1 A message from the President Dear Friends and Colleagues, We are happy to welcome you to Birmingham for the 2016 Spring Meeting of the British Veterinary Dermatology Study Group. This year we are delighted to have two well-known international speakers, Mona Boord and Sonya Bettenay. There will be a vast range of sessions covering the frustrating subject of pododermatitis and claw diseases, from the pathogenesis to the clinical manifestations, to the medical and surgical therapeutic options. I am sure this will provide an ideal occasion for exchange of experiences which will contribute to future education. This meeting aims to educate first opinion practitioners and specialists in the field of veterinary dermatology, supporting and improving the welfare of our patients. I believe that this will be not only an excellent opportunity for all participants to develop further skills in their field of interest but also to indulge in social events. We have again, fantastic sponsorship for this event creating not only high quality, but outstanding value for money CPD. Thank you for coming, and we look forward to welcoming you to our 40 th anniversary meeting in the Autumn! Filippo De Bellis DVM CertVD DipECVD MRCVS European Specialist in Veterinary Dermatology BVDSG President 2 BVDSG Spring Meeting – April 2016 Pododermatitis Programme & Contents Wednesday 6 th April 09.00 – 09.30 REGISTRATION Morning Session – Chair: Filippo De Bellis 0 09.30 - 10.15 Approach to the patient with pedal disease Page 5 Mona Boord 10.15 – 11.00 Interdigital dermatitis, Atopic dermatitis, Demodicosis Page 11 and pedal infections Mona Boord 11.00 – 11.30 COFFEE & COMMERCIAL EXHIBITION Chair: Carly Mason 11.30 – 12.15 Diseases affecting the pawpads: hepatocutaneous Page 17 syndrome, PF, dermatophytosis, plasma cell pododermatitis Sonya Bettenay 12.15 – 13.00 Diseases affecting the claw and claw bed, SLO, Page 25 dermatophytosis Sonya Bettenay 13.00 – 14.30 LUNCH & COMMERCIAL EXHIBITION Afternoon Session – Chair: Sarah Warren 14.30 – 15.15 Treatment considerations Page 35 Mona Boord 15.15 – 16.00 Surgical options for pododermatitis (fusion podoplasty, Page 41 onychectomy, laser and cold steel) Mona Boord 16.00 – 17.00 Abstracts: Page 47 Efficacy Of Afoxolander (NexGard ®) Against Canine Mites: Treatment Of Generalised Demodicosis Fred Beugnet and Esther Rawlinson 3 4 APPROACH TO THE PATIENT WITH PEDAL DISEASE Mona Boord DVM, Dip ACVD, Animal Dermatology Clinic of San Diego Dr. Mona Boord is a veterinarian with specialized training in the field of dermatology. She graduated from the University of California Davis in 1992. She became a Diplomate of the American College of Veterinary Dermatology (ACVD) in 1997. She became an owner and board of director with the Animal Dermatology Clinics with the goal of improving the quality of life of her patients and their families by caring for and improving their skin conditions. Dr. Boord's publications include contributing author of Kirk's Current Veterinary Therapy XIII, Current Therapy in Equine Medicine V, Small Animal Dermatology Secrets, and Veterinary Allergy, as well as publications in several veterinary journals. She teaches dermatology as an Associate Professor at the Western University of Health Sciences, a mentor of multiple residency programs for the American College of Veterinary Dermatology, a national/international speaker and by mentoring visiting veterinarians from abroad. Outside of work, Dr. Boord enjoys competitive performance events with her own dogs including obedience, agility, herding, and tracking. INTRODUCTION Pododermatitis is a common problem in the dog and is less common in the cat. The term pododermatitis refers to an inflammatory skin disease that affects the paws. It is a pattern of distribution, not an etiologic diagnosis. The paw has many different structures (haired skin, skin folds, claw folds, claws, haired to pawpad junctional skin, and pawpads); the distribution of the disease on the paw helps to determine which differential diagnoses are more or less likely. In order to have the best clinical response to therapy, it is important to have not only an accurate diagnosis, but also to understand that with chronic disease, chronic pathologic change to the tissue may occur. This change can, and often does, hinder therapeutic success. 5 HINT I often consider chronic pododermatitis the way I compare severe and chronic otitis. They can have predisposing factors, primary factors, secondary or primary infections, and perpetuating factors. It often doesn’t really help to culture the paws. Multimodality therapy is often needed. EVALUATING THE PATHOGENESIS OF CLINICAL SIGNS Complicating factors in determining the underlying etiology of pododermatitis in the dog are the large range of diseases that cause pedal disease. The skin only has so many ways to react to disease. As a clinician we appreciate alopecia, erythema, excoriations, lichenification, papules, pustules and other signs that occur with various diseases. The problem is the skin often appears similar in a variety of diseases. The two most common causes of canine pododermatitis are atopic dermatitis and demodicosis. In the early stages these diseases appear very similar. Both of these diseases may result in secondary folliculitis and pyoderma which appears similar in both cases. The pathogenesis of pododermatitis can be evaluated in the following way , which can help improve therapeutic success. Look for predisposing factors, primary factors, secondary factors, and perpetuating factors. Failure to address any of these factors will lead to recurrence of disease or failure of therapy. Addressing key features in the history such as age of onset and level of pruritus, as well as evaluating the body areas most affected, allow us to take a long list of differential diagnoses and put them in an order of most likely to least likely causes of the symptoms the patient is experiencing. PREDISPOSING FACTORS Predisposing factors are those historical or physical findings that make the patient more susceptible or likely to develop certain conditions causing pathologic changes to the tissue. These factors work in conjunction with either primary causes or combine with secondary causes to cause a patient to be more susceptible to clinical disease. Examples of predisposing factors here would include the following; environmental factors, such as rough terrain or plant burrs; patient care, such as lack of grooming with overgrown claws or interdigital hair mats ; over grooming , such as clipper burns or very short cut hairs may cause inflammation; patient factors, including very short hair coat, abnormal weight bearing (conformation) and/or obesity may cause abnormal weight distribution to the paws. PRIMARY FACTORS Primary factors are the diseases or agents that directly induce the problem. The primary etiology may, without any additional factors, cause disease. However, once pododermatitis is present, secondary and perpetuating factors occur, and, in many cases, they become the focus of therapy. As with any medical problem, the primary factors can be broken down into multiple sub-groupings; infectious, immune mediated, keratinization, environmental, congenital, neoplastic, metabolic, and nutritional. 6 The approach to defining the primary factor is similar to any medicine case. Historical evaluation and physical examination help rank the primary factors as more or less likely. The clinician should then base the diagnostic approach on what he or she feels are the most likely differentials. Many clinicians will follow flow-charts and, although they are helpful, they may not be considering the most cost-effective test. Some primary causes of pododermatitis are very inexpensive, yet very important, to rule-out before performing more expensive diagnostic tests; an example of this is ruling out demodicosis prior to allergy testing. The following is a list of many primary factors causing pododermatitis: Infectious Bacterial Staph. Intermedius Gram negative or mixed infection Anaerobic infections Fungal Malassezia Dermatophytes Deep mycoses Parasitic Demodicosis Hookworm dermatitis Pelodera Leishmania Dirofilaria immitis Viral Papilloma virus Distemper Cowpox virus (cats) FeLV/FIV Immune Mediated Allergic Atopic dermatitis Contact allergy Adverse food reaction Autoimmune Pemphigus complex Bullous pemphigoid Systemic lupus Other Keratinization Seborrhea Vitamin A responsive Digital hyperkeratosis Sebaceous adenitis Environmental Foreign body Trauma Toxin Frost bite Burns Irritant contact reaction Congenital Familial dermatomyositis Zinc-responsive Acral mutilation syndrome Neoplastic Primary Metastatic Paraneoplastic Metabolic Endocrine Hyperadrenocorticism Hypothyroid Hepatocutaneous Syndrome Xanthomas Nutritional Zinc-responsive Vitamin A responsive Miscellaneous Drug eruption Plasma Cell Pododermatitis Onychodystrophy 7 SECONDARY FACTORS Secondary factors contribute to or cause disease only in the abnormal paw or in association with predisposing factors. Microorganisms act as opportunists and significantly contribute to the inflammation and pathology in the compromised pedal skin. The more commonly isolated bacterial organisms include Staphylococcus pseudintermedius , Pseudomonas spp., Proteus spp. , Escherichia coli , and Klebsiella spp .. Malassezia pachydermatis is the most common yeast contributing to pododermatitis; it is a budding yeast that has a peanut shape. The problem here is the focus of treatment becomes the infection, and the primary etiology