Rodent ulcer - anything new?

RE: Rodent ulcer - anything new?

Benjamin Alyoshkin — Wed, 03 Feb 2021 17:35:12 GMT

Veterinary dermatology: unusual complaints and case studies

Ariane Neuber December 07, 2015

RE: Rodent ulcer - anything new?

Benjamin Alyoshkin — Wed, 03 Feb 2021 17:34:01 GMT

Hello, seeing this discussion 7 years after it was started. I saw a couple of cat in less than 10 days in Jan'21 in a first op practice in South London and asked myself precisely the same question as the discussion. There is a 2019 American article with free access and a little older brief update in VT, I'll post the links shortly ,cheers, Ben

RE: Rodent ulcer - anything new?

Benjamin Alyoshkin — Wed, 03 Feb 2021 17:30:00 GMT

Novel presentation of eosinophilic granuloma complex in a cat

Kaitlin P Hopke , Sandra J Sargent

First Published December 16, 2019 Case Report

Article Information

Volume: 5 issue: 2,

Article first published online: December 16, 2019; Issue published: July 1, 2019

Kaitlin P Hopke, Sandra J Sargent

Pittsburgh Veterinary Dermatology, Pittsburgh, PA, USA

Corresponding Author:

Kaitlin P Hopke DVM, Pittsburgh Veterinary Dermatology, 807 Camp Horne Road, Pittsburgh, PA 15237, USA Email: kaitlinhopke@gmail.com

This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (http://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).

Re: Rodent ulcer - anything new?

Rob Loxley — Tue, 11 Feb 2014 17:59:42 GMT

[quote user="Thomas Johnson"] I wondered if the stress and increased cortisol production triggered the recurrence of the diabetes[/quote]

Indeed, with cats often the definition of 'diabetic' isn't clear cut. Hence why some cats can go into remission given some insulin (and 'pancreatic rest') or change to low carb diet. I'd suspect these cats that go into DM shortly after giving steroids were teetering on the edge of preclinical/clinical insulin resistance.

Re: Rodent ulcer - anything new?

Thomas Johnson — Tue, 11 Feb 2014 17:28:03 GMT

[quote user="Anthony Todd"]

[quote user="Thomas Johnson"]I agree, coincidence is possible. Interestingly this cat was stabilised on Caninsulin, then went into remission 3 months later, but 9 months after that was attacked by another cat and became diabetic again a week later.[/quote]

[/quote]

The cat didn't recieve any treatment for the cat fight, according to the owner the wounds were all quite superficial but the cat was very subdued for a few days, so I wondered if the stress and increased cortisol production triggered the recurrence of the diabetes.

Re: Rodent ulcer - anything new?

emma_j — Tue, 11 Feb 2014 16:45:08 GMT

Has no one mentioned atopica yet?

I've switched quite a few of the long-term-repeat-depo cats I've seen onto the atopica liquid that is now licenced for cats, including 2 or 3 diabetics and at least 1 case that was EGC + diabetes has gone into diabetic remission after switching to atopica.

Re: Rodent ulcer - anything new?

Anthony Todd — Tue, 11 Feb 2014 16:00:17 GMT

Mmmm, why, this time, is the relapse not blamed on whatever drugs the CBA was treated with; see how steroids get such a bad name!

If I was under 25, or some others on here, I'd just say "WTF is it with diabetic cats" otherwise I'd say "Could the wise ones explain this".

[Does it mean that Depomed is saved from the recycle bin?]

Re: Rodent ulcer - anything new?

Thomas Johnson — Tue, 11 Feb 2014 15:10:07 GMT

[quote user="Anthony Todd"]

[quote user="Thomas Johnson"]Glucose in the urine ++++, hyperglycaemia, 25.6mmol/L (normal 3.9-8.0) and high fructosamine, 630umol/L (normal 0-340). Bloods were taken 5 weeks after DepoMed injection, 0.3ml to a 4.5kg cat. Owners reported that she became pu/pd a week after DepoMed injection and then progressivly more lethargic and inappetant.[/quote]

Sorry to suggest aspersions, I can only retreat behind "coincidence".

Surprised there is no mention, apart from use in known diabetics, in the datasheet.

[/quote]

I agree, coincidence is possible. Interestingly this cat was stabilised on Caninsulin, then went into remission 3 months later, but 9 months after that was attacked by another cat and became diabetic again a week later.

Re: Rodent ulcer - anything new?

Lindsay Sissons — Tue, 11 Feb 2014 13:29:07 GMT

I had also assumed that this cat must have been a borderline diabetic even tho blood glucose was normal when first bled before surgery for the excision biopsy of the lesion on its forehead.

Re: Rodent ulcer - anything new?

Lindsay Sissons — Tue, 11 Feb 2014 13:23:42 GMT

The cat in my post: BG 18.0-20.6 over several blood glucose tests, urine glucose of ++ at first sample, then ++++ second and subsequent samples, weight loss, PU/PD. BG increasing as time goes on. No glucosamine as costs being kept to a minimum.

Apoquel is not advised in cats - they have only done toxicity tests in healthy cats and know that apoquel doesn't kill them if they eat the dog's meds!!

Radiation not an option for this owner.

Re: Rodent ulcer - anything new?

Anthony Todd — Tue, 11 Feb 2014 12:13:33 GMT

Sorry to suggest aspersions, I can only retreat behind "coincidence".

Surprised there is no mention, apart from use in known diabetics, in the datasheet.

Re: Rodent ulcer - anything new?

Thomas Johnson — Tue, 11 Feb 2014 11:52:29 GMT

[quote user="Anthony Todd"]

[quote user="Thomas Johnson"]a cat that went diabetic a week after a DepoMed injection.[/quote]

Or did it just become polyuric, polydipsic and glycosuric for a while [like Westies often do if you give them a small dose of steroids]?

[/quote]

Glucose in the urine ++++, hyperglycaemia, 25.6mmol/L (normal 3.9-8.0) and high fructosamine, 630umol/L (normal 0-340). Bloods were taken 5 weeks after DepoMed injection, 0.3ml to a 4.5kg cat. Owners reported that she became pu/pd a week after DepoMed injection and then progressivly more lethargic and inappetant.

Re: Rodent ulcer - anything new?

Anthony Todd — Mon, 10 Feb 2014 21:34:42 GMT

[quote user="mariette asselbergs"]

Don't you think diabetes became manifest after the steroid injection? Were you sure the cat didn't have underlying DM when you gave the injection?

Mariette

[/quote]

Particularly if it's just being diagnosed on the polys and glycosuria....

Re: Rodent ulcer - anything new?

Anthony Todd — Mon, 10 Feb 2014 21:30:38 GMT

[quote user="Lindsay Sissons"]

Just to add a slightly different take on this thread - 8yo neutered female dsh with histo diagnosed EGC - lesions over the forehead. Depomedrone worked really nicely, but after 2 injections @4 weeks apart, cat became diabetic - now I am unable to use steroids, atopica or ovarid and the lesions have been returning since 6 weeks post last depo injection. The owner is aware that this is a difficult combination of conditions and PTS is high on the list. The cat has been on hypooallergenic food, advocate and droncit since diagnosis, with care taken with environmental chemicals - but I am struggling to find anywhere else to go with this. Any Suggestions??

[/quote]

Since PTS is on the cards a strong topical steroid [human] prep might be still worth the risk [if any] apart from my hope that the apartment diabetes, whilst being associated with the injections, may just be the result of them.

Could even try a weaker steroid say dexamethasone?

Could just give dex by injection, as and when lesions start to relapse, whith was my standard practice, rather than the course and taper so in vogue now.

Is being a "diabetic", or having the signs of it for a short period better than PTS?

Re: Rodent ulcer - anything new?

Anthony Todd — Mon, 10 Feb 2014 21:23:31 GMT

[quote user="Thomas Johnson"]a cat that went diabetic a week after a DepoMed injection.[/quote]

Or did it just become polyuric, polydipsic and glycosuric for a while [like Westies often do if you give them a small dose of steroids]?

Just so I'm clear, how are you defining diabetic; is it just sugar in the urine, high blood sugar etc. and for how long 'cos I seem to remember bitches in oestrus having glycosuria, which vanished after oestrus??

Are the cases quoted are permanent, forever diabetics needing insulin forever??

As far as I can see preexisting "diabetes" is only mentioned as a contraindication for Dmed's use.

It's been around for yonks; I would have thought it would have made the "warnings" by now??

Re: Rodent ulcer - anything new?

mariette asselbergs — Mon, 10 Feb 2014 17:33:13 GMT

Don't you think diabetes became manifest after the steroid injection? Were you sure the cat didn't have underlying DM when you gave the injection?

Mariette

Re: Rodent ulcer - anything new?

Thomas Johnson — Mon, 10 Feb 2014 17:24:00 GMT

[quote user="Anthony Todd"]

[quote user="Thomas Johnson"]but after 2 injections @4 weeks apart, cat became diabetic [/quote]

I don't think I have ever seen any side effects with Depomed in cats, certainly not diabetes, but many would say "he would say that"....

[/quote]

Not my quote, but I have seen a cat that went diabetic a week after a DepoMed injection.

Re: Rodent ulcer - anything new?

mariette asselbergs — Mon, 10 Feb 2014 16:48:15 GMT

Any Suggestions??

Radiation

Mariette

Re: Rodent ulcer - anything new?

Anthony Todd — Mon, 10 Feb 2014 16:35:46 GMT

[quote user="Thomas Johnson"]but after 2 injections @4 weeks apart, cat became diabetic [/quote]

I don't think I have ever seen any side effects with Depomed in cats, certainly not diabetes, but many would say "he would say that"....

Coincidents do happen?

Anyone else had that side effects?

Continuous Ovarid, for sure, they get fatter and fatter; not sure they're diabetic too though?

Re: Rodent ulcer - anything new?

Thomas Johnson — Mon, 10 Feb 2014 12:50:28 GMT

[quote user="Lindsay Sissons"]

[/quote]

You could speak to Zoetis to see if they've got any information on the use of Apoquel in cats yet.

Re: Rodent ulcer - anything new?

Lindsay Sissons — Mon, 10 Feb 2014 06:16:19 GMT

Re: Rodent ulcer - anything new?

Anthony Todd — Sat, 08 Feb 2014 12:13:49 GMT

[quote user="Louise Alexander"] a fair amount of FAD cats [/quote]

[quote user="Louise Alexander"]I find that getting on top of flea control very strictly (I discuss with the O' that this is a 'treatment' and must be taken seriously rather than 'applying Advocate when you remember!' etc![/quote]

I agree with all the advice about flea control and would only add that I found "28days" or "7 days" or even "Thursday" got more compliance than "monthly etc.

At last the flea message is getting through though and there is wide, but comparatively recent, acceptance of fleas as the cause in the vast majority of "miliary dermatitis" or "hormone deficiency" cases.

As far as "rodent ulcers" are concerned I don't think I have ever seen them associated with FAD but I'm prepared to be corrected.

[quote user="Louise Alexander"]As for steroids, I prefer prednisolone tablets as the dose can be tapered easily.[/quote]

I can't ever see the point of a taper if you only give one large dose as necessary and a long acting prep seems to have so many advantages both with compliance and client perception ["an injection" of anything is always perceived as being much much more effective than those fiddly little half tabletty things]

Single high doses only when gave better results and control in my hands.

[quote user="Louise Alexander"]The owner was worried about using steroids so we checked everything we could manage before starting them.[/quote]

The olympics have a lot to answer for in this regard.....

[quote user="Louise Alexander"]diagnosis of exclusion[/quote]

Yes, we actually did have a cat allergic to fish, only resolved by an almost uniquely diligent owner who followed exclusion advice to the letter. Boy, is it difficult to get the "exclusion" advice across!

Re: Rodent ulcer - anything new?

bob lehner — Sat, 08 Feb 2014 11:13:45 GMT

[quote user="Evelyn Barbour-Hill"]Cos humans get something called rodent ulcer (which is like, um, an ulcer which gnaws away at you)[/quote]

I always thought it was called a rodent ulcer because it looks like a rat (or mouse) has been nibbling at the tissue.

(Sort of thing that would happen to Baldrick whilst incarcerated in a dungeon).

Re: Rodent ulcer - anything new?

Louise6732 — Sat, 08 Feb 2014 10:40:21 GMT

[quote user="GrooveJet"]

Depo alone just didn't seem to cut it. When he's at his worst he has patches of necrosis and purulent plaques, especially inside his mouth. Convenia seems to help reduce this.

Given the total absence of FAD lesions, I'm just not convinced fleas are that much of a factor here. Also his last Allercept titre was 0 for fleas.

I'm sure it must be contact related, but to what? Perhaps I should suggest a RMB diet

[/quote]

Hi Groovejet, just my thoughts on this case as I have seen a fair amount of FAD cats this past 12-18months, and we have an excellent dermatologist vet who helps us with these cases, so I'll give you my advice which is from her protocol.

(I have recently signed off a rodent ulcer case, which I initially started on oral prednisolone tablets, but the dose I used wasn't high enough. Once I went up the ulcer really resolved very well.)

In these cases, I prefer to use Comfortis q4w, and if tricky to tablet, can get in q4w for nurses to give, which ensures compliance. Ensure all in-contact animals are treated q4w with Comfortis, although in my most recent case, Advocate has been sufficient q4w. Even if you see no signs of fleas or flea dirt, I would be thorough with flea control first as it is easy and rules out fleas as the cause (most common cause of skin allergies in cats) Also ensure house is sprayed with Acclaim/similar and hovered regularly. I have found Frontline to be useless in FAD cases, and in some cats just switching to a different flea control (Comfortis/Advocate) resolved the lesions, no additional treatment was needed, these are perhaps milder cases.

As for steroids, I prefer prednisolone tablets as the dose can be tapered easily. We started on 2 mg/kg/day for 10-14days and then tapered down for my most recent case. Finances were not unlimited for this case, so I just ran basic bloods - ALP/ALT/urea/creat/TP/gluc first before using the high dose. The owner was worried about using steroids so we checked everything we could manage before starting them.

I find that getting on top of flea control very strictly (I discuss with the O' that this is a 'treatment' and must be taken seriously rather than 'applying Advocate when you remember!' etc!) and using a good dose of steroids and tapering down sorts out the majority of cases. If you have done this and are still struggling then next step is a diet trial, which can be difficult in cats that go outside. But is worth persevering with.

The Convenia will be useful when there is infection, but if facilities allow, it's always worth taking impression smears and checking for bacteria (and eosinophils) with a Diff Quik, and only using antibiotics where necessary.

Maybe I've missed some info, but I'm not sure what you mean when you say 'absence of FAD lesions'? A rodent ulcer is an FAD lesion in my opinion, but I'm happy to hear your thoughts/input!

As with a lot of skin cases, diagnosis of exclusion is usually the way forward and communicating this to the owner at the start is vital, or else they lose faith!

Hope this is helpful, sorry if I've repeated advice from others I've just scanned the thread thus far.

Louise

Re: Rodent ulcer - anything new?

Anthony Todd — Fri, 07 Feb 2014 23:54:33 GMT

[quote user="grob"]

Ovarid......... wean down to 5mg every other week until totally resolved then try off.

[/quote]

Yep. you got it, but not these days; you've got to get a diagnosis first..... and steroids are BAD

Tried to give you more than 5 of these stupid stars but it stopped at one!