Crusting of muzzle andperineum in a CavalierKing Charles spaniel
Author: Ross Bond
Editor: David Lloyd
  © European Society of Veterinary Dermatology
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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
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History - 1
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11 year-old entire male Cavalier King Charlesspaniel
Progressive skin disease of 3 weeks duration
Owner reported reluctance to walk and interdigitaldermatitis.  Now “blisters” on perineum and scrotum
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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
History - 2
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Dog reportedly depressed
Skin lesions progressively more severe
Thirst and appetite considered normal
Moderate pedal and perineal pruritus
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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
Peri-oral crusts andfissures
Clinical signs - 1
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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
Clinical signs - 2
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Linear preputiallesion; erythema,erosion, crust
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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
Clinical signs - 3
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Interdigital erythemaand exudation
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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
How would youapproach this case?
Signs
What are the next steps you would take?
Make a list of your principle differential diagnoses
List any samples you would collect
List any tests you would perform to assist in making adefinitive diagnosis
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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
Case investigation
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Principle differential diagnoses
Metabolic epidermal necrosis (superficial necrolyticdermatitis, hepatocutaneous syndrome, necrolyticmigratory erythema)
Pemphigus foliaceus
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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
Tests - 1
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Diagnostic tests
Skin scrapings
Skin biopsy
Haematological and biochemical profiles
Urinalysis
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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
Tests - 2
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No evidence of parasites and fungal elements onmicroscopy
Elevated alkaline phosphatase, alanineaminotransferase, glucose, cholesterol
Mild lymphopenia and eosinopenia
Urinalysis unremarkable
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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
Tests - 3
Skin biopsies showed
compact diffuse parakeratosis and hydropicdegeneration of the upper epidermis
Mild acanthosis and sparse mononuclear cell infiltratein the upper dermis
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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
What is yourdiagnosis?
Do the investigations permit a definitive diagnosis?
Are there any additional investigations which you thinkmay need to be done?
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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
Diagnosis
Metabolic epidermal necrosis
Historical and clinical features suggestive, supportedby biopsy results
Laboratory tests support a metabolic disorder
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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
Further tests
Post-prandial bile acids were elevated, consistent withhepatobiliary dysfunction
Abdominal ultrasonography showed diffuse hepaticdisease
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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
How would you dealwith this case?
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What is your prognosis?
How will you advise the owner?
What treatment would you consider?
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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
Prognosis
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Prognosis is poor
Many cases are difficult to manage and requireeuthanasia, either because of the severe skindisease or due to hepatic disease or pancreaticneoplasia
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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
Therapy - 1
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Symptomatic therapy only
Systemic and / or topical antibacterial therapy
Nutritional supplementation with high protein dietsare helpful in some cases
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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
Therapy - 2
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Glucocorticoids are generally contra-indicated due tothe metabolic disease
Specific therapy for hepatic or pancreatic disease isideal but seldom possible
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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
Comment - 1
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Most dogs have associated hepatic disease(vacuolar alteration or cirrhosis); a few havepancreatic glucagonomas
Some dogs become diabetic
The cause of the hepatic and skin disease isunknown
Skin lesions may reflect hypoaminoacidemia(present in this case)
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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
Comment - 2
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The periorificial lesions plus footpad hyperkeratosisare the usual findings
Often confused with autoimmune diseases
Ultrasound may allow visualisation of pancreaticneoplasia or metastases in rare cases, anddistinguish from liver disease
Bile acid assays useful for assessment of hepaticfunction
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History  |  Signs  |  Differentials  |  Tests  |  Therapy  |  Notes
Review
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