crusting of muzzle and perineum in a cavalier king charles spaniel author: ross bondeditor: david...

Crusting of muzzle and perineum in a Cavalier King Charles spaniel

Author: Ross BondAuthor: Ross Bond Editor: David LloydEditor: David Lloyd

© European Society of Veterinary Dermatology © European Society of Veterinary Dermatology


History - 2

• Dog reportedly depressed

• Skin lesions progressively more severe

• Thirst and appetite considered normal

• Moderate pedal and perineal pruritus

HistoryHistory


Peri-oral crusts and fissures

Clinical signs - 1

SignsSigns


Clinical signs - 2

SignsSigns

Linear preputial lesion; erythema, erosion, crust


Clinical signs - 3

SignsSigns

Interdigital erythema and exudation


How would youapproach this case?

SignsSigns

• What are the next steps you would take?

• Make a list of your principle differential diagnoses

• List any samples you would collect

• List any tests you would perform to assist in making a definitive diagnosis


Case investigation

DifferentialsDifferentials

• Principle differential diagnoses• Metabolic epidermal necrosis (superficial necrolytic

dermatitis, hepatocutaneous syndrome, necrolytic migratory erythema)

• Pemphigus foliaceus


Tests - 1

TestsTests

• Diagnostic tests• Skin scrapings• Skin biopsy• Haematological and biochemical profiles• Urinalysis


Tests - 2

TestsTests

• No evidence of parasites and fungal elements on microscopy

• Elevated alkaline phosphatase, alanine aminotransferase, glucose, cholesterol

• Mild lymphopenia and eosinopenia

• Urinalysis unremarkable


Tests - 3

• Skin biopsies showed• compact diffuse parakeratosis and hydropic

degeneration of the upper epidermis• Mild acanthosis and sparse mononuclear cell infiltrate

in the upper dermis

TestsTests


What is yourdiagnosis?

• Do the investigations permit a definitive diagnosis?

• Are there any additional investigations which you think may need to be done?

TestsTests


Diagnosis

• Metabolic epidermal necrosis• Historical and clinical features suggestive, supported

by biopsy results• Laboratory tests support a metabolic disorder

TestsTests


Further tests

• Post-prandial bile acids were elevated, consistent with hepatobiliary dysfunction

• Abdominal ultrasonography showed diffuse hepatic disease

TestsTests


How would you deal with this case?

• What is your prognosis?

• How will you advise the owner?

• What treatment would you consider?

TherapyTherapy


Prognosis

• Prognosis is poor• Many cases are difficult to manage and require

euthanasia, either because of the severe skin disease or due to hepatic disease or pancreatic neoplasia

TherapyTherapy


Therapy - 1

TherapyTherapy

• Symptomatic therapy only

• Systemic and / or topical antibacterial therapy

• Nutritional supplementation with high protein diets are helpful in some cases


Therapy - 2

• Glucocorticoids are generally contra-indicated due to the metabolic disease

• Specific therapy for hepatic or pancreatic disease is ideal but seldom possible

TherapyTherapy


Comment - 1

NotesNotes

• Most dogs have associated hepatic disease (vacuolar alteration or cirrhosis); a few have pancreatic glucagonomas

• Some dogs become diabetic

• The cause of the hepatic and skin disease is unknown

• Skin lesions may reflect hypoaminoacidemia (present in this case)


Comment - 2

NotesNotes

• The periorificial lesions plus footpad hyperkeratosis are the usual findings

• Often confused with autoimmune diseases

• Ultrasound may allow visualisation of pancreatic neoplasia or metastases in rare cases, and distinguish from liver disease

• Bile acid assays useful for assessment of hepatic function


Review

NotesNotes

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crusting of muzzle and perineum in a cavalier king charles spaniel author: ross bondeditor: david...

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