SAD Ch 18 Miscellaneous Skin Disease

Question 1

What leads to the development of cicatricial alopecia?

Answer 1

Cicatricial alopecia results from insults to the skin that cause fibrous tissue deposition that replaces follicular units and adnexal structures.

Question 2

What are the most common causes of cicatricial alopecia?

Answer 2

Localized injection reactions, ischemic dermatopathy, vasculitis, dermatomyositis, sterile nodular panniculitis, posttraumatic scarring, erythema ab igne, and thermal burns.

Question 3

True or false: alopecia seen in cicatricial alopecia is permanent

Answer 3

True

Question 4

What are the histopathologic features of cicatricial alopecia?

Answer 4

Fibrosing dermatitis with lack of hair follicles or adnexal glands that connect to the overlying epidermis. The overlying epidermis is often acanthotic but may be ulcerated or unremarkable

Question 5

What is the treatment for cicatricial alopecia?

Answer 5

Surgical removal of the affected area, otherwise the area will remain alopecic.

Question 6

What is the cause and pathogenesis of granulomatous sebaceous adenitis?

Answer 6

Idiopathic It is believed that sebaceous gland destruction is due to a cell mediated immunologic reaction directed against a component of the sebaceous gland

Question 7

What breeds are predisposed to sebaceous adenitis

Answer 7

Standard poodles, viszlas, akita’s, German Shepherd dogs, and samoyeds. Also Springer spaniel’s and Lhasa apsos

Question 8

What variation and clinical presentation is commonly seen with Akitas and Springer spaniel’s with sebaceous adenitis?

Answer 8

More pyoderma and severe disease

Question 9

What are follicular casts?

Answer 9

When a hair or group of hairs develop a sheath of keratin debris that remains attached to the hair above the follicular ostia

Question 10

True or false: pruritus is not typically present with sebaceous adenitis unless a secondary infection is present

Answer 10

False. Pruritus varies from not present to intense and as such is not a helpful diagnostic finding

Question 11

True or false: dogs and cats rarely undergo spontaneous remission of sebaceous adenitis

Answer 11

True

Question 12

What is the only treatment to date shown to result in an increase in sebaceous glands along with clinical improvement in sebaceous adenitis?

Answer 12

Cyclosporine

Question 13

What condition has been characterized by chronic idiopathic hypereosinophilia associated with a diffuse infiltration of various organs by mature eosinophils?

Answer 13

Hypereosinophilic syndrome

Question 14

It has been recommended that peripheral blood eosinophil counts exceeding _____ be considered hypereosinophilia in dogs and cats.

Answer 14

5x10^9/L

Question 15

What signalment of cat is more likely to be affected by hypereosinophilic syndrome?

Answer 15

Middle-aged females

Question 16

Which organs are typically involved in hypereosinophilic syndrome?

Answer 16

Bone marrow, lymph nodes, liver, spleen, GI tract. Rarely cardiac.

Question 17

What dermatologic signs are seen in cats with hypereosinophilic syndrome?

Answer 17

Generalized maculopapular erythema, severe pruritus, marked excoriation, and possibly wheals and soft-tissue swellings of the limbs.

Question 18

How is hypereosinophilic syndrome diagnosed?

Answer 18

Combination of unexplained prolonged eosinophilia and evidence of multi organ involvement.

Question 19

What is the prognosis for hypereosinophilic syndrome?

Answer 19

Poor. Survival times are short and patients do not respond to treatment.

Question 20

What condition is characterized by progressively enlarging skin folds, especially over the neck and trunk?

Answer 20

Idiopathic diffuse lipomatosis

Question 21

What are the histopathologic findings in idiopathic diffuse lipomatosis?

Answer 21

Diffuse thickening of the panniculus. Proliferating fat may resemble mature adipose tissues with mucinosis only of interlobular septae and with small numbers of primitive mesenchymal cells and lipoblasts around blood vessels. In other cases, the normal anatomy of the panniculus is lost in a proliferative mixture of normal appearing and dysplastic lipocytes.

Question 22

What is the treatment for idiopathic diffuse lipomatosis?

Answer 22

No effective therapy.

Question 23

At what age are animals with idiopathic greasy skin and haircoat with sebaceous gland hyperplasia diagnosed?

Answer 23

Usually within the first year of life

Question 24

What are the histopathologic findings of idiopathic greasy skin and haircoat with sebaceous gland hyperplasia?

Answer 24

Remarkable sebaceous gland hyperplasia. Otherwise, the skin appeared normal.

Question 25

What’s wrong with this dog?

Answer 25

Lichenoid dermatitis

Question 26

What is the cause of lichenoid dermatosis?

Answer 26

Unclear, but immune-mediate pathomechanism is suggested.

Question 27

Describe the lesions present in lichenoid dermatoses.

Answer 27

Asymptomatic symmetric onset of grouped, angular, flat-topped papules, which develop a scaly to markedly hyperkeratotic surface.

Question 28

What are the differentials for lichenoid dermatoses?

Answer 28

Psoriasiform lichenoid dermatosis of English Springer spaniels, actinic keratosis, some papilloma viral lesions, and cyclosporine induced lichenoid plaques.

Question 29

What are the histopathologic findings in lichenoid dermatoses?

Answer 29

Hyperkeratotic and hyperplastic lichenoid and hydropic interface dermatitis

Usually lymphoplasmacytic inflammatory infiltrate

Question 30

In lichenoid dermatoses, what histopathologic findings might influence your treatment plan?

Answer 30

If intraepidermal pustular dermatitis, suppurative folliculitis or both are present, suspect a lichenoid tissue reaction in response to staphylococcal infection. Should respond to antibiotics.

If eosinophilic microabscesses are present, suspect a lichenoid tissue reaction in response to an ectoparasite (especially scabies or cheyletiellosis) or Malassezia

Question 31

What is the prognosis for idiopathic lichenoid dermatoses?

Answer 31

Good. All cases have undergone spontaneous remission after a course of six months to two years.

Question 32

What form of therapy has consistently been shown to be beneficial in the treatment of idiopathic lichenoid dermatoses?

Answer 32

Sorry, trick question. No form of therapy has consistently been shown to be beneficial.

Question 33

What are some ideologic factors involved in the genesis of panniculitis in dogs and cats?

(hint, there’s a lot)

Answer 33

Question 34

Which two species of bacteria appear to target the panniculus?

Answer 34

Mycobacterium and Nocardia

Question 35

Panniculitis has been associated with disease of which internal organ?

Answer 35

Pancreas

Question 36

Which hereditary disease predisposes humans to sterile panniculitis?

Answer 36

Hereditary deficiency of α1-antitrypsin

Question 37

True or false: association with anti-trypsin levels has been detected in dogs with sterile nodular panniculitis.

Answer 37

False. It has not been detected

Question 38

Which breed has been reported to be predisposed to sterile nodular panniculitis?

Answer 38

Dachshunds (51% in one study)

Possibly also miniature poodles and collies.

Question 39

What other clinical signs can be seen with panniculitis, especially in dogs with multiple lesions?

Answer 39

Pyrexia, poor appetite, depression, lethargy, arthralgia, abdominal pain, vomiting, hepatosplenomegaly.

Fat necrosis in other organs including bone, spinal canal, and abdomen have also been reported.

Question 40

Do dogs with sterile nodular panniculitis more commonly present with a solitary lesion or multiple lesions?

What about cats?

Answer 40

Dogs-debatable, one study showed more often it was single one study showed more often it was multiple.

Cats-solitary lesion in the majority(95%). Most commonly over the ventral abdomen and ventrolateral thorax

Question 41

What might you see on an aspirate from a nodule in sterile nodular panniculitis?

Answer 41

May be suppurative, pyogranulomatous, or granulomatous with lipid or fat cells present.

Macrophages may be particularly foamy, but no microorganisms are seen

Occasionally the presence of spindle cells leads to an erroneous cytologic diagnosis of neoplasia.

Question 42

Describe the histopathologic findings of panniculitis.

Answer 42

Usually lobular or diffuse but in some cases maybe septal.

The infiltrate maybe granulomatous, pyogranulomatous, suppurative, eosinophilic, necrotizing, or fibrosing.

The presence of saponification and necrotic fat is associated with pancreatic disease-induced sterile nodular panniculitis and also vitamin E pansteatitis in cats.

Question 43

What is considered the minimum database to search for concurrent disease before a definitive diagnosis of sterile nodular panniculitis can be reached?

Answer 43

Abdominal ultrasound in chemistry screens with amylase and lipase (E. G., pancreatic lipase immunoreactivity)

CBC may show mild to moderate leukocytosis and neutrophilia, and a mild non-regenerative anemia in animals with multiple lesions And systemic illness.

Question 44

What is the treatment for sterile nodular panniculitis?

Answer 44

In one case, when pancreatitis was resolved, the panniculitis also resolved.

Careful surgical excision of solitary lesions maybe curative.

Multiple lesions usually respond well to systemic glucocorticoids. (2 mg/kg once daily in dogs, 4mg/kg once daily in cats). If no cause is found or the underlying disease is effectively treated, attempts to stop therapy after remission are warranted. Recurrent cases can be treated with alternate day steroid therapy.

Azathioprine or cyclosporine can also be used.

Oral vitamin E 400IU q12 has shown good results. Tetracycline and niacinamide have been reported effective.

Question 45

What is split paw pad disease?

Answer 45

Unknown etiology. Thought to be associated with a congenital defect in cornification of the foot pads. The defect weakens the epithelium and results in separation of the superficial layers from the deeper layers of the epidermis when friction is applied to the pad.

Wet feet are at greater risk

Question 46

What are the characteristic histopathologic findings for split paw pad disease?

Answer 46

Brightly eosinophilic, coagulated appearance that extends into the superficial dermis and resembles the severe coagulation no necrosis of a burn.

Question 47

What is the treatment for split paw pad disease?

Answer 47

Supportive care. Protective bandaging during healing. Pain medications as needed. Use of hunting boots that breathe may limit the frequency and severity of relapses.

Question 48

Which breeds may be predisposed to sterile granuloma/pyogranuloma syndrome?

Answer 48

Collies, dachshunds, Doberman pinschers, English bulldog, Weimeraners, great Danes, boxers, and golden retrievers.

Question 49

Describe the lesions seen in sterile granuloma/pyogranuloma syndrome

Answer 49

Lesions are firm, painless, nonpruritic dermal papules, plaques, and nodules.

May develop in circular donut shaped lesions and become alopecic, ulcerated, and secondarily infected.

Usually multiple and typically affects the head (especially bridge of the nose, muzzle, and periocular region), pinnae, and paws

Question 50

What are the differentials for sterile granulomatous/pyogranulomatous syndrome?

Answer 50

Other granulomatous and pyogranulomatous (bacterial, mycotic, foreign body) and neoplastic disorders.

Question 51

What is history of pathologic findings of sterile granuloma/ pyogranuloma syndrome?

Answer 51

Nodular to diffuse, granulomatous to pyogranulomatous dermatitis. Generally the center is more neutrophilic, the outer peripheral infiltrate has more macrophages.

Question 52

Which microorganism should be tested for using PCR before making a definitive diagnosis of sterile granuloma/pyogranuloma syndrome?

Answer 52

Leishmania

Question 53

What are some treatment options for sterile granuloma/pyogranuloma syndrome?

Answer 53

Tetracycline and niacinamide

Surgical excision of solitary lesions maybe necessary if pharmicotherapy is ineffective.

Glucocorticoids for multiple lesions. About 60% of dogs and require prolonged alternate morning glucocorticoids therapy.

Cyclosporine or azathioprine maybe used in dogs

Chlorambucil in cats.

Question 54

Which syndrome in dogs has been compared to Wells syndrome in humans?

Answer 54

Eosinophilic dermatitis and edema

Question 55

Which breed has been overrepresented with eosinophilic dermatitis and edema?

Answer 55

Labrador retrievers

Question 56

How does eosinophilic dermatitis and edema present?

Answer 56

Acute onset of erythematous macules that progressed and coalesced into arciform and serpiginous plaques or wheals, especially on the ventral abdomen, pinnae, and thorax.

Question 57

What are some possible underlying causes of eosinophilic dermatitis and edema?

Answer 57

Drugs, gastrointestinal disease, new diets, arthropods, and concurrent allergic or immune mediated diseases.

Question 58

What are the histopathologic findings in eosinophilic dermatitis and edema?

Answer 58

Superficial and deep perivascular to interstitial dermatitis with marked dermal edema and vascular dilation. Numerous eosinophils. Flame figures seen about 50% of the time.

Question 59

What is the treatment for eosinophilic dermatitis and edema?

Answer 59

Drug withdrawal where appropriate, systemic glucocorticoids, and antihistamines.

Question 60

True or false: eosinophilic dermatitis and edema requires meticulous Long term care.

Answer 60

False. Most cases are resolved within weeks, with no further episodes.

Occasionally there may be recurrences or a waxing and waning course.

Question 61

What has been suggested as the underlying cause for canine eosinophilic granulomas?

Answer 61

Insect bite reactions.

Possible hypersensitivity reactions to pollens, molds.

Question 62

What 2 breeds have been overrepresented with canine eosinophilic granulomas?

Answer 62

Cavalier King Charles spaniels and Siberian Huskies

Question 63

What is the typical appearance of eosinophilic granulomas in dogs?

Answer 63

Most commonly seen in the oral cavity as ulcerated palatine plaques and vegetative lingual masses.

Less commonly, they occur as multiple cutaneous papules, nodules, and plaques over the ventral abdomen, prepuce, flanks, and cheek.

Question 64

True or false: cutaneous lesions in K9 eosinophilic granuloma are usually nonpururitic and painless.

Answer 64

True!

Question 65

What are the characteristic histopathologic findings in canine eosinophilic granuloma?

Answer 65

Variably sized foci of flame figure formation, eosinophilic and histiocytic cellular infiltration, and palisading granulomas.

Question 66

How are canine eosinophilic granulomas treated?

Answer 66

Very glucocorticoid responsive.

Lesions regressed in 10 to 20 days, and no further therapy was needed.

Some lesions undergo spontaneous remission, and some lesions are seasonally or chronically recurrent.

Question 67

Hereditary cutaneous hyaluronosis is an inherited disorder of which breed of dog?

Answer 67

Chinese Shar-Pei

Question 68

What are the clinical signs of hereditary cutaneous hyaluronosis?

Answer 68

Generalized, thickened, puffy, non-pitting skin.

Most prominent over the face, neck, and limbs.

Multiloculated vesicles or bullae may occur with the thickened skin or as the only lesions. When ruptured, these lesions yield an acellular, clear, viscid, sticky, stringy fluid.

Question 69

How is hereditary cutaneous hyaluronosis diagnosed?

Answer 69

Diagnosis is supported by puncturing the skin with a hypodermic needle. Stringy, sticky, clear fluid loses from the puncture site.

Confirmation is by biopsy, which revealed marked diffuse dermal mucinosis and mild perivascular accumulations of mast cells and eosinophils.

Question 70

In which conditions may Chinese Shar-Peis also experience localized and generalized mucinosis?

Answer 70

Hypersensitivities (atopy, food hypersensitivity, flea bite hypersensitivity), and hypothyroidism.

Question 71

How is hereditary cutaneous hyaluronosis treated?

Answer 71

May spontaneously resolved or deflate as the dog ages.

Glucocorticoids (triamcinolone may work better than prednisone)

Pentoxifylline 10mg/kg q8h

Question 72

At what age are puppies typically affected by juvenile cellulitis?

Answer 72

Between three weeks and four months.

A few reports of dogs with older age onset and typical lesions and findings have been reported.

Question 73

Which dog breeds are predisposed to juvenile cellulitis?

Answer 73

Golden retrievers, dachshunds, and Gordon setters.

English cocker spaniel, Labrador retriever, and Lhasa apso may be predisposed

Question 74

What are the most common clinical signs in juvenile cellulitis?

Answer 74

Acutely swollen face, especially eyelids, lips, and muzzle.

Submandibular lymphadenopathy

Papules and pustules within 24 to 48 hours. Progress to fistulate, drain, and crust.

This externa is common, pinnae are frequently thickened and edematous.

Concurrent sterile pyogranulomatous panniculitis with firm to fluctuant subcutaneous nodules on the trunk may be seen.

Question 75

What are the differentials for juvenile cellulitis?

Answer 75

Staphylococcal dermatitis, demodicosis, and adverse cutaneous drug reaction.

Question 76

Describe the histopathologic findings in juvenile cellulitis.

Answer 76

Multiple discrete or confluent granulomas or pyogranulomas consisting of clusters of large epithelioid macrophages with variably sized cores of neutrophils

Sebaceous glands and epitrichial sweat glands maybe obliterated

In later severe lesions, suppurative changes in the superficial dermis in and around ruptured hair follicles and in the subjacent panniculus are predominant

Question 77

What is the treatment for juvenile cellulitis?

Answer 77

Early and aggressive therapy with large doses of glucocorticoids to prevent scarring (2mg/kg once daily) for 14-28 days (until disease is inactive)

Antibiotics if concurrent bacterial infection is present

Can use cyclosporine with prednisone

Question 78

Describe the cause and pathogenesis of sterile eosinophilic pustulosis

Answer 78

The cause and pathogenesis are unknown. Intradermal skin testing, hypoallergenic diet, and immunopathologic studies have not been helpful in elucidating the etiopathogenesis.

Question 79

What are the differentials for sterile eosinophilic pustulosis?

Answer 79

Staphylococcal folliculitis, pemphigus foliaceus, drug reaction, and subcorneal pustular dermatosis.

Question 80

True or false: most dogs with sterile eosinophilic pustulosis have a peripheral eosinophilia.

Answer 80

True.

Question 81

What are the histopathologic findings in sterile eosinophilic pustulosis?

Answer 81

Combination of subcorneal, intra-epidural, or follicular eosinophilic pustules.

Eosinophilic folliculitis and furunculosis may occur.

Flame figures are occasionally visible in the surrounding dermis.

Direct and indirect immunofluorescence results are negative.

Question 82

How is sterile eosinophilic pustulosis treated?

Answer 82

Glucocorticoids. 2.2 to 4.4 mg/kg once daily. Rapid response in 5 to 10 days.

Cure is unlikely, so long term alternate morning therapy is indicated.

Can also use antihistamine(Diphenhydramine) and an omega six and omega three fatty acid supplement.

Question 83

Which disease has been compared to sweet syndrome in humans?

Answer 83

Sterile neutrophilic dermatosis

Question 84

What are the causes of sweet syndrome in humans?

Answer 84

Four forms described

1. Classic form - middle-aged women after an upper respiratory infection, inflammatory bowel disease, pregnancy, or idiopathic
2. Associated with malignancy
3. Drug induced
4. Associated with lesions developing following trauma, such as following injections, surgical incisions, animal bites, burns, or sunburn.

Question 85

What is pathergy?

Answer 85

The test used to help diagnose some sterile neutrophilic diseases such as Behςet syndrome, but also sweet syndrome and pyoderma gangrenosum.

It involves pricking the skin with a needle point and the subsequent development of induration, with a sterile neutrophilic pustule developing at the site.

Question 86

Which drug has been associated with sterile neutrophilic dermatosis in dogs?

Answer 86

Carprofen

Question 87

What is the suspected pathogenesis of sterile neutrophilic dermatoses?

Answer 87

Speculated that there is an antigen-induced T cell-mediated immune reaction.

Drug administration and paraneoplastic syndromes may be the source of an antigenic stimulus.

Question 88

What are the three requirements for diagnosis of acute febrile neutrophilic dermatosis in humans?

Answer 88

1. Clinical findings of acute onset of tender or painful erythematous or violaceous plaques or nodules
2. Histopathology of lesions demonstrating predominately neutrophilic infiltration in the dermis, without leukocytoclastic vasculitis
3. The patient must also have two of the following minor criteria:

• Preceding fever or infection
• Accompanying fever, arthralgia, conjunctivitis, or underlying malignant lesion
• Leukocytosis
• Good response to systemically administered corticosteroids but not to antibiotics
• Increased erythrocyte sedimentation rate

Question 89

What are the histopathologic findings in dogs with sterile neutrophilic dermatoses?

Answer 89

Moderate to severe neutrophil-rich dermal infiltrate that may be superficial to deep and perivascular to diffuse

Edema is generally prominent, and leukocytoclasia is uncommon, and if present mild.

Question 90

What is the treatment for sterile neutrophilic dermatoses?

Answer 90

Stopping any possible inducing drug and treatment with systemic glucocorticoids should be effective

Question 92

Which rare disease in cats is related to abnormal collagenesis during wound healing?

Answer 92

Acquired reactive perforating collagenosis

Question 93

What are the clinical signs of acquired reactive perforating collagenosis?

Answer 93

Multiple firm, conical, hyperkeratotic, yellowish brown lesions, 2 to 7 mm in diameter, are present over various areas of the body. The lesions tend to cluster and form linear configurations.

The lesions cannot easily be scraped or pulled off, and when they are, hemorrhage is likely.

Lesions often occur in areas where the cat is pruritic or where there has been trauma.

Question 94

What are the histopathologic findings for acquired reactive perforating collagenosis?

Answer 94

Superficial interstitial dermatitis Rich in eosinophils and mast cells underlying a conical exophytic projection from the skin surface.

The exophytic mass consists of necrotic cellular debris, strands of keratin, and numerous collagen fibers in varying degrees of degeneration

Question 95

Which stain can be helpful in the diagnosis of acquired reactive perforating collagenosis?

Answer 95

Masson trichrome.

Normally, collagen fibers stain homogenously blue.

In perforating dermatitis, collagen fibers show segmental red bands. Presumably indicating some kind of abnormality in collegen metabolism (Synthesis, packing, degradation)

Question 96

What treatments have been reported for acquired reactive perforating collagenosis?

Answer 96

Oral vitamin C (100 mg every 12 hours)

Depo-Medrol

Control of con current allergic skin disease

Topical betamethasone, which inhibits collagen I and III production, as well as topical hallofuginone, a specific collagen I inhibitor.

Question 97

How is acquired skin fragility characterized?

Answer 97

Markedly thin and fragile skin in the absence of hyperextensibility

Question 98

What are some of the causes associated with acquired skin fragility?

Answer 98

Spontaneous or iatrogenic Cushing’s syndrome

Diabetes mellitus

Excessive use of progestational compounds

Isolated cases have been reported in association with liver disease (lipidosis, cholangiohepatitis, Or cholangiocarcinoma), phenytoin administration, feline dysautonomia, nephrosis, and feline infectious peritonitis

Question 99

What are the histopathologic findings of skin fragility syndrome?

Answer 99

Severely atrophic dermis. Dermal collagen fibers are very thin and disorganized.

Panniculus is usually not present in biopsy specimens. The epidermis and hair follicles may be atrophied.

Masson trichrome stained sections may show the segmental staining abnormality of collagen seen in cutaneous asthenia, but milder

Question 100

What is the prognosis for acquired skin fragility syndrome?

Answer 100

Grave. Affected cats are very difficult to handle without skinning them. Early cases in association with spontaneous or iatrogenic Cushing’s syndrome have resolved when the inciting cause was eliminated.

Question 101

What three lesions have traditionally been recognized in feline eosinophilic granuloma complex?

Answer 101

1. Indolent ulcer
2. Eosinophilic plaque
3. Eosinophilic granuloma

Question 102

Which form of feline eosinophilic granuloma complex is most variable in its presentation and more likely to be determined to be idiopathic?

Answer 102

Feline eosinophilic granuloma(linear granuloma)

Question 103

Where do most feline eosinophilic granulomas occur?

Answer 103

Caudal thighs, face, and in the oral cavity (especially the tongue and palate)

Question 104

True or false: feline eosinophilic granulomas are often pruritic.

Answer 104

False. They are often nonpruritic.

Question 105

Describe the histopathologic findings of feline eosinophilic granuloma

Answer 105

Nodular to diffuse granulomatous dermatitis with multifocal areas of collagen surrounded by cytolytic eosinophils and extruded granular material, which are referred to as flame figures.

Multinucleated histiocytic giant cells are common

Mucinosis of the epidermis and hair follicle outer root sheath, focal infiltrative to necrotizing mural eosinophilic folliculitis or furunculosis and focal eosinophilic panniculitis may be present

Eosinophils are less prominent in chronic lesions

Question 106

True or false: feline eosinophilic plaque is often pruritic.

Answer 106

True. It is likely that licking contributes to the formation of many of these lesions.

Question 107

Where are most eosinophilic plaques on the body?

Answer 107

Abdomen and medial thigh. Occasionally mucocutaneous junctions

Question 108

What are the main differential diagnosis for eosinophilic plaque?

Answer 108

Cutaneous neoplasia, particularly squamous cell carcinoma, lymphoma, mast cell tumor, and metastatic mammary adenocarcinoma.

Question 109

What might you see on biopsy of an eosinophilic plaque?

Answer 109

Hyperplastic superficial and deep perivascular dermatitis with eosinophilia, to interstitial or diffuse eosinophilic dermatitis.

Diffuse spongiosis that involves the outer root sheaths of hair follicles and eosinophilic microvesicles and micro abscesses may be visible.

Some lesions have remarkable mucinosis of the epidermis and hair follicle outer root sheath

Question 110

What are the differential diagnosis for indolent ulcers?

Answer 110

Infectious ulcers(Bacterial, fungal, viral), trauma, and neoplasia(squamous cell carcinoma, mast cell tumor, lymphoma)

Question 111

Describe the therapy for feline eosinophilic granuloma complex

Answer 111

Antibiotics (clavamox, convenia, clindamycin, and marbofloxacin)

Glucocorticoids (prednisolone, methylprednisolone, or triamcinolone)

Cyclosporine

Question 112

Where are feline idiopathic ulcerative dermatitis lesions typically seen?

Answer 112

Dorsal neck and shoulder. Usually solitary

Question 113

How is feline idiopathic ulcerative dermatitis treated?

Answer 113

Either surgical excision or aggressive glucocorticoid therapy is usually curative once secondary infections are controlled.

Question 114

Describe the clinical appearance of plasma cell pododermatitis

Answer 114

Soft swelling of usually multiple footpads, rarely a single footpad is involved.

The surface of affected pads is cross patched with white scaly striae.

With chronicity, depigmentation and even loss of pad architecture may be seen.

Ulceration present in 20 to 35% of cases

Question 115

What are the differentials for plasma cell pododermatitis?

Answer 115

Eosinophilic granuloma of the footpad - typically will not involve multiple pads of multiple paws and may have concurrent skin lesions.

If only one pad is involved, neoplasia and foreign body

Question 116

How is plasma cell pododermatitis diagnosed?

Answer 116

A tentative diagnosis maybe based on history, physical exam, and aspiration cytologic study wherein plasma cells are numerous.

Biopsy shows diffuse dermal and even adjacent adipose tissue infiltration with numerous plasma cells. May only see superficial and deep perivascular plasma cell dermatitis.

Russell bodies (Mott cells) are typically seen.

Fibrosis may be seen in chronic lesions

Question 117

How would you treat plasma cell pododermatitis?

Answer 117

Doxycycline (10mg/kg q24) - inexpensive, safe, and effective in resolving about one third of cases and improving over 80%.

Make sure you chase it with water. Continue treatment until pads are normal, this may take 10 weeks.

Glucocorticoids are indicated if there is poor response to doxycycline and the cat has significant symptoms associated with the disease.

Can use cyclosporine.

Surgical excision has been described as beneficial in cases not responding to medical therapy