Patient with Nasal, Footpad and Mucocutaneous Lesions Flashcards
why is the nasal, footpad and MC skin odd?
because all the major ddx hit the haired skin
major differentials for nasal, footpad and MC lesions (12)
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
Where can be the level of attack for IM problems and what are their disease names?
IC antigens (pemph group) BM (subep, bullous dzs) Nuclear protein antigens (LE) blood vessels (vasculitis) melanin/melanocytes (uveodermatologic syndrome)
What gets attacked in PF?
desmoglein I, part of the desmosome in intracellular adhesion
what does PF cause?
loss of adhesions of epidermis causing pustular, crusting dermatitis
Who is pre-disposed to PF? when?
chows, akitas at about 4 years
What is the progression of PF?
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.
Which structures are spared in PF?
don’t see lesions in MM, but other forms of pemphigus, yes.
Clinical signs of PF?
pruritis +/- pain +/- febrile systemically ill marked neutrophilia
What is different about PF in cats?
will affect the nails and nipples
Dx of PF
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
Tx of PF
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
Prognosis for PF
fair, but tx side-effects are common
tx is lifelong
DLE is aggrevated by
sunlight in about 50% of cases
How is SLE different from LE
no internal organ involvement
Breed predispositions to DLE
Border collies
German Shepherds
Clinical signs of DLE
depigmentation, erythema, and scaling of the nasal planum –> progressing to erosions, ulceration and crusting
Dx of DLE
C/S
Histopath
collect from the depigmenting parts of the lesions
Tx of DLE (it is a little milder dz)
don't need lcorticosteroids avoid the sun topical steroids maybe tacrolimus vitamin E TTC+Niacinamide (not niacin)
more severe - cortster, azathioprine, and cyclosporine
another name for uveodermatologic syndrome
vogt-koyanangi-harada-like syndrome
breeds predisposed to UDS
chow chows, akitas, samoyeds, siberian huskies
CLinical signs of UDS
acute uveitis
depig of nasal planum
Dx of UDS
ophthalmic exam and skin biopsies
Tx of UDS
needs to be aggressive to prevent glaucoma, cataracts, vision loss
steroids and azathioprine
Superficial necrolytic dermatitis is also called
necrolytic migratory erythema
hepatocutaneous syndrome
mechanism of Superficial necrolytic dermatitis
keratinocytes degenerate because of deprived AA - animals with this have low levels
CLinical signs of Superficial necrolytic dermatitis
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
What are possible causes for Superficial necrolytic dermatitis
drugs like PhB
Glucagonoma
Dx of Superficial necrolytic dermatitis
C/S, skin biopsies (bloodwork first) and lab findings
Histopath - a few samples
cytology for secondary infections
Prognosis of Superficial necrolytic dermatitis
most dogs die or are euthanized in 5 months.
surgical removal of glucagonoma may be good.
Tx of Superficial necrolytic dermatitis
IV protein supplement (eggs, FA, zinc)
Steroids are contra-indicated, may trigger DM
Cutaneous lymphoma is also called the
great mimicker
What do non-epitheliotropic forms of cutan lymphoma cause?
MF nodules, and systemic
what do epitheliotropic forms of cutan lymphoma cause?
pleomorphic and can hit anywhere and look like anything.
Dx of cutaneous lymphoma
histopath -
prognosis for cut. lymphoma
grave, but maybe get some remission
DDx for nasal and footpad hyperkeratosis
IM dz cut lymphoma drugs rxns zinc responsive dermatosis SND hypothyroidism distemper lieshmaniasis
Forms of Nasal and footpad hyperkeratosis
hereditary
idiopathic
concurrent
Where has unilateral hyperkeratosis been see
damage to parasymp nerves secondary to otitis media
who does the familial footpad hyperkeratoiss hit? what about nasal?
Irish seters and dogue de bordeux at 6 months of age
Nasal hits the labs
Clinical signs of the hyperkeratosis
lameness maybe
thickening pad-like horn structures
Dx of hyperkeratosis
C/S
histopathology
For nasodigital hyperkeratosis, when is biopsy indicated?
when ulceration, depig, erythema, crusting,
systemic signs,
young patient
Tx of the nasal and digital hyperkeratosis
trim excess keratin after soaking and so on
petroleum jelly
propylene glycol
urea cream
How much more likely are white cats to get SCC
13X
what is different about the SCC lesions in the cat?
they are ulcerative not nodular
Plasma cell podoermatitis is associated with
FIV infection
Tx/Dx for plasma cell pdodermatitis
corticosteroids
DXC
Biopsy, aspirate
