pathology of the integumentary systempeople.upei.ca/hanna/skin3/skinl3-webf17.pdf · pathology of...
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Pathology of the Integumentary System
Lecture 3 Congenital / Environmental / Infectious
(Web review)
Paul Hanna Fall 2017
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CONGENITAL AND HEREDITARY SKIN DISEASE
Congenital Hypotrichosis
• all domestic species
• absence of hair follicles &/or abnormal follicular development
Cattle: • hereditary vs acquired (BVD, iodine, pituitary hypoplasia, teratogens)
• r/o telogen or anagen defluxion
Dogs and Cats: • several hereditary forms
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Congenital Hypotrichosis
Congenital hypotrichosis in an Ayrshire calf
(note: thin hair coat due to failure of normal
development of many hair follicles)
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Anagen or Telogen Defluxion (Effluvium)
eg anagen defluxion following severe neonatal diarrhea / sepsis
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[For information only] Hereditary collagen dysplasia
Ichthyiosis
Hereditary collagen dysplasia
(note: distensible skin which tears easily)
Calf with ichthyosis - a congenital keratinization disorder
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[For information only] Epidermolysis Bullosa
Various forms of epidermolysis
bullosa are recognized in humans
and domestic animals that are
associated with inherited defects
of adhesion molecules in the
hemidesosomes / basement
membrane.
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[For information only] Epidermolysis Bullosa
Epidermolysis bullosa is
described in Belgian foals.
In the first few days of life
see skin / oral ulceration
and also separation /
sloughing of the hooves.
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[For information only] Epidermolysis Bullosa
Extensive subepidermal clefting causing vesicle / bulla
formation in the skin
Note, extensive subepidermal clefting / separation also
occurs in oral cavity & esophagus
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Canine Recurrent Flank Alopecia
aka = Seasonal (cyclic) flank alopecia
Also:
Color dilution alopecia
Black hair follicular dysplasia
Other follicular dysplasias
[For information only] Pattern alopecia (Pattern baldness)
Idiopathic bald thigh syndrome,
a form of pattern baldness seen in greyhounds
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ENVIRONMENTAL INDUCED SKIN DISEASE
I. ACTINIC (SUN) INJURY
II. CHEMICAL INJURY
III. PHYSICAL INJURY
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ACTINIC (SUN) INJURY
Epidemiology
• amount of light reaching skin:
Environmental Factors (atmosphere / latitude / altitude / shelter)
Host Factors (quantity of hair / pigmentation / stratum corneum / genetics)
Path of sunlight through atmosphere.
In general the farther you are from the equator
the farther the suns radiant energy has to travel
through the atmosphere with greater amount of
filtering / absorption of the radiation.
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Etiopathogenesis
• visible light vs UV-A vs UV-B vs UV-C
• UV-B free radicals damages nucleic acids, proteins & lipids cell death
www.skin-science.com
ACTINIC (SUN) INJURY
Note, arrows indicate apoptotic
keratinocytes (“sunburn cells”) due to
UV-B radiation. These can be induced
within 30 minutes of sun exposure.
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Sunburn
• due to: direct endothelial damage
damage to keratinocytes with release of inflammatory mediators
Solar dermatitis
• chronically see thickened inflamed skin +/- dysplasia / neoplasia
ACTINIC (SUN) INJURY
Sunburn on
udder of a goat
Fig 14-5 (Hnilica – Sm An
Derm) Feline Solar
Dermatosis. Alopecia,
erythema, erosions, and
crusting on the ear pinna.
As the disease progresses,
papules will develop, with
erosion and ulceration that
suggest progression to
squamous cell carcinoma.
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• Mutagenesis:
pyrimidine dimer formation; esp in mutation “hot spots” on P53 gene
impaired P53 protein function no delayed replication & no apoptosis if not repaired
also promoter preferential replacement of damaged cells with mutated P53 cells
ACTINIC (SUN) INJURY
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ACTINIC (SUN) INJURY
UV induced dimer results in permanent mutation
Sci Am, 1996
Pyrimidine dimer
formation
Sci Am, 1996
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ACTINIC (SUN) INJURY
Pyrimidine dimers are efficiently corrected by Nucleotide Excision Repair
(NER) mechanisms. Even if it was 99.99% effective, the more exposure to
sunlight, the more pyrimidine dimers are formed which will increase the
risk of a dimer remaining unrepaired and going on to form a somatic
mutation. Also certain individuals can have defects in their NER repair
mechanism which would greatly increase the risk of mutations (eg
xeroderma pigmentosa).
Nucleotide Excision Repair (NER)
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ADDITIONAL
SUNBURNS
ACTINIC (SUN) INJURY
UV light can not only cause somatic mutations of the cells (left image), it can also act as a cancer promoter, ie sunburns
injures/kills keratinocytes which results in hyperplasia. Hyperplasia is fertile ground for replicating / amplifying / inducing
additional mutations → neoplastic transformation.
Sci Am, 1996
UV light as a cancer promoter
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ACTINIC (SUN) INJURY
Photosensitization after treatment with a phenothiazine anthelmintic
Many plants contain chemicals which are
photoreactive, eg St John’s wort (above)
Photosensitization
• photodynamic substances in skin are activated by UV-A or visible light
Type I exogenous origin of photodynamic agents
Type II aberrant heme pigment synthesis
Type III (hepatogenous type) failure to remove phylloerythrin
Type IV idiopathic
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Photosensitization
Photosensitization associated with liver disease; note
only poorly haired &/or white haired areas affected
Photosensitization in cattle; note only white areas affected. There
is enough pigment in the colored hair to absorb / block the light and
prevent activating the photodynamic agents.
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CHEMICAL INJURY
Local application
• agent must penetrate hair & stratum corneum; enhanced by moisture &/or damage
Systemic absorption
• ingestion of toxins with systemic effects on the skin and usually other organs
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1. Primary Contact Irritant Dermatitis
• skin contact by substances expected to cause irritation:
caustic chemicals (eg acids, alkalis)
concentrated drugs (eg insecticides)
soaps / detergents
body excretions (eg anal sac, urine)
CHEMICAL INJURY
Contact irritant dermatitis (eg concentrated lye solution) Contact irritant dermatitis (eg concentrated pour-on insecticide)
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2. Gangrenous Ergotism and Fescue Toxicosis
3. Many Others: thallium, selenium, mercury, arsenic, etc
CHEMICAL INJURY
gangrenous necrosis of distal limbs due to
severe peripheral vasoconstriction with ergotism
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Acral Lick Dermatitis
• esp large active breeds, esp < 5 yrs
• psychogenic boredom &/or anxiety
PHYSICAL INJURY
Acral lick dermatitis, note focal area of
alopecia, erythema, erosion / ulceration
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PHYSICAL INJURY
Abrasion / Laceration / Ulceration / Foreign Bodies
Radiation
Extremes in Temperature
Callus / Hygroma
Feline Psycogenic Dermatitis
Burn victim – note epidermal
necrosis / ulcers, crusts
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INFECTIOUS SKIN DISEASE
VIRAL SKIN DISEASES
BACTERIAL SKIN DISEASES
MYCOTIC SKIN DISEASES
PARASITIC SKIN DISEASES
PROTOZOAL SKIN DISEASES
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VIRAL SKIN DISEASES
Contagious Pustular Dermatitis (= contagious ecthyma = "Orf“)
• common / worldwide parapoxvirus infection of sheep & goats.
• typical pox phases (vesicles / pustules / crusts), but more hyperplastic
Fig. 17-31 (Zachary) Schematic diagram of the development of a poxvirus lesion over time.
Local Infection
• intact skin resistant to local infecting viruses (eg papillomaviruses, parapoxviruses)
• requires abrasion or arthropod bite
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Contagious Pustular Dermatitis
• lesions on lips; ± eyelids, feet, oral cavity; rarely GI tract / viscera
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Contagious Pustular Dermatitis
Note, ballooning degeneration and
intracytoplasmic inclusion bodies.
Contagious pustular dermatitis is a relatively common
zoonosis in individuals handling sheep & goats
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Systemic Viral Infection
• epitheliotropic
• other, eg 2o to pruritus
• pantropic
Canine distemper – “hard pad”
Scrapie Vesicular exanthema
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Diagnosis
• history & clinical signs / lesions
• skin biopsy
• serology
• virus isolation or identification
VIRAL SKIN DISEASES
Raccoon – scale / crust on
distal limbs due to canine
distemper virus infection
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CANINE
Papilloma virus
Canine distemper virus
CATTLE
Bovine mammillitis virus
Pseudocowpox
Papilloma virus
SWINE
Swinepox
HORSES
Papilloma virus
VIRAL SKIN DISEASES
Swinepox
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BACTERIAL SKIN DISEASES (PYODERMAS)
healthy skin is resistant to bacterial infection due to:
lack of moisture
stratum corneum forms physical barrier + continuous desquamation
antibacterial effects of sebum / sweat and the normal microflora
• result depends on agent pathogenicity / host defence mechanisms
factors assisting bacterial colonization / proliferation:
moisture and dirt
altered cornification
physical damage
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PRIMARY SECONDARY
SKIN Otherwise healthy Not healthy
BACTERIA One species > 1 species
PATTERN Characteristic Not characteristic
ANTIBIOTICS Successful Not successful
• pyodermas are common in dogs
BACTERIAL SKIN DISEASES (PYODERMAS)
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SUPERFICIAL DEEP
INVOLVE epidermis dermis / subcutis
REPAIR no scarring scarring
DURATION short chronic
LYMPH NODE no yes
SYSTEMIC no +/-
GROSS pustules, crusts pustule, nodule, abscess, sinus
HISTOLOGY pustular &/or perivascular dermatitis
with neutrophils
folliculitis / furunculosis
&/or nodular to diffuse
dermatitis / panniculitis,
suppurative to granulomatous,
± bacterial agent
BACTERIAL SKIN DISEASES (PYODERMAS)
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Diagnosis
history & lesions
culture
skin biopsy
BACTERIAL SKIN DISEASES (PYODERMAS)
Fig 3-14 (Hnilica – Sm An Derm) Superficial
Pyoderma. Erythematous dermatitis with
epidermal collarettes formation is apparent.
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CANINE
Pyotraumatic dermatitis ("hot spots” or “acute moist dermatitis”)
• intense pruritus➞ self-trauma ➞ secondary bacterial infection.
focal alopecia, excoriation (erosion / ulceration), exudation
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CANINE
Impetigo
• primary superficial pustular dermatitis, esp dogs (“puppy pyoderma”)
• predisposed by moist / dirty environments, abrasions, parasitism, poor nutrition
Note, pustules and epidermal collarettes
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CANINE Skin fold pyoderma
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FELINE
Subcutaneous Abscesses
Note, bite wounds overlying area of inflammation (panniculitis / cellulitis and abscessation), which is not
obvious on external visual examination, ie often need to dissect to find the underlying inflammation.
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RUMINANTS
Papillomatous Digital Dermatitis (“hairy heel warts”)
Initially an erosive / ulcerative plaque-like lesion, which is intensely painful and progresses
to a proliferative / papillomatous (with long, thin papillae), less painful lesion
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Papillomatous Digital Dermatitis
See epidermal hyperplasia & prominent papillae extending
from the surface. Basophilic material at base of papillae is
composed of myriads of bacteria (H&E stain).
Note, see myriads of spirochete bacteria along the
epidermal surface with silver staining.
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Papillomatous Digital Dermatitis
Transmission electron micrograph showing numerous spirochetes in an advanced
stage of a typical digital dermatitis lesion. Int J Syst Bacteriol. 1997 Jan;47(1):175-81]
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RUMINANTS
Dermatophilosis (D. congolensis)
• a superficial exudative dermatitis, seen most commonly in hot, humid areas.
Characteristic branching
filaments of D. congolensis.
Filaments undergo
longitudinal & transverse
septation to form parallel
rows of coccoid bodies
which will mature into
zoospores.
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PORCINE
Exudative Epidermitis (Greasy Pig Disease)
• acute, rapidly spreading, often fatal exudative pyoderma of suckling to weaner pigs.
• infection with Staphylococcus hyicus, which have exfoliative exotoxins.
Note: cell crusts composed of
degenerate inflammatory cells
admixed with keratin, bacteria
In the common acute form see
greasy brown-black exudate /
crust which typically starts on
face &/or limbs and quickly
spread to the entire body.
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PORCINE
Septicemia
Salmonella
"Diamond Skin Disease"
“Diamond Skin Disease” in pig with Swine Erysipelas
Note rhomboid / ‘diamond shaped’ erythematous
plaques typical of infection with Erysipelothrix rhusiopathiae.
Salmonellosis - or other endotoxemias; note venous
infarction of extremities due to endotoxin induced venous
thrombosis.
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Diagnosis
history & lesions
fungal id / culture
skin biopsy
Cutaneous Mycoses
Subcutaneous Mycoses
Systemic Mycoses
Dermatophytosis (Ringworm)
Malasseziasis
Candidiasis
Cutaneous Mycoses of Wildlife
MYCOTIC SKIN DISEASES
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Dermatophytosis (Ringworm)
• common / worldwide distribution; mainly Microsporum & Trichophyton
• young / immunocompromised
• predisposing factors: overcrowding, high humidity, poor sanitation / nutrition
• contagious direct or fomites
• dermatophytes attack keratinized layers inflammation due to proteases
Cutaneous Mycoses
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Dermatophytosis (Ringworm)
• circular patches of scaling / alopecia to papules / pustules / furunculosis / crusting
Canine pinna, note focal alopecia,
erythema and scaling Bovine head, note mulifocal alopecia with scaling / crusting
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Dermatophytosis (Ringworm)
note multiple, often coalescing, areas of alopecia with scale & crust
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Dermatophytosis (Ringworm)
Arthrospores surrounding and hyphae within hair shaft.
Ringworm is the most commonly reported zoonosis in people
working with cattle. Although less common in small animals, one
study indicated ~50% of people exposed to either symptomatically
or asymptomatically infected cats develop lesions.
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Malasseziasis (Malassezia pachydermatis)
• yeast that are part of the normal microflora proliferate & cause dermatitis
secondary to underlying skin disease (eg allergies, seborrhea)
Malasseziasis in a couple of Westies (above) and same dogs following treatment (right). Vet Dermatol. 2001 Oct;12(5):285-90.
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Malasseziasis
Fig. 17-54B (Zachary) Stratum corneum contains numerous Malassezia pachydermatis yeast (arrows), which are bilobed (“peanut”-shaped). The
dermis is mildly edematous—note the mild separation of the collagen bundles by nonstaining to lightly amphophilic extracellular fluid. Gomori's
methenamine silver stain–H&E counter stain. [note: cytologic methods are much more sensitive than histology in detecting yeast]
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austriantribune.com
wikimedia.org
http://www.nwhc.usgs.gov
news.berkeley.edu
Chytridiomycosis of frogs and salamanders
White-nose syndrome of bats Snake fungal disease
Cutaneous Mycoses of Wildlife
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• traumatic implantation of a wide variety of saprophytic fungi
primarily by inhalation; esp Blastomycosis & Cryptococcosis
host usually has compromised resistance to infection
Subcutaneous Mycoses
Systemic Mycoses
Papular / nodular dermatitis, due to Blastomycosis
note: crusted papules / nodules on nostril and lip.
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