NY Vet: Skin Conditions That Can Signal an Emergency
Kristen Coppock, MA, Editor
Veterinarians should consider some dermatology cases as emergencies. Here's what to watch for.
Some dermatologic conditions require immediate attention, according to Andrew Rosenberg, DVM, PhD, DACVIM, who discussed the topic at the NY Vet Conference in New York City. "Although nonemergency dermatology cases are common," he said, "a skin issue can be a sign of a more serious condition."
Dr. Rosenberg, who owns Animal Dermatology & Allergy Specialists in White Plains, NY, and Riverdale Veterinary Dermatology in Riverdale, NJ, advised pet health care providers to consider some dermatology cases as emergencies. He recommended looking for certain clinical findings and relying on diagnostic results to determine the appropriate course of action. “Cytology is extremely important,” he said.
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When clinical signs began, how long they have been present, whether medications have been taken or vaccinations received by the pet, and the age and breed of the animal should all be considered in dermatology cases. “Certain breeds are predisposed to some of the emergency diseases,” Dr. Rosenberg said. Among the serious conditions that manifest in dermatologic issues are juvenile cellulitis, postgrooming furunculosis, burns, and feline-acquired skin fragility syndrome, as well as urticaria and angioedema. Toxic epidermal necrolysis, erythema multiforme, and uveodermatolgic syndrome (a condition in dogs that is much like Vogt-Koyanagi-Harada syndrome in humans) can also manifest with skin problems.
Mainly affecting puppies between 3 weeks and 4 months of age, juvenile cellulitis is a sterile granulomatous and pustular disorder. Signs include swelling of the face and muzzle, enlarged lymph nodes, and progression of pustules over a 48-hour period. Lesions form and crust in these patients, and some pets are lethargic. According to Dr. Rosenberg, this condition is thought to be an autoimmune disorder and affected puppies typically respond to steroid treatments.
Breeds with short, stiff hair coats are predisposed to postgrooming furunculosis, which occurs following trauma to the hair follicles during grooming. The pet usually presents with severe crusting and furuncles within 48 hours after it has been bathed or groomed. Left untreated, the condition progresses and may result in painful ulceration, fistulations, and bullae, as well as sepsis, multiorgan dysfunction, and death. Dr. Rosenberg said aggressive therapy is needed to treat postgrooming furunculosis. In addition, grooming procedures should be investigated at the place they occurred.
Dr. Rosenberg discussed severe burns caused by a variety of sources, including chemicals, open flames, and water-filled heating pads used during surgery. Solar burns, which are common in the southwest region of the United States, also can be severe.
Superficial burns affect only the skin, while a partial-thickness burn injures the epidermis and superficially affects deeper layers of skin. A full-thickness burn completely destroys the epidermis in the affected area, injures all skin layers, and may lead to panniculus and deeper tissue damage. “Superficial burns will heal from the outside in," Dr. Rosenberg said. "Deep burns will contract over time to heal the wound.” A burn can remain hidden by a pet’s coat for up to a week, when necrotic skin typically appears. Clinical signs include a change in behavior; hard, dry skin with separation from underlying tissue; eschar formation; and, in severe cases, large areas of sloughing necrotic skin.
Dogs with burns are typically in pain, Dr. Rosenberg said, so analgesics are extremely important. Treating burns with systemic antibiotics can be difficult, he noted, suggesting the use of topical antibiotics instead. “I typically recommend silver sulfadiazine,” he added. Dr. Rosenberg also recommended using pentoxifylline, which increases blood flow and promotes healing for burns.
Urticaria and Angioedema
Clinical signs of urticaria and angioedema typically develop within minutes or hours of a pet coming into contact with a trigger, such as an allergen or a venomous insect. According to Dr. Rosenberg, swelling typically occurs on the muzzle or face of a pet. Anaphylaxis may also develop, however, and could result in bronchospasm, hypotension, vomiting, diarrhea, and death. “The best way to treat this is to get rid of the inciting factor,” Dr. Rosenberg said. A variety of medications can treat clinical signs; epinephrine is used for anaphylactic reactions.
Feline Acquired Skin Fragility Syndrome
Dr. Rosenberg said feline acquired skin fragility syndrome is associated with systemic diseases. Found only in cats, the condition is marked by acute sloughing of the skin. “An owner will go to pick up a cat by its neck or to play, and skin will just come off,” he said. Although some cats with feline acquired skin fragility syndrome will recover with early diagnosis and treatment, many cases end in euthanization, according to Dr. Rosenberg. “If you can’t identify the underlying cause, it’s a grave prognosis,” he said.