皮肤是猫咪健康状况的标志-全身性疾病的皮肤表现（1）

王帆

皮肤是猫咪健康状况的标志

SKIN AS A MARKER OF GENERAL FELINE HEALTH

全身性疾病的皮肤表现

Cutaneous manifestations of systemic disease

作者：Linda J Vogelnest

翻译：何梦婷  校对：王帆

实用意义：尽管大多数皮肤病变是由影响皮肤的疾病引起的，但有些皮肤病变反映了重要的全身性疾病。此类病变可能与全身疾病直接相关，也可能是由于免疫抑制引起的继发性皮肤病。尽早发现皮肤变化是提示存在全身性疾病，可最大化提高患病动物的预后。

临床挑战：在老年或明显虚弱的猫出现皮肤病的时，通常明显有潜在的全身性疾病。同样，对于出现严重溃疡性或多灶性结节性皮肤病，或并发全身疾病症状的猫，更提示要对全身性疾病进行评估。患猫表现为脱毛、皮屑、红斑和/或轻度结痂性皮肤病，有或没有瘙痒时更有难度；过敏性和感染性皮肤病是最常见的考虑因素，但有时全身性疾病也会导致皮肤病变。掌握何时进行实验室检查、影像检查或其他系统性诊断并不总是那么简单。

证据基础：本文回顾了兽医文献报道的全身性疾病的皮肤表现，并讨论了重要的鉴别诊断。作者借鉴临床经验，发表的疾病流行率和病例评估数据以及专家对常见全身性疾病的处理方法的意见，为何时最适合进行全身性疾病的调查提供指导。

Practical relevance: Although most skin lesions occur due to diseases primarily affecting the skin, some reflect important systemic diseases. Such lesions may relate directly to the systemic disease, or may occur due to secondary skin diseases that develop because of immunosuppression. Early recognition of skin changes as a marker of systemic disease will maximise patient outcomes.

Clinical challenges: In older or clearly debilitated cats presenting with skin disease, the potential for underlying systemic disease is often readily apparent. Similarly, cats presenting with severe ulcerative or multifocal nodular skin lesions, or with concurrent signs of systemic illness, will more instinctively prompt systemic evaluation. More challenging is the cat presenting with alopecic, scaling, erythemic and/or mildly crusted skin disease, with or without pruritus; hypersensitivities and infectious dermatoses are the most common considerations, but occasionally systemic disease underlies the skin changes. Knowing when screening laboratory testing, body imaging or other systemic diagnostics are indicated is not always straightforward.

Evidence base: This article reviews cutaneous presentations of systemic diseases reported in the veterinary literature, and discusses important differential diagnoses. The author draws on clinical experience, published data on disease prevalence and case evaluations, and expert opinions on approach to common systemic problems to provide guidance on when investigation for underlying systemic disease is most appropriate.

皮肤是机体最大并最容易接近的器官，皮肤病很常见并且容易观察。和许多哺乳动物一样，猫的皮肤病常见特异性疾病或直接针对皮肤的原发病，但有时也会反映出重要的潜在的全身性疾病。健康的皮肤基于良好的全身健康状况，任何导致不健康的病因都可能会引起皮肤和被毛受损。此外，某些全身性疾病可能会产生早期或特征性皮肤病变，从而提供非常有用的诊断线索。然而，许多皮肤病变是非特异性的，并且发生在各种各样的皮肤疾病中。

Skin is the largest and most accessible body organ, and skin disease is common and readily visualised. Skin disease in cats, as for many mammals, most frequently occurs due to diseases specifically or primarily targeting the skin, but will sometimes reflect important underlying systemic illness. Healthy skin is dependent on good general body health, and any cause of suboptimal health can result in skin and haircoat impairment. In addition, some systemic diseases may produce early or characteristic skin lesions that provide very useful diagnostic clues.  However, many skin lesions are non-specific, and occur in a wide range of skin diseases.

对患有皮肤病的猫进行仔细的病史调查和全面的体格检查，往往为潜在的全身性疾病提供最有用的线索。认识到全身性免疫抑制在某些感染性皮肤病的发展中可能发挥的作用也很重要。早期识别一些皮肤表现是全身性疾病的标志有助于最大化提高患病动物的预后。

Careful screening of history and complete body physical examination in cats presenting with skin disease often provides the most useful clues to the potential for underlying systemic disease. Awareness of the possible role of systemic immunosuppression in the development of some infectious skin diseases is also important. Early recognition of some skin presentations as markers of systemic disease aids optimal patient outcomes.

本文将全身性疾病的皮肤表现分为以下几种表现形式： 被毛无光泽、粗乱的患猫 脱毛、红斑、皮屑和/或局灶性结痂的患猫 瘙痒的患猫 皮肤糜烂和溃疡的患猫 有结节和/或结节肿胀的患猫

For the purpose of this article, cutaneous manifestations of systemic disease are grouped into the following presentations: < The cat with a dull, unkempt haircoat < The cat with alopecia, erythema, scaling and/or focal crusting < The cat with pruritus < The cat with skin erosions and ulceration < The cat with nodules and/or nodular swelling