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With chronicity, erosions, ulcerations and crusting occur. Annular to polycyclic hyperpigmented plaques involving the neck, trunk and extremities may be seen in the generalized variant cases. Histopathology reveals interface basal cell degeneration (apoptosis), with a moderate pleocellular lichenoid infiltrate of the dermis. As this disease can closely mimic mucocutaneous pyoderma both clinically and histopathologically, cytologic evaluation of the nasal planum below a crust can be useful; treatment of mucocutaneous pyoderma is recommended if bacteria are present. In most cases of DLE, the use of potent immunosuppressants are unnecessary; a systemic immunomodulatory approach utilizing a tetracycline (doxycycline, minocycline) and niacinamide coupled with topical therapy (topical steroids, tacrolimus) is often successful at controlling the disease. In refractory or severe cases, high doses of corticosteroids may be needed initially. In the reported generalized variants, hydroxychloroquine or cyclosporine were effective treatments. As sunlight plays a significant role in DLE, it is important that sun exposure be minimized with avoidance and use of sunscreens. Vitamin E supplementation (400 IU daily) may also be helpful. Erythema multiforme A rare immune-mediated dermatosis, erythema multiforme (EM) can be idiopathic in nature or triggered by numerous factors, including drugs, bacterial infections, parvovirus, food, vaccination and neoplasia. In one review of 44 dogs with EM, drugs were the trigger in 26 (59%) cases; the most commonly implicated drugs are antibiotics such as trimethoprim-potentiated sulfonamides, penicillins and cephalosporins. EM has been subclassified into major and minor forms. EM minor is mild, with acute onset of the typical target lesions most often involving the extremities, with no or slight mucosal involvement; if present, it is limited to the oral mucosa, and systemic symptoms are not noted. EM major is more severe, with significant mucosal involvement and often constitutional symptoms such as lethargy and pyrexia. The distinction between EM major and Stevens-Johnson syndrome (SJS) can be difficult, and it is possible that many cases diagnosed as EM may actually be a result of SJS. Skin lesions are variable, and this disease can mimic many other dermatoses; however lesions may have an acute onset and are often symmetrical, consisting of erythematous macules or elevated papules that spread peripherally, clearing centrally.
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