MOTIVATION Our deepest fear is not that we

MOTIVATION “Our deepest fear is not that we are inadequate, our deepest fear is that we are powerful beyond measure…” -Marianne Williamson

DERMATOLOGY NOT DONE YET!

OTITIS EXTERNA An acute or chronic inflammatory disease of the external ear canal Clinical signs: › › › Head rubbing or shaking Ear scratching Head tilt – with the affected ear tilted down Malodorous otic discharge (brown, greenish-yellow) Lichenification, hyperpigmentation, crusts, erythema and excoriations may be present › Aural hematoma

OTITIS EXTERNA NOTE THE EXCESS BROWN EXUDATE ERYTHEMA, HYPERPIGMENTATION, LICHENIFICATION AURAL HEMATOMA

OTITIS EXTERNA • PREDISPOSING FACTORS: – Conformation • Heavy, pendulous ears • Stenotic ear canals • Ear hair – Excessive moisture • Frequent bathing or swimming – Hypersensitivities • Food allergy, atopy

OTITIS EXTERNA • DIAGNOSIS: – Otoscopic exam – Clinical signs – Cytology, ear smear • Yeast, bacteria, cerumen, skin cells

OTITIS EXTERNA • MALASSEZZIA OTITIS Malassezzia resemble footprints, bowling pins, or snowmen

OTITIS EXTERNA • BACTERIAL OTITIS ROD-SHAPED BACTERIA AND A SKIN CELL

OTITIS EXTERNA • TREATMENT – Always treat the underlying condition if present – Topical meds instilled daily • Antibacterial, antifungal, or combination products often with steroids (otomax, tresaderm, baytril otic) • Cleaning ears during treatment – Surgical intervention may be required • Aural hematoma • Chronic conditions (Total Ear Canal Ablation)

ANAL SAC DISEASE The anal sacs are located between the muscle layers of the anus at the 4 and 8 o’clock positions. Each sac connects to the surface through a narrow duct. Sebaceous glands produce a foul-smelling oily, brown fluid. The sacs are naturally expressed during defecation, but can sometimes overfill.

ANAL SAC DISEASE

ANAL SAC DISEASE • IMPACTION – When the sacs overfill, the water can be reabsorbed, and the material dries out. • Sacs become a source of discomfort for the dog and are difficult to express at this time. – Impaction can lead to abscessation and rupture. • Clinical signs include: scooting rear end across the floor, painful defecation, tail chasing, perianal erythema, and/or swelling

ANAL SAC DISEASE

ANAL SAC DISEASE • DIAGNOSIS – Palpation (rectally or externally) – Clinical signs • TREATMENT – Express contents – Flush sac – Instill antibiotic ointment – Oral antibiotics, anti-inflammatories – Surgery?

ANAL SAC DISEASE WEARING GLOVES, GENTLY MILK THE GLANDS IN AN UPWARD MOTION TO EXPRESS.

TUMORS OF THE SKIN Tumors are a new growth of tissue characterized by progressive, uncontrolled proliferation of cells. Benign vs. Malignant Localized vs. Invasive Adenoma/Carcinoma vs. Sarcomas

BENIGN TUMORS OF THE SKIN • HISTIOCYTOMA: small, button-like tumors that are usually pink, hairless, and raised. They are rapidly growing Common locations include the pinnae, head, and legs

BENIGN TUMORS OF THE SKIN HISTIOCYTOMA › Occurs almost exclusively in young dogs <4 yrs old DIAGNOSIS › Appearance › biopsy TREATMENT › These tumors may spontaneously regress, but surgical excision is the treatment of choice ROUND CELL TUMOR

BENIGN TUMORS OF THE SKIN • LIPOMA: tumor of the subcutaneous adipocytes (fat cells) that are typically freely movable and wellcircumscribed – Common in older, female, obese dogs • DIAGNOSIS: – Biopsy – Fine needle aspirate

BENIGN TUMORS OF THE SKIN • LIPOMA – TREATMENT: • Surgical excision • Benign neglect lipocytes

BENIGN TUMORS OF THE SKIN • PAPILLOMAS: wart-like growths that develop as smooth, white/pink/pigmented, elevated lesions in the oral cavity (oral papillomatosis) or on the skin (cutaneous papillomas) – These growths are caused by a papillomavirus

BENIGN TUMORS OF THE SKIN • PAPILLOMAS – DIAGNOSIS: • Appearance • Biopsy – TREATMENT • Usually spontaneous regression • Autogenous vaccine

BENIGN TUMORS OF THE SKIN • SEBACEOUS GLAND CYSTS: Slow growing, encapuslated, round, and exude a gray, cheeselike material. Caused by degenerative changes in the glandular area surrounding the follicle. – Common in cocker spaniels • DIAGNOSIS • Contents of the cyst • histology • TREATMENT – Surgical removal of entire encapsulated cyst

BENIGN TUMORS OF THE SKIN SEBACEOUS CYSTS

MALIGNANT SKIN TUMORS • FELINE VACCINE-INDUCED FIBROSARCOMAS: rapidly developing, highly invasive, malignant tumors that occur at the site of vaccination ~4 -6 weeks later. – VACCINES MOST COMMONLY IMPLICATED ARE THOSE WITH ADJUVANTS (substance that enhances the immune response by increasing the stability of a vaccine in the body) SUCH AS Fe. LV AND RABIES

MALIGNANT SKIN TUMORS • VACCINEASSOCIATED SARCOMAS – DIAGNOSIS: • Biopsy of fine needle aspirate • Physical exam findings – Swelling in area of recent vaccination – Rapidly growing firm elongated mass

MALIGNANT SKIN TUMORS • VACCINE-ASSOCIATED SARCOMAS – TREATMENT • Radical surgical excision which may involve limb amputation is the treatment of choice – CLIENT INFORMATION • Poor prognosis if not detected early and treated aggressively • Inflammatory lumps may do develop after vaccines but usually disappear within 1 -2 weeks

MALIGNANT SKIN TUMORS FELINE VACCINE-ASSOCIATED SARCOMAS

MALIGNANT SKIN TUMORS • MAST CELL TUMORS: firm nodules on the skin that may be ulcerated or edematous. Mast cells contain histamine and heparin

MALIGNANT SKIN TUMORS FINE NEEDLE ASPIRATE OF MAST CELL TUMOR; NOTE THE NUMER

MALIGNANT SKIN TUMORS IN CATS, MAST CELL TUMORS ARE USUALLY BENIGN AND MAY SPONTA

MALIGNANT SKIN TUMORS • MAST CELL TUMOR – TREATMENT • • Chemotherapy Radiation therapy BENADRYL H 2 blockers to treat gastric ulceration and irritation – PROGNOSIS • Depends on biopsy “grading” results

MALIGNANT SKIN TUMORS • MELANOMA (Benign or Malignant) – BENIGN: small, slow growing, hairless, pigmented – MALIGNANT: large, dome-shaped sessile +/pigmentation • Ex: Tumors of the oral cavity and digits • Poor prognosis – Metastasize readily – Recurrence after surgery is common

MALIGNANT SKIN TUMORS TREATMENT INVOLVES SURGICAL REMOVAL AND POSSIBLY TREATME

Immune mediated conditions • • Pemphigus (‘blistering disease’)Foliaceus Pemphigus Erythematosus Pemphigus Vulgaris Bullous Pemphigoid Lupus Erythematosus Alopecia Areata Pseudopelade

Immune mediated • antibody-mediated or cell-mediated immune response directed against normal components of the skin • Pemphigus complex: pemphigus foliaceus (PF), pemphigus erythematosus (PE), panepidermal pustular pemphigus, pemphigus vulgaris (PV), and paraneoplastic pemphigus • autoantibodies target adhesion proteins, intra- or subepidermal separation results in autoimmune blistering skin disease

Pemphigus Foliaceus • target the desmosomes between keratinocytes – Ig. G autoantibodies • Genetics: Akitas and chows • age of onset is variable – 1 to 16 years in dogs – less than 1 year of age to up to 17 years of age in cats • UV light A pustule just caudal to the planum nasale o alopecia and erythema are also present in the dorsal nasal region

Pemphigus Foliaceus • Drugs: cimetidine, cephalexin, amoxicillin and clavulanic acid, ampicillin, and trimethoprimsulfonamide combinations • Lesions: – erythematous macules that then progress rapidly to a pustular stage – crusting dermatitis, Scale, alopecia, erosions, collarettes, and erythema – "face, feet and ears"

Pemphigus Foliaceus Ulceration from a deep pyoderma in a patient Crusts from ruptured pustules on a do with pemphigus foliaceus. nasal planum and dorsal nasal region Ulcers should not be seen in pemphigus foliaceus patients unless another condition such as a pyoderma is present. Note the symmetrical appearance of the facial lesions.

Pemphigus Foliaceus • Clinical signs: – Skin lesions – Systemic signs such as fever, lethargy, anorexia, and lymphadenopathy – +/- Pruritus (skin lesions develop before pruritus)

Pemphigus Foliaceus • mild and localized disease – erosions and yellowish crusts • Dx: – acantholytic keratinocytes (arrows), histology, IFA – Dogs can have a mild to moderate leukocytosis with neutrophilia and a mild to moderate nonregenerative, normocytic, and normochromic anemia (anemia of chronic disease – Cats: as above and basophilia, eosinophilia, lymphopenia, and monocytosis

Pemphigus Foliaceus

Pemphigus Foliaceus • Treatments – Glucocorticoids • Prednisone is initially started at 2 mg/kg/day orally in dogs, • prednisolone is initially started at 2 to 4 mg/kg/day orally in cats • cats, triamcinolone can be initially dosed at 2 to 4 mg/kg/day orally, and dexamethasone can be initially dosed at 0. 3 to 0. 6 mg/kg/day orally

Pemphigus Foliaceus • Prognosis: – Mortality from pemphigus foliaceus can occur because of disease progression, medication side effects, or clientrequested euthanasia. – Severe cases of pemphigus foliaceus can result in marked cachexia or sepsis secondary to infections. – Adverse effects are common with most of the medications used for pemphigus foliaceus. – Euthanasia accounted for almost 70% of deaths in pemphigus foliaceus dogs in one retrospective study • Client education

References • Common diseases of companion animals, Alleice Summers, 2007 • Immune-Mediated Feline Skin Diseases (V 69), Western Veterinary Conference 2010, Lauren R. Pinchbeck • http: //veterinarymedicine. dvm 360. com/vetmed /Article. Standard/Article/detail/653149