinnae
footpads
tip of tail

41
Q

how can vasculitis be managed?

A

pentoxifylline
cyclosporine/tacrolimus
sulfasalazine
steroids
oclacitinib

42
Q

what is the etiology of feline plasma cell pododermatitis?

A

unknown
likely infectious or immune-mediated
no viral, bacterial, or allergic components found

43
Q

what is seen on cytology of feline plasma cell pododermatitis?

A

plasma cell predominating

44
Q

what are the early signs of feline plasma cell pododermatitis?

A

scaling of footpads
softness

45
Q

within each protein group in desmosomes, when do amounts of particular proteins differ?

A

depending on layer and body area

46
Q

in what percentage of dogs with pemphigus foliaceus with high IgG autoantibodies in desmocollin-1 did those titers lower with clinical improvement?

A

70%

47
Q

which cats are predisposed to pemphigus foliaceus?

A

no sex or breed predisposition
DSH, DLH, siamese overrepresented
females slightly

48
Q

what diseases in cats can cause pemphigus foliaceus?

A

thymoma
leishmaniosis

49
Q

what is the main clinical presentation of pemphigus foliaceus?

A

crust

50
Q

can pemphigus foliaceus be generalized and have systemic signs?

A

yes

51
Q

what can be seen on cytology with pemphigus foliaceus?

A

non degenerative neutrophils
acantholytic cells

52
Q

how can you treat pemphigus foliaceus in cats?

A

prednisolone
triamcinolone
prednisolone and chlorambucil
prednisolone and cyclosporine
oclacitinib/apoquel

53
Q

what does the prognosis of pemphigus foliaceus depend on?

A

severity of clinical presentation and necessity of systemic treatment
response to initial treatment
possibility to taper or withdraw medications
presence of adverse side effects

54
Q

what is pemphigus erythematosus like?

A

“combination” of pemphigus foliaceus and facial discoid lupus
mostly pustular and crusted disease

55
Q

what are the types of pemphigoids?

A

mucous membrane pemphigoid
bullous pemphigoid
epidermolysis bullosa acquisita

56
Q

what happens in lupus erythematosus?

A

UV-sensitivity
basal cells damage by lymphocytes- basal keratinocyte apoptosis
lymphocytic/histiocytic dermal infiltration
autoantibodies to nuclei and/or cytoplasmic antigens
immune complexes deposition along basal membrane

57
Q

what is facial discoid lupus erythematosus like?

A

no systemic signs
photosensitivity in 50%
infiltration of skin mainly by plasma cells

58
Q

what breeds are predisposed to facial discoid lupus?

A

german shepherds
collies
huskies
german pointers

59
Q

what is the prognosis of facial discoid lupus?

A

good, but life-long treatment often

60
Q

is there a sex predilection for uveodermatologic syndrome?

A

yes- males>females

61
Q

where are skin lesions in uveodermatologic syndrome?

A

always on face/nose or head
depigmentation
erosions, ulcers

62
Q

what is canine perianal fistulas/anal furunculosis?

A

painful sinuses around anus
not related to anal sacs

63
Q

how can you diagnose canine perianal fistulas?

A

mostly clinical
histological changes not specific

64
Q

what can be used in mild cases of canine perianal fistulas?

A

tacrolimus topically

65
Q

how can you diagnose juvenile cellulitis?

A

unique presentation, some breeds
negative skin scrapings for demodicosis
cytology: sterile pyogranulomatous inflammation
adult: skin biopsy

66
Q

why should you biopsy thee 3rd phalange in lupoid onychodystrophy?

A

rule out other diseases
not very specific histological changes

67
Q

what is the prognosis of lupoid onychodystrophy?

A

not predictable response to treatment
partial response common
life-long usually
aggressive therapy not always

68
Q

what is the usual cause of vasculitis in dogs?

A

idiopathic

69
Q

what are the later signs of plasma cell pododermatitis?

A

dark color of deeper tissue
eventual ulceration

70
Q

how can you treat plasma cell pododermatitis?

A

doxycycline and niacinamide
prednisolone
cyclosporine
surgical excision

Clinical Dermatology (16 decks)

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