Page 262 - WSAVA2017
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An Urban Experience
In severe cases, immunosuppressive therapy may
be indicated. The most frequently used medications
are glucocorticoids (prednisolone 2.2mg/kg per
day), but adjunctive medications may also be added. These include cyclosporine (5mg/kg once daily) or mycophenolate mofetil (10mg/kg twice daily). Intravenous administration of human immunoglobulin (IVIG; 0.4- 0.5g/kg [5% solution] IV once over 4-8 hours) has been reported to be effective in some cases, including one managed at the author’s institution. The prognosis depends upon a number of factors, including ability to identify (and address) the inciting cause, and the extent of the condition. Patients with extensive epithelial loss are predisposed to the development of secondary infection and sepsis.
In cases demonstrating persistent lesions, a food allergy elimination diet trial may be indicated to rule out food associated EM.
Juvenile cellulitis (puppy strangles):
This is an idiopathic inflammatory condition of young dogs. There is evidence suggesting both a genetic (Labrador retriever, dachshund, pointer and beagles may be predisposed) and immune mediated components (the condition is glucocorticoid responsive, and may closely follow vaccination).
Clinical appearance:
The condition typically appears in puppies < 6 months of age, but it may occasionally appear in young adults. The condition may appear shortly (days to 1-2 weeks) after vaccination. Affected puppies develop a sudden onset of facial and pinnal swelling. The affected areas rapidly develop short-lived vesicles or pustules, particularly on the lips, eyelid margins and on the concave surface of the pinnae. These vesicles rupture to leave crusting and erosions, which may exude serous or serosanguinous discharge. Pinnae are often markedly edematous, with erosion extending to the canal. Secondary otitis externa is common. Lymph nodes (especially the submandibular and prescapular nodes) are often markedly enlarged
and painful. The skin overlying the nodes is often ulcerated and draining. Patients may have one or more body regions affected. Puppies are often depressed (sometimes severely so), and may express pain upon opening the mouth.
Differential diagnoses include angioedema, demodicosis with secondary infection, drug reactions, bacterial furunculosis / abscessation and caustic substance exposure. Deep skin scrapings should be negative. Cytology of fresh lesions should demonstrate purulent to pyogranulomatous inflammation. Culture obtained from fresh lesions should be negative but some bacteria may be seen if secondary infection is present. Biopsy of fresh lesions should demonstrate a sterile pyogranulomatous infiltrate in the deep dermis and subcutis.
Patients typically respond well to immunosuppressive doses of glucocorticoids. Glucocorticoid therapy
should be continued until the lesions are completely
in remission. Although the lesions are usually sterile, adjunctive antibiotic therapy is prudent in cases with significant ulceration. Gentle daily cleansing with an antiseptic solution is appropriate if practical. Patients may require adjunctive analgesic therapy. Nonsteroidal anti- inflammatory drugs are not appropriate in conjunction with glucocorticoids, so alternative medications such as tramadol should be used. Most patients demonstrate improvement within a week or so, although individuals may require several weeks for full improvement. The author has seen one particularly severely affected case which was quite systemically ill, failed to respond and died despite therapy. If vaccination is thought to be an inciting cause, it may be prudent to minimize and/or spread out future vaccinations.
Post grooming furunculosis:
This is an uncommon but not rare condition in which deep bacterial infection appears to develop subsequent to bathing or immersion in water, although a single case has been reported in which the lesions appeared after scrubbing the skin in preparation for a hemilaminectomy. Patients may have been bathed at home or at a professional grooming parlor. One case was reported following a therapy session on an underwater treadmill.
It is thought that the combination of exposure to contaminated water, shampoo or scrub solution along with the physical act of scrubbing causes microtrauma to the skin and follicles and introduces microbes deep into the dermis.

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