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

2. DERMATOLOGY NOT DONE YET!

3. 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

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

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

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

7. OTITIS EXTERNA MALASSEZZIA OTITIS Malassezzia resemble footprints, bowling pins, or snowmen

8. OTITIS EXTERNA BACTERIAL OTITIS ROD-SHAPED BACTERIA AND A SKIN CELL

9. 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)

10. 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.

11. ANAL SAC DISEASE

12. 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

13. ANAL SAC DISEASE

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

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

16. 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

17. 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

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

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

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

21. 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

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

23. 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

24. BENIGN TUMORS OF THE SKIN SEBACEOUS CYSTS

25. 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 FeLV AND RABIES

26. MALIGNANT SKIN TUMORS VACCINE- ASSOCIATED SARCOMAS – DIAGNOSIS: Biopsy of fine needle aspirate Physical exam findings – Swelling in area of recent vaccination – Rapidly growing firm elongated mass

27. 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

28. MALIGNANT SKIN TUMORS FELINE VACCINE-ASSOCIATED SARCOMAS

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

30. MALIGNANT SKIN TUMORS FINE NEEDLE ASPIRATE OF MAST CELL TUMOR; NOTE THE NUMEROUS GRANULES

31. MALIGNANT SKIN TUMORS IN CATS, MAST CELL TUMORS ARE USUALLY BENIGN AND MAY SPONTANEOUSLY REGRESS

32. MALIGNANT SKIN TUMORS MAST CELL TUMOR – TREATMENT Chemotherapy Radiation therapy BENADRYL H2 blockers to treat gastric ulceration and irritation – PROGNOSIS Depends on biopsy “grading” results

33. 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

34. MALIGNANT SKIN TUMORS TREATMENT INVOLVES SURGICAL REMOVAL AND POSSIBLY TREATMENT WITH THE VACCINE

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

36. 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

37. Pemphigus Foliaceus target the desmosomes between keratinocytes – IgG 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 of a dog; alopecia and erythema are also present in the dorsal nasal region

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

39. Pemphigus Foliaceus Ulceration from a deep pyoderma in a patient with pemphigus foliaceus. 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. Crusts from ruptured pustules on a dog's nasal planum and dorsal nasal region.

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

41. 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

42. Pemphigus Foliaceus

43. 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

44. Pemphigus Foliaceus Prognosis: – Mortality from pemphigus foliaceus can occur because of disease progression, medication side effects, or client- requested 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

45. References Common diseases of companion animals, Alleice Summers, 2007 Immune-Mediated Feline Skin Diseases (V69), Western Veterinary Conference 2010, Lauren R. Pinchbeck http://veterinarymedicine.dvm360.com/vetmed /ArticleStandard/Article/detail/653149