Dr Giulia Nadasan-Cozma
Giu The Vet- veterinary clinic
Arad, Romania
Pacient data and history:
Name: Connor
Breed: Bull Terrier
Age: 2 years
Patient presented for a dermatological consult after a few days of bleeding from the auricular pinnae.
The owner noted that the onset was acute, the lesions appeared “ overnight” and the animal was bothered by them, and started scratching and bleeding.
Dermatological findings:
Vasculitis lesions are noted bilaterally on the apex of the pinnae consisting of alopecia, ulceration, crusting in different stages and necrosis that led to loss of tissue and altered the shape of the pinnal apex.
The crust comes off very easily and hemorrhage starts.
Lesions begin at the apical margins of the pinnae and spread along the concave surface.
Diagnosis:
Diferential diagnosis:
Proliferative thrombovascular necrosis of the pinnae is the dermatological diagnosis but to confirm this diagnosis, a biopsy and a histopathology exam is needed.
Ear tip ulcerative dermatitis can be another dermatological diagnosis.
Vaccine associated vasculitis can be another cause.
Vasculitis can be associated with coexisting disease like hypersensitivity disorders, food allergies, insect bites and many drugs administration, even dexamethasone or prednisone.
Given the note that Connor is an atopic dog, atopy itself can be the reason these lesions appeared because he was treated with prednisolone over an year because of his atopic syndrome and owner’s budget restraints.
Treatment and outcome:
After a long talk the owner chose surgery but in the end we managed to convince him to try medication for at least 14 days.
The following treatment options were offered:
1: Oclacitinib
Dosage: 0.5-0.6 mg/kg/12 h
1 tablet of 16 mg to be given BID 30-90 days according to the studies
2.
- Local topical Tacrolimus 0,1%
- Pentoxifylline tablets, dosage 15mg/kg BID
- Doxicycline tablets, 5 mg/kg BID
- Niacinamide tablets 500 mg/dog TID, for 30-90 days, may not work.
Treatment with oclacitinib (Apoquel 16 mg) was started despite budget restraints and Connor started to get better by day 7.
The treatment lasted 7 weeks ( 49 days) until complete remission of lesions.
He continued with Apoquel 16 mg 1×1/24 h to control his atopic syndrome.
Conclusion:
Oclacitinib it is not typically used to treat vasculitis in dogs but should be included
among the therapeutic options for ear tip vasculitis if there are no signs of infection. Oclacitinib has immune modulatory effects on numerous cytokine-mediated inflammatory, autoimmune or immune-mediated diseases in dogs. This type of vascular damage of the pinna is sometimes idiopathic and is hard to find a definitive diagnosis without a histopathology exam.
References:
- Silvia Colombo, Luisa Cornegliani, Antonella Vercelli, Alessandra Fondati – Ear tip ulcerative dermatitis treated with oclacitinib in 25 dogs: a retrospective case series (2021) – Veterinary Dermatology
- Thelma Lee Gross, P. J. Ihrke, E.J. Walder, V.K.Affolter – Skin diseases of the dog and cat, 2nd Edition, 2020, Blackwell
- Rosanna Marsella, Katherine Doerr, Andrea Gonzales,Wayne Rosenkrantz – Oclacitinib 10 years later: lessons learned and directions for the future
(2023) – J Am Vet Med Assoc.
- William H. Miller Jr., Craig E. Griffin, Karen L. Campbell – Muller and Kirk’s Small animal dermatology, 7nd Edition, 2012, Elsevier
