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Pemphigus - Coggle Diagram
Pemphigus
CS
pustules initially
rarely seen
rupture quicly
crusts
scales
alopecia
erosions
erythema
+/-
pain
pruritus
distribution
dorsal muzzle
nasal planum is a hallmark
pinnae
footpads
can appear elsewhere and be generalized
paronychia
inflammation of soft tissue around nails
pathomechanism
IgG binds to desmosomes
adhesion molecules destroyed
acantholysis
acantholytic cells are detached from immature keratinocytes
diagnosis
history and CS
cytology
non-degenerate neutrophils
acantholytic keratinocytes
+/- eosinophils
histopathology
P. foliaceus
subcorneal or intraepidermal pustules
multiple acantholytic keratinocytes
neutrophils
+/- eosinophils
CBC/Chem/UA
usually normal
possible inflammatory changes
treatment
oral glucosteroids @ immunosuppressive dose
:first_place_medal: prednisone or prednisolone
:second_place_medal: triamcinolone
:third_place_medal: dexamethosone
about 50% response
recheck every 14d
NSAID immunomodulatory
:dog:
azathioprine
4-6w to notice effect
side effects
vomting
diarrhea
bne marrow suppression
hepatotoxicity
:cat:
cyclosporine
:dog::cat:
chlorambucil
mycophenolate mofetil
used as a glucocorticoid sparing agent
mau take 3-4w to notice effect
side effects
vomiting
diarrhea
anorexia
oclacitinic (Apoquel)
anecdotal effectiveness
monitor for side effects
4w to affectivness
refractory cases
human IV immunoglobin :dog::cat:
history
lesions appear rapidly
pruritus is variable
systemic signs uncommon
general
forms
superficial
P. erythematousus
P. foliaceus
most common
:dog::cat:
lesions underneath
stratum corneum
stratum granulosum
deep
P. vulgaris
lesions just above the basal layer
target AG
inter-keratinocytes
adhesion molecules - desmosomes