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Crusting and exudation in a Welsh stallion pony. Author: Mark Craig. Editor: David Lloyd. © European Society of Veterinary Dermatology. History -1. 10-year-old Welsh pony stallion Weight 300 kg . Click to reveal the text on this screen Click the forward arrow to jump to the next screen.

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Crusting and exudation in a welsh stallion pony l.jpg

Crusting and exudation in a Welsh stallion pony

Author: Mark Craig

Editor: David Lloyd

© European Society of Veterinary Dermatology


History 1 l.jpg

History -1

  • 10-year-old Welsh pony stallion

  • Weight 300 kg

Click to reveal the text on this screen

Click the forward arrow to jump to the next screen

History


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History -2

  • First signs developing over a 4-week period

    • Papules on flank and neck, pruritus

    • Generalised crusting and exudation

    • Swelling of all four legs accompanied by stiffness and lameness

    • Weight loss and lethargy

  • No treatment by the referring vet

History


Clinical signs 1 l.jpg

Clinical signs - 1

The horse was thin and there was generalised crusting with diffuse alopecia

No peripheral lymphadenopathy was detected

Signs


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Clinical signs - 2

Close-up views of alopecic andcrusted areas

Clipped area on the withers

Signs


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How would youapproach this case?

  • What are the next steps you would take?

  • Make a list of your principle differential diagnoses

  • List any samples you would collect

  • List any tests you would perform to assist in making a definitive diagnosis

Signs


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Test - 1

  • Principle differential diagnoses

    • Bacterial folliculitis, dermatophilosis, dermatophytosis

    • Ectoparasitic infestation

    • Pemphigus complex, SLE, drug eruption

    • Allergy

Differentials


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Tests - 2

  • Tests

    • Blood tests: routine haematology and biochemical screens; ANA test

    • Multiple punch and excision biopsy samples from crusted and alopecic areas

    • Skin scrapings, crusts and hair pluckings for microscopic examination, smears, bacterial and fungal culture

Tests


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Results

  • Scrapings, crusts and hairs did not reveal ectoparasites or fungal structures; Dermatophilus was not demonstrated on microscopic examination

  • Haematological and biochemical profiles were within accepted limits. The ANA test was negative

  • Histopathology revealed a superficial pustular dermatitis. No micro-organisms were found in the lesions

Tests


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What now?

  • What treatment, if any, should you now institute whilst waiting for the fungal cultures?

  • What are now your principle differential diagnoses?

  • Are there any other samples you would collect?

Tests


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Initial therapy

  • Ectoparasitism and neoplasia were deemed unlikely

  • Autoimmune or immune-mediated disease seemed likely and the horse was deteriorating hence therapy was initiated

  • Prednisolone, 0.5 mg/kg daily; trimethoprim and sulphadiazine (Uniprim), 0.5 sachet daily

Therapy


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What is yourdiagnosis?

  • What is your principle diagnosis?

  • Do the investigations permit a definitive diagnosis?

  • Are there any additional investigations which you think may need to be done?

Therapy


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Histopathology

Further tests

  • A superficial pustular dermatitis was present

  • The pustules contained many neutrophils & acanthocytes but no micro-organisms

Therapy


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Diagnosis

  • Pemphigus foliaceus

    • Lesion type and histopathology are consistent

    • No history of previous drug therapy

    • Fungal culture was negative

Therapy


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How would you deal with this case?

  • What is your prognosis?

  • How will you advise the owner?

  • What treatment would you consider?

Therapy


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Response to therapy - 1

  • After 5 days the lesions were unchanged

  • The prednisolone dose was increased to 300 mg per day and there was a moderate improvement over a period of 10 days - decreased scaling and some hair regrowth

  • Steroid therapy lapsed (owner’s choice) and the horse’s condition remained stable over a two-month period but then again worsened

Notes


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Response to therapy - 2

  • Prednisolone therapy at 300 mg twice daily (1 mg/kg b.i.d.) was resumed. Within 2 weeks all lesions had disappeared and after 1 month the horse was reported to be in good condition

  • Attempts will be made to lower the dose over the coming months

Notes


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Prognosis

  • Prognosis is guarded

    • The disease may require potent immunosuppressive therapy with significant side effects

    • It may not respond adequately

Notes


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Review

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Notes


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