Uveodermatological syndrome

41 Uveodermatological syndrome




INITIAL PRESENTATION


Depigmentation, crusting, scaling and alopecia on the nose.



INTRODUCTION


Uveodermatological syndrome is a rare condition characterized by ocular and cutaneous signs in dogs. The ocular signs include uveitis, glaucoma, conjunctivitis, blepharospasm and photophobia. The cutaneous signs include depigmentation of the skin and hair, crusting, erythema and ulceration, usually at the mucocutaneous sites. The condition is similar to Vogt–Koyanagi–Harada syndrome described in people. Vogt–Koyanagi–Harada syndrome is progressive, starting with a meningoencephalitis phase, followed by an ophthalmic–auditory phase, which progresses to a convalescent stage, where the ocular signs subside, but the cutaneous changes occur and remain. During the early phase of the disease the clinical signs include fever, malaise, headaches, nausea and vomiting. The ocular signs and deafness are followed by poliosis, alopecia and leucoderma during the convalescent stage. In contrast, in dogs, ocular signs are usually acute and precede the cutaneous signs. Ophthalmic assessment is essential in dogs, even when there are no obvious ocular signs. This chapter describes a case where the cutaneous signs preceded ocular signs, and where early recognition and treatment for ocular disease allowed early intervention.




CASE PRESENTING SIGNS


A 5-year-old, castrated Japanese akita was presented with depigmentation, crusting and alopecia on the nose.



CASE HISTORY


Ocular signs are the usual reason for presentation of these cases. The owner may present the dog because it has ocular discharge, conjunctivitis, oedema, photophobia or blindness. Depigmentation of skin and hair may be evident, and may be accompanied by erythema, ulceration and alopecia. The relevant history in this case was:


• Onset of depigmentation and alopecia on the nose, with duration of about 1 year.

• General health was unaffected.

• The nasal condition was non-pruritic.

• The dog had travelled to northern France, but the condition started before going abroad.

• Familial history was unknown and no zoonosis was reported.

• The dog was up to date with routine vaccination and endoparasitic and ectoparasitic control.

• Only after close questioning did the owner report that the dog was uncomfortable in sunlight.

• There was no previous history of eye problems, and the nasal lesions were poorly responsive to topical treatment with fusidic acid- and betamethasone-containing ointment.


CLINICAL EXAMINATION


This is a condition where physical examination should include a detailed ophthalmic examination. Ocular signs include conjunctivitis, blepharospasm, anterior and posterior uveitis, retinal haemorrhage and/or detachment. The main cutaneous sign is depigmentation of the nasal planum, eyelids, scrotum, vulva and paw pads. Crusting, ulceration, erythema and alopecia are likely to be present in advanced cases. Oral ulceration may also be observed in chronic, untreated cases.


In this case the relevant findings on dermatological examination were:


• Crusting, scaling, erythema and alopecia on the nose at the junction of the nasal planum and the haired skin (Fig. 41.1)

• Depigmentation of the lip margins

• Depigmentation of several pads on the feet (Fig. 41.2)

• Mild crusting at the medial canthi and few depigmented macules of only 1–2 mm in size on the lower eyelids (Fig. 41.3)

• There was no obvious evidence of uveitis, but an ophthalmic referral was arranged.

image

Figure 41.1 Scaling, crusting, depigmentation and alopecia on the bridge of the nose.


image

Figure 41.2 Depigmentation of the footpads.


image

Figure 41.3 Focal depigmented macules on the medial canthi.

Related posts:

  1. Cheyletiellosis in a rabbit
  2. Metabolic epidermal necrosis
  3. Adverse food reaction
  4. Epitheliotropic lymphoma

Stay updated, free articles. Join our Telegram channel
Tags:
Sep 3, 2016 | Posted by in SMALL ANIMAL | Comments Off on Uveodermatological syndrome

Full access? Get Clinical Tree
Get Clinical Tree app for offline access