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Immune-Mediated Skin Disease Flashcards

(43 cards)

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1
Q

define autoimmune disease

A

specific humoral or cell mediated immune repsonse against autoantigens -> disease

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2
Q

define immune-mediated disease

A

mediated by the immune system - innappropriate inflammation or immune attack where specific humoral or cellular response to SELF AG NOT demonstrated.
- excludes hypersesntivities (even those these are immune mediated technically)

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3
Q

are immune mediated diseases common?

A

no

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4
Q

what type of immune assault leads to vesicles and bullae? what other lesions may be seen associated with these?

A

basement membrane or basal keratinocytes targetted
(epidermis separates from underlying tissue)
- erosions and ulcers more commonly seen as vesicles fragile

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5
Q

egs. of bullous or vesicular disease

A
  • bullous pemphigoid
  • pemphigous vulgaris
    (NB: pempigous folacious = pustular disease)
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6
Q

what is targetted in subepidermal vesicular autoimmune disease?

A
  • basememnt membrane

- accumulation of inflammatory cells (neutrophils, eosinophils) may be seen in conjunction with 1* lesions

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7
Q

where are subepidermal vesicular autoimmune disease lesions commonly seen?

A

mucocutaneous junction, axilla, groin, mucous membranes

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8
Q

Is bullous pemphigoid a single disease?

A

NO! recent molecular studies -> multiple types of subepidermal vesicular dermatitides eg.

  • BP (bullous pemphigoid) dogs, cats, pigs, horses
  • MMP (mucous membrane pemphigoid) dogs, cats
  • EBA (epidermal bullosa acquisita) dogs
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9
Q

what is targetted in pemphigus vulgaris?

A

desmosomes

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10
Q

Ddx subepidermal vesicular autoimmune diseases?

A
  • other ulcerative autoimmune diseases
  • drug reactions
  • epitheliotropic lymphoma
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11
Q

Dx of subepidermal vesicular autoimmune disease?

A
  • hx, cs

- biopsy (cell rich or cell poor subepidermal vesic. dermatitis)

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12
Q

What occours with intraepidermal vesicular dermatitis?

A
  • autoAb to desmosomal adhesion molecules (desmogleins)
  • separation of keratinocyutes (acantholysis)
  • blister/pustule formation
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13
Q

eg. of intraepidermal vesicular dermatitis? What is seen in this condition?

A
  • pemphigus vulgaris
  • suprabasilar clefting (“tombstone” appearance on histo as basal keratinocytes still attached to basement membrane)
  • oral cavity affected in 90% cases
  • mucocutaneous junction, claws, ears, axilla, grouin
  • 2* bacterial infection common
  • fever and depression severe
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14
Q

Dx of pemphigus vulgaris?

A
  • h, cs

- skin biopsy: cupra basilar split, tombstones, FEW inflam cells)

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15
Q

Tx and prognosis of pemphigus vulgaris?

A
  • suppress immune response (See later questinos on general tx principles)
  • prognosis poor, needs agressive tx, difficult to get on top of
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16
Q

Most common pemphigus disease? What type of disease is this?

A
  • pemphigus folaceous

- intraepidermal pustular disease

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17
Q

Which animals are affected by pemphigus folaceous?

A
  • dogs cats horses
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18
Q

Clinical signs of pemphigus folaceous?

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A
  • pustules, crusts, scales, hair loss, erosions, epidermal collarettes
  • face (ears first)
  • feet inc foot pads
  • groin
  • becomes generalised (esp horses)
  • fever and depression if severe
  • may wax and wane with no new lesions for weeks
19
Q

Dx pemphigus folaceous?

Study These Flashcards
A
  • hx, cs
  • biopsy
  • pustule smears (acantholytic cells and neutrophils, NO BACTERIA)
  • histo of multiple intact 1* lesions or edge of recent lesion (less useful)
20
Q

What is the only cause of interface dermatitis?

Study These Flashcards
A
  • AUTOIMMUNE OR IMMUNE MEDIATED DISEASE!!

- > Tx = antiinflam

21
Q

Histo of interface dermatitis? Egs. of pathologies that show this?

Study These Flashcards
A
  • dermo-epidermal junction obscured by inflammatory cells or hydropic [swollen, vacuolated] degeneration (or combination)
    eg.
  • discoid lupus erythematosus (nasal cutaneous lupus)
  • erythema multiforme/toxic epidermal necrolysis (immune mediated often triggered by drugs not autoimmune)
22
Q

Where should melanin be found/not be found?

Study These Flashcards
A

should NOT be found deep to demo-epidermal junction

-> this would be seen as DEPIGEMNTATION of skin

23
Q

Alternative name for discoid lupus erythematosus?

Study These Flashcards
A

nasal cutaneous lupus erythematosus

- not a form of systemic lupus erythematosus

24
Q

nasal cutaneous LE common?

Study These Flashcards
A

uncommon dogs, v rare in cats

25
What may nasal cutaneous lupus erythematosus be exaccerbated by?
exposure to sunlight
26
clinical signs of nasal cutaneous lupus erythematosus? breed predisposition?
> collies, shelties, gsd, huskies - no systemic signs - depigmentation, scaling and erythema of the nose (+- ears and periobribatal areas) - loss of cobblestone appearance of nasal planum - erosion and crusting - small oral ulcers - histo: cell rich, lymphocytic interface dermatitis
27
Tx discoid lupus erythematosus?
- avoid sunlight - initial topical fluorinated GCs BID tapered to EOD - switch to less potent 1-2% hydrocortisone or tacrolimus - tetracycline/niacinamide tx combination - Vit E and EFAs - systemic prednisolone +- immunosuppressants if severity ^
28
Tx mild cases of immune mediated/autoimmune disease
- topical steroids - vit E - oxytet/niacinamide - low dose steroids
29
Tx more severe autoimune disease
High dose steroid (pred or dexomethosone) + azathioprene (NOT CATS) - chlorambucil good for cats - monitor for myelosuppression fortnightly
30
Dosage prednisolone? Actions?
- fast > dogs: 2-4mg/kg SID -> EOD -> taper > cats: double dosage required and tolerated - lower doses used for allergy tx
31
Dosage azathioprine? Actions?
- combination with systemic presnisolone (first line tx or if pred alone does not work) - NOT FOR CATS > dogs: 2-4mg/kg/d PO until response seen then EOD for 4-6 weeks -> taper - NB. cost - monitor myeolosuppression ~ few weeks
32
What alternative drug to azathioprine can be given to cats? Dosage?
- Chlorambucil (good for cats with PF unresponisve to steroids alone) > dogs and cats: 0.1-0.2 mg/kg q24-48hrs - monitor haem 2x monthly
33
Speed of action ciclopsporin? Efficacy and usefulness?
- works slow - $$$ - poor efficacy in canine PF - + azathioprine for refrctory cases may be useful
34
What cases is tetracycline and niacinamide indicated for? Dose? When are effects ecpected to be seen?
- Abx + Vit B -> anti-inflam - good for mild autoimmune diseases (risks of more potent drugs not justified) > dogs>10kg = 500mg each substance q8hrs > dogs<10kg 250mg TID - expect effects in 8 weeks
35
Is feline cowpox zoonotic? What type of virus is this and which animals acct as reservoir hosts? Which animals are susceptible?
- YES - orthopoxvirus - voles and woodmice reservoir -> hunting cats esp in rural environment - esp seen in autumn when reservoir hosts most active
36
Clinical signs of feline cowpox? Ddx?
> Ddx = cat bite abscess/RTA - small ulcer/abscessation/cellulitis face or distal limb - 7-10d later, (viral replication in raining node and white cell assoc viraemia stage) multiple nodular lesions develop - histo: inclusion bodies - lesions well demarkated, raised, erthematous, vesicular top -> crust +- central depression or crater
37
Prognosis of pathgenesis of feline cowpox?
- spontaneously resolves after 4-6 weeks | - cats otherwise healthy
38
Dx feilne cowpox?
- virus isolation - electron miccroscopy of crusts - serology (cats seroconvert early) - skin biopsy > degernative changes in surface and follicular epithelium inc adnexal glands + marked dermal infiltrate of inflam cells. Characteristic intracytoplasmic eosinophilic inclusion bodies in non-necrotic epidermis
39
Tx feline cowpox?
NOT STEROIDS!!! -> pneumonia - supportive symptomatic tx - cowpox is a zoonosis but standard hygeine measured should prevent spread (beware immunosuppressed people)
40
How is vasculitis characterised?
- many cells in the vessel walls cf. dermis - haemorrhage and oedema - degeneration of endothelial cells - +- infarcts and adnexal atrophy > difficult dx in cats and dgos
41
where should inflammatory cells not be seen?
near an arteriole
42
Where may vasculitis be seen?
- extremitis (pinna, distal limb) | - immune complex deposition/infectious disease/idiopathic
43
Outline 3 main immune mediated clinical patterns and associated histological patterns.
> pustular crusts (PF) - intraepidermal pustular - neutrophils and acanthocytes > vesicles and bulla, erosions and ulcers (PV + BP +BP variants) - intra/subepidermal vesicular, skin and mms - suprabasalar split (PV), both cell poor > erythema, vesicles, erosions and depigmentation (LE) - interface, widespread or confined nasal planum - cell rich, lymphocytic

Dermatology (25 decks)

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