犬缺血性皮肤病的潜在辅助治疗

赵博

Potential Adjuvant Treatment for Canine Ischemic Dermatopathy

犬缺血性皮肤病的潜在辅助治疗

作者：Paul Bloom, DVM, DACVD, DABVP (Canine & Feline)

Allergy, Skin and Ear Clinic for Pets

Livonia, Michigan

Michigan State University

In the Literature

文章来源：Levy BJ, Linder KE, Olivery T. The role of oclacitinib in the management of ischaemic dermatopathy in four dogs. Vet Dermatol. 2019;30(3):201-e63.

翻译；刘双元

校对：赵博

FROM THE PAGE

摘自此页

Ischemic dermatopathy is composed of a heterogenous group of vasculopathic syndromes with indistinguishable clinical and histopathologic appearances. The underlying pathology for any of the syndromes in this heterogenous group is a process by which immunologic damage is directed against vessel walls. Ischemic dermatopathy appears clinically as alopecia with crusting and postinflammatory hyperpigmentation or depigmentation. In more advanced cases, erosions and ulcers are present, particularly over bony prominences. Treatment is variably successful and has traditionally included pentoxifylline and vitamin E ± immunosuppressive therapy (eg, corticosteroids, modified cyclosporine).

缺血性皮肤病由一组异质性血管病变综合征组成，临床和组织病理学表现难以区分。这种异质性组中任何一种综合征的病理学基础都是免疫损伤直接作用于血管壁的过程。缺血性皮肤病在临床上表现为脱毛伴结痂和炎症后色素沉着或色素减退。在更晚期的病例中，存在糜烂和溃疡，尤其是在骨突起的位置。治疗的成功率各不相同，传统上包括己酮可可碱和维生素E±免疫抑制治疗（例如皮质类固醇、改良环孢素）。

This article describes 4 cases of canine ischemic dermatopathy; all dogs were <1 year of age, and diagnosis was made based on signalment, clinical presentation, and/or histopathologic changes. Three of the 4 dogs were littermates, and skin biopsies were performed on only 1 of these 3 dogs.

本文描述了4例犬缺血性皮肤病；所有犬均 < 1岁，并根据临床表现症状和/或组织病理学变化进行诊断。4只犬中的3只为同窝犬，仅对这3只犬中的1只进行了皮肤活检。

One dog required daily prednisolone (initial dose, 2.4 mg/kg every 24 hours) despite concurrent treatment with modified cyclosporine (5 mg/kg every 24 hours). In this patient, the cyclosporine dose was progressively increased (≤13 mg/kg every 24 hours) for over a year, with only poor clinical improvement observed;cyclosporine was then replaced with mycophenolate mofetil (16 mg/kg every 12 hours). Although clinical improvement was observed with mycophenolate mofetil, severe diarrhea developed.Mycophenolate mofetil was discontinued for 14 days then reinstituted at a lower dose; however, diarrhea reoccurred. Treatment was modified to include prednisolone (0.4 mg/kg every 24 hours) and oclacitinib (0.6 mg/kg every 12 hours), and disease was eventually well controlled with oclacitinib (0.5 mg/kg every 24 hours).

1只犬需要每日给予泼尼松龙（初始剂量，2.4mg/kg，每24小时一次），尽管同时给予改良的环孢素（5mg/kg，每24小时一次）。该患者环孢素剂量在一年多内逐渐增加（每24小时≤13 mg/kg），仅观察到较差的临床改善；然后用吗替麦考酚酯替代环孢素（16 mg/kg，每12小时一次）。尽管在吗替麦考酚酯治疗后观察到临床改善，但发生了严重腹泻。停用吗替麦考酚酯14天，然后以较低剂量重新开始治疗；然而，腹泻复发。对治疗进行了改进，包括泼尼松龙（0.4 mg/kg，每24小时一次）和奥拉替尼（0.6 mg/kg，每12小时一次），最终用奥拉替尼（0.5 mg/kg，每24小时一次）控制良好。

Cases 2, 3, and 4 were littermates that experienced disease control only when receiving modified cyclosporine (≤8.5 mg/kg every 24 hours) and prednisolone (≤0.8 mg/kg every 24 hours). Complete remission was achieved with administration of oclacitinib (0.5-0.7 mg/kg every 12 hours) and prednisolone (0.5-1 mg/kg every 24 hours) for 30 days. The prednisolone dose was tapered and eventually discontinued; lesions remained in complete or near full remission with monotherapy of oclacitinib (0.2 mg/kg every 24 hours in 1 dog, 0.4-0.6 mg/kg every 12 hours in 2 dogs).

病例2、3和4同窝出生，仅在接受改良环孢素（≤8.5 mg/kg，每24小时一次）和泼尼松龙（≤0.8 mg/kg，每24小时一次）时疾病得到控制。给予奥拉替尼（0.5-0.7 mg/kg，每12小时一次）和泼尼松龙（0.5-1 mg/kg，每24小时一次）30天后达到完全缓解。逐渐减少泼尼松龙剂量，并最终停药；奥拉替尼单药治疗后（1只犬0.2 mg/kg每24小时一次，2只犬0.4-0.6 mg/kg每12小时一次），病变保持完全缓解或接近完全缓解。

… TO YOUR PATIENTS

……致您的患者

Key pearls to put into practice:

付诸实践的关键要点：

1.    Canine ischemic dermatopathy— except for vaccine-associated ischemic dermatopathy—is either genetic (eg, dermatomyositis) or idiopathic in origin.

犬缺血性皮肤病（疫苗相关性缺血性皮肤病除外）为遗传性（例如，皮肌炎）或特发性的。

2.    Initial therapy with immunosuppressive doses of prednisolone with or without concurrent immunosuppressive agents (eg, modified cyclosporine, mycophenolate mofetil) is typically required for treating generalized ischemic dermatopathy.

治疗全身性缺血性皮肤病通常需要免疫抑制剂量的泼尼松龙，联合或不联合免疫抑制剂（如改良环孢素、吗替麦考酚酯）

3.    Monotherapy with oclacitinib may be another treatment option for dogs affected by ischemic dermatopathy.

对缺血性皮肤病患犬，奥拉替尼单药治疗可能是另一种治疗选择。

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老师，这个与皮下水肿，血管通透性改变有关系是吗

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