Today's Veterinary Practice

JUL-AUG 2015

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TodAy's VeTerinAry PrAcTice | July/August 2015 | tvpjournal.com obserVATions in oPhThAlmology Peer reviewed 76 • Pemphigus vulgaris: cleft and vesicle formation with suprabasilar acantholysis, basal epidermal cells arranged in row of "tombstones," and, sometimes, inflammatory reaction that is interstitial to lichenoid. Treatment. effective treatment depends on diagnosis of the particular pemphigus variant. general long-term treatment includes topical and systemic corticosteroids, combined with additional immune suppression through the use of cyclophosphamide, azathioprine, or cyclosporine for refractory cases. blepharoplasty may be indicated for correction of cicatricial entropion. Discoid Lupus Erythematosus Description. canine discoid lupus erythematosus (dle) is a relatively benign skin disease that lacks systemic involvement. 6,11 Pathogenesis is unclear, but photosensitivity may exacerbate the disease. 5 dle (Figure 9) has been associated with facial dermatitis consisting of crusts, depigmentation, erosions, and ulcers, which typically affect the nasal planum and muzzle, but eyelids and oral lesions are also documented. 5,6,12 Diagnosis. diagnosis includes: • history and physical examination with thorough evaluation of eyelids, facial skin, and muzzle • biopsy with histopathologic examination to identify focal thickening of basement membrane zone, marked accumulations of mononuclear cells and plasma cells around skin vessels, and focal hydropic degeneration of basal epidermal cells with pigmentary incontinence, where melanin granules are free in the dermis and macrophages, that is associated with damage to the stratum basale and basement membrane of the epidermis. Antinuclear antibody test results are not reliable. Treatment. Treatment includes: • Avoidance of exposure to sunlight • Topical immunosuppressive drugs, such as cyclosporine or dexamethasone • systemic corticosteroids for refractory cases. lifelong treatment is recommended. Uveodermatologic Syndrome Description. Uveodermatologic syndrome (Figure 10) is an idiopathic condition theorized to have FIGURE 9. Three-year-old spayed female Akita with immune-mediated blepharitis (discoid lupus erythematosus). Note the crusts, depigmentation, and ulceration of the nasal planum with ocular involvement. Biopsy of the nasal planum revealed mononuclear cells and plasma cells around skin vessels, with pigmentary incontinence of the basal epidermis. Topical dexamethasone and cyclosporine were implemented for the ocular disease, while oral corticosteroids were administered long term to control the disease. Courtesy Dr. Brian L. White FIGURE 10. Two-year-old castrated male Siberian husky with uveodermatologic syndrome. Note the ulceration, crusting, and depigmentation of all 4 eyelids and nasal planum. This patient presented for chronic loss of pigmentation around the nose and eyelids concurrent with blindness. Corneal edema, aqueous fare, and bilateral retinal detachments were observed on ophthalmic examination. Topical corticosteroids were initiated for uveitis, along with oral corticosteroids and azathioprine. Disease was severe and ultimately controlled, but blindness was irreversible. Courtesy Dr. Kimberly Coyner

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