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Lupus/Pemphigus Flashcards

1
Q

What do you see with generic lupus

A

1) Lymphocyte-rich interface dermatitis
2) Basal keratinocyte apoptosis
3) Typically associated with planum disease but not always

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2
Q

With generic lupus, what would you see on biopsy

A

lymphocyte rich interface dermatitis that makes it hard to tell the epidermis from dermis

basal keratinoctyte apoptosis

dead reds with satellitosis

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3
Q

What do you see with Discoid Lupus Erythematosis (DLE)

A

depigmentation (pigmentary incontinence)
crusting
erosion ulceration
tissue loss/fibrosis
UV-sensitive
Secondary infection common (cytology)

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4
Q

What causes Discoid Lupus Erythematosis (DLE)

A

immune mediated (idiopathic)

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5
Q

What exacerbates Discoid Lupus Erythematosis (DLE)

A

UV-light

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6
Q

What is the most common site for Discoid Lupus Erythematosis (DLE) to occur

A

the nasal planum

can also see it on the perioral and periocular skin
(mostly sticks to the face- but can become generalized)

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7
Q

Discoid Lupus Erythematosis (DLE) that is generalized

A

GDLE - generalized discoid lupus erythematosis

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8
Q

lupus variant where erosion to ulceration lesion occur at the mucocutaneous junctions

A

Mucocutaneous Lupus Erythematosus (MCLE)

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9
Q

What should you always do before biopsying

A

cytology treat any infections prior to biopsying

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10
Q

What are different differentials for lupus erythematosus

A

1) Mucocutaneous pyoderma (lichenoid band-reaction pattern)
2) Epitheliotropic lymphoma
3) VKH-like syndrome (uveodermatologic)
4) Vitiligo
5) Squamous Cell Carcinoma
6) Nasal philtrum arteritis

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11
Q

If you biopsy a mucocutaneous pyoderma it is indistinguishable from

A

DLE - use antimicrobial first before treating

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12
Q

What breeds commonly get vitiligo

A

rottweilers and schnauzers

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12
Q

Animals with uveodermatologic disease present with eye or skin issues first

A

eye

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13
Q

What breeds are overrepresented for nasal philtrum arteritis

A

St Bernards
Giant Schnauzers

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14
Q

With nasal philtrum arteritis, where do you typically see the lesions

A

ulceration/erosions on the dorsal alar ridge of the nose

dont biopsy these

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15
Q

what are the breed-specific lupus disease

A

1) Vesicular Cutaneous Lupus Erythematosus (VCLE)
-Collies/Shetlands
2) Exfoliative Cutaneous Lupus Erythematosus (ECLE)
-German Short-Haired Pointers/ Viszlas

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16
Q

What are the different Lupoid Diseases

A

1) Discoid Lupus Erythematosus (DLE)
2) Generalized Discoid Lupus Erythematosus (GDLE)
3) Mucocutaneous Lupus Erythematosus (MCLE)
4) Vesicular Cutaneous Lupus Erythematosus (VCLE)
5) Exfoliative Cutaneous Lupus Erythematosus (ECLE)
6) Systemic Lupus Erythematosus (SLE)

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17
Q

Vesicular Cutaneous Lupus Erythematosus (VCLE) occurs in what breeds

A

Collies/Shetland sheepdogs

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18
Q

What is seen with Vesicular Cutaneous Lupus Erythematosus (VCLE)

A

Vesicular Disease- primarily ventrum
+/- mucocutaneous junctions
can resemble pyoderma

no age/gender predisposition but occurs in collies/shetland sheepdogs

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19
Q

What breeds is Exfoliative Cutaneous Lupus Erythematosus (ECLE) seen in

A

German Short-haired pointers/ Viszlas

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20
Q

Why do German short-haired pointers and viszlas get Exfoliative Cutaneous Lupus Erythematosus (ECLE)

A

Autosomal recessive genetic
young (median: 8months)

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21
Q

What is seen with Exfoliative Cutaneous Lupus Erythematosus (ECLE)

A

scaling/alopecia (exfoliative dermatitis) that is generalized
systemic: arthralgia, dyscrasias
occurs in young german short-haired pointers and viszlas

can resemble sebaceous adenitis

22
Q

Is VCLE or ECLE better prognosis

A

VCLE

ECLE affects other body systems

23
Q

T/F: DLE can become SLE

A

False - it is its own distinct clinical issue

SLE is very rare

24
What are the symptom criteria of SLE diagnosis
Fever IMPA/polymyositis Discoid rash Proteinuria Dyscrasias (thrombocytopenia most common) Photosensitivity Ulcerative stomatitis Body cavity effusions Neurologic disorders ANA?
25
What might be a helpful test for SLE diagnosis
ANA (anti-nuclear antibody) titers Positive if > 1:160 Can be positive in normal dogs or any with immune mediated disease or infectious disease (Bartonella, Ehrlichia) Can be negative in SLE cases only want to run in suspicious patients with lots of the criteria
26
How do you treat Lupus *
Tacrolimus (topically) - massaged in and distract them from licking Systemically: Steroids, Cyclosporine, Azathioprine, Apoquel, Hydroxychloroquine, or subtherapeutic doses of Doxycycline Sunscreen for DLE
27
What immunosupressive drug might be used for ECLE
Mycophenolate
28
Symmetric Lupoid Onychodystrophy (SLO)
idiopathic immune mediated disease where multiple nails are affected, also the dewclaws* secondary infection possible painful
29
Biopsy diagnosis of Symmetric Lupoid Onychodystrophy (SLO) requires
Amputation of P3
30
How do you treat Symmetric Lupoid Onychodystrophy (SLO)
Pentoxifylline - 30mg/kg BID Same treatment for vasculitis Omega-3 fatty acids Severe: Cyclosprine, Steroids Treatment is slow and the claws may never be normal
31
Is prognosis of `gus foliaceus or vulgaris better
foliaceus
32
What is the pathogenesis of pemphigus foliaceus
auto-antibodies to desmosomes- connections of superficial cells in the epidermis leading to acantholytic keratinocytes
33
What is the pathogenesis of pemphigus vulgaris
aut-antibodies to hemidesmosomes which lifts the superficial epidermis and only have basal keratinocytes (tombstone effect)
34
Pemphigus foliaceus is _______ while vulgaris is
foliaceus: superficial vulgaris: deep
35
Why is the prognosis of Pemphigus vulgaris much worse than with pemphigus foliaceus
Vulgaris - significant risk for sepsis with widespread ulceration
36
What is seen on cytology of pemphigus foliaceus
Lots of neutrophilic infiltration acantholytic keratinocytes +/- secondary bacterial infection
37
What are reasons you might see acantholytic keratinocytes on cytology
1) pemphigus foliaceus 2) bacterial pyoderma 3) dermatophytosis
38
What are the 3-Ps of pemphigus foliaceus in sites
Pawpads Pinna Planum cats have crusting at claw folds and nipples
39
What is the most common dermatologic immune disease of dogs and cats
pemphigus foliaceus
40
What do you see with pemphigus foliaceus
Pustules (fragile) Crusting/erosions Acantholytic keratinocytes* on cytology secondary infections, pruritus vairable Dogs: hyperkeratosis of the face and paws Cats: face, nail beds, perinipular
41
Where do cats typically get pemphigus foliaceus lesions
Face nail beds Perinipular
42
What are differentials for pemphigus foliaceus
Pyoderma Demodicosis Dermatophytosis (Trichophyton) DLE (if only on face) Cutaneous drug eruption Acantholysis- Staph, Dermatophyotisis
43
although pemphigus foliaceus can be diagnosed with clinical suspicion and cytology, what is needed for the definitive diagnosis
biopsy
44
pemphigus foliaceus is typically idopathic but could occur secondary to
drug reaction paraneoplastic syndrome
45
What is seen with pemphigus vulgaris
Rare, severe, life-threatening -Ulcers on Oral, mucocutaneous junctions, paws -No acantholytic keratinocytes Idiopathic (drug reaction)
46
T/F: you will see acantholytic keratinocytes with pemphigus vulgaris
False- only foliaceous
47
What are you differentials for pemphigus vulgaris
subepidermal blistering diseases
48
T/F: pemphigus vulgaris is rare in cats
True
49
What are the pemphigus variants
Pemphigus erythematousus (PF/DLE hybrid) Pemphigus vegetans (papillomatous PV) Paraneoplastic pemphigus
50
What is the goal of pemphigus treatment
Immunosuppression for goal of epithelialization -Steroids (immunosuppressive) -Cyclosporine -Azathiorpine -Mycophenolate -Apoquel (PF) -Adequan (PF)
51
How do you diagnose all variants of pemphigus
Biopsy
52
How do you treat pemphigus
Immunosuppression for goal of epithelialization -Steroids (immunosuppressive) -Cyclosporine -Azathiorpine -Mycophenolate -Apoquel (PF) -Adequan (PF)

Dermatology (10 decks)

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