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Clinical Dermatology > Immune-Mediated and Autoimmune Diseases > Flashcards

Immune-Mediated and Autoimmune Diseases 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
what happens in uveodermatologic syndrome?
autoimmune attack to melanocytes or melanocyte-associated antigens
26
what are the skin lesions like in uveodermatologic syndrome?
always face (nose) or head depigmentation erosions, ulcers
27
what is needed for diagnosis of uveodermatologic syndrome?
clinical presentation and breed histological examination
28
what is the prognosis of uveodermatologic syndrome?
cautious: lifetime treatment may be required, changes in eyes may be irreversible, no spontaneous remission
29
how is uveodermatologic syndrome treated?
systemic aggressive immunosuppressive treatment: predniso(lo)ne or predniso(lo)ne with azathioprine or cyclosporine topical eye treatment
30
what dogs are predisposed to canine perianal fistulas/anal furunculosis?
german shepherd dogs middle-aged
31
are canine perianal fistulas/anal furunculosis related to anal sacs?
no
32
what are the clinical signs with canine perianal fistulas?
painful defecation bloody discharge tenesmus painful while manipulating/getting cleaned odor
33
is surgical management effective for canine perianal fistulas?
no
34
what is the main treatment for canine perianal fistulas?
cyclosporine
35
what are the other names for juvenile cellulitis?
sterile granulomatous dermatitis and lymphadenitis puppy strangles
36
what are the clinical signs of juvenile cellulitis?
deep papules, pustules, nodules, draining tracts lymphadenitis, abscesses purulent otitis joint pain/lameness fever
37
how can juvenile cellulitis be treated?
prednisone 2mg/kg SID wait with vaccination systemic antibiotics only if cytology shows secondary infection
38
what is lupoid onychodystrophy/symmetrical idiopathic onychomadesis like?
nail/nailbeds inflammation: dystrophy and sloughing of nails syndrome, not single diagnosis
39
what is the treatment for lupoid onychodystrophy?
fish oil doxycycline and niacinamide cyclosporine steroids pentoxifylline apoquel? nail removal 3rd phalanges amputation
40
where are ischemic skin lesions due to vasculitis seen?
ear pinnae footpads tip of tail
41
how can vasculitis be managed?
pentoxifylline cyclosporine/tacrolimus sulfasalazine steroids oclacitinib
42
what is the etiology of feline plasma cell pododermatitis?
unknown likely infectious or immune-mediated no viral, bacterial, or allergic components found
43
what is seen on cytology of feline plasma cell pododermatitis?
plasma cell predominating
44
what are the early signs of feline plasma cell pododermatitis?
scaling of footpads softness
45
within each protein group in desmosomes, when do amounts of particular proteins differ?
depending on layer and body area
46
in what percentage of dogs with pemphigus foliaceus with high IgG autoantibodies in desmocollin-1 did those titers lower with clinical improvement?
70%
47
which cats are predisposed to pemphigus foliaceus?
no sex or breed predisposition DSH, DLH, siamese overrepresented females slightly
48
what diseases in cats can cause pemphigus foliaceus?
thymoma leishmaniosis
49
what is the main clinical presentation of pemphigus foliaceus?
crust
50
can pemphigus foliaceus be generalized and have systemic signs?
yes
51
what can be seen on cytology with pemphigus foliaceus?
non degenerative neutrophils acantholytic cells
52
how can you treat pemphigus foliaceus in cats?
prednisolone triamcinolone prednisolone and chlorambucil prednisolone and cyclosporine oclacitinib/apoquel
53
what does the prognosis of pemphigus foliaceus depend on?
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
what is pemphigus erythematosus like?
"combination" of pemphigus foliaceus and facial discoid lupus mostly pustular and crusted disease
55
what are the types of pemphigoids?
mucous membrane pemphigoid bullous pemphigoid epidermolysis bullosa acquisita
56
what happens in lupus erythematosus?
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
what is facial discoid lupus erythematosus like?
no systemic signs photosensitivity in 50% infiltration of skin mainly by plasma cells
58
what breeds are predisposed to facial discoid lupus?
german shepherds collies huskies german pointers
59
what is the prognosis of facial discoid lupus?
good, but life-long treatment often
60
is there a sex predilection for uveodermatologic syndrome?
yes- males>females
61
where are skin lesions in uveodermatologic syndrome?
always on face/nose or head depigmentation erosions, ulcers
62
what is canine perianal fistulas/anal furunculosis?
painful sinuses around anus not related to anal sacs
63
how can you diagnose canine perianal fistulas?
mostly clinical histological changes not specific
64
what can be used in mild cases of canine perianal fistulas?
tacrolimus topically
65
how can you diagnose juvenile cellulitis?
unique presentation, some breeds negative skin scrapings for demodicosis cytology: sterile pyogranulomatous inflammation adult: skin biopsy
66
why should you biopsy thee 3rd phalange in lupoid onychodystrophy?
rule out other diseases not very specific histological changes
67
what is the prognosis of lupoid onychodystrophy?
not predictable response to treatment partial response common life-long usually aggressive therapy not always
68
what is the usual cause of vasculitis in dogs?
idiopathic
69
what are the later signs of plasma cell pododermatitis?
dark color of deeper tissue eventual ulceration
70
how can you treat plasma cell pododermatitis?
doxycycline and niacinamide prednisolone cyclosporine surgical excision

Clinical Dermatology (16 decks)

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