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1 Sponsorship Introduc.on% Garret%Pach.nger,%VMD,% DACVECC% COO,%VETgirl% 1%

2 Introduction Jus.ne%A.%Lee,%DVM,% DACVECC,%DABT% CEO,%VETgirl% Conflict of Interest Disclosure VETgirl On-The-Run! The tech-savvy way to get online veterinary CE!! A subscription-based podcast and webinar service offering veterinary RACE-approved CE 2%

3 VETgirl ELITE podcasts/year plus 24+ hours of webinars!! $199/year! 30+ hours of RACE-CE VETgirl TEAM memberships!! Up to 5 members: $599/year! Up to 10 members: $999/year! > 10 members: $1399/year! > 20 members: Ping us 3%

4 New and improved video! Easier playback, less buffering better! Download our itunes podcasts free! Social media and our blog! 4%

5 Logistics: CE Certificates " No%need%to%raise%your%hand!% " Type%in%ques.ons% " ed%to%you%48%hours%aPer%the%webinar% " Ac.ve%par.cipa.on%=%no%quiz% " Watching%video%later,%must%complete%quiz% " ELITE%members%only% " %/%contact%with%ANY%ques.ons% " " Call in from Smart Phone! Dr. Amy Haarstad, DACVD! North Carolina State University- DVM 2001! Purdue University Small Animal Internship ! Small animal private practice for 9 years! Dermatology residency at McKeever Dermatology Clinics in Minnesota ! Diplomate of ACVD 2014! Veterinary Dermatologist at McKeever Dermatology Clinics 5%

6 The Wild and Crazy Immune System and how it affects the skin Diseases! Discoid Lupus Erythematosus (DLE)! Symmetrical Lupoid Onychodystrophy (SLO)! Pemphigus Foliaceus (PF)! Sterile Nodular Panniculitis! Perianal Fistulas! Sebaceous Adenitis! Dermatomyositis! Ear Margin Vasculitis Total cases in 9 years! DLE=2! SLO=1! Pemphigus Foliaceus=1 in a cat! Panniculitis=0! Perianal Fistulas=1! Sebaceous Adenitis=2! Dermatomyositis=0! Ear Margin Vasculitis=2! Plasma Cell Pododermatitis=0 6%

7 Why is this happening?! Most cases are idiopathic! Recent vaccination! Medication history Cutaneous adverse drug reactions in dogs and cats Dogs! Pemphigus foliaceussulfonamides, ampicillin, penicillin, cephalosporins, diethylcarbamazine, metaflumazone/amitraz! Panniculitis-rabies vaccine, others! Vasculitis-rabies vaccine, others Cats! Pemphigus foliaceusampicillin, cimetidine, doxycycline, cephalexin, sulfonamides! Panniculitis-vaccines, glucocorticoids! Vasculitis-vaccines, ivermectin, antibiotics! Clinical Appearance! Dermatohistopathology Diagnosis 7%

8 ! Cytology! Skin scrape Quick Reminder! Dermatophyte culture! Bacterial culture and sensitivity Tape IT!! Tape prep! Scotch 3M packaging tape! Microscope slide size! Stain with orange and purple only! Impression smear! Use for moist lesions My top 5 tips for performing a skin biopsy 1. Keep it DIRTY 2. Keep it HAIRY Do you feel lucky, well, do ya? 8%

9 My top 5 tips for performing a skin biopsy 3. Just say NO! to ulcerated skin! to normal skin 4. Keep that CRUST! 5. Get the FAT! Drugs and Vitamins! Glucocorticoids! Azathioprine! Atopica! modified cyclosporine! Minocycline/Doxycycline! with Niacinamide! Topical tacrolimus! Nutritional supplements (Omega-3s, Vitamin E, A) Treatment Phases! Induction! Transition! Maintenance 9%

10 How Low Can You GO?! Every Other Day Glucocorticoids! Transition and Maintenance phases What s up with that sore sniffer? 10%

11 Discoid Lupus Erythematosus! Most common immune-mediated dermatosis! Localized, photoaggravated skin lesions! Shetland Sheepdogs, Rough Collies, German Shepherds, and Siberian Huskies are predisposed! Nose and nasal planum! Alopecia, erythema, and varying depigmentation! Absence of systemic signs! Epitheliotropic lymphoma-ddx Biopsy Buzz Words! DLE! Interface basal cell degeneration! Apoptotic keratinocytes only in the basal layer! Lichenoid inflammation or band-like infiltrate! Lymphocytes, plasma cells, histiocytes! Pigmentary incontinence! Melanin drops out into the dermis! Management Discoid Lupus Erythematosus! *Minocycline or doxycycline/niacinamide*! *Topical 0.1% tacrolimus ointment (Protopic )*! Prednisone! Modified cyclosporine A (Atopica )! Vitamin E! Topical corticosteroids (ie. Betamethasone cream)! *Topical sun-blocking creams and sun avoidance* 11%

12 Symmetrical Lupoid Onychodystrophy! SLO! Sloughing of claws! Early lesions 1-3 nails! Remove loose nails! Bandage if needed! Treat secondary bacterial infection! Diagnosis! History! Clinical appearance! Biopsy-usually not! Management SLO! *Minocycline or doxycycline/niacinamide*! Atopica (modified cyclosporine)! Corticosteroids! *Omega-3 fatty acids*! Frequent nail trims! Expectations-more nails to follow Crusty Crusts on Crusts 12%

13 Pemphigus Foliaceus! Pathogenesis! Type II Hypersensitivity! Autoantibody (IgG) against desmocollin-1! Signalment:! Chow, Akita, Bearded Collie, etc.! Many breeds Pemphigus Foliaceus! Clinical signs! Pustular dermatitis! Secondary erythema, scale, alopecia, erosion, crusts! Dorsal muzzle, face, pinnae, pawpads, generalized! Systemic signs PF in cats 13%

14 Acantholytic Cells Pemphigus Foliaceus! Diagnosis! Cytology! Neutrophils! Acantholytic cells! Dermatophyte culture! R/O Trichophyton mentagrophytes! Histopathology! Keep those crusts! Special stains! GMS or PAS Biopsy Buzz Words! Pemphigus foliaceus! Superficial epidermal pustules! Acantholysis! Lack of infectious organisms 14%

15 Pemphigus Foliaceus! Treatment! *Glucocorticoids*! *Azathioprine*! Minocycline or doxycycline/niacinamide! Atopica (modified cyclosporine)! Mycophenolate! Damaged lipocytes Sterile Nodular Panniculitis! Solitary or multiple draining nodules! Dachshunds most frequent breed affected! Diagnosis! Excisional or wedge biopsy! Fungal and acid fast stains! Rule out fungal disease (ie. blastomycosis), nocardiosis, mycobacterial infection) Draining Lesions 15%

16 Biopsy Buzz Words! Sterile Nodular Panniculitis! Epidermis may be normal or acanthotic (thick)! Epidermis may be ulcerated in area of draining tract! Pyogranulomas replacing adipose tissue! Special stains are negative Sterile Nodular Panniculitis! Treatment! *Minocycline or doxycycline/niacinamide*! Atopica (modified cyclosporine)! Methylprednisolone or prednisone! Vitamin E Straining? 16%

17 Perianal Fistulas! Unknown cause! German Shepherd Dogs! Tenesmus! Erythema, ulcers, fistulous tracts! Diagnosis based on history and clinical findings! Treatment of choice! *Atopica (modified cyclosporine)* Treatment on a Budget! Elimination Diet! Limited ingredient or Hydrolyzed! Sulfasalazine! Prednisone! 1 mg/kg once daily until resolution of lesions, then dose is reduced to 0.5 mg/kg Q24h for 6-8 weeks, then lowest every other day dose.! Topical tacrolimus 0.1% twice daily 17%

18 Sebaceous Adenitis! Autoimmune destruction of sebaceous glands! Young adult to middle aged! Breeds--Standard Poodles, Vizslas, Akitas, Samoyeds, etc.! Autosomal recessive! Clinical! Follicular casts, scaling, alopecia or poor coat! Dorsum of neck and back, top of head, bridge of nose, ears! In short coated dogs scales fine and non-adherent. Longercoated have tightly adherent scales. Akitas may be greasy! Diagnosis--clinical and histopathology Biopsy Buzz Words! Sebaceous adentitis! Follicular plugging or casts! Absence of sebaceous glands Management! *Bathe with Douxo Chlorhexidine PS shampoo weekly*! *Propylene glycol or baby oil 50% in water weekly for 4-6 weeks then 1-2 times a month*! *Vitamin A*! *Atopica (modified cyclosporine)*! Can regrow sebaceous glands! Prednisone or methylprednisolone! Minocycline or doxycycline/niacinamide! Retinoids (ie. Acitretin) 18%

19 Dermatomyositis Dermatomyositis! Hereditary inflammatory disease! Collies and Shetland Sheepdogs! <6 months of age! Symmetrical scarring alopecia of face and limbs! Atrophy of muscles of mastication! Waxing and waning! Not pruritic or painful Dermatomyositis! Diagnosis! Physical exam! Electromyography (EMG)! Histopathology! Management! *Pentoxifylline*! *Vitamin E*! Prednisone! Atopica (modified cyclosporine)! Minocycline or doxycycline/niacinamide 19%

20 Naked and Notched Ears Ear Margin Vasculitis! Ulcerative lesions affecting pinna! Dachshunds predisposed! Alopecia#Pigmented#Thickened#Necrosis! Diagnosis clinical findings and biopsy! Management! Sulfasalazine! *Atopica (modified cyclosporine)*! Minocycline or doxycycline/niacinamide! Pentoxifylline! Prednisone! Cats Plasma Cell Pododermatitis! Plasma cell infiltration into one or more footpads! Swollen pads, striae, and blue/violet discoloration! Bridge of nose can be affected! Diagnosis--clinical appearance or histopathology! Treatment! *Doxycycline*! Atopica (modified cyclosporine)! Glucocorticoids 20%

21 Medication doses! Minocycline/doxycycline 5mg/kg BID-TID! Niacinamide (with mino or doxy)! <15 kg give 250 mg BID-TID! >15 kg give 500 mg BID-TID! Prednisone 1-4 mg/kg Q24 initially, then lowest effective EOD! Atopica (modified cyclosporine) 5 mg/kg Q24 then taper! Azathioprine 2 mg/kg EOD! Vitamin E IU/day Medication doses! Omega-3 fatty acids 180mg EPA per 10lbs per day! Sulfasalazine mg/kg TID! Pentoxifylline mg/kg BID! Vitamin A 8,000-10,000 IU/20 lb. PO Q24h! Acitretin 1 mg/kg PO q 12-24h References! Scott, DW, et al. Immune mediated dermatoses in domestic animals: Ten years after. Part I. Compend Contin Educ Small Anim Pract. 1987;9:423! Scott, DW, Miller, WHJ. Idiosyncratic cutaneous adverse drug reactions in the cat: Literature review and report of 14 cases ( ). Feline Pract. 1998;26(4):10-14! Scott, DW, Miller, WHJ. Idiosyncratic cutaneous adverse drug reactions in the dog: Literature review and report of 101 cases ( ). Canine Pract. 1999;24(5):16-22.! Nuttall, T, Harvey, RG & McKeever, PJ. Skin Diseases of the Dog and Cat. 2 nd edn, Manson Publishing Limited, 2009.! Gross, TL, Ihrke, PJ, Walder, EJ, Affolter, AK. Skin Diseases of the Dog and Cat. 2 nd edn, Blackwell Publishing, 2005.! Miller, WJ, Griffin, C, Campbell, K. Muller and Kirk s Small Animal Dermatology. 7 th edn, Saunders-Elsevier, %

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23 Check out our 2015 upcoming VETgirl appearances! Dr. Justine Lee! NAVC, Jan 2016! IVS, Fiji, Feb 2016! WVC, March 2016! AAHA, March 2016! AVMA, July 2016 Dr. Garret Pachtinger! NAVC, Jan 2016! WVC, March VetGirlOnTheRun% This material is copyrighted by VETgirl, LLC. None of the materials provided may be used, reproduced or transmitted, in whole or in part, in any form or by any means, electronic or otherwise, including photocopying, recording or the use of any information storage and retrieval system, without the consent of VETgirl, LLC. Unless expressly stated otherwise, the findings, interpretations and conclusions expressed do not necessarily represent the views of VETgirl, LLC. Medical information here should be references by the practitioner prior to use. Under no circumstances shall VETgirl, LLC. be liable for any loss, damage, liability or expense incurred or suffered that is claimed to have resulted from the use of the information provided including, without limitation, any fault, error, omission, interruption or delay with respect thereto. If you have any questions regarding the information provided, please contact 23%