Patient with Nasal, Footpad and Mucocutaneous Lesions

Question 1

why is the nasal, footpad and MC skin odd?

Answer 1

because all the major ddx hit the haired skin

Question 2

major differentials for nasal, footpad and MC lesions (12)

Answer 2

PF
DLE
Uveodermatologic syndrome
superificial necrolytic dermatitis
cutaneous lymphoma
nasal/footpad hyperkeratosis
SCC
SLE
Cutaneous lupus
other neoplasia
systemic neoplasia
dermatitis sceondary to nasal discharge

Question 3

Where can be the level of attack for IM problems and what are their disease names?

Answer 3

IC antigens (pemph group)
BM (subep, bullous dzs)
Nuclear protein antigens (LE)
blood vessels (vasculitis)
melanin/melanocytes (uveodermatologic syndrome)

Question 4

What gets attacked in PF?

Answer 4

desmoglein I, part of the desmosome in intracellular adhesion

Question 5

what does PF cause?

Answer 5

loss of adhesions of epidermis causing pustular, crusting dermatitis

Question 6

Who is pre-disposed to PF? when?

Answer 6

chows, akitas at about 4 years

Question 7

What is the progression of PF?

Answer 7

begins on face and ears esp the nasal planum, footpads and inner pinnae. It will look like pyoderma but in places pyo doesn’t go.

Question 8

Which structures are spared in PF?

Answer 8

don’t see lesions in MM, but other forms of pemphigus, yes.

Question 9

Clinical signs of PF?

Answer 9

pruritis +/-
pain +/-
febrile
systemically ill
marked neutrophilia

Question 10

What is different about PF in cats?

Answer 10

will affect the nails and nipples

Question 11

Dx of PF

Answer 11

C/S
Histopath from unbroken pustules because those are sterile. Look for free-floating keratinocytes, acantholytic cells
IHC - not usual though
Cytology - will r/o pyoderma, will have neutrophils, no bacteria
Biopsies *** always recommended

Question 12

Tx of PF

Answer 12

Immunosuppressive therapy - systemic oral corticoids like pred, prednis, dex, cyclosporine - right away
Also azathioprine - delayed
chlorambucil - delayed
Mild - TTC and niacinamide
Make sure to monitor blood work carefully

Question 13

Prognosis for PF

Answer 13

fair, but tx side-effects are common

tx is lifelong

Question 14

DLE is aggrevated by

Answer 14

sunlight in about 50% of cases

Question 15

How is SLE different from LE

Answer 15

no internal organ involvement

Question 16

Breed predispositions to DLE

Answer 16

Border collies

German Shepherds

Question 17

Clinical signs of DLE

Answer 17

depigmentation, erythema, and scaling of the nasal planum –> progressing to erosions, ulceration and crusting

Question 18

Dx of DLE

Answer 18

C/S
Histopath
collect from the depigmenting parts of the lesions

Question 19

Tx of DLE (it is a little milder dz)

Answer 19

don't need lcorticosteroids
avoid the sun
topical steroids maybe
tacrolimus
vitamin E
TTC+Niacinamide (not niacin)

more severe - cortster, azathioprine, and cyclosporine

Question 20

another name for uveodermatologic syndrome

Answer 20

vogt-koyanangi-harada-like syndrome

Question 21

breeds predisposed to UDS

Answer 21

chow chows, akitas, samoyeds, siberian huskies

Question 22

CLinical signs of UDS

Answer 22

acute uveitis

depig of nasal planum

Question 23

Dx of UDS

Answer 23

ophthalmic exam and skin biopsies

Question 24

Tx of UDS

Answer 24

needs to be aggressive to prevent glaucoma, cataracts, vision loss

steroids and azathioprine

Question 25

Superficial necrolytic dermatitis is also called

Answer 25

necrolytic migratory erythema | hepatocutaneous syndrome

Question 26

mechanism of Superficial necrolytic dermatitis

Answer 26

keratinocytes degenerate because of deprived AA - animals with this have low levels

Question 27

CLinical signs of Superficial necrolytic dermatitis

Answer 27

skin disease, lots of footpad involvement. muzzle, distal limbs, and pressure points skin lesions are crusts and peripheral erythema or ulcers US viewable and Histo viewable liver disease sequelae - normo nonregn anemia, DM hyperglycemia, high liver enzymes, hypoalbuminemia

Question 28

What are possible causes for Superficial necrolytic dermatitis

Answer 28

drugs like PhB | Glucagonoma

Question 29

Dx of Superficial necrolytic dermatitis

Answer 29

C/S, skin biopsies (bloodwork first) and lab findings Histopath - a few samples cytology for secondary infections

Question 30

Prognosis of Superficial necrolytic dermatitis

Answer 30

most dogs die or are euthanized in 5 months. surgical removal of glucagonoma may be good.

Question 31

Tx of Superficial necrolytic dermatitis

Answer 31

IV protein supplement (eggs, FA, zinc) | Steroids are contra-indicated, may trigger DM

Question 32

Cutaneous lymphoma is also called the

Answer 32

great mimicker

Question 33

What do non-epitheliotropic forms of cutan lymphoma cause?

Answer 33

MF nodules, and systemic

Question 34

what do epitheliotropic forms of cutan lymphoma cause?

Answer 34

pleomorphic and can hit anywhere and look like anything.

Question 35

Dx of cutaneous lymphoma

Answer 35

histopath -

Question 36

prognosis for cut. lymphoma

Answer 36

grave, but maybe get some remission

Question 37

DDx for nasal and footpad hyperkeratosis

Answer 37

``` IM dz cut lymphoma drugs rxns zinc responsive dermatosis SND hypothyroidism distemper lieshmaniasis ```

Question 38

Forms of Nasal and footpad hyperkeratosis

Answer 38

hereditary idiopathic concurrent

Question 39

Where has unilateral hyperkeratosis been see

Answer 39

damage to parasymp nerves secondary to otitis media

Question 40

who does the familial footpad hyperkeratoiss hit? what about nasal?

Answer 40

Irish seters and dogue de bordeux at 6 months of age Nasal hits the labs

Question 41

Clinical signs of the hyperkeratosis

Answer 41

lameness maybe | thickening pad-like horn structures

Question 42

Dx of hyperkeratosis

Answer 42

C/S | histopathology

Question 43

For nasodigital hyperkeratosis, when is biopsy indicated?

Answer 43

when ulceration, depig, erythema, crusting, systemic signs, young patient

Question 44

Tx of the nasal and digital hyperkeratosis

Answer 44

trim excess keratin after soaking and so on petroleum jelly propylene glycol urea cream

Question 45

How much more likely are white cats to get SCC

Answer 45

13X

Question 46

what is different about the SCC lesions in the cat?

Answer 46

they are ulcerative not nodular

Question 47

Plasma cell podoermatitis is associated with

Answer 47

FIV infection

Question 48

Tx/Dx for plasma cell pdodermatitis

Answer 48

corticosteroids DXC Biopsy, aspirate