Foot pad lesions

RE: Foot pad lesions

Anthony Todd — Wed, 17 May 2017 12:11:06 GMT

[quote user="Sarah Keir"]Do I be brave and try 'roids?[/quote]

Any update?

RE: Foot pad lesions

mariette asselbergs — Sun, 07 May 2017 19:18:14 GMT

There is a nice detailed article on nose and pad problems in the latest In Practice.

Mariette

RE: Foot pad lesions

Anthony Todd — Fri, 05 May 2017 18:11:14 GMT

[quote user="Sarah Keir"]Do I be brave and try 'roids?[/quote]

Or what else? What have you got to lose?

But if you do, give an adequate, or high dose for a short period. You will get a response within 48 hours or not.

Don't do the usual inadequate, minimal, dose for a month and then say they don't work!

In the meantime or concurrently explore the possible causes, and there's no disadvantage in supplementing the Zn.

It's going to be quicker and cheaper than more narrative biopsies etc.

RE: Foot pad lesions

Sarah Keir — Fri, 05 May 2017 09:32:01 GMT

The primary lesions are ulcers and the feet are only pruritic when an ulcer appears and tries healing so I think the histo report is only reporting the secondary changes.

Do I be brave and try 'roids?

RE: Foot pad lesions

Sarah Keir — Tue, 02 May 2017 16:55:36 GMT

Histopathology report

DIAGNOSIS
Dermatitis/pododermatitis, severe, chronic, lymphoplasmacytic and histiocytic,
lichenoid to interface, with prominent epithelial hyperplasia, orthokeratotic and
parakeratotic hyperkeratosis, multifocal apoptotic keratinocytes, basal degeneration,
pigmentary incontinence and dermal fibrosis (please see comment)
CLINICAL HISTORY
Biopsies from the footpads are taken from Rufus. The dog shows ulcerated areas on the
sides of several pads, including a dew pad. The main pads are soft but normal. The
lesion is ulcerated and then raw and dried out. They are nonpruritic until ulcerated.
Bloods are normal, and no other skin or mucocutaneous lesions are seen.
HISTOLOGY
Blocks A+B, 7 sections: Findings are largely similar in all sections. They reveal the
presence of a severe, lichenoid and partially interface infiltration of the dermis,
mainly by lymphocytes and plasma cells with fewer neutrophils. The overlying epidermis
shows a prominent hyperplasia with rete ridge formation as well as severe
orthokeratotic and parakeratotic hyperkeratosis. There are multifocal crusts composed
of parakeratotic keratin, cellular debris, fibrin, proteinaceous fluid and clusters of
bacteria. The inflammatory cells multifocally transmigrate the epidermal and
follicular epithelium, and there are multifocal apoptotic keratinocytes. Moderate
basal degeneration is present. There is multifocal pigmentary incontinence. There is
moderate dermal fibrosis, and apocrine glands are moderately dilated. The sebaceous
glands show a moderate hyperplasia.
COMMENT
This is a difficult case. Based on the histopathological findings alone, this lesion
could represent a chronic bacterial infection with secondary self-mutilation/trauma
and acral lick dermatitis. However, the presence of lesions on nearly all feet also
raise the concern for an underlying non-infectious/immune-mediated disease, especially
given the basal cell degeneration and multifocal apoptotic cells. There is also
prominent hyperkeratosis which is, however, assumed to represent a secondary change in
this case. I have shared this case with my colleague Dr Fernando Ramiro-Ibanez who has
a special interest and many years of experience in dermatopathology, and I will share
his opinion on this case with you as soon as possible. It might definitely be worth to
take samples for bacterial/fungal culture, since there is evidence for bacterial infection.

=========================== FURTHER REPORT =============================
I shared this case with my colleague Dr Fernando Ramiro-Ibanez. His main aetiological
differential for this lesion is an irritant-contact response with secondary pyoderma. I
recommend specific antibiotic treatment to clear the bacterial infection and evaluation
of the possible underlying reaction. It might also be worth to discuss this case with a
clinical dermatologist, who can be reached via the customer support team.

RE: Foot pad lesions

Lou Dawson — Sun, 30 Apr 2017 10:08:30 GMT

In my opinion, a number of dermatopathies are just descriptions - cyclical flank alopecia, colour dilution alopecia, deep pyoderma, interdigital furunculosis....

Split pawpad disease is described in Chapter 4 of the textbook 'Skin Diseases of the Dog and Cat' by Thelma Lee Gross et al. It's rare so I doubt many would be aware of it unless they'd seen a case. http://onlinelibrary.wiley.com/store/10.1002/9780470752487.fmatter/asset/fmatter.pdf;jsessionid=F123D3C51653F5551532DBFD9119B415.f03t02?v=1&t=j24gv1mi&s=337f276d2d6afe2d33589bc37c85131c873f1752

(apologies for clogging up your thread Sarah)

RE: Foot pad lesions

David Mills — Sun, 30 Apr 2017 01:14:47 GMT

GSD = pemphigus. Trial preds/doxy.

"split pad disease" we are scraping barrels. Since when did a description = diagnosis?!

RE: Foot pad lesions

Noweia — Fri, 28 Apr 2017 22:45:09 GMT

[quote user="Sarah Keir"]

Bloods were normal and no weight loss or anything else to suggest serious liver disease.

[/quote]

Neither had ours, just had pawpad lesions on several pads on several paws, which slowly progressed to all the pads. She had no other signs of disease initially either. Took us a while to pinpoint the cause!

RE: Foot pad lesions

Anthony Todd — Fri, 28 Apr 2017 19:28:22 GMT

[quote user="Lou Dawson"]pawpads are third most commonly affected site for zn-responsive dermatosis according to the literature, after periorbital and perioral regions.[/quote]

You may well be right, I was only [frankly] going on the one time I saw it when a dried food [well known, but name forgotten] produced a dried diet low in fat therefore low in Zn and the original description of "fat deficiency" in dried food way back when in some Texas Vet Journal, which was the basis for the fat-free phobia.

The one I saw matched the picture in the Texas journal of a raised circular area looking rather like a foot pad on the front leg of a dog, or exuberant ringworm.

I doubt if it will ever be seen now 'cos the manufacturers add Zn....

RE: Foot pad lesions

Lou Dawson — Fri, 28 Apr 2017 16:34:42 GMT

[quote user="Anthony Todd"]

[quote user="Lou Dawson"]zinc responsive dermatosis[/quote]

Don't think you get lesions at muco/cut junctions??

[/quote]

pawpads are third most commonly affected site for zn-responsive dermatosis according to the literature, after periorbital and perioral regions. Can't comment on whether that is an accurate representation of what walks through the door as I've never seen a clinical case, only biopsies and I'm lucky if I get told what site they are from! (As an aside, zn in adult dogs is husky breeds so unlikely here, just that the lesions are similar grossly)

RE: Foot pad lesions

Anthony Todd — Fri, 28 Apr 2017 16:27:56 GMT

[quote user="Lou Dawson"]zinc responsive dermatosis[/quote]

Don't think you get lesions at muco/cut junctions??

RE: Foot pad lesions

Sarah Keir — Fri, 28 Apr 2017 15:52:11 GMT

Bloods were normal and no weight loss or anything else to suggest serious liver disease.

RE: Foot pad lesions

Lou Dawson — Fri, 28 Apr 2017 09:08:17 GMT

Checked in the book and split pawpad disease doesn't have any breed predispositions listed. I have a vague recollection that the only case I've diagnosed was in a GSD so must be where I got that idea from! The book lists ddx as pemphigus foliaceus, zinc responsive dermatosis, generic dog food dermatosis and hepatocutaneous syndrome but for all of those, lesions are not confined to the pawpads. Hope you get your biopsy result soon!

RE: Foot pad lesions

emma o'connor — Thu, 27 Apr 2017 09:44:02 GMT

Another vote here for hepatocutaneous syndrome or immune-mediated disease. Hopefully the biopsies will help.

RE: Foot pad lesions

Utlendigur — Wed, 26 Apr 2017 22:33:54 GMT

[quote user="Noweia"]Hepatocutaneous syndrome? [/quote]

+1 for hepatocutaneous syndrome

RE: Foot pad lesions

rhmrcvs — Wed, 26 Apr 2017 22:32:54 GMT

2nd vote for hepatocutaneous syndrome

RE: Foot pad lesions

Noweia — Wed, 26 Apr 2017 22:04:00 GMT

Hepatocutaneous syndrome? We had one that had normal ALT and ALKP but liver looked like swiss cheese on ultrasound.

RE: Foot pad lesions

Sarah Keir — Wed, 26 Apr 2017 21:52:02 GMT

I could find a lot of 'diseases of foot pads in GSD' given a variety of names but tehy just sound like made up thing!

RE: Foot pad lesions

Lou Dawson — Wed, 26 Apr 2017 21:48:40 GMT

Split pawpad disease? Would have to double check in the books but think that's a GSD thing...

RE: Foot pad lesions

Joyce Whitehead — Wed, 26 Apr 2017 21:46:05 GMT

Sorry, didn't notice that sentence!

RE: Foot pad lesions

Sarah Keir — Wed, 26 Apr 2017 21:42:40 GMT

That is why I mentioned not mentioning the obvious! No other lesions anywhere on mucocutaneous junctions or skin.

RE: Foot pad lesions

Joyce Whitehead — Wed, 26 Apr 2017 21:36:49 GMT

Pemphigus foliaceus would be my suspicion - hopefully your biopsies would be diagnostic if that is the case. I've certainly seen pad lesions with it. And I think GSDs are over represented.

RE: Foot pad lesions

Sarah Keir — Wed, 26 Apr 2017 20:31:07 GMT