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Dermatology > Patient with Nasal, Footpad and Mucocutaneous Lesions > Flashcards

Patient with Nasal, Footpad and Mucocutaneous Lesions Flashcards

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Dermatology Board Prep flashcards
1
Q

why is the nasal, footpad and MC skin odd?

A

because all the major ddx hit the haired skin

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2
Q

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

A 
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
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3
Q

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

A 
IC antigens (pemph group)
BM (subep, bullous dzs)
Nuclear protein antigens (LE)
blood vessels (vasculitis)
melanin/melanocytes (uveodermatologic syndrome)
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4
Q

What gets attacked in PF?

A

desmoglein I, part of the desmosome in intracellular adhesion

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5
Q

what does PF cause?

A

loss of adhesions of epidermis causing pustular, crusting dermatitis

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6
Q

Who is pre-disposed to PF? when?

A

chows, akitas at about 4 years

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7
Q

What is the progression of PF?

A

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.

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8
Q

Which structures are spared in PF?

A

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

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9
Q

Clinical signs of PF?

A 
pruritis +/-
pain +/-
febrile
systemically ill
marked neutrophilia
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10
Q

What is different about PF in cats?

A

will affect the nails and nipples

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11
Q

Dx of PF

A

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

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12
Q

Tx of PF

A

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

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13
Q

Prognosis for PF

A

fair, but tx side-effects are common

tx is lifelong

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14
Q

DLE is aggrevated by

A

sunlight in about 50% of cases

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15
Q

How is SLE different from LE

A

no internal organ involvement

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16
Q

Breed predispositions to DLE

A

Border collies

German Shepherds

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17
Q

Clinical signs of DLE

A

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

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18
Q

Dx of DLE

A

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

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19
Q

Tx of DLE (it is a little milder dz)

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

more severe - cortster, azathioprine, and cyclosporine

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20
Q

another name for uveodermatologic syndrome

A

vogt-koyanangi-harada-like syndrome

21
Q

breeds predisposed to UDS

A

chow chows, akitas, samoyeds, siberian huskies

22
Q

CLinical signs of UDS

A

acute uveitis

depig of nasal planum

23
Q

Dx of UDS

A

ophthalmic exam and skin biopsies

24
Q

Tx of UDS

A

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

steroids and azathioprine

25
Q

Superficial necrolytic dermatitis is also called

A

necrolytic migratory erythema

hepatocutaneous syndrome

26
Q

mechanism of Superficial necrolytic dermatitis

A

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

27
Q

CLinical signs of Superficial necrolytic dermatitis

A

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

28
Q

What are possible causes for Superficial necrolytic dermatitis

A

drugs like PhB

Glucagonoma

29
Q

Dx of Superficial necrolytic dermatitis

A

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

30
Q

Prognosis of Superficial necrolytic dermatitis

A

most dogs die or are euthanized in 5 months.

surgical removal of glucagonoma may be good.

31
Q

Tx of Superficial necrolytic dermatitis

A

IV protein supplement (eggs, FA, zinc)

Steroids are contra-indicated, may trigger DM

32
Q

Cutaneous lymphoma is also called the

A

great mimicker

33
Q

What do non-epitheliotropic forms of cutan lymphoma cause?

A

MF nodules, and systemic

34
Q

what do epitheliotropic forms of cutan lymphoma cause?

A

pleomorphic and can hit anywhere and look like anything.

35
Q

Dx of cutaneous lymphoma

A

histopath -

36
Q

prognosis for cut. lymphoma

A

grave, but maybe get some remission

37
Q

DDx for nasal and footpad hyperkeratosis

A 
IM dz
cut lymphoma
drugs rxns
zinc responsive dermatosis
SND
hypothyroidism
distemper
lieshmaniasis
38
Q

Forms of Nasal and footpad hyperkeratosis

A

hereditary
idiopathic
concurrent

39
Q

Where has unilateral hyperkeratosis been see

A

damage to parasymp nerves secondary to otitis media

40
Q

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

A

Irish seters and dogue de bordeux at 6 months of age

Nasal hits the labs

41
Q

Clinical signs of the hyperkeratosis

A

lameness maybe

thickening pad-like horn structures

42
Q

Dx of hyperkeratosis

A

C/S

histopathology

43
Q

For nasodigital hyperkeratosis, when is biopsy indicated?

A

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

44
Q

Tx of the nasal and digital hyperkeratosis

A

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

45
Q

How much more likely are white cats to get SCC

A

13X

46
Q

what is different about the SCC lesions in the cat?

A

they are ulcerative not nodular

47
Q

Plasma cell podoermatitis is associated with

A

FIV infection

48
Q

Tx/Dx for plasma cell pdodermatitis

A

corticosteroids
DXC

Biopsy, aspirate

Dermatology (8 decks)

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