1. Crusting of muzzle and perineum in a Cavalier King Charles spaniel
Author: Ross Bond
Editor: David Lloyd
© European Society of Veterinary Dermatology

2. History - 1 11 year-old entire male Cavalier King Charles spaniel
Progressive skin disease of 3 weeks duration
Owner reported reluctance to walk and interdigital dermatitis. Now “blisters” on perineum and scrotum
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History

3. History - 2 Dog reportedly depressed
Skin lesions progressively more severe
Thirst and appetite considered normal
Moderate pedal and perineal pruritus
History

4. Clinical signs - 1
Peri-oral crusts and fissures
Signs

5. Clinical signs - 2 Linear preputial lesion; erythema, erosion, crust

6. Clinical signs - 3
Interdigital erythema and exudation
Signs

7. How would you approach this case?
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
Signs

8. Case investigation Principle differential diagnoses
Metabolic epidermal necrosis (superficial necrolytic dermatitis, hepatocutaneous syndrome, necrolytic migratory erythema)
Pemphigus foliaceus
Differentials

9. Tests - 1 Diagnostic tests Skin scrapings Skin biopsy
Haematological and biochemical profiles
Urinalysis
Tests

10. Tests - 2 No evidence of parasites and fungal elements on microscopy
Elevated alkaline phosphatase, alanine aminotransferase, glucose, cholesterol
Mild lymphopenia and eosinopenia
Urinalysis unremarkable
Tests

11. 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
Tests

12. What is your diagnosis?
Do the investigations permit a definitive diagnosis?
Are there any additional investigations which you think may need to be done?
Tests

13. Diagnosis Metabolic epidermal necrosis
Historical and clinical features suggestive, supported by biopsy results
Laboratory tests support a metabolic disorder
Tests

14. Further tests
Post-prandial bile acids were elevated, consistent with hepatobiliary dysfunction
Abdominal ultrasonography showed diffuse hepatic disease
Tests

15. How would you deal with this case?
What is your prognosis?
How will you advise the owner?
What treatment would you consider?
Therapy

16. 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
Therapy

17. Therapy - 1 Symptomatic therapy only
Systemic and / or topical antibacterial therapy
Nutritional supplementation with high protein diets are helpful in some cases
Therapy

18. Therapy - 2
Glucocorticoids are generally contra-indicated due to the metabolic disease
Specific therapy for hepatic or pancreatic disease is ideal but seldom possible
Therapy

19. Comment - 1
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)
Notes

20. Comment - 2
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
Notes

21. Review
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Notes