Dermatology

case #06
 Anamnesa
⋆ Hungarian Vizla, neutered female, 5
y.o
⋆ 36 hours Reluctant standing, loss
appetite, hyperventilation
⋆ Increasingly reluctance to play in
weeks
⋆ No vaccine, regularly dewormed
Physical Examination
 Differential diagnoses
Causes of hyperkeratotic footpads:
⋆ Pemphigus folicaeus (PF)
⋆ Hypothyroidism
⋆ Hepatocutaneous syndrome
⋆ Distemper
⋆ Idiopathic hyperkeratosis of specific breeds
(Springer spaniels, irish terrier, Kromfhorlander,
Dogue de Bordeaux)
 Differential diagnoses
Causes of widespread pustules containing
neutrophils:
⋆ Superficial bacterial pyoderma
⋆ PF
⋆ Pustular dermatophytosis
⋆ Drug eruption
 Diagnostic tests
⋆ Physical exam  depressed, lies down, prescapular & popliteal lgl enlarged
⋆ Dermatological exam  pics + erythema and hyperkeratosis in dorsal nasal, the feet are
hot and painful to touch
⋆ Cytology 
⋆ Stained impression smear 
high number of neutrophils
intracytoplasmic cocci ( bacterial skin infection)
low number of acantholytic cells ( common in bacterial pyoderma)
⋆ Cytology on ear pinnae  more suggestive of PF than bacterial
(*secondary bacterial pyoderma is common)
⋆ Skin biopsies ( lesional skin on lateral thorax and one fore limb)
⋆ Histology : hyperplastic epidermis (+ prominent keratin layer), inflammatory reaction
in superficial dermis
⋆ PAS staining : no fungal
⋆ PF
 Treatment
⋆ Immediate analgesia w/ tramadol and
paracetamol
⋆ No NSAID!  glucocorticoid (Prednisolone)
⋆ Cephalexin  bacterial pyoderma
⋆ Bathe weekly with clorhexidine shampoo --?
Remove crust and scale & lower risk of bacterial
infection

Post treatment : better, prednisolone dosage is

reduced gradually
 “
More about pemphigus?

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 PEMPHIGUS
Pathogenesis : an immune-mediated disease, causing loss of
cohesion between keratinocytes
Most common : Pemphigus foliaceus
Other : deep pemphigus (paraneoplastic p., p. vulgaris, and bullous
p.), p. erythematosus
Clinical signs :
⋆ Crust, scales, alopecia in a symmetrical pattern
⋆ Areas : face, ears, feet, mucocutaneous junction , nipples
(occasionaly have only foot lesions)
⋆ Commonly involve feet and footpads  hyperkeratosis and
ulceration
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 DIAGNOSIS
⋆ Direct smear from vesicles/pustules  acantholytic
keratinocytes
⋆ Biopsy : subcorneal pustules  acantholytic keratinocytes
and neutrophils
⋆ DD: SLE (rare+systemic signs), insect hypersensitivity

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 treatment
⋆ High dose of glucocorticoid
⋆ Topical : betamethasone/triamcinolone
⋆ Systemic : prednisone; prednisolone;dexamethasone
Additions:
⋆ Azathioprine (immunosuppressive)  dogs
⋆ Chlorambucil (anticancer)  cats
⋆ Antibiotic (Niacinamide with tetracycline/doxy)  mild
cases
⋆ Chrysoterapy (gold salt;solganal;schering)
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 referensiiii
⋆ https://
www.dvm360.com/view/canine-and-feline-pemphigus-foliaceus-i
mproving-your-chances-successful-outcome
⋆ https://todaysveterinarynurse.com/articles/how-to-recognize-autoi
mmune-skin-disease-pemphigus-foliaceus/

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Merci!

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