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Cutaneous manifestations of systemic disease
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Common diseases are seen commonly – but we must not forget that rare diseases can occur too. Here Patricia White describes some of the systemic diseases that can present with dermatologic signs, and offers some pointers for a diagnostic approach.
Patricia D. White
DVM, MS, Dip. ACVD
Dr. White earned her DVM degree from Tuskegee University’s Veterinary School. After completing a dermatology residency, Master’s degree and post-doctorate fellowship at The Ohio State University, she opened a specialist dermatology clinic in her hometown of Atlanta. Her clinical areas of interest include ear disease and creative management of atopic dermatitis.
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Key Points
- The limited ways in which the skin responds to disease may make cutaneous manifestations of systemic disease (CMSD) difficult to recognize.
- Clinical signs that wax and wane with or without treatment, or fail to respond to appropriate therapy, should raise suspicion for a CMSD.
- Certain distribution patterns and symmetry suggest an internal etiology, and abnormalities noted on general physical exam may be related to the dermatologic condition.
- Treatment and management of CMSD may be lifelong, so it is vital to make an early diagnosis.
Introduction
It is common to treat dermatologic signs in veterinary practice without identifying a clear cause. Typically a clinician may take a brief history, perform a physical exam, treat any secondary infection, and make a tentative diagnosis. Because the skin has a limited number of ways of responding to injury, this approach may miss the opportunity to diagnose the rare cutaneous manifestations of systemic disease (CMSD).
Although unusual, CMSD can resemble many commonly seen skin problems, so obtaining a thorough history and interpreting clinical findings in light of this information is vital. A complete history includes: age of onset and duration; all medications, topical therapies and nutritional supplements (for both pet and owner); diet quality and composition (to check for potential deficiencies, homeopathic supplements); concurrent diseases/conditions and their treatment; exposure to pets in the household and other animals (daycare/ boarding/travel); presence of pruritus; response to specific therapy and any evidence of other organ systems involved.
Routine bench diagnostic tests (skin scraping, fur pluck, tape prep, impression smear, dermatophyte culture) should be done in every patient to identify microbial overgrowth or demodicosis, and to get a handle on basic supportive care needs. Recognizing dermatologic changes that are markers for specific internal conditions allows the clinician to choose specific tests to obtain a definitive diagnosis, and it is at this point that successful treatment for these rare conditions begins. This article presents a brief overview of just a few systemic diseases that announce their presence with dermatologic clues.
Paraneoplastic disorders
Paraneoplastic skin disorders occur as a result of a neoplasm elsewhere in the body; the cancer itself is not in the skin ( 1 ). The cause of the associated skin lesion(s) is generally unknown but may be the result of immune-mediated activity, the impact of a tumor protein on the skin, or the development of enzymes that interfere with normal skin function. These patients may have vague signs of illness (lethargy, weight loss, inappetence, vomiting, diarrhea) but the skin changes announce the systemic abnormality. [...]
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