Derm SA med Autoimmune problems

nschwart's version from 2016-01-31 15:44

Section 1

Question Answer
How to DX autoimmune dzNot something you can just look at and be like ohh it's autoimmune prob
Age of oneset of Autoimmune probsusually at a young age but PF is middle aged to old!
Signalment of pemphigus foliaceous?Middle aged to older dogs, no sex predilection, common in dobbies and rotties if given trimethroprim sulfa
What is the primary lesion of pemphigus foliaceus?Pustule is the PRIMARY LESION and you will see ancantholytic cells on histopath surrounded by neutrophil! Ulcers and crusting can result
How to dx PF?Biopsy the pustules!
What if you see acantholytic cells and bacteria?Rid of the bacteria first because they can cause acantholytic cells to come in small amounts but can confuse the pathologist so treat the bac t first then send in the biopsy! R/O the deep pyo by doing this
What tick preventative can cause PF?Amitraz! Also some systemic and topical meds
When do you need to rid of bacteria before doing a biopsy??Macerated tissue culture because its targeting the deep bacteria so need to clean off the superficial bacteria
What area of the body does PF like to target?IT LOVES THE FACE and the planum nasale. Can affect the entire body though including the paw pads and ears you can see severe crusting/pustules (slide 19)
How to dx?Biopsy + histopath
What steroid to treat?Steroids in 2-3x aggressive dose until remission. Taper off slowly and monitor chem and urine because steroids increase ALP and if you also see ALT increase you know liver dmg is happening.
What immuno suppresent used to treat PF?Cyclosporin (azathiaprine is liver toxic dont use)
Prognosis of pemphigus foliaceous?Guarded to good

Section 2

Question Answer
Feline pemphigus foliaceous differs from canine becausePustules are rarely seen and cats have fewer acantholytic cells. You'll see a generalize crusting with recurrent PARONYCHIA (claw bed inflammation)
Where are the lesions of PF in cats?they're on the head, clawbed (sometimes the only place) and NIPPLES WTF??
How to treat cats with pemphigus foliaceous?use prednisOLONE. Methylprednisolone, dexamethasone, chlorambucil.

Section 3


Question Answer
Pemphigus erythematosis has characteristics of what two autoimmune dz's?pemphigus foliaceus and lupus erythematosus
Dogs that have pemphigus and erythema should avoid?AVOID ALL UV LIGHT INCLUDING SUNLIGHT.
Where can the lesions of pemphigus erythamatosus be found?mostly face and the ears (think planum nasale!)
How to dx pemphigus erythamatosus?biopsy
How to treat pemphigus erythamatosus?same as PF but might respond better.
What must you rule out on your top diff?Pemphigus foliaceus and lupus erythema

Section 4


Question Answer
Pemphigus vulgaris is common or rare?Rare as fudge
PRIMARY LESIONS IN PEMPHIGUS VULGARIS??vesicles and ulcers and it's deep that pemphigus foliaceus
Prognosis of PEMPHIGUS VULGARIS?poor/pray, hard to treat
What type of cells do you see on histopath for PEMPHIGUS VULGARIS? Tombstone cells and neutrophils.
How to dx? Bipsoy an intact vesicle but if not then biopsy the ulcers margin using the surgical ellipse biospy (should include part of the ulcer). Breaking a vesicle can make
Question Answer
What is nikolskys sign? (slide 34)Nikolsky sign is a skin finding in which the top layers of the skin slip away from the lower layers when slightly rubbed. found in pemphigus vulgaris
Treatment of pemphigus vulgaris?very aggressive immuno suppressants.

Section 5


Question Answer
Bullous pemphigoid primary lesion?vesicles with ulceration BUT NO ACANTHOLYTIC CELLS on impression smear.
What diseases other than Bullous pemphigoid can cause vesicles?Pemphigus Vulgaris, Bullous pemphigoid, drug erruptions, burns, systemic lupus.

Section 6


Question Answer
Systemic Lupus Erythematosus lesions?vesicles -ulcers - crusts. You will see polyarthropathy with weight shifting, anemia, thrombocytopenia, proteinuria, waxing and waning fever.
Dx of Systemic Lupus Erythematosus?skin biopsy, cbc, serum chem, ANA, joint tap/ biospy, make sure you rule out everything else.
Discoid Lupus Erythamatosus is common or rare?this is the benign form of SLE and is very common.
DLE lesionsPlanum nasale with no systemic signs. RULE OUT SLE first. Avoid UV light it is terrible. Causes poliocis which is graying of the skin common in auto immune dz.
Tx of DLEBe aggressive with steroids until remission but not as aggressive as you would in pemphigus. NO UV light.
How can you treat this without steroids (KNOW THIS)doxy is an anti inflammtory AB and naicinamide becomes thiamine. Use this combo instead of steroids to tx. not as good but healthier.