1. Crusting and ulceration in a crossbred dog
Author: David Grant
Editor: David Lloyd
© European Society of Veterinary Dermatology

2. History – 1 2-year-old entire male crossbred dog Weight 10 kg
Initial ‘sores’ on lip, nose, scrotum developed over ‘a week or two’
Dog otherwise healthy. No pruritus.
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History

3. History - 2 Treated with antibiotics and steroids
2 weeks later no response
Dog now shows malaise, anorexia
History

4. History - 3 No other history of dermatological disease
There is a healthy canary but no other animals in the house
Owners have no lesions
No history of contact with or ingestion of irritant substances
Rectal temperature 103oC
Depressed demeanour
History

5. Clinical signs - 1
Crusting, mucopurulent discharges and ulceration are apparent at various sites
Ulceration and discharge from the lids of the left eye
Ulceration of the lip margins
Signs

6. Clinical signs - 2
Crusting, exudation and pustular lesions affecting the footpads
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. Differential diagnoses
Bullous pemphigoid, drug eruption, SLE, mococutaneous candidiasis
Also ulcerative stomatitis, neoplasia, dermatophytosis, secondary pyoderma
Differentials

9. Tests - 1 Skin scrapings, Nikolsky test
Blood tests: routine haematology and biochemical screens
Fungal culture of crusts and exudate
Multiple biopsy samples from intact vesicles/pustules and edges of ulcers
Tests

10. Tests - 2
Scrapings from crusted areas did not reveal ectoparasites or fungal structures
The Nikolsky sign was not elicited
Smears of exudate stained with Giemsa showed coccoid and rod- shaped bacteria in moderate numbers, neutrophils, and some acanthocytes
No satisfactory smears were obtained from intact pustules or vesicles
Tests

11. What now?
What treatment should you now institute, if any, whilst waiting for the fungal cultures and biopsy results?
What are now your principle differential diagnoses?
Are there any other samples you would collect
Tests

12. Tests - 3
Blood screens showed a slight neutrophilia but were otherwise unremarkable
Fungal cultures were negative for dermatophytes or yeasts
Histopathological examination of biopsy samples revealed an intra- and sub-epidermal vesicular dermatitis
Tests

13. Tests - 4 Histopathology
Acanthosis with suprabasilar and some subepidermal clefts. A lichenoid band of inflammatory cells and some pigmentary incontinence in upper dermis and around follicles
Tests

14. 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

15. Diagnosis Pemphigus vulgaris
Lesion type, location and histopathology are consistent
No history of previous drug therapy and histopathology not consistent with EM and TEN
Vesicles or bullae are subepidermal in bullous pemphigoid
Fungal culture was negative
Tests

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

17. Prognosis Prognosis is guarded
Disease can be fatal if not successfully treated
Dogs may not tolerate steroids and other immunomodulatory drugs
Lifelong therapy is necessary
Tests

18. Therapy Induction therapy - first 3 weeks
Methylprednisolone orally, 5 mg/kg daily
Azathioprine orally, 2.2 mg/kg every other day
Therapy

19. Response to therapy After 3 weeks the lesions were in remission
Therapy continued as
Methylprednisolone, 2 mg/kg every other day
Azathioprine, 2.2 mg/kg on the alternate days
At 6 months the dog was still in remission
Notes

20. Review
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Notes