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Lecture 8
Immune mediated skin disease
35
Veterinary Medicine
Professional
08/30/2016

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Term
What are some of the immune mediated skin diseases seen in small animals?
Definition
-pemphigus
-discoid lupus
-SLE
-vasculitis
-sebaceous adenitis
-VKH
-sterile pyogranulomatous dermaitis
Term
What is the term for inflammation and exudate around the base of the nail?
Definition
-paramechia
Term
If you see a case of what looks like ringworm but with exudate around the nails and acanthocytes on cytology, what is it?
Definition
-Pemphigus follaceous
Term
How do we treat a cat with pemphigus follaceous?
Definition
-corticosteroids with cyclosporine
Term
How do we trat a dog with pemphigus foliaceous?
Definition
-corticosteroids with azothioprine
Term
IN addition to lesions around the nail bed, where else do we see lesions that point to pemphigus foliaceous and away from ringworm?
Definition
-foot pads with exudate, inflammation, and redness
Term
What do we see on histopath that diagnoses pempigus foliaceous?
Definition
-acantholytic epithelial cells
Term
What is the most common immune mediated skin disease in dogs and cats?
Definition
-Pemphigus foliaceous
Term
What physiologically happens with pemphigus foliaceous?
Definition
-auto-antibodies attack intercellular cohesive proteins in the upper epidermis (subcorneal)
Term
Where do we see pustular lesions due to pemphigus foliaceous? Is it pruritic?
Definition
-foot pads, nail beds, all over
-can be pruritic
Term
How do we treat penphigus foliaceous?
Definition
-Corticosterioids with Azathioprine or Cyclosporine
-can also use Mycophenolate
Term
Describe the presentation of DLE in the dog.
Definition
-depigmentation and erosions of the nose and crusty erosive lesions of the ear margins along the basement membrane
Term
HOw do we treat DLE in dogs?
Definition
-Doxy, niacinamide, pentoxfylline, and prednisone
-can also use Tacrolimus topically
=sun screens
Term
What does DLE look like on histopath?
Definition
-interface dermatitis with pigmentary incontinence
Term
What is the alternative name for superficial necroltic dermatitis?
Definition
-hepatocutaneous syndrome
Term
How do wwe confirm superficial necrolytic dermaittis?
Definition
-skin biopsy and liver profile with US
Term
What conditions can predispose dogs to superficial necrolytic dermatitis?
Definition
-liver fialure, diabetes mellitus, long-term phenobarbital use
Term
How do we diagnose SND on hoistopath?
Definition
-use Trichrome stain
-characteristic red, white, and blue appearance
Term
What do we see on the liver of dogs with SND?
Definition
-swiss cheese liver
Term
What external lesions do we see due to SND?
Definition
-hyperkeratosis and crusts around painful and cracked foot pads
Term
HOw does pemphigus vulgaris present?
Definition
-non-healing erosions around the mucus membranes
Term
How do we treat pemphigus vulgaris?
Definition
-immunosuppressive doses of prednisone
-Mycophenolyte
-Cyclosporine
Term
HOw does epitheliotrophic lymphoma present in the dog?
Definition
-plaques around the mucocutaneous junctions
-inflamed erythematous plaques
-inflamed oral mucosa
Term
What is the first thing we do with mucocutaneous erosions?
Definition
-biopsy, biopsy, biopsy
Term
What are the rule outs for mucocutaneous erosions? Clues?
Definition
-Mucocutaneous pyoderma: nor oral lesions and has crusted papules
-Pemphigus vulgaris: mucosal erosions and ulcers
-Epitheliotrophic lymphoma: plaques
Term
Describe the multisystemic effects of Systemic Lupus Erythematosus.
Definition
-polyarthritis, glomerulonephritis, immune-mediated hemolytic anemia
Term
Describe the pathogenesis of SLE.
Definition
-autoantibodies against DNA or RNA
Term
WHat kinds of skin lesions can occur due to SLE?
Definition
-erosive to proliferative lesions
-face
-mucus membranes
-feet
-extremities
Term
What is the etiology of Uveodermatologic Syndrome aka Vogt-Koyanagi-Harada Syndrome?
Definition
-immune mediated against melanocytes
Term
What breed of dogs is the poster child for VKH?
Definition
-Akitas
Term
What are the ophthalmic clinical signs of VKH? Derm signs?
Definition
-O: severe bilateral uveitis with retinal detachment
-D: depigmentation, ulceration
Term
How do we treat VKH?
Definition
-lifelong systemic immunosuppressive therapy
-topical prednisolone, atropine
Term
What is immune mediated vasculitis? Outcome?
Definition
-severe full thickness necrosis of skin
-euthanisia
Term
Which breed is predisposed to sterile pyogranulomatous dermatitis? Lesions?
Definition
-young labs
-acute onset of very pruritic nodular dermaitis of face
Term
How do we treat sterile pyogranulomatous dermatitis?
Definition
-high dose corticosteroids
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