Immune-mediated dermatoses: conditions

Question 1

what are general things to know about immunosuppressive treatment

Answer 1

combination therapy gives synergistic benefit w/o synergistic side effects
side effects vary
most of the dz are not life threatening but drug side effects can be; find lowest dose and frequency
avoid trigger factors
often remission/resolution not possible

Question 2

autoimmune condition that attacks adhesions between outer layer of keratinocytes, so see large non-follicular pustules at face (symmetrical), nasal bridge and plane, pinnae, pawpaws, and in cats in nailed and nipples

Answer 2

pemphigus foliaceus

Question 3

what are main differentials for pemphigus foliaceus and how would you differentiate?

Answer 3

dermatophytosis, pyoderma, Demodex skin scrape to rule out Demodex
presumptive dx by cytology - see acantholytic keratinocytes, neuts, eosinophils in dog
but need biopsy for definitive dx

Question 4

what we lookin at

Answer 4

acantholytic keratinocytes (large deep staining cytoplasm, nuclei are still present)
we see many, probably pemphigus

Question 5

how to tx pemphigus foliaceus in DOG

Answer 5

combination therapy often needed: start prednisolone alone or with azathioprine or Atopica
recheck q2 weeks, taper if possible, probs need steroids for life
if refractory consider mycophenolate or chlorambucil, topicals for tough to control regions
pulse dosing pred is a possible alternative protocol

Question 6

how is pemphigus foliaceus treated in CAT

Answer 6

prednisolone and recheck it 2 weeks
often GCs alone effective
if refractory: Atopica or chlorambucil
cats don’t appreciate topical therapy

Question 7

what is benign form of pemphigus, limited to face, and is a crossover between pemphigus foliaceus and DLE, that can be exacerbated by sun exposure

Answer 7

pemphigus erythematosus

Question 8

how is pemphigus erythematosis treated

Answer 8

tacrolimus, tetracycline/niacinamide, topical steroids

Question 9

this disease is very rare, autoimmune attack of epidermal attachment sin lower levels of epidermis, results in vesicles/erosion/ulcerations of oral cavity, mucocut jxns, footpads, claw bed, scrotum, often febrile and anorexic, and should trigger search for underlying dz

Answer 9

pemphigus vulgaris

Question 10

how to tx pemphigus vulgaris

Answer 10

aggressive! combination therapy with GCs from beginning, at immunosuppressive doses
AMD therapy
px is poor

Question 11

this lupus disorder is confined to skin, usually face, and starts with depigmentation of nasal plant (light blue-grey) and loss of cobblestone appearance, but can get erosion, ulceration, scaling, crusting

Answer 11

discoid lupus erythematosis (also the circle is where you should biopsy)

Question 12

how is DLE diagnosed

Answer 12

cytology, scrape, and DTM to rule out other dermatoses
biopsy rarely done, but can look like mucocutaneous pyoderma clinically and histologically, so often do a trial course of AMD (this is top DDX)

Question 13

how is DLE treated

Answer 13

tetracycline.niacinimade, vitamin E. EFAs, topical tacrolimus, steroids if needed, avoid peak sun hours, use sunscreen if not possible

Question 14

this condition causes erosions and ulcers and mucous and mucocutaneous junctions, G shep predisposed, genital and perianal most common sites, and on biopsy looks similar to DLE so differentiation is clinical

Answer 14

mucocutaneous lupus

Question 15

how is mucocutenaous lupus treated

Answer 15

tetracycline/niacinimide, Atopica, GCs, tropical steroids, tacrolimus

Question 16

the most aggressive form of cutaneous lupus, which causes ventral ulceration (abdomen, inguinal, medial thighs, mucoasae), affects Shetland sheepdogs and collies, histologic characteristics of lupus disorder, and see more cases in summer/UV exposure

Answer 16

vesicular cutaneous lupus