Hyperkeratotic erythema multiforme variant in 17 dogs.

BACKGROUND: A new canine subgroup defined as 'old-dog' or 'hyperkeratotic' erythema multiforme (HKEM) with marked hyperkeratosis and parakeratosis has been proposed without any detailed description of larger case series. OBJECTIVES: We report herein the signalment, clinical signs, treatment outcome, and histopathological and immunological findings in 17 dogs with HKEM. ANIMALS: Inclusion criteria were the presence of (i) scaly skin lesions with or without crusting; and (ii) microscopic lesions typical of EM (i.e. a panepidermal cytotoxic lymphocytic dermatitis with or without basal keratinocyte apoptosis); and (iii) microscopic ortho- and/or parakeratotic hyperkeratosis affecting the interfollicular epidermis. MATERIALS AND METHODS: Clinical questionnaires and skin biopsies were reviewed. Polymerase chain reactions for epidermotropic viruses and direct immunofluorescence were performed. RESULTS: Various breeds were affected with an over-representation of males in their mid-to-late adulthood (median age 9 years). Generalised skin lesions included multifocal-to-coalescing, linear and annular macules and plaques with erythema and adherent firm crusting. Microscopic lesions were specific for EM and featured prominent superficial epidermal apoptosis with lymphocytic satellitosis and parakeratosis. No drug triggers were identified. Polymerase chain reactions for canine herpesvirus polymerase gene, canine parvovirus and canine distemper virus were negative in all HKEM and canine erosive EM (15 dogs) biopsies. Lesions failed to respond to oral and/or topical antimicrobials. Complete remission of signs was achieved in 9 of 17 dogs (53%) using immunosuppressive regimens. CONCLUSIONS AND CLINICAL RELEVANCE: Hyperkeratotic erythema multiforme (HKEM) is a chronic, persistent and clinically distinctive erythema multiforme (EM) variant that differs from 'classic' vesiculobullous erosive-to-ulcerative EM in dogs.

Impression Smear Agreement with Acetate Tape Preparation for Cytologic Sampling.

Cutaneous cytologic sampling techniques are used to detect bacteria, yeast, and inflammatory cells for diagnosis and therapeutic monitoring. Studies have examined slide evaluation techniques, ear swab cytology staining methods, and observer variations; few studies compare common clinical sampling techniques. The primary aim of this study was to measure detection of microorganisms and neutrophils by impression smear compared to acetate tape preparation; comparison of agreement between two acetate tape staining methods was a secondary aim. Thirty lesions consistent with superficial pyoderma were sampled via impression smear and acetate tape preparation. Acetate tape preparations were either stained with modified Romanowksy stain solutions two and three or solution three alone. Impression smears were stained in the standard manner. Bacteria, yeast, and neutrophils were evaluated using a semi-quantitative scale [0-4]. Quantities were aggregated and compared using Cohen's kappa to measure agreement between methods. When impression smears were compared to acetate tape, the lowest agreement occurred for neutrophils, with impression smears detecting more neutrophils. Comparison of acetate tape staining methods had the highest agreement for yeast detection. Sampling technique and staining method did not differ for detection of bacteria. Impression smears detected more neutrophils, and yeast detection appeared equivalent for acetate tape staining methods.

Prior antibacterial drug exposure in dogs with meticillin-resistant Staphylococcus pseudintermedius (MRSP) pyoderma.

BACKGROUND: The emergence of meticillin-resistant Staphylococcus pseudintermedius (MRSP) has become a significant animal health problem. Recent studies have indicated that previous antibacterial drug exposure is a factor in acquisition of meticillin-resistant strains of staphylococci. HYPOTHESIS/OBJECTIVES: The purpose of this study was to identify factors associated with prior antimicrobial drug use and MRSP pyoderma in dogs presented to a veterinary teaching hospital. ANIMALS: Dogs diagnosed with pyoderma associated with MRSP (n = 53) or meticillin-sensitive S. pseudintermedius (MSSP; n = 45). METHODS: The medical records of dogs diagnosed with pyoderma associated with isolation of S. pseudintermedius between January 2006 and November 2012 were reviewed. All cases with a complete twelve month to 3 yr drug history prior to the diagnosis were included. RESULTS: Fifty two of 53 (98%) MRSP cases and 42 of 45 (93%) MSSP cases had received at least one course of antibacterial drug prior to diagnosis. The total number of antibacterial drug prescriptions provided to pet owners and the variety of antibacterial drug classes represented were higher for cases with MRSP than for cases with MSSP (P < 0.0001 and P = 0.009, respectively). More cases with MRSP (98%) received beta-lactam drugs than those with MSSP (82%; P = 0.007) and the proportion of MRSP cases that had received concurrent immunomodulatory therapy was higher (62% versus 42%; P = 0.048). CONCLUSIONS AND CLINICAL IMPORTANCE: These results suggest that the total number of antibacterial drug prescriptions, exposure to multiple drug classes (beta-lactams in particular) and concurrent immunomodulatory therapy may be associated with increased risk for acquisition of MRSP.

Relationship of body weight to maintenance cyclosporine a dose in canine atopic dermatitis.

Cyclosporine A (CsA) is a commonly prescribed and effective therapy for canine atopic dermatitis. The purpose of this study was to investigate the potential relationship between patient body weight and CsA dosing. Seventy-seven cases of canine atopic dermatitis managed between 2000 and 2011 were evaluated retrospectively. Duration of CsA therapy was at least 16 wk. Groups analyzed included the study population as a whole, those treated with only CsA, and those treated with both CsA and metoclopramide. The division between small and large dogs was set at 15 kg. Descriptive analysis, two-way analysis of variance, Pearson correlations, and a Student t test were used to analyze data. There were no significant differences between CsA dose and body weight regardless of method of analysis. Concurrent corticosteroid use, other medication use, and pruritus score were also analyzed over the study period. There was a significant decrease in CsA dose, corticosteroid dose, medication score, and pruritus score between the time points for all patients, but no significant relationship between those changes and body weight. These study findings suggest that differential CsA dosing is not warranted based on body weight.

The efficacy of cetirizine hydrochloride on the pruritus of cats with atopic dermatitis: a randomized, double-blind, placebo-controlled, crossover study.

BACKGROUND: Various antihistamines have been used in the management of feline atopic dermatitis, with variable reported benefit. To date, there have been no randomized, double-blind, placebo-controlled, crossover clinical trials on the use of this drug class in cats. HYPOTHESIS/OBJECTIVES: To evaluate the clinical efficacy of cetirizine hydrochloride for the control of pruritus and dermatitis in cats diagnosed with atopic dermatitis. METHODS: In this randomized, double-blind, placebo-controlled crossover clinical trial, 21 client-owned cats diagnosed with mild to moderate nonseasonal atopic dermatitis were randomly assigned to two groups. Cats in each group received either 1 mg/kg cetirizine hydrochloride or placebo once daily per os for 28 days followed by a 14 day wash-out period. Treatments were then crossed over, and cats received placebo or cetirizine hydrochloride for another 28 days. Owners marked a pruritus severity scale before inclusion in the study and weekly throughout the entire study period. Lesions were scored by the clinician using a Canine Atopic Dermatitis Extent and Severity Index (CADESI)-03 modified for the cat before enrolment and at day 28 of each treatment. RESULTS: Nineteen cats completed the study. There were no statistically significant differences between treatment with cetirizine hydrochloride and placebo for modified CADESI-03 or pruritus scores. CONCLUSION AND CLINICAL IMPORTANCE: This study suggests that cetirizine hydrochloride cannot be recommended for the management of feline atopic dermatitis.

Corynebacterium spp. in dogs and cats with otitis externa and/or media: a retrospective study.

The role of Corynebacterium spp. in the pathogenesis of canine and feline otitis externa/media and their appropriate antimicrobial therapy are unclear. The objectives of this study were to (1) better establish the pathogenicity of Corynebacterium spp. in otitis utilizing reported criteria and by assessing clinical response to antibiotic therapy and (2) to determine the antimicrobial susceptibility patterns of Corynebacterium spp. associated with otitis. The study was retrospective, targeting cultures positive for Corynebacterium spp. Corynebacterium spp. were part of mixed microbial populations in 79/81 cultures. Corynebacterium spp. pathogenicity was highly questionable because of their almost invariable presence with other microbes and the observation that Corynebacterium spp. usually disappear from the ear with resolution of other infections, even when the Corynebacterium spp. are resistant to the prescribed antibiotic(s). However, 2/81 cultures came from two canine ears wherein Corynebacterium spp. may have been pathogenic. Antimicrobial sensitivities for Corynebacterium spp. were available for 54 isolates. Most isolates were susceptible to chloramphenicol (53/54), amikacin (50/54), tetracycline (50/54), gentamicin (46/54), and enrofloxacin (32/54). Among those antibiotics available in otic products, gentamicin and enrofloxacin would be rational choices for the empirical, topical therapy of Corynebacterium spp.

A randomized, double-blind, placebo-controlled study to evaluate the effect of EFF1001, an Actinidia arguta (hardy kiwi) preparation, on CADESI score and pruritus in dogs with mild to moderate atopic dermatitis.

Canine atopic dermatitis (AD) is common and new therapies are beneficial. This multicentric, randomized, double-blind, placebo-controlled study tested the efficacy of Actinidia arguta (hardy kiwi) (EFF1001) in dogs with mild/moderate AD. The study was divided into two stages. Stage 1 lasted 6 weeks. In the first 2 weeks prednisolone [days 1-3: 0.2 mg/kg twice daily (BID), days 4-14: 0.2 mg/kg every other day (EOD)] was administered. Responsive dogs were placed on prednisolone 0.2 mg/kg EOD + assigned test article [either placebo or EFF1001 (30 mg/kg)] once daily for 4 weeks. Stage 1 responders were advanced to stage 2, which involved 4 weeks of just EFF1001. Clinicians scored lesions using Canine Atopic Dermatitis Extent and Severity Index (CADESI) and owners scored pruritus using a Pruritus Visual Analogue Scale. Seventy-seven dogs were enrolled, 76 were randomized on day 14, and 57 (57/76 = 75%) completed stage 1 (27 in EFF1001 and 30 in placebo). At the end of stage 1, 35 of 57 dogs (35/57 = 61%) responded (18 in EFF1001 and 17 in placebo) and advanced to stage 2. At completion of stage 1, CADESI scores did not significantly differ between groups while pruritus decreased in EFF1001 group and approached significance. At completion of stage 2, 19 dogs (19/35 = 54%) responded (15/19 = 79% had received EFF1001 and 4/19 = 21% placebo in stage 1). After completing stage 2, dogs placed on EFF1001 throughout the study were 3.5 times more likely to either maintain or improve scores than those that started it in stage 2. It is concluded that EFF1001 is beneficial adjunctive therapy after prolonged use.