Derm - case of the week

RE: Derm - case of the week

Beats — Thu, 23 May 2019 21:52:28 GMT

Enough suspense:

Got 5 days preds at approx 1mg/kg/d, kept the buster collar on for a bit and had a cytopoint injection [queue controversy]. As well as a nexgard tablet.

A week later was re-examined and the nasal lesions had healed to little pink scars, the medial pinnal lesions had resolved, and the crusting was still present on the pinnal edges - on washing this off, the skin beneath was 90% healed.

Given the acute presentation, and lesions present, and marked pruritus, I personally thought this had to be facial eosinophilic furunculosis (secondary to flea bite at groomers??). Given the expected rapid resolution, I couldn't justify biopsy to prove a point, but I considered the cytology supportive, though hardly diagnostic with low numbers of eosinophils (but as Roger says, that is not unusual - I've seen cases before with no eosinophils noted at all on cytology).

I've seen them get hotspots before with the pruritus (albeit the case that springs to mind was a Golden Retriever), and this one was still very pruritic 24hrs after dexamethasone injection, hence the cytopoint on this occasion, but whether it helped or not is anyone's guess - thoughts welcome!

RE: Derm - case of the week

Rob Loxley — Thu, 23 May 2019 17:45:22 GMT

Yes, I got a biopsy report back the other week of proliferative thrombovascular necrosis - responded well to oxytet/B3

RE: Derm - case of the week

Anthony Todd — Thu, 23 May 2019 16:53:16 GMT

[quote user="Matt Hilary"]

Yes - see https://www.msdvetmanual.com/ear-disorders/diseases-of-the-pinna/miscellaneous-diseases-of-the-pinna.

[/quote]

Sure, but that's not what I said: "crusting on pinnal edges" which isn't even mentioned as far as I can see???

RE: Derm - case of the week

Matt Hilary — Thu, 23 May 2019 12:49:04 GMT

Yes - see https://www.msdvetmanual.com/ear-disorders/diseases-of-the-pinna/miscellaneous-diseases-of-the-pinna.

RE: Derm - case of the week

Anthony Todd — Thu, 23 May 2019 09:56:20 GMT

[quote user="Beats"] crusting on pinnal edges.[/quote]

Do you ever, ever, get any [classic] "crusting on pinnal edges" that isn't sarcoptes??

RE: Derm - case of the week

Beats — Wed, 22 May 2019 21:54:21 GMT

Timeline of lesions:

No lesions.

Trip to groomers.

4 days later trip to vets with reporting of crusting on pinnal edges.

Maybe 2 or 3 more days later trip to vets again - nose lesions present at that stage.

Photos and cytology taken day after that. Had been given some antihistamines and the day before had an injection of colvasone (dexamethasone) and a buster collar applied IIRC.

[I might edit this post tomorrow to make it more factually accurate if I've got some of that wrong; I only saw it the day of the photos, so can't say for sure exactly what lesions were present or looked like prior to that]

I'll give it a few days for anyone wanting to look at the cytology and comment before posting on how things progressed.

RE: Derm - case of the week

Beats — Wed, 22 May 2019 20:00:42 GMT

This picture above and next 2 are nose lesion cytology x 100objective

All rest of pictures are of impression smear made from prick of one of the medial pinnal papules (the one that looked most like a pustule!) which bled quite a bit on pricking. 1st photo at x40objective, rest at x100objective:

RE: Derm - case of the week

Neil Wheadon — Mon, 20 May 2019 16:55:44 GMT

No reason why it shouldn't be 2 different causes?

Maybe the ear has been there some time and only noticed now the nose lesions have appeared

The ear looks like sarcoptes, the nose is pretty interesting

Neil

RE: Derm - case of the week

Thomas Johnson — Mon, 20 May 2019 16:18:10 GMT

[quote user="David Mills"]Sarcoptic mange[/quote]

[quote user="robloxley"]Vasculitis? Antibiotics then biopsy?[/quote]

The pruritis and pinna lesions do make me wonder about sarcoptes, and I would definitely treat for it while continuing investigations as the lesions around the nose don't look typical.

I would have epitheliotropic lymphoma on my differential list.

RE: Derm - case of the week

Rob Loxley — Sun, 19 May 2019 16:29:55 GMT

Vasculitis? Antibiotics then biopsy?

RE: Derm - case of the week

Anthony Todd — Sun, 19 May 2019 11:34:34 GMT

Nose lesions wouldn't be something stupid like pushing nose through knot hole in garden fence when neighbours have barbecue or bitch on heat??

RE: Derm - case of the week

Roger Wilkinson — Sun, 19 May 2019 09:11:54 GMT

..oops mean to say '....they'll probably go away with steroids'

RE: Derm - case of the week

Roger Wilkinson — Sun, 19 May 2019 09:11:08 GMT

Cytology findings in eosinophilic folliculitis/furunculosis are a bit inconsistent. Altho theoretically, and quite often in practice, eosinophils should be apparent....they aren't always. Biopsy the muzzle lesions if you want a reasonable chance of a definitive diagnosis. But as Anthony says, If EFF then they'll probably go away.

I wouldn't give ABs personally since no firm indication

http://www.vetpracticesupport.com/long-term-cryptic-adverse-effects-of-antibiotic-therapy/

RE: Derm - case of the week

Anthony Todd — Sat, 18 May 2019 22:53:31 GMT

Never seen sarcoptes ever look anything like that on the nose, ear tips is classic and for sure, so Eurax rubbed well in daily anyway and check the owners inner forearms and neck for itchy pin-pricks to confirm.

The inner ear lesions aren't connected IMHO and would benefit from the 'roids as well but after checking for ear mites.

My guess is that the nose will end up on the dreaded 'roids, plus/minus ABs, get better, and we'll never know.

RE: Derm - case of the week

Roger Wilkinson — Sat, 18 May 2019 22:01:22 GMT

My money would be on eosinophilic folliculitis/furunculosis. Acute onset. Those lesions next to planum look too deep and exudative for Sarcoptes.

RE: Derm - case of the week

Beats — Sat, 18 May 2019 21:44:30 GMT

[quote user="Lucy Fleming"]What's the dog's travel history?[/quote]

Nowhere outside UK&Ireland to my knowledge.

RE: Derm - case of the week

David Mills — Sat, 18 May 2019 20:18:24 GMT

Sarcoptic mange

RE: Derm - case of the week

Lucy Fleming — Sat, 18 May 2019 18:08:02 GMT

What's the dog's travel history?

RE: Derm - case of the week

Beats — Sat, 18 May 2019 17:19:46 GMT

[quote user="Louise6732"]does the dog have a history of skin issues or any other medical problems? [/quote]

Not that I'm aware of.

[quote user="Louise6732"]When was last parasiticide applied and what product was used?[/quote]

nothing recent

[quote user="Louise6732"]Have you done any cytology on the lesions?[/quote]

I do have cytology - I'll try to photograph the slides next week (and failing that I'll just post my own interpretation).

[quote user="Louise6732"]Is the pruritus localised to the ears and nose lesions?[/quote]

Yes. (Rubbing head mainly, and also scratching at face and licking at nose lesions a lot)

Thanks for playing :-)

RE: Derm - case of the week

Louise6732 — Sat, 18 May 2019 15:17:36 GMT

Great pictures!

I have a few question—

does the dog have a history of skin issues or any other medical problems?

When was last parasiticide applied and what product was used?

Have you done any cytology on the lesions? Those under the nostrils look perfect for impression smears!

Is the pruritus localised to the ears and nose lesions? Or generalised?

Thanks!

Louise