Crusting of muzzle and perineum in a Cavalier King Charles spaniel

Crusting of muzzle andperineum in a CavalierKing Charles spaniel

Author: Ross Bond

Editor: David Lloyd

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History - 1

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•11 year-old entire male Cavalier King Charlesspaniel

•Progressive skin disease of 3 weeks duration

•Owner reported reluctance to walk and interdigitaldermatitis. Now “blisters” on perineum and scrotum

History

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History - 2

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•Dog reportedly depressed

•Skin lesions progressively more severe

•Thirst and appetite considered normal

•Moderate pedal and perineal pruritus

History

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Peri-oral crusts andfissures

Clinical signs - 1

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Signs

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Clinical signs - 2

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Signs

Linear preputiallesion; erythema,erosion, crust

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Clinical signs - 3

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Signs

Interdigital erythemaand exudation

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How would youapproach this case?

Signs

•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 adefinitive diagnosis

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Case investigation

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Differentials

•Principle differential diagnoses

•Metabolic epidermal necrosis (superficial necrolyticdermatitis, hepatocutaneous syndrome, necrolyticmigratory erythema)

•Pemphigus foliaceus

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Tests - 1

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Tests

•Diagnostic tests

•Skin scrapings

•Skin biopsy

•Haematological and biochemical profiles

•Urinalysis

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Tests - 2

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Tests

•No evidence of parasites and fungal elements onmicroscopy

•Elevated alkaline phosphatase, alanineaminotransferase, glucose, cholesterol

•Mild lymphopenia and eosinopenia

•Urinalysis unremarkable

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Tests - 3

•Skin biopsies showed

•compact diffuse parakeratosis and hydropicdegeneration of the upper epidermis

•Mild acanthosis and sparse mononuclear cell infiltratein the upper dermis

Tests

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What is yourdiagnosis?

•Do the investigations permit a definitive diagnosis?

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

Tests

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Diagnosis

•Metabolic epidermal necrosis

•Historical and clinical features suggestive, supportedby biopsy results

•Laboratory tests support a metabolic disorder

Tests

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Further tests

•Post-prandial bile acids were elevated, consistent withhepatobiliary dysfunction

•Abdominal ultrasonography showed diffuse hepaticdisease

Tests

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How would you dealwith this case?

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•What is your prognosis?

•How will you advise the owner?

•What treatment would you consider?

Therapy

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Prognosis

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•Prognosis is poor

•Many cases are difficult to manage and requireeuthanasia, either because of the severe skindisease or due to hepatic disease or pancreaticneoplasia

Therapy

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Therapy - 1

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Therapy

•Symptomatic therapy only

•Systemic and / or topical antibacterial therapy

•Nutritional supplementation with high protein dietsare helpful in some cases

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Therapy - 2

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•Glucocorticoids are generally contra-indicated due tothe metabolic disease

•Specific therapy for hepatic or pancreatic disease isideal but seldom possible

Therapy

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Comment - 1

Notes

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

•Some dogs become diabetic

•The cause of the hepatic and skin disease isunknown

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

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Comment - 2

Notes

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•The periorificial lesions plus footpad hyperkeratosisare the usual findings

•Often confused with autoimmune diseases

•Ultrasound may allow visualisation of pancreaticneoplasia or metastases in rare cases, anddistinguish from liver disease

•Bile acid assays useful for assessment of hepaticfunction

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Review

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Notes

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