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Dermatology 2 > Equine dermatology 2 > Flashcards

Equine dermatology 2 Flashcards

Neoplasia

1
Q

Describe melanocytomas

A
  • Rare
  • Benign, no coat colour predilection, surgical excision is curative
  • Usually young horses
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2
Q

What are eosinophilic granulomas in horses?

A

Nodular lesions commonly in saddle area, aka collagen necrosis (not histopathologically accurate)

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3
Q

What is the cause of eosinophilic granulomas?

A
  • Precise cause and pathogenesis unknown
  • Often occur spring and summer, so attributed to fly hypersensitivity or atopic dermatitis
  • Others suggest trauma
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4
Q

Where do squamous cell carcinomas commonly occur?

A
  • Face
  • Eyelids/cornea/globe
  • Genitalia
  • Typically mucocutaneous junctions (but can be anywhere)
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5
Q

What are the risk factors for the development of squamous cell carcinomas?

A
  • Susceptibility to UV light

- Smegma

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6
Q

Describe the spread of squamous cell carcinomas

A
  • Can be along lymphatic chains

- Or by direct transplantation

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7
Q

List the treatment options for melanomas

A
  • Benign neglect/monitoring
  • Cimetidine
  • Surgical removal
  • Intra-lesional treatments e.g. cisplatin, mitomycin C
  • Vaccines/immunotherapy
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8
Q

Discuss the benign neglect approach to melanomas

A

Standard approach, but all lesions will progres

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9
Q

Discuss the use of cimetidine in the treatment of melanomas

A
  • Evidence contradictory
  • Oral antacid
  • Expensive, off license and need to use for some months
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10
Q

Discuss the use of vaccines/immunotherapy in the treatment of melanoma

A
  • Expensive (approx £2000 for initial course, then £500/vaccine thereafter)
  • Unproven efficacy
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11
Q

Outline the treatment of eosinophilic granuloma

A
  • Intra- or peri-lesional steroids (methylpred or triamcinolone)
  • Systemic steroids (pred or dex)
  • Foam pads may be useful under saddle
  • Removal difficult due to tight skin, margins difficult to achieve
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12
Q

List the treatment options for squamous cell carcinoma in horses

A
  • Depends on location
  • Surgical excision
  • Brachytherapy
  • Chemotherapy
  • NSAIDs
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13
Q

Where would surgical excision of a squamous cell carcinoma be appropriate?

A
  • Third eyelid
  • Penile reeding/distal phallectomy
  • En bloc penile resection
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14
Q

Outline the use of brachytherapy in the treatment of squamous cell carcinoma

A
  • Iridium-12 very effective for periocular lesions
  • Plesiotherapy (strontium-90 beta-emitter) useful for small lesions and corneal lesions
  • Both only available at AHT and expensive
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15
Q

Outline the use of chemotherapy in the treatment of squamous cell carcinoma

A
  • Cisplatin, 5-FU can be effective

- Mitomycin-C shown to be effective topically and intra-lesionally, often used in conjunction with surgical removal

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16
Q

List the treatment options for sarcoids

A
  • Surgical removal
  • Ligation
  • Cryosurgery
  • Immunotherapy
  • Chemotherapy
  • Photodynamic therapy
  • Topical cytotoxic therapy
  • Radiotherapy
  • Imiquimod, acyclovir, bloodroot ointment, bleomycin, topical mitomycin C, taxarotene
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17
Q

Compare sharp and laser excision for the removal of equine sarcoids

A
  • Sharp: smaller sarcoids e.g. nodular, but failure rate high
  • Laser: higher success rate, not widely available, time to heal, looks ugly during but good once healed
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18
Q

Discuss the use of ligation in the treatment of equine sarcoids

A
  • Some owners use hair tails, poor idea
  • Only where can be sure there is no root
  • Elastrator rings useful for some nodular and pedunculated fibroblastic sarcoids for debulking prior to treatment of source
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19
Q

Evaluate the use of cryosurgery in the treatment of equine sarcoids

A
  • Only for small superficial tumours
  • Time consuming
  • High recurrence if not used effectively
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20
Q

Evaluate the use of immunotherapy in the treatment of equine sarcoids

A
  • BCG injection for peri-ocular or fibroblastic lesions
  • Not for verrucose or occult lesions
  • Injected into lesions
  • Care re. anaphylaxis
  • Not available in UK
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21
Q

Discuss the use of chemotherapy in the treatment of equine sarcoids

A
  • Intralesion injection of cytotoxic drugs e.g. cisplatin, mitomycin C, 5-fluoro uracil
  • Can beeffective but danger to surgeon, not recommended
  • Topical 5-FU canbe effective
  • Requires heavy sedation of horse, draw up in fume cupboard etc.
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22
Q

How does photodynamic therapy work in the treatment of equine sarcoids?

A

Application of chemical to lesion leads to significant cell damage when exposed to a certain wavelength of light

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23
Q

Evaluate the use of photodynamic therapy in the treatment of equine sarcoids

A
  • Poor penetration
  • Only applicable to very small, superficial lesions
  • Side effects when animal exposed to sunlight
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24
Q

What is the main topical cytotoxic therapy used in the treatment of equine sarcoids?

A
  • AW5-LUDES (aka Liverpool cream), contains 5FU and other heavy metals
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25
Q

Evaluate the use of Liverpool cream in the treatment of equine sarcoids

A
  • Reasonably effective in certain circumstances
  • Requires repeated topical application by vet only, q48-72hours
  • Health and safety concerns: nasty, cytotoxic, vaseline on normal skin to protect, gloves
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26
Q

Discuss the use of radiotherapy in the treatment of equine sarcoids

A
  • Treatment only takes a few minutes
  • Excellent cosmesis and 95% success
  • Expensive
  • For periocular lesions, only AHT
  • Early treatment for best results
  • May result in discolouration/scarring
  • NO longer available in UK
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27
Q

Describe the method for radiotherapy treatment of equine sarcoids

A
  • High dose brachytherapy
  • high activity Iridium 192 source, emits gamma radiation
  • Catheters implanted into lesion, source driven through catheters by remove afterloader
  • Treatment takes a few minutes, delivered in 2 fractions a week apart
  • Horse not radioactive between treatments
  • No operator exposure
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28
Q

List the common causes of crusting and scaling in horses

A
  • Infectious
  • Dermatosis of lower limb
  • Photo dermatitis
  • Seborrhoea
  • Localised keratinisation defects
  • Immune mediated causes
  • Idiopathic causes
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29
Q

What are the main infectious causes of crusting and scaling in horses?

A
  • Dermatophilosis
  • Dermatophytosis
  • Staphylococcus spp.
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30
Q

Name the dermatoses of the lower limb that lead to crusting and scaling

A
  • Leukocytoclastic vasculitis

- Pastern dermatitis

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31
Q

Name the localised keratinisation defects that cause crusting and scaling in horses

A
  • Cannon keratosis

- Linear keratosis

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32
Q

Name the immune mediated causes of crusting and scaling in horses

A
  • Pemphigus foliaceous (rare)

- Coronary band dystrophy (rare)

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33
Q

Name the idiopathic causes of crusting and scaling in horses

A
  • Multisystemic eosinophili epitheliotrophic disease (MEED) (rare)
  • Generalised granulomatous disease (sarcoidosis) (uncommon)
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34
Q

What conditions may allow Dermatophilosis to occur?

A
  • Skin damage e.g. other skin disease, insect bites, environmental trauma
  • Wet skin e.g. sweat, rain, washing
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35
Q

Which horses are at risk of dermatophilosis?

A
  • Genetic susceptibility, some more prone
  • Immunocompromised/malnourished animals
  • Short lived immunity, recurrent infection likely
  • Animals in contact withother infected animals (contagious)
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36
Q

Describe the clinical signs of dermatophilosis

A
  • Follicular/non-follicular tufted papules, rapidly coalesce and become exudative, matted hair = paintbrush lesions
  • Plucking leaves erosions/ulcerations +/- bleeding, purulent
  • Commonly seen on rump and top line, saddle area, pastern, coronet, heels
  • Lesions may be painful e.g. distal limb swelling, oedema, lameness
  • Rarely pruritic
  • Healing produces dry crusts, scaling, alopecia
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37
Q

Outline the methods for diagnosis of dermatophilosis

A
  • History
  • Clinical signs
  • Impression smears of purulent material and cytology (G+ve branching, filamentous chain like coccus)
  • Culture
  • Skin biopsy
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38
Q

List the differential diagnoses for dermatophilus

A
  • Staphylococcal folliculitis
  • Dermatophytosis
  • Pemphigus foliaceous (rare)
  • Photo dermatitis (sunburn)
  • Other causes of pastern dermatitis
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39
Q

Describe the management of dermatophilosis

A
  • Prevent wetting
  • Remove rugs to prevent sweating
  • Keep tak and groowing kit clean and for individual
  • Most will spontaneously regress in 1 month
  • Remove and dispose of crusts carefully
  • Topical or systemic treatment may be required
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40
Q

Describe the topical treatment of dermatophilosis

A
  • Chlorhexidine shampoos
  • Silver sulphadiazine (flammazine) cream
  • Not steroids as is an infection and need immune response to clear
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41
Q

Describe the systemic treatment of dermatophilosis

A
  • Only if horse is systemically ill or chronically infected, not usually the case
  • antibiotics e.g. penicillin/TMPS
42
Q

Describe the epidemiology of cutaneous Staphylococcus infection in horses

A
  • Sporadic infection
  • Common spring and summer, post-clipping/during coat change
  • Fine skinned horses e.g. TB
  • Potentially contagious if shared tack
43
Q

Describe the clinical signs of cutaneous Staph. aureus infection in horses

A
  • Lesion starts as focal papul
  • Hairs stik up against lie of coat, can be glued by small crusts
  • Can progress to furunculosis - nodules, draining tracts, ulcers, crusts
  • Can get cellulitis, lymphatic engorgement
  • Painful - removal of scabs painful
  • Lesions mainly on contact areas of tack, saddle pads, rider’s legs
44
Q

Outline the diagnosis of cutaneous Staphylococcus infection in horses

A
  • Clinical signs
  • Swab and culture exudate
  • Staph aureus is a commensal, need pure growth for diagnosis
45
Q

List the differentials for cutaneous Staphylococcus infection

A
  • Pemphigus foliaceous
  • Other bacterial infection (Strep/Dermatophilosis)
  • Onchocerciasis
46
Q

Describe the management of cutaneous Staphylococcal infection in horses

A
  • NSAIDs for pain
  • Avoid contact with tack, rider, rugs, other horses
  • topical antiseptic shampoos - chlorhexidine/povidone iodine based
  • Systemic antibiotics
47
Q

Describe the epidemiology of dermatophytosis

A
  • Highly contagious, potentially zoonotic
  • Transmission via contact with infected animals or environment/fomites
  • Incubation period 1-6 weeks
  • Young animals especially susceptible
  • Some immunity with age/post infection
  • Endemic in many liver/racing yards
48
Q

Name the agents that cause dermatophytosis in horses

A
  • Trichophyton equinum and verrucosum

- Microsporum gypseum and equinum

49
Q

What are the regulations regarding dermatophytosis in race horses

A
  • Not allowed on racecourse with active lesions
  • If have old lesions, need form from vet to show they have been treated for dermatophytosis and that infection no longer active
  • May also not be exported with active lesions
50
Q

Describe the clinical signs of dermatophytosis

A
  • Tack contact sites common
  • Multiple lesions
  • Initially change in angels of hairs
  • Small, often circular patches
  • Amongst hairs, finely keratinised squames (cigarette ash appearance)
  • Hairs easily broken/epilated
  • focal areas coalesce leading to extensive scaling and flaking
  • Variable pain
  • Variable pruritus
51
Q

How do dermatophyte fungi produce the lesions seen in dermatophytosis?

A

Produce keratolytic enzymes which lead to weakening of hairs which easily break/are epilated

52
Q

Describe the healing of dermatophyte lesions and explain the importance of this for sampling

A
  • Healing occurs from the centre
  • Hair will usually grow back, but may have some change in colour
  • Most active fungal growth is at the margins of the lesion
53
Q

Describe the methods in the diagnosis of dermatophytosis

A
  • Hair plucks at periphery of lesions for microscopy and culture
  • Wood’s lamp not useful in horses
  • Skin punch biopsy - fungal spores within hair follicles may be seen
54
Q

Briefly outline the culture method for dermatophytosis

A
  • Use Sabouraud’s method
  • Red phenol dye used, agar red if +ve
  • Add drop of vit B to culture to facilitate growth of Microsporum spp.
  • Culture can take up to 30 days
55
Q

Describe the management of equine dermatophytosis

A
  • ID of species not important for treatment
  • Most are self-limiting in 5-10 weeks
  • Wear gloves
  • Main principles: treat active infection to decrease spore formation, and eliminate infective spores from environment
  • Usually topical, rarely systemic
  • Use disinfectants with anti-fungal action
56
Q

Discuss the potential causes of pastern dermatitis

A
  • Common, often winter, multifactorial, chronic wetting of skin, white legs predisposed, folds on sire legs
  • Infectious: bacteria, fungus, virus, parasite
  • Non-infectious: trauma, immune mediated, neoplastic
57
Q

List the differentials for pastern dermatitis (and briefly state how they differ)

A
  • Dermatophylosis: cursts on top of pus, little pain
  • Staphylococcal dermatitis: extremely painful
  • Pastern and cannon leukocytoclastic vasculitis: immmune mediated, not painful
  • Other autoimmune disease e.g. SLE, immune mediated necrotising vasculitis
58
Q

Describe the clinical signs of pastern dermatitis

A
  • Mild: alopecia, erythema, mild serum exudation
  • Progression to: papules, significant serum exudation, crusts, scabs
  • +/- pain on palpation, lameness, cellulitis
59
Q

Outline the methods for the diagnosis of pastern dermatitis

A
  • Clinical signs
  • Coat brushings
  • Skin scrapes
  • Swabs from exudate (culture/sensitivity)
  • Skin biopsy
  • Elimination of other causes
60
Q

Evaluate the use of skin biopsy in the diagnosis of pastern dermatitis

A
  • Often poor return
  • May help in recurrent or refractory cases
  • Cn be difficult to take from medial/lateral side of leg as blood vessels and nerves shallow under skin
61
Q

Discuss the key considerations in the treatment of pastern dermatitis

A
  • Owners often tried own methods before call vet
  • No single treatment works
  • In some cases, not totally resolvable
  • Secondary infections with bacteria/fungi lead to complications
62
Q

Outline a general treatment approach to pastern dermatitis

A

1: Clean and clip area
2: Debride crusts using cream and bandage overnight to allow topical treatment to penetrate into region where organism is located
3: Next day gently wash with dilute chlorhexidine, dry and clip more if needed
4: Repeat 2 if crusts still present
5: care of balance of over-wetting and need to wash area
6: Apply topical treatment once crusts removed
7: Carefully dispose of crusts and do not reuse same towel to dry

63
Q

List the topical treatments that can be used for the treatment of pastern dermatitis

A
  • Chlorhexidine
  • Antiseptic, antifungal e.g. malaseb
  • Antibiotic cream e.g. Flammazine
  • Combined antibiotic + steroid cream e.g. fuciderm
64
Q

What is a key consideration with the use of topical treatment in the treatment of pastern dermatitis?

A

Care with repeated use of topical steroids as these could delay epithelialisation/cause thinning of skin, but may help with pain/inflammation

65
Q

Other than creams, what other treatment would be appropriate in the treatment of pastern dermatitis?

A

NSAIDs in lame horse e.g. phenylbutazone, meloxicam, flunixin meglumine

66
Q

Outline how pastern dermatitis can be prevented

A
  • Avoid over wetting skin by using barrier creams for exercise e.g. petroleum jelly
  • Do not aggressively wash and scrub area
  • Clean, dry bedding, avoid prickly straw
  • Dry paddocks
67
Q

What is the cause of pastern leukocytoclastic vasculitis?

A

Unknown, associated with bacterial infection

68
Q

Describe the clinical signs of pastern leukocytoclastic vasculitis

A
  • in almost all cases white limbs affected
  • Often follows blood vessels on lateral and medial limb
  • Firmly attached crusts on distal limbs
69
Q

How is pastern leukocytoclasic vasculitis diagnosed?

A
  • Skin biopsy

- Will see vasculitis and karryorrhexis of neutrophils

70
Q

Describe the treatment of pastern leukocytoclastic vasculitis

A
  • Topical steroids
  • Systemic steroids e.g. prednisolone/dexamethasone
  • Avoid sun
71
Q

Which areas are predisposed to photodermatitis and how can this be prevented?

A
  • Unpigmented, pink skin e.g. palomino, cream horses
  • Areas maximally exposed to sun: nose, muzzle
  • Prevented by using suncream
72
Q

Describe the appearance of photo dermatitis

A
  • Erythema
  • Scaling
  • Necrosis
73
Q

How does photosensitisation occur?

A
  • Normal light exposure
  • Indirectly caused by photodynamic agents in skin due to ingestion of plants containing photodynamic agents, or failure of liver to detoxify phylloerythrin of hepatotoxic plants
74
Q

Give examples of plants that can lead to photosensitisation and state which mechanism this is by

A
  • St Johns Wort (Hypericum perforatum): direct absorption of photodynamic agents into blood
  • Ragwort (Senecio jacobea): failure of liver detoxicifation
75
Q

Outline how photosensitisation by plants can be avoided

A
  • Check paddocks and identify plants, remove

- Check and remove from hay (palatable when cut)

76
Q

Describe the onset of clinical signs of photosensitisation

A
  • Typically not seen until months after ingestion
  • Can affect multiple horses in a group
  • Not all horses have liver failure, but need to rule this out
77
Q

Describe the clinical signs of photosensitisation

A
  • Erythema
  • Oedema
  • Pain
  • Vesicles
  • Serum exudation
  • Skin necrosis
  • Ulceration
  • Sloughing
  • Possible other signs of liver disease
  • Secondary bacterial infection
78
Q

Outline the management of photosensitisation

A
  • Sun avoidance (stable in day, turn out at night)
  • UV mask, high factor sun screens, avoid grazing with toxic pants
  • Use topical creams to remove crusts and sooth e.g. dermisol, aloe vera
  • Evidence of severe liver disease have guarded prognosis (need to check liver parameters in any case of suspected photosensitisation)
79
Q

Describe the clinical signs of pemphigus foliaceous in the horse

A
  • Lesions start on face, become generalised over several months
  • Early lesions papules and crusts
  • Annular thick crusts, annular erosions with/without epidermal collarettes, annular alopecia, oozing, matted hair coat, scaling
80
Q

Describe the diagnosis of pemphigus foliaceous in the horse

A
  • Skin biopsy (acantholysis, neutrophils, eosinophils seen)
  • Direct smear of pustule/erosions for cytology
  • Immunohistochemistry
81
Q

Outline the treatment of pemphigus foliaceous in the horse

A
  • Rarely may have spontanous resolutin (foals)
  • Aggressive treatment usually with immunosuppressive doses of steroids
  • Immunomodulators (azathioprine)
  • Gold salts
  • Approx 50% r=of cases relapse after prolonged treatment
82
Q

Describe steroid use in the treatment of pemphigus foliaceous

A
  • Immunosuppressive doses e.g. pred PO SID starting 2-4mg/kg or dex
  • Laminitis risk high
83
Q

What is leukotrichia?

A

White hair growth on areas of scarring, may be a result of ulcers and erosions

84
Q

List common causes of ulcers and erosions in horses

A
  • Saddle/tack sores
  • Chemical irritants
  • Vasculitis
  • Chemical/thermal burns
  • Coital exanthema (EHV-3)
  • Pemphigus vlgaris/bullous pemphigoid
  • Inherited defects
  • Ulcerative lymphangitis
  • Glanders and Farcy
  • Epizootic lymphangitis
  • Vesicular stomatitis
85
Q

Identify the notifiable causes of erosions and ulcers in horses

A
  • Glanders and Farcy (Burkholderia mallei)
  • Epixzootic lymphangitis (Histoplasma farciminosum)
  • Vesicular stomatitis
86
Q

What are the inherited defects of horses that may lead to ulcers and erosions?

A
  • Cutaneous asthenia
  • Epidermolysis bullosa
  • Aplasia cutis
87
Q

What is the causative agent of ulcerative lymphangitis?

A

Corynebacterium paratuberculosis

88
Q

What may cause vasculitis in horses leading to ulcers and erosions?

A
  • Post infection e.g. Streptococcus equi equi (strangles)
  • Drug related reaction
  • Photoactivated
  • Type III and type I hypersensitivity
89
Q

Describe the appearance and treatment of post infection vasculitis as a result of Streptococcus equi equi

A
  • Purpura haemorrhagica
  • Urticaria
  • Oedema of head, limbs
  • Petechiation of mucous membrane
  • Exudation
  • Skin sloughing
  • Treatment: steroids, antibiotics, nursing
90
Q

List the types of haircoat disorders that may occur in horses

A
  • Hirsuitism
  • Seasonal abnormal shedding
  • Anagen deluxation
  • Telogen defluxation
  • Coat colour changes
  • Alopecia
91
Q

Briefly describe seasonal abnormal shedding

A
  • Alopecia commonly on face, shoulders, rump
  • Skin normal
  • Horse otherwise healthy
  • Pathogenesis unknown
  • Spontaneous recovery over several months
92
Q

Describe the cause and appearance of anagen defluxation

A
  • Disease (infectious, metabolic, fever) can disrup the hair cycle leading to sudden hair loss
  • Hair shaft breakage
93
Q

Describe the cause and appearance of telogen defluxation

A
  • Stress (pregnancy, fever, severe illness, surgery, anaesthesia) causes abrupt premature cessation of growth of anagen hairs
  • Within 1-3 months a large number of telogen hairs are shed
94
Q

Describe the treatment of anagen and telogen defluxation

A

Both spontaneously resolve when inciting cause is corrected

95
Q

Name the common coat colour changes that may occur in horses

A
  • Leukotrichia/leukoderma
  • Vitiligo
  • Spotted leukotrichia
  • Reticulated
96
Q

Describe leukotrichia/leukoderma

A
  • Acquired loss of coat colour without loss of skin pigment
  • e.g. freeze brand, bandage rub
  • Non-progressive
97
Q

Describe vitiligo

A

Gradual appearance of non-pigmented skin without other change, e.g. pink periocular areas of arabs

98
Q

Describe spotted leukotrichia

A
  • Shire, TB, Arab
  • Non-inflammatory whitehaired spots on normal skin
  • Increased number of static spots
  • Commonly seen on chestnuts
99
Q

Describe reticulated leukotrichia

A
  • white hair patterns
  • Can be painful
  • Quarter horse, TB, SB
  • Cause unknown
  • Generally not treated
100
Q

How can the coat colour conditions of horses be differentiated?

A

Clinical signs or histopathology of biopsies, but not important as no treatment required for any

Dermatology 2 (23 decks)

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