Vasculitis in cats: causes, types and methods of treatment. Vasculitis in dogs. Valery Shubin, veterinarian, Balakovo

Vasculitis is a process of inflammation and destruction of the endothelial (inner) layer blood vessels. Severe skin lesions that occur in this case are not the disease itself, but only its symptom.

It is characterized by the appearance of crater-like ulcers, necrosis, pustules or papules, plaques and other skin lesions. Most often they occur on the paws, tail, auricles, scrotum and mucous membranes. oral cavity. The "concentration" of lesions is the higher, the more blood vessels in the tissues (that's why the symptoms are more often visible on the mucous membranes). For an accurate diagnosis in without fail need a biopsy.

Important! Possible reasons the appearance of this disease are numerous, but most often it is: autoimmune pathology, infectious diseases, especially chronic, allergic reactions (to food, vaccinations, drugs).

Other predisposing factors:

Tumors (usually malignant).
Chronic inflammatory diseases, especially bursitis.
Genetic predisposition (sphinxes).

Attention! Thus, hundreds of various factors can lead to vascular pathologies. So this is another good reminder of the need for regular veterinary checkups.

What is it like?

For some reason, it is generally accepted that skin vasculitis is the only type this disease. Unfortunately, it is not. The most dangerous is systemic vasculitis. At the same time, it is affected most of blood vessels in the body, which is fraught with the development of cardiac and lung pathologies, problems with lymphatic system etc.

Read also: Urolithiasis in cats: causes, diagnosis and treatment of the disease

Respectively, the second type of this disease is cutaneous vasculitis. With this pathology, only the vessels of the skin are affected and subcutaneous tissue. But! Many researchers warn that there is no clear line between these two types of diseases, and that at any time pathological processes can occur in the vessels internal organs. So in the article we will not clearly distinguish between systemic and cutaneous vasculitis, since the differences between them are very vague.

Clinical picture

We will immediately warn you that the specific symptoms of vasculitis in cats directly depend on the organ whose blood vessels are affected. pathological process. But common Clinical signs are:

Purple-red spots on the skin.
Papules and pustules filled with clear fluid.
Painful, bald areas on the legs, ears, genitals and abdomen. In addition, deep ulcers often appear on all visible mucous membranes.
The skin on the paws may become "loose" and as if swollen.
Severe skin itching.
AT severe cases deep, necrotic ulcers appear on the skin, which are quickly seeded with pyogenic microflora.
Bad appetite.
Depression.
Increased body temperature.

Read also: Blepharitis in cats: symptoms and causes

When making a diagnosis, it is necessary to exclude different types frostbite, burns, erythema, eczema and other skin diseases. In addition, it is important to rule out tick-borne infections that can cause similar symptoms. The final diagnosis is made only on the basis of a biopsy, and a sample of pathological material should be taken exclusively from the border between diseased and healthy tissue.

How to treat it?

The main task of treatment in this case is to completely eliminate the cause due to which vasculitis developed. Of course, this cannot be done in all cases. Since the resulting ulcers and foci of necrosis on the skin are often seeded pathogenic microflora, you should immediately deal with its suppression in order to avoid septic processes. For this, the cat is prescribed antibiotics. a wide range actions.

This is of particular importance in the case when the autoimmune nature of the disease has been proven. The fact is that in this case the animal is prescribed corticosteroids, including progesterone. Its use allows you to suppress excessively active immune system, but reverse side This results in an increased susceptibility of the body to bacterial infections. To avoid the death of an animal from some bacterium that is almost harmless in other conditions, it is required to prescribe prolonged antibiotics. Reception time - at least four weeks.

Important! When appointed prednisone or methylprednisolone their oral use is practiced daily, until the appearance of pronounced positive effects. hope for fast recovery don't, as vasculitis in cats can take up to eight weeks to heal! After that, the dose begins to slowly and smoothly reduce, stopping at the moment when the first signs of relapse appear. In the minimum concentration, the drug continues to be used for up to four to six weeks.

Ulcerations and other skin lesions showing a tendency to necrotic decay are excised surgically. But only in cases where there is a direct threat of sepsis. Exposing the body of a cat who is prescribed potent drugs to such a test is not a good idea.

Cutaneous vasculitis is an inflammatory disease of the blood vessels that is usually secondary to the deposition of immune complexes in vascular wall. Cutaneous vasculitis is just a term to describe a pattern skin reaction which can be due to many reasons.

Etiopathogenesis

Cutaneous vasculitis includes many diseases, the final link of which is an immunological reaction with damage to the vascular component of the skin or subcutaneous tissue. More often postcapillary venules are affected, thrombosis and blockage of which cause tissue hypoxia with subsequent necrosis.

Cutaneous vasculitis can be caused by:

Diseases: food hypersensitivity, insect bites, neoplasms, lesions connective tissue, metabolic disorder(ex. diabetes, uremia), SLE, cold agglutinin disease;
drugs: vaccines, itraconazole and even corticosteroids (prednisolne and dexamtetasone);
infections: bacteria, viruses, protozoa.

In most cases of canine and feline vasculitis, underlying causes are not identified and the disease is idiopathic.

Clinical signs

The disease most often affects dogs, but rarely occurs in cats. The disease is represented by various syndromes, the main ones are listed below.

Proliferative thrombovascular necrosis of the auricle.

Wedge-shaped necrosis of the tips of the ears is characteristic. Dogs of small and that breeds are predisposed. Initially, edema, erythema, and discoloration of the center of the apex of the ventral medial surface of the auricle. With the progress of the disease, erosions and ulcers are formed, which spread wedge-shaped from the tip of the ear towards the base. Probable necrosis with total loss ear tissues. Bilateral symmetrical lesions are more common, but unilateral lesions are also likely. signs systemic diseases missing. This syndrome characterized by a chronic and progressive course.

Hereditary cutaneous vasculopathy in German shepherds.

The onset of the disease is 4-7 weeks of age, characterized by loss of pigment and swelling of the pads, followed by the development of erosions, ulcers and crusts. Depigmentation is likely before ulceration begins. Similar lesions are likely on the ears, tip of the tail, and nasal speculum (rare). Likely signs systemic lesion- lymphadenopathy, fever, depression.

Similar lesions have been described in Fox Terriers and Miniature Schnauzers.

Greyhound vasculopathy (skin and renal glomerular vasculopathy).

Age predisposition - 1-5 years. Localization of lesions - in most cases on the limbs, sometimes spread to the trunk and groin, the head and mucocutaneous junctions remain intact. At the beginning of the lesion, erythema is noted, which quickly progresses to ulcers. Ulcers are deep, with well-circumscribed edges, about 1-5 cm in diameter, merge into groups of seven or more. With a significant lesion, swelling of the distal parts of the limbs is often noted. Once healing has begun, new lesions do not develop.

The disease also affects the vessels of the kidneys with the development of nephropathy. varying degrees gravity. Probable systemic manifestations are depression, hyperthermia, polyuria / polydipsia, vomiting and diarrhea, acute renal failure.

In addition to Greyhounds, the disease has been described in Great Danes.

Focal cutaneous vasculitis and alopecia at the rabies vaccination site.

Breed predisposition - poodle, Yorkshire Terrier, silky terrier. The lesion develops 2-6 m after subcutaneous injection vaccines are stored for months or years. The lesion itself is characterized by alopecia and hyperpigmentation, with occasional erythema or scaling.

Generalized ischemic dermatopathy.

Characterized by multiple skin lesions due to generalized ischemic dermatopathy. There are several syndromes that can manifest as alopecia, crusts, hyperpigmentation. Localization - the edges of the ears, periocularly, the skin over the bony protrusions, the tip of the tail, the pads. Possibly a tongue lesion.

Urticarial vasculitis(urticaria) - an acute lesion, characterized by the development of intense erythroderma, and consolidating blisters. Common in dogs with underlying food allergies.

Diagnosis

The presumptive diagnosis is clinical picture and exclusion of other diseases. The final diagnosis is histopathological examination.

It is important to try to identify and correct probable underlying causes.

Differential Diagnosis

Systemic lupus erythematosus
Syndrome of disseminated intravascular coagulation
cold agglutinin disease
Hypersensitivity reactions.
Erythema multiforme/toxic epidermal necrosis
Bullous pemphigoid (pemphigus)
Pemphigus vulgaris
Reaction to drugs
frostbite
Dermatosis of the edges of the ears

Treatment

In mild cases, for symptomatic therapy optimal use of pentoxifylline, in view of its likely positive effect and virtually no side effects.

At severe course It is optimal to use a combination of corticosteroids and non-steroidal immunosuppressive drugs. Corticosteroids are prescribed systemically in immunosuppressive doses with further reduction to the minimum effective dose. Probably local use of ointments with corticosteroids. Of the non-steroidal immunosuppressive drugs, cilosporin is more commonly used, but other drugs such as azathioprine, chlorambucil, cyclophosphamide, and some others are also likely to be used.

Drugs such as dapsone, sulfasalazine, and doxycycline are also likely to be used.

Valery Shubin, veterinarian, Balakovo.

Skin diseases in dogs are almost always quickly detected even by inattentive owners, since it is necessary to try hard not to suspect a patient in a bald, scabbed and ulcerated pet. So the owners notice vasculitis in dogs almost immediately, but few people know how dangerous redness and baldness of small areas of the skin can be ...

Vasculitis is an inflammation of the blood vessels leading to serious injuries their walls. Inflammation is caused by an autoimmune reaction when defense mechanisms organisms begin to destroy their own tissues and cells. There are many causes of vasculitis: infections (bacterial, viral, fungal), reactions to medications and some vaccines, neoplasia, and certain primary autoimmune diseases.

In dogs, this disease is not very common, but the pathology can affect animals of all ages, breeds, it does not depend on gender and physiological state. Other causes for systemic vasculitis include:

"Wrong", unpredictable interaction between drugs. This often happens when owners decide to “treat” their pet on their own, stuffing it with medicines without regard to their compatibility. Nobody reads the instructions.

Neoplasia is an abnormal growth of tissue, a tumor.

Surprisingly, .

. The more predisposed a dog is to them, the higher the risk of developing vasculitis or other autoimmune disease.

Chronic joint diseases such as rheumatoid.

Read also: Ear Diseases in Dogs: List of Diseases, Symptoms and Treatment

Clinical signs and diagnosis

Since the disease can affect almost all organs and tissues (which is not surprising, since there are vessels everywhere), the symptoms in different occasions strikingly different. For example, in vasculitis due to an inadequate response to a vaccine, there is a strong inflammatory response and hair loss at the injection site.

It is very easy to distinguish this phenomenon from the usual side effects or infection caused by non-compliance with the rules of asepsis and antisepsis: it develops two to three months after vaccination.

The veterinarian will start with a standard diagnostic study, which implies a complete blood count, its biochemistry, urinalysis. The more methods used, the more accurate the diagnosis. X-rays and ultrasound are also used: with their help, lesions of internal organs are detected. The "gold standard" for diagnosing vasculitis is a skin biopsy.

Read also: Malassezia dermatitis - fungal disease in dogs

If suspected allergic reaction for food, medicines, care products, then for some time it is desirable to exclude them. When they were the cause feeling unwell animal, it will be possible to do without strong drugs. The prognosis for this disease depends on many factors: the root cause, the localization of the main morphological and functional disorders (on the skin or in the internal organs - the difference is large), and the neglect of the case.

Therapeutic methods

The main goal of therapy is to eliminate the root cause that led to the development of an autoimmune reaction. Of course, this is true only for those cases where it was possible to install it at all.

Common treatments for vasculitis in dogs involve the use of the following medications:

Corticosteroids, including prednisolone.
Pentoxifylline.
A combination of tetracycline antibiotics and niacin (nicotinic acid).
Dapsone.
Sulfasalazine.
Cyclosporins.
Imuran.

Typically required combined treatment. In some cases, the dog will have to be on medication for life, while other dogs heal relatively quickly. Relapses are possible, and their appearance does not depend on the time of cessation of active treatment.

The "non-standard" methods of therapy include massage. It is known to reduce inflammation and increase blood circulation. Since vasculitis is an inflammation of the blood vessels and in many cases implies side effects», manual therapy will be useful in many situations.

Massage is also helpful for dogs with vasculitis who are prescribed prednisone. The fact is that one of the side effects of this drug is overweight and manual therapy helps to maintain muscle tone.

But! If the dog has pronounced symptoms of vasculitis, including inflammation and even tissue necrosis, massage is strictly contraindicated, as it can worsen the condition of the animal, and one should not forget about severe pain. This technique should only be used (!) as a supplement drug treatment, and only after fading bright severe symptoms. In addition, massage can be useful as a measure to prevent recurrence of the disease (with the exception of the periods of relapse themselves).

If the owner has found very strange sores on the tips of the ears of his beloved pet, then in no case should he be negligent about this kind of problem. It shouldn't be left unattended at all.

For every dog, her ears are perhaps the most main body feelings, they can be called with absolute certainty an important analyzer, therefore, every dog owner must ensure that his ears and hearing are in perfect order.

At home, the dog's ears can be treated with hydrogen peroxide, improve the pet's condition and diet.

Vasculitis

Even the most inattentive owner can find sores, ulcers and scabs on the tips of their dog's ears. Vasculitis can be noticed immediately, because it is characterized not only by the appearance of sores, but also by hair loss and redness of large areas. skin pet.

Vasculitis is called inflammation of the blood vessels, leading to rather serious damage to their walls. This pathology causes an autoimmune reaction, during which the protective mechanisms operating in the body begin to actively destroy their own cells, and subsequently tissues.

Causes

This disease is caused by:

Various kinds of infections.
Reaction to medications. Often, the owners themselves try to cure their pets by stuffing them with a variety of drugs. Quite often, dogs are vaccinated.
Autoimmune diseases (for example, neoplasia - pathological growth of tissues in the body).

Vasculitis is not a common disease, but it affects both young and old animals equally.

Signs of the disease

Since the onset of this pathology in the body of the dog, it has been all over the body. To a greater extent, ulcers can occur on the tips of the ears, at the site of which bleeding occurs.

The affected area begins to swell, although signs of inflammation may not be seen.
The dog may have a fever.
The animal is in pain, his appetite is markedly reduced and there is a progressive weight loss.

Diagnostics

Analysis of urine.
Taking a complete blood count.
Biochemistry of blood.

In case of diagnosing vosculitis impossible to do without x-rays and ultrasound - it is necessary to study the condition of the internal organs of the animal. How more methods diagnosis will be used, the faster it will be detected main reason occurrence of pathology.

Therapy

The main decision in the process of treating vosculitis is to determine the root cause that led to the abnormal development of the autoimmune system, and its further elimination. Treatment of this disease involves the use of drugs such as:

Corticosteroids (Pentoxifylline, Prednisolone).
tetracycline antibiotics and nicotinic acid(niacin) (Dapson, Sulfasazalin).
Immunosuppressants - cyclosporins (Imuran).

Treating a pet requires a combined approach. Some dogs can get rid of the vosculitis quite quickly, while others with this pathology live throughout their lives. Also, recurrence of the disease is not excluded.

Disease prevention

The owner should periodically check the condition of the blood of his pet. It is almost impossible to cure vasculitis at home on your own.

Allergic reaction

The cause of sores on the tips of the dog's ears can be a banal allergy to care products, medications and food.

Treatment of sores on the tips of the ears of dogs at home

Not always the owner can take his pet to veterinary clinic, for example, this happens if the dog lives in the country. In this case, first aid to the pet can be provided as follows:

Buy at a pharmacy Birch tar and actively lubricate the tips of the dog's ears.
The previous option can be replaced with Vishnevsky's ointment.
Also, the affected areas are washed with a solution of furatsilina (2 tablets are dissolved in a glass of warm boiled water), and then they are sprinkled with streptocide on top.
Review the dog's diet, excluding porridge and potatoes for a while.
Treat with hydrogen peroxide and cauterize with brilliant green (after all, it is possible that the pet could simply fight with other dogs).

It would be best to show your dog to a specialist, represented by a veterinarian.

Article from the book "A Color Handbook of Skin Diseases of the Dog and Cat" SECOND EDITION 2009 G

Translation from English: veterinarian Vasiliev AB

Etiology and clinical manifestations

Cutaneous vasculitis is inflammatory disease blood vessels, which is usually secondary to the deposition of immune complexes in the walls of blood vessels. Vasculitis is usually associated with infections (bacterial, viral, fungal, rickettsial), malignant tumors, drug reactions, rabies vaccination, metabolic diseases ( diabetes, uremia), systemic lupus erythematosus or hypothermia (cold agglutinin disease), or may be idiopathic. It is uncommon in dogs and rare in cats.

In most cases, clinical symptoms characterized by purpura, necrosis, and punctate ulcers, especially on the auricles, lips, oral mucosa, fingertips, tail, and scrotum. Acrocyanosis may be observed. Vasculitis in the form of urticaria (acute onset of intense erythroderma with confluent erythematous wheals that do not fade) has been described in dogs due to food hypersensitivity. In some dogs with rabies vaccine alopecia, a focal area of alopecia that develops at the site of vaccine administration appears 1 to 5 months after the onset of multifocal lesions. skin lesions caused by generalized ischemic dermatopathy. These lesions are characterized by variable alopecia, crusting, erosions, and ulcers at the pinna margins, periocular areas, skin over bony prominences, the tip of the tail, and the balls of the fingers. Erosions and ulcers of the tongue may also be seen. Animals with cutaneous vasculitis may have concurrent anorexia, depression, fever, arthropathy, myopathy, and pastose edema of the extremities.

In idiopathic canine auricular vasculitis, which is predisposed to dachshunds and is less common in other breeds, affected animals first develop alopecia along the edges of the auricles. Then the skin in focal areas (0.2–2.0 cm) along the same margin of the auricle becomes darkened, slightly thickened, and undergoes necrosis leading to ulceration (Figure 22). Typically, both ears are involved and each will have one to eight lesions. Sometimes, small ulcers are not visible on internal parts auricle. The lesions do not appear painful or itchy and there are no other skin or systemic symptoms. Ulcers, if left untreated, will slowly increase.

Differential Diagnosis

For dogs with auricular lesions only differential diagnosis should also include:

Proliferative thrombovascular necrosis
Disseminated intravascular coagulation
cold agglutinin disease
cryoglobulinemia
Ischemic necrosis associated with intoxication

Diagnosis

Rule out other differential diagnoses.
Titers for rickettsial infections should be determined to exclude diseases caused by ticks.
Dermatohistopathology: neutrophilic, eosinophilic, or lymphocytic vasculitis. In ischemic dermatopathy caused by rabies vaccination, cases of moderate to severe follicular atrophy, collagen hyalinization and mural folliculitis can be observed.

Treatment and prognosis

Any underlying disease must be identified and corrected.
To treat or prevent secondary pyoderma in dogs, appropriate prolonged systemic antibiotics(minimum 4 weeks). Dogs treated with antibiotics during the induction phase of immunosuppressive therapy have significantly more high performance survival than dogs treated with immunosuppressive drugs alone. Antibiotic therapy should be continued as long as concomitant immunosuppressive therapy keeps the autoimmune disease under control.
The goal of treatment is to control the disease and its symptoms as much as possible. safe treatment using the lowest possible doses. Ideally, drug combinations should be used to provide a comprehensive treatment plan to minimize the side effects of any one drug. Depending on the severity of the disease, more or less should be selected aggressive treatment. To achieve remission of the disease, higher doses are initially used and then reduced over 2-3 months to the lowest effective dose.

Topical treatment applied every 12 hours in the form of steroid-containing drugs and tacrolimus helps reduce focal inflammation and reduces doses systemic drugs required to control the symptoms of the disease. As soon as remission occurs, the frequency of application should be minimized in order to reduce the frequency of local side effects.
conservative systemic treatment(see table) includes drugs that help reduce inflammation with little or no side effects. These drugs help reduce the need for more aggressive therapies such as steroids or chemotherapy drugs. Steroid therapy is one of the most predictable treatments for autoimmune diseases skin: however, the side effects associated with the high doses required to control symptoms can be severe. Although glucocorticosteroid therapy alone may be effective in maintaining remission, the required doses may lead to undesirable side effects, especially in dogs. For this reason, the use of non-steroidal immunosuppressive drugs alone or in combination with glucocorticosteroids is usually recommended for long-term maintenance treatment.
Immunosuppressive doses of prednisone or methylprednisolone oral administration should be administered daily (see table). After resolution of the lesions (after about 2-8 weeks), the dose should be tapered gradually over a period of several (8-10) weeks to the lowest, possibly every other day, dose that maintains remission. If there is no significant improvement within 2-4 weeks of starting therapy, coexisting skin infection should be ruled out, then alternative or additional immunosuppressive drugs considered.
Alternative steroids for failure of prednisone and methylprednisolone include triamcinolone and dexamethasone (see table).
In cats, treatment with immunosuppressive doses of triamcinolone or dexamethasone is often more effective than therapy with prednisolone or methylprednisolone. Oral triamcinolone or dexamethasone should be given daily until remission is achieved (approximately 2-8 weeks), then the dose should be gradually reduced to the lowest possible dose with as little as possible. frequent use, which supports remission (see table)
If unacceptable side effects develop or there is no significant improvement in the first 2-4 weeks of treatment, consider using alternative corticosteroids or non-steroidal immunosuppressive drugs (see table).

Alternative treatments that may be effective include the following:
Dapsone (dogs only) 1 mg/kg po q 8 hours until lesions resolve (approximately 2-3 weeks). Once remission is achieved, the dose is gradually reduced to 1 mg/kg orally every 12 hours for 2 weeks, then 1 mg/kg every 24 hours for 2 weeks, then 1 mg/kg every 48 hours.
Sulfasalazine 10–20 mg/kg (maximum 3 g/day) orally every 8 hours until lesions resolve (approximately 2–4 weeks). Once remission is achieved, the dose is reduced to 10 mg/kg every 12 hours for 3 weeks, then 10 mg/kg orally every 24 hours.
Non-steroidal immunosuppressive drugs that may be effective include azathioprine (dogs only), chlorambucil, cyclophosphamide, mycophenolate mofetil, and leflunomide (see table). A positive response is observed within 8-12 weeks from the start of therapy. Once remission is achieved, attempts are made to gradually reduce the dose and frequency of non-steroidal immunosuppressive drugs for long-term maintenance treatment.

4 Regardless of the drug used, some patients may eventually discontinue therapy after 4–6 months of treatment; in others, long-term maintenance therapy is needed to maintain remission.

5 The prognosis is variable, depending on the underlying cause of the disease, the prevalence of skin lesions, and the degree of involvement of other organs.

Photo 1 Vasculitis of the skin of dogs and cats.

Photo 2 Vasculitis of the skin of dogs and cats. Erythematous lesions with alopecia on the face of an adult Jack Russell Terrier

Photo 3 Vasculitis of the skin of dogs and cats. Same dog in photo 2. Erosive lesions on the hard palate are typical of vasculitis. Lesions of the oral mucosa are often observed in vasculitis, pemphigus vulgaris, bullous pemphigoid and systemic lupus erythematosus (SLE).

Photo 4 Vasculitis of the skin of dogs and cats. Alopecia, crusts on the edge of the auricle are typical for vasculitis. Pay attention to the similarity with scabies; however, the dog did not experience intense itching.

Photo 5 Vasculitis of the skin of dogs and cats. Multiple defects in the form of notches on the edge of the auricle in adult dachshund. There is no obvious inflammation, which is an indicator of active vasculitis.

Photo 6 Vasculitis of the skin of dogs and cats. Large perforation defect caused by chronic ear vasculitis

Photo 7 Vasculitis of the skin of dogs and cats. Peripheral edema caused by the outflow of fluid from the vessels due to vasculitis.

Photo 8 Vasculitis of the skin of dogs and cats. An erythematous lesion with well-defined serpentine margins is characteristic of vasculitis, a skin reaction to drugs (erythema multiforme), or an autoimmune skin disease.

Photo 9 Vasculitis of the skin of dogs and cats. Severe ulcerative dermatitis on the paw of an adult Greyhound. Note the well-circumscribed serpentine lesion that is characteristic of vasculitis, skin drug reaction (erythema multiforme), or autoimmune skin disease.

Photo 10 Vasculitis of the skin of dogs and cats. Focal ulcerative lesion in the center of the pad is unique feature vascular disease.

Photo 11 Vasculitis of the skin of dogs and cats. Crusted lesions on the pads (especially on the central pads) are a unique feature of vasculitis.

Photo 12 Vasculitis of the skin of dogs and cats. Flaking of the skin on the pads of a dog with vasculitis. Injuries to the pads of the fingers can also be seen in autoimmune skin diseases.

Photo 21 Vasculitis of the skin of dogs and cats. Pad ulcers in a dog with vasculitis.

Photo 22 Vasculitis of the skin of dogs and cats. Alopecia, crusts on auricle. The nasal mirror is not changed. Note the similarity of the lesions to scabies; this dog had little itching.

Text of the article and photo 1-21 from the book

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