犬猫皮肤病急诊病例诊疗方法

王帆

原文网址：狗和猫的紧急皮肤病学病例的方法 (wiley.com)

https://bvajournals.onlinelibrary.wiley.com/doi/epdf/10.1002/inpr.247原文链接 

 

Approach to emergency dermatology cases in dogs and cats

犬猫皮肤病急诊病例诊疗方法

作者：Filippo De Bellis,Diana Di Mattia

 

翻译：郑江涛 校对：王帆

Background: Skin disease is a common presentation in small animal, first-opinion veterinary practice and it generally has an insidious onset, requiring long-term management by both practitioners and clients. However, there are a handful of dermatopathies that occur acutely, causing striking skin lesions and / or systemic disease . The majority of these emergency dermatopathies are not regularly seen, thus the literature is minimal and practitioners may not be familiar with their aetiology, clinical appearance, diagnosis, treatment and prognosis.

背景:皮肤病是小动物的常见表现，通常起病隐匿，需要医生和客户长期管理。然而，也有少数皮肤疾病急性发作，引起显著的皮肤病变和/或全身性疾病。这些急诊皮肤病大多不是常见病，因此文献很少，医生可能不熟悉其病因、临床表现、诊断、治疗和预后。

 

Aim of the article : This article discusses the key features of the main dermatological emergencies of dogs and cats, with a focus on clinical presentation, diagnosis and therapeutic options.

文章的目的：这篇文章讨论了犬和猫的主要皮肤病急症的主要特征，重点是临床表现，诊断和治疗选择。

 

Emergency dermatopathles

急诊皮肤病

Urtlcarla and angloedema

荨麻疹和血管性水肿

Urticaria and angloedema can be encountered relatively frequently in small animal practice and represent typical cutaneous signs of anaphylaxis, which is a serlous generalised hypersensitivity reaction. In dogs, the most common shock organs involved in anaphylaxis are the liver, gastrointestinal and cardiovascular systems, and skin; less frequently respiratory and neurological systems may be affected . Urticaria and angioedema can be triggered by immunological and non-immunological mechanisms.Reported example hypersensitivity reactions induced by vaccinations insects, food and medicines, while reported examples of non-immunological triggers are heat, pressure,cold and vibrations.

荨麻疹和血管水肿在小动物实践中相对常见，代表了过敏反应的典型皮肤症状，这是一种严重的全身性超敏反应。在犬中，与过敏反应有关的最常见的休克器官是肝脏、胃肠道和心血管系统以及皮肤。可能较少影响呼吸和神经系统。荨麻疹和血管水肿可通过免疫机制和非免疫机制触发。已报道的超敏反应的例子是由接种疫苗、昆虫、食物和药物诱发，而已报道的非免疫触发因素的例子是热、压力、冷和振动。

 

In an observational study, Rostaher and others (2017) examined 24 cases of urticaria, 16 of which were associated with anaphylaxis, with eight of these confined to the skin. Breeds over-represented included the Rhodesian ridgeback, boxer, beagle, Jack Russell terrier, French bulldog and vizsla. Along with skin lesions, the most common clinical d signs were vomiting and diarrhoea. The most common laboratory finding was elevated alanine aminotransferase values.

在一项观察性研究中，Rostaher等人（2017）检查了24例荨麻疹病例，其中16例与过敏反应有关，其中8例局限于皮肤。主要代表品种包括罗得西亚脊背犬、拳狮犬、比格犬、杰克罗素㹴犬、法国斗牛犬和维兹拉犬。除了皮肤病变外，最常见的临床症状是呕吐和腹泻。最常见的实验室检查结果是丙氨酸氨基转移酶升高。

 

Urticarial lesions can occur locally or generalised and manifest as variably pruritic, erythematous wheals with a domed or flattened surface. Multiple wheals may coalesce and form arcuate patterns. Lesions are usually visible on glabrous skin and, on haired regions, are more obvious in short-coated dogs. Angloedema is less demarcated, with the swelling involving mostly the extremities, such as a distal limb or the head (Fig 1a). If the upper respiratory tract become emergencies.

荨麻疹可局部或全身出现，表现为不同程度的瘙痒性，发红风团，表面呈圆顶状或扁平状。多个风团可合并形成弓形图案。病变通常在无毛的皮肤上可见，在有毛的区域，短毛犬更明显。血管水肿边界不清，肿胀主要累及四肢，如肢体远端或头部（图1A）。如果涉及上呼吸道症状则变为紧急情况。

 

Diagnosis

诊断

Diagnosis is usually straightforward,based on history and clinical signs, and ruling out differential diagnoses. For urticaria these include bacterial folliculitis, mastocytosis, vasculitis, erythema multiforme, and cutaneous lymphoma, while for angloedema other differentials to be considered include juvenile granulomatous dermatitis and lymphadenitis, and mast cell tumour. Diascopy can be useful, showing blanching erythema(Fig 1b); histopathology is a valuable supportive measure.

诊断通常是简单，根据病史和临床症状，并排除鉴别诊断。荨麻疹包括细菌性毛囊炎，肥大细胞增生症、血管炎、多形红斑和皮肤淋巴瘤，而对于血管水肿，其他需要考虑的鉴别诊断包括幼年性肉芽肿性皮炎和淋巴结炎，和肥大细胞瘤。玻片压诊法可能是有用的，显示红斑变白（图1B）；组织病理学是一项有价值的支持措施。

 

 

Fig 1: (a) Case of urticaria and angioedema secondary to an adverse reaction to oral antibiotics in a young boxer. Urticaria appears as multiple circular areas of tufted hair and angioedema is present on the head and on all limbs. Note also the erythema on the ventral abdomen. (b) Use of diascopy to confirm blanching erythema

图1：（a）年轻拳狮犬口服抗生素不良反应继发荨麻疹和血管性水肿的病例。荨麻疹表现为头部和四肢出现多个圆形簇状毛发和血管性水肿。同时注意腹部的红斑。（B）使用玻片压诊法来确认红斑变白情况

 

Treatment

治疗

Patients presenting with life-threatening anaphylaxis should receive emergency treatment, consisting of epinephrine, fluid therapy, oxygen, glucocorticoids and antihistamines. For non- life-threatening cases,treatment typically Involves administering an oral glucocorticoid and antihistamine. Furthermore, pentoxifylline can be administered if there is concurrent vasculitis (Table 1). In both life-threatening and non-life-threatening scenarios, the prognosis is good if the correct treatment is promptly administered, and can be further improved if the primary trigger is identified.

出现致命性过敏反应的患病动物应给予紧急治疗，包括肾上腺素、液体疗法、吸氧、糖皮质激素和抗组胺药。对于不危及生命的病例，治疗通常包括口服糖皮质激素和抗组胺药。此外，如果同时存在血管炎，可给予己酮可可碱（表1）。在危及生命和非危及生命的情况下，如果及时给予正确的治疗，预后良好。如果确定了主要诱因，预后可进一步改善。

 

Juvenile sterile granulomatous dermatitis and lymphadenitis

幼年动物无菌性肉芽肿性皮炎和淋巴结炎

Juvenile sterile granulomatous dermatitis and lymphadenitls(SGDL),also known as canine juvenile cellulitis or puppy strangles , is an uncommon pustular, granulomatous dermatopathy affecting puppies and adult dogs. Although historically the condition has been described mostly in puppies (three to 16 weeks of age), Inga and others (2020) described it in go adult dogs, providing strong support for eliminating the age parameters. The exact aetiology and pathogenesis of SGDL remain unknown, with infectious-and vaccine-(the DHP [distemper, Infectious hepatitis and parvovirus] vaccine) related aetiologies suggested but never proven. Clinical signs start with acute swelling of the face (eyelids, lips, muzzle and ear pinnae ) ; submandibular and prescapular lymphadenopathy have also been reported. Within 24 to 48 hours the swollen areas develop papules , pustules and crusting ( Fig 2 ) , along with erosions, ulcerations, purulent otitis externa and suppurative lymphadenitis. Other areas involved include the perianal/genital skin, and less frequently neck and chest, trunk and limbs.Furthermore,patients can present with secondary bacterial infection, pyrexia, lethargy and arthralgia.

幼年动物无菌性肉芽肿性皮炎和淋巴结炎(SGDL)，也称为犬幼年蜂窝织炎或幼犬腺疫，是一种不常见的脓疱性肉芽肿性皮肤病，影响幼犬和成年犬。虽然历史上对该病的描述主要发生在幼犬(3 -16周龄)，但Inga等人(2020年)描述了成年犬的情况，为消除年龄参数提供了有力支持。SGDL的确切病原学和发病机制尚不清楚，认为与感染和疫苗(DHP[犬瘟热、传染性肝炎和细小病毒]疫苗)相关，但从未得到证实。临床症状开始于面部(眼睑、嘴唇、口鼻和耳廓)急性肿胀，颌下和肩胛前淋巴结病也有报道。在24 - 48小时内，肿胀的区域出现丘疹、脓疱和结痂(图2)，同时出现糜烂、溃疡、化脓性外耳炎和化脓性淋巴结炎。其他部位包括肛周/生殖的皮肤，较少发生在颈部和胸部、躯干和四肢。此外，患病动物可出现继发性细菌感染、发热、嗜睡和关节痛。

Table 1: Treatments for emergency dermatopathies
Dermatopathy	Treatment
Urticaria and angioedema	Life threatening ·Epinephrine(1:1000)0.1-0.5mlSC/IM ·Methylprednisolone succinate 1 mg/kg, or dexamethasone sodium phosphate 0.25 mg/kg IV Non-life threatening · Prednisolone 1 mg/kg every 24 hours PO, tapered upon response ·Chlorphenamine 4-8 mg/kg every eight hours PO, discontinued upon response ·±Pentoxifylline 10-30 mg/kg every eight to 12 hours PO, discontinued upon response
Juvenile sterile granulomatous dermatitis and lymphadenitis	Systemic signs ·IV fluid therapy at an appropriate rate · Analgesia IV; for example, buprenorphine 0.02 mg/kg every six hours No systemic signs ·Prednisolone 1-2 mg/kg every 24 hours PO for approximately one to two weeks, then gradually tapered ·Cyclosporine 5 mg/kg every 24 hours PO, if needed ±Systemic antibiotics
Irritant contact dermatitis	·Eliminate causative substance ·±Glucocorticoid:topical(eg,betamethasone every 12 hours for seven to 10 days);systemic(eg,prednisolone 0.5-1 mg/kg every 24 hours PO for approximately five days, then gradually tapered)
Eosinophilic furunculosis of the face	Prednisolone 1-2 mg/kg every 24 hours PO for approximately one to two weeks, then gradually tapered
Erythema multiforme(EM)	Cause identified ·Eliminate inciting cause ·Symptomatic treatment: IV fluid therapy with an appropriate type of fluid at an appropriate rate; analgesia IV(eg, buprenorphine 0.02 mg/kg every six hours); nutritional support; wound management Cause unidentified ·Immunosuppressant: prednisolone 0.5-4 mg/kg every 24 hours PO; cyclosporine 5 mg/kg every 24 hours PO;t azathioprine(dogs)1-2 mg/kg every 24 hours PO, then tapering to 0.5-1 mg/kg every 48 to 72 ·Human immunoglobulin(ivHIG)0.51g/kg5percentsolutionoversevenhours(NuttallandMalham2004) ·Oclacitinib 0.6-1 mg/kg every 12 hours PO until skin lesions resolved, then tapering(High and others 2020)
Toxic epidermal necrolysis	See EM and burns
Cutaneous adverse drug reaction	·Stop and/or antagonise offending drug ·Symptomatic treatment(see EM) ·士Immunosuppressant(see EM) ·iVHIG(see EM)
Vasculitis	·Remove inciting cause ·Pentoxifylline 10-30 mg/kg every eight to 12 hours PO ·±Immunosuppressant(see EM) ·±Chlorambucil(alternative to azathioprine)0.1-0.2 mg/kg every 24 to 48 hours PO (Innera 2013) ·Dapsone 1 mg/kg every 24 to 36 hours PO until skin lesions resolved, then tapering(Nichols and others 2001,Innera2013) ·±Sulfasalazine 20 to 25 mg/kg every eight to 12 hours PO (Nichols and others 2001, Innera 2013)
Burns	·IV fluid therapy with an appropriate type of fluid at an appropriate rate ·±Oxygen supplementation ·IV analgesia (eg, methadone 0.2 mg/kg every four hours) ·Antibiotic via parenteral route in case of sepsis ·Nutrition ,Wound management
IM Intramuscular, IV Intravenous, PO Orally, SC Subcutaneous

 

表1：紧急皮肤病的治疗
皮肤病	治疗
荨麻疹和血管性水肿	危及生命 ·肾上腺素（1：1000）0.1-0.5ml sc/im ·琥珀酸甲泼尼龙1 mg/kg，或地塞米松磷酸钠0.25 mg/kg，静脉注射 无生命危险 ·泼尼松龙1 mg/kg，每24小时口服，根据效果逐渐减量 ·扑尔敏4-8mg/kg，每8小时一次，口服，有效后停药 ·±己酮可可碱10-30 mg/kg，每8至12小时口服，有效后停药
幼年动物无菌性肉芽肿性皮炎和淋巴结炎	全身症状 ·以适当的速度进行静脉输液治疗 ·镇痛IV；例如，丁丙诺啡0.02mg/kg，每六小时一次 没有全身症状 ·口服泼尼松龙1-2 mg/kg，每24小时一次，持续约一至两周，然后逐渐减量 ·口服环孢素5 mg/kg，每24小时一次，如果需要 ·±全身性抗生素
刺激性接触性皮炎	·消除致病物质 ·±糖皮质激素：外用（如倍他米松，每12小时一次，持续7至10天）；全身（如，泼尼松龙0.5-1 mg/kg，每24小时口服，持续约5天，然后逐渐减量）
面部嗜酸性疖病	泼尼松龙1-2 mg/kg，每24小时口服，持续约1-2周，然后逐渐减量
多形红斑	病因明确 ·消除刺激病因 ·对症治疗：以适当的速度使用适当类型的液体进行IV液体治疗；镇痛IV（如丁丙诺啡每6小时0.02mg/kg）；营养支持；伤口处理 病因不明 ·免疫抑制剂：口服泼尼松龙0.5-4mg/kg每24小时一次；口服环孢素5mg/kg每24小时一次；±口服硫唑嘌呤（犬）1-2mg/kg，每24小时一次，然后逐渐减至0.5-1mg/kg，每48-72小时口服一次 ·人免疫球蛋白（ivHIG）0.51g/kg 5%溶液超过7小时（Nuttall和Malham2004年） ·口服奥拉替尼0.6-1 mg/kg，每12小时一次，直至皮肤病变消退，然后逐渐减少（高和其他2020)
中毒性表皮坏死松解症	同多形红斑和烧伤
皮肤药物不良反应	·停药和/或清除不良药物 ·对症治疗（参见EM） ·±免疫抑制剂（参见EM） ·ivHIG（参见EM）
血管炎	·消除刺激病因 ·口服已酮可可碱10-30 mg/kg，每8至12小时一次 ·±免疫抑制剂（参见EM） ·±口服苯丁酸氮芥（硫唑嘌呤的替代品）0.1-0.2 mg/kg，每24至48小时一次（Innera 2013） ·口服氨苯砜1 mg/kg，每24至36小时一次，直至皮肤病变消退，然后逐渐减量（Nichols等人2001，Innera 2013） ·±柳氮磺吡啶，每8至12小时口服一次20至25 mg/kg（Nichols等，2001，Innera 2013）
烧伤	·以适当的速度使用适当类型的液体进行IV液体治疗 ·±氧气补充 ·IV镇痛（如美沙酮0.2 mg/kg，每4小时一次） ·在败血症的病例，通过胃肠外途径使用抗生素 ·营养 ·伤口处理
IM肌肉注射 IV静脉注射 PO口服 SC皮下注射

 

 

Diagnosis

诊断

Clinical differential diagnoses for SGDL include drug eruptions, deep pyoderma, generalised demodicosis and angioedema (early stage). For adult dogs, the differentials also include sterile granuloma pyogranuloma syndrome and eosinophilic furunculosis of the face. Definitive diagnosis is reached by a combination of history, clinical signs and histopathology.

SGDL的临床鉴别诊断包括药疹、深层脓皮病、全身性蠕形螨病和血管性水肿（早期阶段）。对于成年犬，鉴别诊断还包括无菌性肉芽肿、脓性肉芽肿综合征和嗜酸性面部疖病。结合病史、临床症状和组织病理学可作出明确诊断。

 

Fig 2: Sterile granulomatous dermatitis and lymphadenitis in an adult English setter. Alopecia, papules, eroded plaques, erosions and crusting affecting the muzzle can be seen

图2：成年英国塞特犬的无菌性肉芽肿性皮炎和淋巴结炎。可见口周的脱毛、丘疹、糜烂斑块、糜烂和结痂

 

Treatment

治疗

Treatment consists of systemic glucocorticoids at immunosuppressive dose(oral prednisolone 1 to 2 mg/kg once daily ), tapered once there are signs of lesion resolution. Additionally, otitis externa and secondary bacterial infections should be treated appropriately and puppies with systemic clinical signs may require hospitalisation for intravenous fluid therapy and analgesia (Table 1). Prognosis is good but relapse is possible when the administration of glucocorticoids is discontinued. In these cases, glucocorticoids should be reinitiated; in cases that are refractory to high doses of glucocorticoids or where severe side effects are seen, other immunomodulatory agents, such as cyclosporine, should be considered for a sparring effect(Bajwa 2022). In our opinion, cyclosporine should ideally be used within the data sheet recommendation, and not as a first-line treatment, especially in dogs younger than six months of age.

治疗包括免疫抑制剂量的全身性糖皮质激素（口服泼尼松龙1至2 mg/kg，每日一次），一旦出现病变消退症状，则逐渐减量。此外，应适当治疗外耳炎和继发性细菌感染，出现全身临床症状的幼犬可能需要住院进行静脉输液治疗和镇痛（表1）。预后良好，但停止使用糖皮质激素时可能复发。在这些病例中，应重新开始使用糖皮质激素。在对高剂量糖皮质激素无效或出现严重副作用的病例中，应考虑使用其他免疫调节剂，如环孢素。在我们看来，环孢素应该在数据表推荐的范围内使用，而不是作为一线治疗，尤其是在小于6月龄的犬中。

 

Irritant contact dermatitis

刺激性接触性皮炎

Irritant contact dermatitis can be defined as a non-specific inflammatory cutaneous reaction following contact with an irritating substance, without any antecedent period of sensitisation. Irritant reactions are dose dependent and can affect any individual. These characteristics are different from those of allergic contact dermatitis, which instead describes an immune-mediated antigen-specific inflammatory skin disease following contact with a specific sensitiser (Ho and others 2015). Allergic contact dermatitis reactions are idiosyncratic and non-dose dependent. In irritant contact dermatitis, speed of onset and severity of lesions are determined by the nature, concentration and contact duration of the irritant. Corrosive substances such as acids or alkalis injure the skin immediately and can cause lesions of various severity, with the most severe being classified as chemical burns and requiring emergency treatment.

刺激性接触性皮炎可定义为与刺激性物质接触后的非特异性炎性皮肤反应，无任何前期致敏期。刺激性反应是剂量依赖性的，可影响任何个体。这些特征与过敏性接触性皮炎不同，后者描述的是一种与特定致敏剂接触后免疫介导的抗原特异性炎症性皮肤病。过敏性接触性皮炎反应具有特异性和非剂量依赖性。在刺激性接触性皮炎中，发病的速度和病变严重程度由其性质决定，刺激物的浓度和接触时间。酸或碱等腐蚀性物质会立即病变皮肤，并可引起各种严重程度的病变，最严重的被归类为化学烧伤，需要紧急治疗。

 

Examples of substances causing irritant contact dermatitis include detergents/cleansers(shampoos, lotions), flea collars and spot-on products, industrial chemicals (eg, fertilisers) and industrial material (carpet, paint, wood preservatives). Environmental irritants cause clinical signs only in the area of direct contact, with acute lesions consisting of oedema, erythema, papules and/or alopecia. In some cases, ulcerations and epidermal necrosis may also occur. In chronic cases, secondary lesions, such as scaling, fissuring and lichenification, may develop. The offending substance could also be ingested through grooming, hence lesions may be present in the oral cavity.

例如，引起刺激性接触性皮炎的物质包括洗涤剂/清洁剂（香波、乳液）、跳蚤项圈和滴剂产品、工业化学品（如化肥）和工业材料（地毯、油漆、木材防腐剂）。环境刺激物仅在直接接触区域引起临床症状，急性病变包括水肿、红斑、丘疹和/或脱毛。在某些病例中，溃疡和表皮坏死也可能发生。在慢性病例中，可发生继发性病变，如皮屑、开裂和苔藓化。这种有害物质也可能通过理毛而摄入，因此口腔中可能出现病变。

 

Diagnosis

诊断

Diagnosis is complicated due to the clinical similarities between irritant contact dermatitis, allergic contact dermatitis and other inflammatory skin conditions. Therefore, it is tentatively based on history and corresponding lesion location. However, if there is no applicable history, differentials include allergic contact dermatitis, atopic dermatitis(food/environmental), cutaneous adverse drug reactions, ectoparasite infestation and cutaneous infections.

由于刺激性接触性皮炎、过敏性接触性皮炎和其他炎症性皮肤病之间的临床相似性，诊断是复杂的。故暂以病史及相应病变部位为依据。但是，如果没有适用的病史，鉴别诊断包括过敏性接触性皮炎、特应性皮炎（食物/环境）、皮肤药物不良反应、体外寄生虫感染和皮肤感染。

 

Treatment

治疗

The best treatment is to eliminate the causative substance, along with topical therapy with water,with or without emollient shampoos to remove the irritant and soothe the skin. Although studies in people have given conflicting results, it is commonly accepted that a course of topical or systemic corticosteroids can be given to control pruritus, pain and inflammation, especially in pruritic patients (Table 1).

最好的治疗方法是消除致病物质，同时用水进行外部治疗。使用或不使用润肤香波来去除刺激物和舒缓皮肤。虽然对人类的研究给出了相互矛盾的结果，但人们普遍认为，外部或全身使用皮质类固醇可以控制瘙痒、疼痛和炎症，尤其是瘙痒患病动物（表1）。

 

Eosinophilic furunculosis of the face

面部嗜酸性细胞疖病

Eosinophilic furunculosis of the face is a rare, acute-onset dermatopathy seen in dogs. Aetiology is not well described but it has been suggested that it represents acute allergic reactions to bites from arthropods or insects(Pali-Scholl and others 2019). Dogs typically present with the acute lesions of papules, nodules, crusting and haemorrhagic exudate. Lesions predominantly occur on the bridge of the nose and muzzle (Fig 3), but can also develop on the periocular areas, pinnae, ventral abdomen, lips and interdigital skin. Pruritus can be severe, and in some cases pain is reported. Permanent scarring is possible and more severely affected dogs may present with pyrexia and depression.

面部嗜酸性粒细胞疖病是犬一种罕见的急性发作性皮肤病。病因不详，但有人认为它代表了对节肢动物或昆虫叮咬的急性过敏反应。犬的典型急性病变表现为丘疹、结节、结痂和出血性渗出物。病变主要发生在鼻梁和口周（图3），但也可发生在眼周区域、耳廓、腹侧腹部、嘴唇和趾间皮肤。瘙痒可能很严重，在某些病例中会出现疼痛。可能有永久性疤痕，更严重的患犬可能会出现发热和精神沉郁。

 

 

Fig 3: Eosinophilic furunculosis on the face of a young adult crossbreed dog. Alopecia, coalescing papules, plaques and erosions involving the dorsum of the muzzle can be seen. The nasal planum is not affected in this case

图3：一只年轻成年杂交犬的面部嗜酸性细胞疖病。可见口周背部的脱毛、融合丘疹、斑块和糜烂。在这病例中，鼻平面未患病。

 

Diagnosis

诊断

Clinical differential diagnoses include bacterial nasal folliculitis and furunculosis, dermatophytosis, demodicosis and autoimmune skin diseases with predominant facial distribution. A high number of eosinophils on lesional cytology increases the index of suspicion, but for a definitive diagnosis histopathology should be performed. Histopathological features include ulceration, dermal oedema and mucinosis, eosinophilic mural and luminal folliculitis and furunculosis. Dermal haemorrhage and flame figures are also commonly reported.

临床鉴别诊断包括细菌性鼻部毛囊炎和疖病、皮肤癣菌病、蠕形螨病和主要分布于面部的自身免疫性皮肤病。病变细胞学检查可见大量嗜酸性粒细胞，增加了怀疑指数，但为了明确诊断，应进行组织病理学检查。组织病理学特征包括溃疡、真皮水肿和粘蛋白增多症、嗜酸性细胞毛囊壁和毛囊腔毛囊炎和疖病。真皮出血和火焰图形也是常见的报告。

 

Treatment

治疗

Treatment consists of oral glucocorticoids (1 to 2 mg/kg once daily) and, in correctly diagnosed cases, a rapid response is seen within 10 to 14 days, making prognosis excellent (Table 1).

治疗包括口服糖皮质激素（1至2 mg/kg，每日一次），在正确诊断的病例中，在10至14天内出现快速反应，预后极好（表1）。

 

Erythema multiforme, Stevens-Johnson syndrome and toxic epidermal necrolysis

多形红斑、Stevens-Johnson综合征和中毒性表皮坏死松解症

Erythema multiforme ( EM ) , Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are uncommon, acute, polymorphic autoimmune diseases that affect people and animals. For many years, there was a lot of confusion regarding their classification, trigger factors and pathogenesis. The current accepted clinical classification in people and animals is that TEN and SJS are variants of the same disease spectrum, most commonly triggered by drugs, whereas EM is considered a separate disease, most commonly associated with herpes simplex virus 1 in people, and as drug induced in animals (Yager 2014, Banovic and others 2015).

多形红斑（EM）、Stevens-Johnson综合征（SJS）和中毒性表皮坏死松解症（TEN）是影响人和动物的罕见、急性、多形性自身免疫性疾病。多年来，关于它们的分类、触发因素和发病机制存在许多混乱。目前公认的人和动物的临床分类是，TEN和SJS是同一疾病谱的变体，最常见的是由药物引发。而EM被认为是一种独立的疾病，在人类中最常与单纯疱疹病毒1相关，在动物中是药物诱导的。

 

Reported drugs and conditions potentially associated with EM in veterinary medicine include antibiotics, levamisole, sulfonamides, a beef/soy diet,a commercial dog food,a nutraceutical product, infectious processes, clipper burn and neoplasia. However, many cases of EM are idiopathic and a recent report failed to identify potential drug triggers in 18 dogs with hyperkeratotic EM (Banovic and others 2018). Flea-dips containing limonene A have been implicated in severe necrotising dermatitis resembling TEN in cats and dogs (Yager 2014), and a recent case of TEN in a dog following a triamcinolone injection for allergy treatment has been reported (BalaZS 2020).

兽医中报道的可能与EM相关的药物和病症包括抗生素、左旋咪唑、磺胺、牛肉/大豆饮食、一种商业犬粮、一种营养产品，感染过程，剃毛烧伤和肿瘤。然而，许多EM病例是特发性的，最近的一份报告未能确定18只患有过度角化EM的犬的潜在药物触发因素。含有柠檬烯A的跳蚤浸液与猫和犬的严重坏死性皮炎（类似于TEN）有关，以及最近报告了一例注射曲安奈德治疗过敏的犬的TEN病例。

 

Little is known about the pathogenesis of EM and SJS/TEN in animals; in each disease, keratinocytes appear to be the target of the self immune response and apoptosis the mechanism for keratinocyte death. The clinical features of canine EM described in most cases are haemorrhagic, vesiculobullous and ulcerative lesions. Less commonly maculopapular eruptions typically involving the trunk,particularly the glabrous skin of the groin and axilla(Fig 4), but also the mucocutaneous junctions, oral cavity (Fig 5), pinnae and footpads are seen. Lesions can occasionally be painful and in rare cases pruritic, frequently associated with a systemic illness like fever, depression, lethargy and anorexia(Scott and Miller 1999). Recently, a new canine variant defined as 'old-dog' and 'hyperkeratotic' EM (HKEM) has been described, with annular to coalescing erythematous and hyperpigmented macules and plaques with adherent haemorrhagic crusts and scales(Banovic and others 2018). In the rare cases reported in cats, lesions mostly associated with EM were maculopapular, vesiculobullous and ulcerative (Scott and Miller 1999, Yager 2014). In SJS/TEN clinical signs appear suddenly with severe systemic signs like pain, anorexia, lethargy and depression, which could also be prodromal signs. Initial skin lesions consist of erythematous and haemorrhagic macules and patches that rapidly evolve to widespread confluent erosions and ulceration (Fig 6), with arciform/serpiginous shape, often involving the footpads and at least one mucosal site. A positive pseudo-Nikolsky sign, characterised by epidermal separation following pressure on erythematous skin (Fig 7), is usually seen (Yager 2014, Banovic and others 2015).

动物中EM和SJS/TEN的发病机制尚不清楚；在每种疾病中，角质形成细胞似乎是自身免疫反应和凋亡的靶点，而凋亡是角质形成细胞死亡的机制。临床表现为出血性、水疱大疱性和溃疡性病变。较少见的斑丘疹通常累及躯干，特别是腹股沟和腋窝的无毛皮肤（图4），但也累及皮肤粘膜交界处。可见口腔（图5）、耳廓和足垫。皮肤病变偶尔会疼痛，在极少数病例中会瘙痒，常伴有全身性疾病，如发热、抑郁、嗜睡和厌食。最近，一种新的犬变种被定义为“老年犬”和“角化过度” EM（HKEM），其具有环状至聚结的红斑和色素沉着斑和斑块，并伴有粘附的出血性结痂和皮屑。在猫中报告的罕见病例中，主要与EM相关的病变是斑丘疹、水疱大疱和溃疡。在SJS/TEN中，临床症状突然出现，伴有严重的全身症状，如疼痛、厌食、嗜睡和抑郁，这些症状也可能是早期症状。最初的皮肤病变包括红斑和出血性斑疹和斑片，迅速演变为广泛的融合性糜烂和溃疡（图6），呈弓形/匐行状，通常累及足垫和至少一个粘膜部位。通常可见阳性假尼氏征，其特征是红斑皮肤受压后表皮分离（图7）。

 

Fig 4: Erythema multiforme in a boxer. Multiple coalescing and erythematous macules and papules with an annular to serpiginous pattern on the caudoventral abdomen can be seen

图4：一只拳狮犬多形红斑。尾腹可见多个融合的红色斑疹和丘疹，呈环状至匐行性。

 

Fig 5: Erythema multiforme in a West Highland white terrier, with punctate ulcers on the dorsal surface and severe ulceration on the lateral border of the tongue

图5：一只西高地白㹴的多形红斑，舌面背部表面有点状溃疡，舌侧缘有严重溃疡。

 

Fig 6: Toxic epidermal necrolysis in an adult Jack Russell terrier, with widespread epithelial detachment affecting the ventral thorax, abdomen and medial aspect of the hindlimbs

图6：一只成年杰克罗素㹴犬的中毒性表皮坏死松解症，广泛的表皮脱落影响到腹侧胸部、腹部和后肢内侧。

 

Fig 7 : Positive pseudo Nikolsky sign demonstrated in a dog with toxic epidermal necrolysis. Picture: Ross Bond, Royal Veterinary College

图7：中毒性表皮坏死松解犬的假尼氏征阳性。图片：罗斯·邦德，皇家兽医学院

Diagnosis

诊断

In contrast to EM in people in which target lesions are pathognomonic,the heterogeneous clinical signs in EM lead to a long list of differentials such as urticaria, dermatophytosis, demodicosis, bacterial folliculitis superficial spreading pyoderma, vasculitis, bullous autoimmune skin disease and epitheliotropic lymphoma (Nemec and others 2012, Yager 2014). Burns, bullous autoimmune diseases, systemic lupus erythematosus, vasculitis and toxic shock syndrome should instead be considered as differential diagnoses in SJS/TEN.

与人EM特异性靶形病变相比，EM中的异质性临床症状鉴别诊断列表很多，如荨麻疹、皮肤癣菌病、蠕形螨病、细菌性毛囊炎、浅表扩散性脓皮病、血管炎、大疱性自身免疫性皮肤病和趋上皮淋巴瘤。烧伤、大疱性自身免疫性疾病、系统性红斑狼疮、血管炎和中毒性休克综合征应是SJS/TEN应考虑的鉴别诊断。

 

The diagnosis of EM, SJS and TEN is clinicopathological. The histological overlap between EM, SJS and TEN, mostly consisting of cytotoxic dermatitis, strongly supports the need for clinical information to differentiate these conditions. Multiple skin biopsies(more than six, each with an 8 mm diameter), including ulcer margins and erythematous areas, should be sampled to confirm the clinical diagnosis of TEN (Banovik 2015).

EM、SJS和TEN的诊断均为临床病理诊断。EM、SJS和TEN之间的组织学重叠，主要由细胞毒性皮炎组成，强烈支持需要临床信息来区分这些情况。应对多个皮肤活检（超过6个，每个直径为8 mm），包括溃疡边缘和红斑区域进行取样，以确认临床诊断。

 

Treatment

治疗

In EM, spontaneous resolution is unlikely without treatment (Yager 2014). However, when a drug is involved as a trigger factor, EM usually resolves within one to two weeks (Scott and Miller 1999). For this reason, in the case of drug history, drug withdrawal is mandatory. In idiopathic cases, immunosuppressive therapy could be considered even if the use is controversial in the literature. Drugs including glucocorticoids, azathioprine and ciclosporin can be used with a variable response, with possible relapse after tapering. A recent report showed a rapid and complete response of HKEM to oclacitinib in two dogs (High and others 2020). In dogs and cats affected by severe EM and refractory to immunosuppressive therapy, hospitalisation with supportive care and intravenous human immunoglobulin(hIVIG)could be considered (Byrne and Giger 2002, Ramos and others 2020). Dogs and cats with SJS/TEN should be hospitalised for supportive care. Treatment is centred upon drug removal, but aggressive patient management with fluid and electrolyte therapy, analgesia and wound care may be implemented. Immunosuppressive drugs and hIVIG have been used successfully in some case reports, but there is minimal evidence to support the efficacy of these treatments (Nuttall and Malham 2004, Yager 2014). Human evidence suggests that early immunosuppressive treatment with rapid tapering could be associated with a better outcome (Yager 2014). It is our opinion that in order to mitigate side effects, when possible, immunosuppressive treatment should be started with oral prednisolone at a dose of 2 mg/kg once daily.

在EM中，如果不进行治疗，自然消退是不可能的。然而，当药物作为触发因素参与时，EM通常在一到两周内消失。为此，在有用药史的病例中，应强制停药。在特发性病例中，即使文献中有争议，也可以考虑免疫抑制治疗。包括糖皮质激素、硫唑嘌呤和环孢素在内的药物可用于不同的反应，逐渐减量后可能复发。最近的一份报告显示，在两只犬上，HKEM对奥拉替尼有快速和完全的效果。在患有严重EM且对免疫抑制治疗无效的犬和猫中，可以考虑住院接受支持性治疗和静脉注射人免疫球蛋白（IVHIG）。患有SJS/TEN的犬和猫应住院接受支持性护理。治疗以停药为核心，但通过液体和电解质疗法对患病动物进行积极管理。可以实施镇痛和伤口护理。免疫抑制药物和IVHIG已在一些病例报告中成功使用，但支持这些治疗疗效的证据很少。人类证据表明，快速减量的早期免疫抑制治疗可能与更好的结果相关。我们认为，为了减轻副作用，在可能的情况下，免疫抑制治疗应从口服泼尼松龙开始，剂量为2mg/kg，每日一次。

 

Cutaneous adverse drug reactions

皮肤药物不良反应

Adverse drug reactions (ADRs) can be classified into two categories: dose dependent or idiosyncratic. Idiosyncratic reactions are unpredictable because they are not dependent on the dose or pharmacological proprieties of the drug. Most ADRs are drug allergies, where the antigen could be the drug or its metabolite, or a drug/metabolite-protein immunocomplex (Voie and others 2012). Four different types of hypersensitivity reactions can occur, leading to a wide range of clinical manifestations:

药物不良反应（ADR）可分为两类：剂量依赖性和特异性。特异性反应是不可预测的，因为它们不依赖于药物的剂量或药理学特性。大多数ADR是药物过敏，其中抗原可能是药物或其代谢物，或药物/代谢物-蛋白质免疫复合物。可发生四种不同类型的超敏反应，导致广泛的临床表现：

l Type I hypersensitivity (IgE mediated) is typically represented by angioedema (Fig 8a), urticaria and anaphylaxis.

l  Type II hypersensitivity or cytotoxic hypersensitivity (IgG/IgM mediated) includes manifestations such as drug-induced pemphigus.

l Type III hypersensitivity (immune-complexes mediated) is represented by vasculitis, for example.

l Type IV hypersensitivity (cell-mediated) includes manifestations such as EM and TEN.

 

l I型超敏反应（IgE介导）通常表现为血管性水肿（图8A）、荨麻疹和过敏反应。

l II型超敏反应或细胞毒性超敏反应（IgG/IgM介导）包括药物诱导的天疱疮等表现。

l III型超敏反应（免疫复合物介导）以血管炎为代表。

l IV型超敏反应（细胞介导）包括EM和TEN等表现。

 

Canine acute eosinophilic dermatitis with oedema (CAEDE) and sterile neutrophilic dermatosis are uncommon hypersensitivity reactions with unclear pathogenesis, associated in some cases to ADRs (Mauldin 2019). Although CAEDE and sterile neutrophilic dermatosis can have overlapping clinical and histological features (Bradley and others 2019), studies documented an association of CAEDE with gastrointestinal disease and administration of metronidazole, and an association of sterile neutrophilic dermatosis with carprofen (Mellor and others 2005, Mauldin 2019).

犬急性嗜酸性皮炎伴水肿（CAEDE）和无菌性中性粒细胞皮肤病是不常见的超敏反应，发病机制不明，在某些病例中与ADR相关。虽然CAEDE和无菌性中性粒细胞皮肤病可能具有重叠的临床和组织学特征，但研究证明CAEDE与胃肠道疾病和甲硝唑给药有关。以及无菌中性粒细胞皮肤病与卡洛芬的相关性。

 

Diagnosis

诊断

Different algorithms and scoring systems have been developed and modified for veterinary use for a better assessment of drug causality, such as the Naranjo scale, drug exposure scoring system (DES), and assessment of drug causality in epidermal necrolysis(ALDEN)(Naranjo and others 1981,Hinn and others 1998, Banovic and others 2015). All these ADR algorithms assigned a drug score, taking into account different factors such as the time between drug intake and the onset of reaction, dechallenge and rechallenge results. However, in most cases, the final diagnosis is done by excluding all other differentials.

为了更好地评估药物的因果关系，已经开发和修改了不同的算法和评分系统，如Naranjo量表。药物暴露评分系统（DES）和表皮坏死松解症（Alden）的药物因果关系评估。所有这些ADR算法都分配了药物评分，考虑了不同的因素，如药物摄入和反应发作之间的时间、去激发和再激发结果。然而，在大多数病例中，最终的诊断是通过排除所有其他鉴别诊断来完成的。

 

Treatment

治疗

Treatment of ADRs consists of drug withdrawal and supportive care, such as fluid therapy and immunosuppressive drugs,depending on the extent of systemic signs and severity of skin lesions (Fig 8b). Immunosuppressive drugs such as glucocorticoids, cyclosporine or azathioprine can be considered as treatment options even if the use is controversial. Usually, glucocorticoids represent the first-line choice, with the others to be considered as sparring agents if needed. hIVIG has been reported to be effective and safe in a few case reports (Nuttall and Malham 2004, Trotman and others 2006).

ADR的治疗包括停药和支持治疗，如液体治疗和免疫抑制药物，具体取决于全身症状的范围和皮肤病变的严重程度（图8B）。免疫抑制药物如糖皮质激素、环孢素或硫唑嘌呤，即使使用有争议，也可考虑作为治疗选择。通常，糖皮质激素是一线选择，如果需要，其他药物可考虑作为辅助药物。在一些病例报告中，IVHIG被报告为有效且安全。

 

Fig 8: (a) Adverse drug reaction in a young crossbreed dog. Angioedema, alopecia, generalised erythroderma and crusting are seen. The patient was severely depressed and was admitted for emergency treatment. (b) The patient at a four-week follow-up appointment following discontinuation of the offending drug and treatment with corticosteroids. Note the remaining scarring alopecia

图8：（a）一只年轻杂交犬的药物不良反应。可见血管性水肿、脱毛、全身性红皮病和结痂。患病动物严重抑郁，紧急入院治疗。（b）患病动物在停用不良药物并接受皮质类固醇治疗后进行为期四周的随访。注意残留的瘢痕性脱毛。

 

Cutaneous vasculitis

皮肤血管炎

Cutaneous vasculitis is a primary inflammatory process of the vessel wall, inducing damage of the vessel architecture and resulting in ischemic changes within the skin. The cause of vasculitis may be infectious or non-infectious. Non-infectious causes can be further classified as immune-mediated and non-immune mediated such as burns and trauma. Wide-ranging triggers, such as medicines, vaccines, food, infectious cases and tumours, can cause vasculitis. Genetic predisposition, such as in Jack Russell terriers, and solar exposure may also play a role. At least 50 per cent of the reports of vasculitis in the veterinary literature are idiopathic (Nichols and others 2001).

皮肤血管炎是血管壁的主要炎症过程，诱导血管结构的病变并导致皮肤内的缺血性改变。血管炎的病因可能是感染性的，也可能是非感染性的。非感染病因可进一步分为免疫介导和非免疫介导，如烧伤和创伤。各种各样的诱因，如药物、疫苗、食物、传染病和肿瘤，都可能导致血管炎。遗传易感性，如杰克罗素㹴犬，太阳照射也可能起到一定作用。兽医文献中至少有50%的血管炎报告是特发性的。

 

Diagnosis

诊断

Because of the heterogeneity of pathomechanisms and trigger factors, cutaneous vasculitis cannot be considered a diagnosis of disease but a reaction pattern that needs to be investigated with a thorough workup to identify underlying disease processes (Innera 2013).

由于病理机制和触发因素的异质性，皮肤血管炎不能被视为疾病的诊断，而是一种反应模式，需要通过彻底的检查来确定潜在的疾病过程。

 

Dermatological lesions commonly described in vasculitis are purpura that does not blanch by diascopy, plaques, haemorrhagic bullae, wheals, punched-out crateriform ulcers and subcutaneous nodules when subcutaneous adipose tissue is involved. Distal extremities and the tail are commonly affected, but any site of the body, including the oral cavity and mucous membranes, can be involved. Systemic clinical signs such as fever, anorexia and depression can also be associated. All these cutaneous and systemic signs can rapidly evolve, so a working diagnosis should be taken in the early stages for a better prognosis.

血管炎中常见的皮肤病变有玻片压诊法不褪色的紫癜、斑块、出血性大疱、风团、穿孔性火山口状溃疡和累及皮下脂肪组织时的皮下结节。四肢远端和尾部通常患病，但身体的任何部位，包括口腔和粘膜，都可能患病。全身性临床症状如发热、厌食和抑郁也可能与之相关。所有这些皮肤和全身症状都可以迅速演变，因此应在早期阶段进行有效诊断，以获得更好的预后。

 

A diagnostic workup may include:

l drug history with attention to vaccinations and dietary supplementation

l physical examination

l complete blood count/chemistry

l urinalysis

l additional diagnostic tests to rule out potentially infectious diseases,such as vector-borne diseases

l D-dimer test, which if shows results>500 ng/ml supports the presence of cutaneous vessel thrombi (Rosser 2009).

诊断检查可包括：

l 药物史，注意接种疫苗和饮食补充剂

l 体格检查

l 全血细胞计数/生化

l 尿液分析

l 额外的诊断测试以排除潜在的感染性疾病，例如病媒传播的疾病

l D-二聚体测试，如果结果显示>500 ng/mL，则支持皮肤血管血栓的存在。

 

Histopathology is mandatory to confirm a diagnosis of vasculitis. In the UK, cutaneous renal glomerular vasculopathy (CRGV), or Alabama rot, is a rare emerging disease with high mortality which is associated with cutaneous vasculitis. CRGV has been reported in different breeds of dogs in the UK, in contrast to data from the US which only reports cases in greyhounds. Vasculitis-like skin lesions and acute kidney injury, due to thrombotic microangiopathy associated with neurological signs and commonly with thrombocytopenia, characterise this condition, of which the cause remains unknown (Jepson and others 2019, Walker and others 2021).

组织病理学是确诊血管炎的必要条件。在英国，皮肤肾小球血管病（CRGV），或阿拉巴马病，是一种罕见的新发疾病，死亡率高，与皮肤血管炎有关。CRGV在英国不同品种的犬中都有报道，而美国的数据只报道了灵缇犬的病例。血管炎样皮肤病变和急性肾损伤，由于与神经症状相关的血栓性微血管病和常见的血小板减少症，是这种情况的特征，其原因尚不清楚。

 

Treatment

治疗

Treatment regimes of cutaneous vasculitis should be tailored to the patient depending on the extension of cutaneous ulcerations and the presence of systemic signs. Once infectious diseases have been ruled out, immunomodulating drugs such as glucocorticoids, cyclosporine, azathioprine, chlorambucil,sulfasalazine and dapsone can be considered for chronic relapsing and systemic forms of vasculitis, in association with pentoxifylline for its presumed rheological and immunomodulatory effects(Nichols and others 2001). Glucocorticoids usually represent the first-line choice, with the others to be considered as sparring agents if needed. Prognosis is determined by the cause and the extent of tissue ischaemia.

皮肤血管炎的治疗方案应根据皮肤溃疡的范围和全身症状的存在而定。一旦排除感染性疾病，对于慢性复发性和全身性血管炎，可以考虑使用糖皮质激素、环孢素、硫唑嘌呤、苯丁酸氮芥、柳氮磺吡啶和氨苯砜等免疫调节药物。与己酮可可碱联用，推测其具有流变学和免疫调节作用。糖皮质激素通常是一线选择，如果需要，其他药物可考虑作为辅助药物。预后取决于组织缺血的病因和程度。

 

Burns

烧伤

Veterinary patients infrequently suffer burn injuries due to their lifestyle; however, when they do occur, they are caused by thermal or chemical insults to the skin. In people, burns are classified according to depth and total body surface area (TBSA) affected (Table 2). These human guidelines can be used in veterinary species as a rough method of estimation; however,you should note that due to the diversity of conformation of our patients, such methods may lack accuracy.

由于他们的生活方式，兽医患病动物很少遭受烧伤；然而，当它们发生时，它们是由对皮肤的热或化学病变引起的。在人类中，烧伤根据深度和受影响的总体表面积（TBSA）进行分类（表2）。这些人类指南可用于兽医物种，作为一种粗略的估计方法。然而，你应该注意到，由于我们的患病动物构造的多样性，这些方法可能缺乏准确性。

 

Diagnosis

诊断

To estimate the TBSA affected, the body is divided into nine anatomical areas(head,neck,each forelimb, each hindlimb, anterior trunk, genitalia, posterior trunk), with each area representing a percentage of the TBSA. Affected area percentages are added together to give an overall TBSA percentage(Vigani and Culler 2017).

为了估计受影响的TBSA，将机体分为9个解剖区域（头部、颈部、每个前肢、每个后肢、躯干前部、生殖器、后躯干），每个区域代表一个TBSA的百分比。将受影响面积百分比加在一起，得出总体TBSA百分比。

 

Treatment

治疗

Patients may present in hypovolaemic shock due to severe burn oedema and require emergency treatment for stabilisation. Emergency treatment Veterinary Specialists involves intravenous fluid therapy, oxygen supplementation (if required), analgesia and nutrition(Table1).Following stabilisation, wound management should be addressed: burns presenting within two hours should be clipped and cooled with cold water for 30 minutes. Wounds should then be debrided, irrigated with cool water (12°), or covered with saline-soaked gauzes over 15 to 30 minutes and treated with topical antimicrobials (eg, silver sulfadiazine cream) under general anaesthesia. This should be repeated two to three times daily, including frequent dressing changes in certain cases.

患病动物可能因严重烧伤水肿而出现低血容量性休克，需要紧急治疗以稳定病情。兽医专家的紧急治疗包括静脉输液治疗，氧气补充（如果需要）、镇痛和营养（表1）。稳定后，应进行伤口处理：两小时内出现的烧伤应剃毛并用冷水冷却30分钟。然后对伤口进行清创，用冷水（12°）冲洗，或用盐水浸泡的纱布覆盖15至30分钟，并用外用抗菌药物治疗（如磺胺嘧啶银乳膏）。这应该每天重复两到三次，包括在某些病例中经常换药。

 

Time taken to achieve wound closure depends on burn depth: superficial burns can heal within a week, while full-thickness burns often require surgical intervention for closure(Fig 9). Prognosis depends on burn depth and the TBSA affected ; if the TBSA exceeds 50 per cent then the prognosis becomes poor (Table 2).

伤口愈合所需的时间取决于烧伤深度：浅表烧伤可在一周内愈合，而全层烧伤通常需要手术干预愈合（图9）。预后取决于烧伤深度和受影响的TBSA；如果TBSA超过50%，则预后变差（表2）。

 

 

Fig 9: (a) Newfoundland caught in a house fire that was presented to the vet practice several days later. Note the full-thickness burns over the left scapula and lumbosacral area, and the superficial and partial-thickness burns on the dorsum, from the apex of the head to the proximal tail. (b) The patient presenting after two months of hospitalisation for surgical and intensive wound management. Note the stages of wound healing-contraction, re-epithelialisation and scar formation-along the dorsum and multiple areas of hair regrowth. Pictures: Soft Tissue Surgery Department, Southern Counties Veterinary Specialists

图9：（a）纽芬兰岛遭遇房屋火灾，几天后被送往兽医诊所。注意左肩胛骨和腰骶部的全层烧伤。背部浅表和部分厚度的烧伤，从头部顶点到尾部近端。（B）患病动物在住院两个月后接受手术和伤口强化处理。注意伤口愈合的阶段-收缩，再上皮化和疤痕形成-沿着背部和毛发再生的多个区域。图片来源：南方县软组织外科兽医专家

 

Table 2: Classification of burns*
Depht	TBSA
Superficial burns Restricted to the epidermis, erythematous, dry and painful	Head and neck:9 per cent
Superficial partial-thickness burns Penetrate the epidermis and beginning of the dermis;the skin black to yellow-white, with/without hair follicles, eschars may be present. Pain sensation with air and temperature Deep partial-thickness burns Epidermis and deep dermis are affected; the area appears waxy or wet . Eschars are present and pain sensation may be reduced	Each forelimb:9 per cent is ; Each hindlimb : 18 per cent
Full-thickness burns Epidermis and dermis are completely affected and the parallel hypodermis, muscle and bone may be involved. Eschars are present, pain sensation may be present only with deep pressure	Anterior trunk:18 per cent Genitalia:1 per cent Posteriortrunk:18percent
	TBSA>50 per cent=poor prognosis
* modified from Vigani and Culler (2017) TBSA Total body surface area

 

 

 

 

 

表2：烧伤分类*
深度	TBSA
浅表烧伤 局限于表皮层，皮肤发红，干燥和疼痛	头部和颈部：9%
浅二度烧伤 穿透表皮层和真皮浅层；皮肤黑色至黄白色，有/无毛囊，可能存在焦痂。痛觉伴有能感知气流和温度 深二度烧伤 表皮层和真皮深层受累；该地区呈蜡状或湿状。焦痂存在且疼痛感觉可能会降低	每个前肢：9% ； 每个后肢：18%
全层烧伤 表皮层和真皮层完全受损，平行的真皮下组织、肌肉和骨骼可能受累。焦痂存在，疼痛感觉可能仅在深层压力时存在	躯干前部：18% 生殖器：1% 后躯干：18%
	TBSA>50%=预后差
*修改自Vigani和Culler（2017）    TBSA 总体表面积

 

Summary

总结

Dermatological emergencies are generally a rare occurrence in small animal, first-opinion veterinary practice, yet it is still important for practitioners to have knowledge of them. Most manifest acutely with striking skin lesions, but some begin with systemic signs or take time for the skin lesions to fully manifest. Knowledge of aetiology, clinical appearance, diagnosis and treatment will ensure that the correct approach is instigated and a definitive diagnosis reached. Histopathology is often essential to obtain a definitive diagnosis, thus it is paramount that sufficient and accurate information is relayed to the pathologist. Providing sufficient and accurate historical and clinical information will maximise the likelihood of the histopathological diagnosis being correct and corresponding with the clinical suspicion. Furthermore, for emergency dermatopathies that present with or cause concurrent systemic disease, the whole patient must be evaluated and urgently treated. Making a prompt diagnosis and decision about emergency treatment will reduce the risk of fatality and improve patient prognosis.

皮肤科急症在小动物的首诊兽医实践中通常是罕见的，但对从业者来说，了解它们仍然是重要的。大多数急性表现为显著的皮肤病变，但有些以全身症状开始或皮肤病变需要一段时间才能完全显现。对病因、临床表现、诊断和治疗的了解将确保采取正确的方法并作出明确的诊断。组织病理学通常是获得明确诊断的必要条件，因此向病理学家提供充分和准确的信息至关重要。提供充分和准确的历史和临床信息将最大限度地提高组织病理学诊断正确并与临床怀疑相对应的可能性。此外，对于与全身性疾病同时出现或引起全身性疾病的急诊皮肤病，必须对整个患病动物进行评估和紧急治疗。及时诊断和决定急诊治疗将降低病死率，改善患病动物预后。

 

 

 

 

 

Boxes 1 and 2 outline the clinical signs that should prompt early referral to a dermatology specialist, and the history that should be obtained and diagnostic tests performed when you suspect an emergency dermatology case.

方框1：提示早期转诊的标志

面部/肢体肿胀 表皮脱离 粘膜患病 病变不变浅 融合性病变 弥散性红皮病 瘀点/紫癜 大面积糜烂/溃疡 发烧 淋巴结病变 关节痛

方框1和2概述了应提示早期转诊至皮肤科专家的临床症状，以及当您怀疑有紧急皮肤科病例时应获得的病史和进行的诊断测试。

BOX1:RED FLAG SIGNS PROMPTING EARLY REFERRAL

Facial/limb swelling Epidermal detachment Mucosal involvement Lesions not blanching Coalescing lesions Diffuse erythroderma Petechiae/purpura Widespread erosion/ulceration Fever Lymphadenopathy Arthralgia

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

方框2：关键历史问题和诊断测试

历史问题 发病类型 动物的环境 旅行史 既往药物/疫苗暴露 接触其他具有传染性疾病动物 诊断测试 组织病理学 细胞学检查 来自新鲜病变的培养物（理想地来自组织） 皮肤深层刮片 全血细胞计数、生化和尿液分析

 

BOX2:KEY HISTORY QUESTIONS AND DIAGNOSTICTESTS

History questions Type of onset Animal's environment History of travel Previous drug/vaccine exposure Exposure to other animals with infectious disease Diagnostic tests Histopathology Cytology Culture from fresh lesions (ideally from tissue) Deep skin scraping Complete blood count,chemistry and urinalysis

 

 

 

 

王帆

感谢郑江涛医生的分享！

zhufessj125

感谢郑江涛医生的分享！

杨怡

王帆 发表于 2022-11-20 21:53
感谢郑江涛医生的分享！

感谢郑江涛医生的分享！厉害????了

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