Lucky, Posavacki gonic, ca. 2y, castrated male ESVD Conference Budapest 2016 MVDr. Lucia Panakova, DipECVD Veterinärmedizinische Universität Wien 2 Lucky s history Lucky s history Referred to the dermatology clinic for allergic skin tests and ASIT 3 3 Lucky s history Referred to the dermatology clinic for allergic skin tests and ASIT Is on elimination diet (HA Royal Canin) for eight weeks no improvement Lucky s history Referred to the dermatology clinic for allergic skin tests and ASIT Is on elimination diet (HA Royal Canin) for eight weeks no improvement Referring vet is annoyed, since low compliance 3 3
Main complaint Main complaint Extremely chewing his feet (pawpads and nailbeds) 4 4 Main complaint Extremely chewing his feet (pawpads and nailbeds) Also itchy on his ventral abdomen 4 5 Lucky was saved from Serbia and lives with the new family in Austria for 4 months Lucky was saved from Serbia and lives with the new family in Austria for 4 months He was found in a bad condition in a bottom 5 5
Lucky was saved from Serbia and lives with the new family in Austria for 4 months He was found in a bad condition in a bottom Treated with Stronghold three times no improvement Lucky was saved from Serbia and lives with the new family in Austria for 4 months He was found in a bad condition in a bottom Treated with Stronghold three times no improvement After prednisolon reduction of pruritus by 50% for short time 5 5 Physical examination Dermatologic examination 6 7 Dermatologic examination Dermatologic examination 7 7
Problem lists Problem lists 8 9 Problem lists Problem lists Severe pedal pruritus Severe pedal pruritus Mildly- moderately hyperkeratotic paws with fissures 9 9 Problem lists Problem lists Severe pedal pruritus Mildly- moderately hyperkeratotic paws with fissures Maculo-papular itchy rash Severe pedal pruritus Mildly- moderately hyperkeratotic paws with fissures Maculo-papular itchy rash Paronychia 9 9
Problem lists Differential diagnoses for pedal pruritus Severe pedal pruritus Mildly- moderately hyperkeratotic paws with fissures Maculo-papular itchy rash Paronychia Discoloration of the nails 9 10 Differential diagnoses for pedal pruritus Differential diagnoses for pawpad hyperkeratosis Malassezia pododermatitis Staphylococcal pododermatitis Food induced allergy Atopic dermatitis Autumn mites (Neotrombicula autumnalis) Ancylostoma et uncinaria pododermatitis Demodicosis 11 12 Differential diagnoses for pawpad hyperkeratosis Differential diagnoses for pawpad hyperkeratosis Hepatocutaneous syndrome/ Zinc responsive dermatoses 13 13
Differential diagnoses for pawpad hyperkeratosis Differential diagnoses for pawpad hyperkeratosis Hepatocutaneous syndrome/ Zinc responsive dermatoses Pemphigus foliaceus Hepatocutaneous syndrome/ Zinc responsive dermatoses Pemphigus foliaceus Keratinization problem (primary) or caused by abnormal environment 13 13 Differential diagnoses for pawpad hyperkeratosis Differential diagnoses for pawpad hyperkeratosis Hepatocutaneous syndrome/ Zinc responsive dermatoses Pemphigus foliaceus Keratinization problem (primary) or caused by abnormal environment Ancylostoma et uncinaria dermatitis Hepatocutaneous syndrome/ Zinc responsive dermatoses Pemphigus foliaceus Keratinization problem (primary) or caused by abnormal environment Ancylostoma et uncinaria dermatitis Distemper 13 13 Differential diagnoses for pawpad hyperkeratosis Differential diagnoses for maculopapular rash Hepatocutaneous syndrome/ Zinc responsive dermatoses Pemphigus foliaceus Keratinization problem (primary) or caused by abnormal environment Ancylostoma et uncinaria dermatitis Distemper Orthopedic problem 13 14
Differential diagnoses for maculopapular rash Differential diagnoses for maculopapular rash Scabies 15 15 Differential diagnoses for maculopapular rash Differential diagnoses for maculopapular rash Scabies Pyoderma Scabies Pyoderma Malassezia dermatitis 15 15 Differential diagnoses for maculopapular rash Differential diagnoses for maculopapular rash Scabies Pyoderma Malassezia dermatitis Parasitic dermatitis (endoparasites) Scabies Pyoderma Malassezia dermatitis Parasitic dermatitis (endoparasites) (Allergy) and contact allergy 15 15
Suggested approach 16 17 Skin scrapings negative 18 19 Treatment 11 days after the beginning of the treatment- no improvement of the itch Cefalexine 20mg/kg BID Malaseb shampoo every day Continue with the diet 20 21
Any further suggestions? Parasitological fecal flotation Positive for eggs from Ancylostoma/ Uncinaria eggs Ancylostoma et uncinaria dermatitis Treatment with fenbendazol (Panacur ) pills 22 23 Four weeks later 7 weeks later 24 25 Ancylostoma et uncinaria dermatitis In Austria rare disease (dogs are regularly dewormed) Maculopapular rash in contact areas, hyperkeratotic pruritic pododermatitis (chronic disease), paronychia Dogs from shelters usually living in poor hygienic conditions Migration of larvae from the stool through the epidermis/dermis tunnels HS reaction Dg: History, clinical signs, fecal parasitological examination Fenbendazol, environmental hygiene/ treatment 26 Approach to the dermatoses on the paws History Breed, age of onset, onset of clinical signs, lesions development Systemic signs fever, hepatic, Ocular, renal, ophtalmic hepatocutaneous sy, PF, SEBD, Leishmaniosis, VKH, paraneoplastic, vasculitis Additional diagnostic tests Hematology, Biochemistry, Urinalysis, ANA Clinical examination Pawpads involvement Pads PF, Vasculitis SEBD Cong.Keratinization Split pawpad dis. Neoplasias Hepatocutaneos Zinc resp.dermatosis Endoparasites Skin biopsies Other skin lesions Interdigital Other space cutaneus Allergies, lesions Malassezia and Vasculitis bacteria Leishmaniasis FB PF Demodicosis CLE, SLE Interdigital Hepatocutaneo cysts us Endoparasites Allergies, demodex Cytology, scrapings, biopsy Cytology, serology, 27 scrapings, cultures, biopsy
Bara, bordercollie, 2y, f Cause of presentation 28 29 History History Skin disease for the last 2 months 30 30 History History Skin disease for the last 2 months First lesions close to the nipples Skin disease for the last 2 months First lesions close to the nipples Severe deterioration of the skin in the last two weeks (june) 30 30
History History Skin disease for the last 2 months First lesions close to the nipples Severe deterioration of the skin in the last two weeks (june) Father of Bara was euthanised because of devastationg skin disease few years ago Therapy: - 3 weeks of (Amoxycillin- clavulanate) 22mg/kg BID - Fluconazol syst. 2 t., different local antiseptics ANA test- negative 30 31 Any additional Qs??? Physical examination T40,3 C 32 33 Dermatologic examination 34 35
36 37 Problem list 38 39 Dermatologic examination Problem list Predominantly ventral symmetric ulcerative and vesicular dermatitis with confluent serpiginous areas of ulceration in the ventral abdomen, groin and medial thighs, but also ulceration and vesicles of buccal mucosa, ulceration of anal mucucutaneous involvement Ulcerative symmetric ventral dermatitis Vesicular and ulcerative mucocutaneous lesions Fever 40 41
Differential diagnoses Differential diagnoses 42 43 Differential diagnoses Differential diagnoses VCLE of shelties and collies VCLE of shelties and collies Dermatomyositis 43 43 Differential diagnoses Differential diagnoses VCLE of shelties and collies Dermatomyositis Vasculitis VCLE of shelties and collies Dermatomyositis Vasculitis DE (Drug Eruption) SJS 43 43
Differential diagnoses Suggested approach VCLE of shelties and collies Dermatomyositis Vasculitis DE (Drug Eruption) SJS (Secondary pyoderma) 43 44 45 46 Dermatohistopathology 47 48
Dermatohistopathology Dermatohistopathology Cell rich predominantly lymphocytic interface dermatitis with prominant apoptosis in the basal cell layer with colonies of bacteria Cell rich predominantly lymphocytic interface dermatitis with prominant apoptosis in the basal cell layer with colonies of bacteria This is compatible with suspect diagnosis of the VCLE 48 48 Diagnose Diagnose VCLE Superficial pyoderma 49 50 Therapy Therapy Ciclosporine A 5mg/kg SID Doxycyklin 10mg/kg SID Prednisolon 2mg/kg/SID Cefalexin 25mg/kg BID Chlorhexidine Shampoo every day 51 52
53 54 55 56 Vesicular Cutaneous Lupus Erythematosus in collies and shelties Cutaneous ulcerative autoimmune disease with predominant ventral involvement Collies (and bordercollies) and shelties Originally mistaken for dermatomyositis Middle old to old dogs 57 58
Vesicular Cutaneous Lupus Erythematosus in collies and shelties Serpiginous, ulcerative to confluent ulcerated lesions of the ventral abdomen and inguinal intertriginous skin Vesicles of the oral/ buccal mucoses Exacerbation in the summer months Vesicular Cutaneous Lupus Erythematosus in collies and shelties ANA tests are negative Pyoderma is secondary Potentially life threatening skin disease Diagnose is confirmed via skin biopsies Therapy: - Combination of IS therapy (GC and ciclosporine ) sometimes also doxycycline - Then tapper down - Tacrolimus ointment in localised cases 59 60 Thank you! 61