Nasal, Footpad and/or Mucocutaneous Lesions

Question 1

What is an essential diagnostic test for lesions involving the nose, footpad or mucocutaneous region

Answer 1

skin biopsy

Question 2

Major differential diagnoses for nasal, foot pad or mucocutaneous lesions

Answer 2

pemphigus foliaceus
DLE
uveodermatologic syndrome
superficialnecrolytic dermatitis
cutaneous lymphoma
nasal/footpad hyperkeratosis
SCC
SLE
cutaneous lupus
other neoplasia
systemic mycoses
dermatitis secondary to nasal discharge

Question 3

what is the most common immune mediated skin disease of dogs and cats

Answer 3

pemphigus foliaceus

Question 4

what is the immune mediated reaction in PF against

Answer 4

desmoglein 1 (glycoprotein of desmosomes involved in intracellular adhesion)

Question 5

what does the immune-mediated attack against desmoglein 1 in PF cause

Answer 5

loss of intracellular adhesions leading to development of pustular, crusting dermatitis

Question 6

which breeds are predisposed to PF

Answer 6

akitas and chow chows

Question 7

what is the average age of onset for PF

Answer 7

4 years

Question 8

where do PF lesions often begin

Answer 8

face and ears

Question 9

where are lesions of PF frequently seen that are not seen in pyoderma

Answer 9

nasal planum, foot pads and/or inner pinnae

loss of cobblestone architecture on nose

Question 10

where do cats often show lesions of PF

Answer 10

nails and nipples

Question 11

how is a diagnosis of PF made

Answer 11

clinical signs and biopsy (histopath)

Question 12

what is the best lesion to sample for PF

Answer 12

pustule

Question 13

what lesion should be sampled in PF if pustules are not present

Answer 13

crusts — make sure to include in biopsy

Question 14

what is seen on histopathology in PF

Answer 14

free-floating keratinocytes – acantholytic cells – in a pustule or crust

Question 15

can cytology be used to diagnose PF

Answer 15

no it can be used as a sneak peak and to rule out pyoderma though

Question 16

treatment of PF

Answer 16

immunosuppressive therapy

• prednisone/prednisolone
• azathioprine (DOGS)
• chlorambucil (CATS)
• cyclosporine

Question 17

what does cyclosporine do in the treatment of PF

Answer 17

steroid sparing

Question 18

what combination can be used to treat mild cases of PF

Answer 18

tetracycline and niacinamide

Question 19

prognosis for PF

Answer 19

fair – treatment side effects are common

Question 20

what is the second most common immune-mediated dermatitis in dogs

Answer 20

discoid lupus erythematosus (DLE)

Question 21

which breeds are predisposed to DLE

Answer 21

Collies and German Shepherds

Question 22

signs of DLE

Answer 22

depigmentation, erythema and scaling of the nasal planum that can progress to erosions, ulceration and crusting
normal cobblestone architecture of nose may be lost

Question 23

diagnosis of DLE

Answer 23

diagnosis is based on clinical signs and histopathology

Question 24

where should you collect areas for biopsy in DLE

Answer 24

areas that are in the process of depigmentation

Question 25

treatment of DLE

Answer 25

sun avoidance and topical sunscreen topical corticosteroids or tacrolimus vitamin E and fatty acid supplements tetracycline and niacinamide

Question 26

what is uveodermatologic syndrome also known as

Answer 26

Vogt-Koyanagi-Harada like syndrome

Question 27

what is affected in uveodermatologic syndrome (immune mediated)

Answer 27

melanin and melanocytes

Question 28

breed predisposition to uveodermatologic syndrome

Answer 28

akitas, chow chows, samoyeds and siberian huskies

Question 29

characteristics of uveodermatologic syndrome

Answer 29

acute onset of uveitis and concurrent or subsequent depigmentation of the skin (esp. nasal planum(

Question 30

diagnosis of uveodermatologic syndrome

Answer 30

opthalmic exam and skin biopsies

Question 31

complications of the uveitis in uveodermatologic syndrome

Answer 31

glaucoma, cataracts and vision loss

Question 32

treatment of uveodermatologic syndrome

Answer 32

systemic corticosteroids and azathioprine

Question 33

what is superficial necrolytic dermatitis

Answer 33

a disease where keratinocytes are thought to degenerate due to AA deprivation

Question 34

what is superficial necrolytic dermatitis most commonly associated with

Answer 34

an underlying ultrasonographically and histologically distinct liver disease

Question 35

what age and breed of dogs is most common to have superficial necrolytic dermatitis

Answer 35

``` old dogs (possibly west highland white terriers and shetland sheepdogs) ```

Question 36

where do lesions of superficial necrolytic dermatitis most commonly occur

Answer 36

footpad, muzzle, distal limbs and pressure points

Question 37

lesions of superficial necrolytic dermatitis

Answer 37

crusts with peripheral erythema overlying erosions or ulcers

Question 38

diagnosis of superficial necrolytic dermatitis

Answer 38

clinical findings, skin biopsies and supporting lab findings

Question 39

prognosis of superficial necrolytic dermatitis

Answer 39

grave (5 months)

Question 40

what is the most effective treatment of superficial necrolytic dermatitis

Answer 40

intravenous AA

Question 41

two types of cutaneous lymphoma

Answer 41

epitheliotropic and non-epitheliotropic

Question 42

what cell line does cutaneous lymphoma originate from

Answer 42

T cells

Question 43

what characterizes the epithelitropic form of cutaneous lymphoma

Answer 43

highly pleomorphic and can look like many different skin diseases

Question 44

what characterizes the non-epitheliotropic form of cutaneous lymphoma

Answer 44

generalized or multifocal nodules and systemic involvement

Question 45

differentials for cutaneous lymphoma when it shows as generalized pruritic erythema and scaling

Answer 45

cheyletiella or hypersensitivity dermatitis

Question 46

differentials for cutaneous lymphoma when it shows as mucocutaneous erythema, depigmentation and ulceration

Answer 46

immune mediated disease

Question 47

differential for cutaneous lymphoma that shows as infiltrative and erosive oral mucosal disease

Answer 47

chronic stomatitis

Question 48

lesions seen in cats with cutaneous lymphoma

Answer 48

annular areas of alopecia, erythema and scaling that can resemble dermatophytosis

Question 49

prognosis of cutaneous lymphoma

Answer 49

grave

Question 50

what can unilateral hyperkeratosis of the nose be sen with

Answer 50

damage to the parasympathetic nerve secondary to otitis media

Question 51

two breeds that have familial footpad hyperkeratosis

Answer 51

irish terriers and dogue de bordeuax

Question 52

which breed may have hereditary nasal parakeratosis

Answer 52

lab

Question 53

treatment of nasal and foot pad hyperkeratosis

Answer 53

depends on underlying condition: excess keratin can be trimmed and keratin build up minimized by using hydrating and softening agents (petroleum jelly, propylene glycol)

Question 54

where is it very common for squamous cell carcinoma to be present in a cat

Answer 54

nose

Question 55

what s plasma cell pododermatitis

Answer 55

distinctive idiopathic disorder of the foot pads of cats

Question 56

diagnosis of plasma cell pododermatitis

Answer 56

biopsy (multiple plasma cells)

Question 57

treatment of plasma cell pododermatitis

Answer 57

corticosteroids | some cats have responded to doxycycline