ABSTRACT OF THE WEEK

Veterinary dermatology
Volume 26 | Issue 6 (December 2015)

Canine sterile nodular panniculitis: a retrospective study of 39 dogs.

Vet Dermatol. December 2015;26(6):451-8, e104-5.

Caitlin L Contreary¹, Catherine A Outerbridge², Verena K Affolter³, Philip H Kass⁴, Stephen D White⁵

¹ William R. Pritchard Veterinary Medical Teaching Hospital, University of California Davis, 1 Garrod Drive, Davis, CA, 95616, USA.; ² Department of Veterinary Medicine and Epidemiology, School of Veterinary Medicine, University of California Davis, 1 Garrod Drive, Davis, CA, 95616, USA.; ³ Department of Veterinary Pathology Microbiology and Immunology, School of Veterinary Medicine, University of California Davis, 1 Garrod Drive, Davis, CA, 95616, USA.; ⁴ Department of Population Health and Reproduction, School of Veterinary Medicine, University of California Davis, 1 Garrod Drive, Davis, CA, 95616, USA.; ⁵ Department of Veterinary Medicine and Epidemiology, School of Veterinary Medicine, University of California Davis, 1 Garrod Drive, Davis, CA, 95616, USA.

Abstract

BACKGROUND:Canine sterile nodular panniculitis (SNP) is an inflammatory disease of the panniculus that is typically managed with immunomodulatory or immunosuppressive treatments. It has been reported to be a cutaneous marker of an underlying systemic disease.

HYPOTHESIS/OBJECTIVES:To assess the presence or absence of concurrent systemic diseases associated with canine SNP and to document breed predispositions.

ANIMALS:Thirty nine dogs presented to a veterinary teaching hospital from 1990 to 2012 which met inclusion criteria.

METHODS:Inclusion in this retrospective study required a diagnosis of SNP via histopathological analysis and negative special stains for infectious organisms. Breed distributions of affected dogs were compared to all other dogs examined at this hospital during the study period. Correlations between the histological pattern of panniculitis and the histological presence of dermatitis, clinical presentation of lesions, dog breed and therapeutic outcomes were assessed.

RESULTS:Australian shepherd dogs, Brittany spaniels, Dalmatians, Pomeranians and Chihuahuas were significantly over-represented, but correlations between inflammatory patterns of panniculitis and other histological and clinical factors were not identified. Based on the information available in medical records, 32 dogs (82.1%) had no concurrent systemic diseases identified. Four dogs had concurrent polyarthritis, which may be related to SNP through unknown mechanisms.

CONCLUSIONS/CLINICAL IMPORTANCE:This study identified several novel breed predilections for SNP; it failed to find any clear correlations with associated systemic diseases other than polyarthritis. The histological inflammatory pattern of SNP does not predict therapeutic outcome.

Companion Notes

Retrospective report on sterile nodular panniculitis in 39 dogs

Introduction on panniculitis

- inflammation of the subcutaneous fat (panniculus adiposus)

- disorder often presents with deep nodules

- with or without visible draining tracts, fistulae and ulcers

- lesions can resemble those of other disorders included the following:

- deep pyoderma

- cutaneous neoplasia

- cutaneous cyst

- infectious etiologies for panniculitis include the following:

- bacterial organisms

- fungal organisms

- viral agents

- parasitic organisms

- protozoal organisms

- noninfectious etiologies include the following:

- foreign body

- post-vaccination/injection reactions

- thermal burns

- trauma

- vitamin E deficiency

- pancreatic disease

- immune-mediated disease

- idiopathic sterile nodular panniculitis (SNP)

- diagnosis via ruling out infectious or noninfectious etiologies

(fine needle aspirate results often inconsistent with histopathology)

- histopathology of full-thickness skin biopsy samples

- with special stains to rule out etiological agents

- bacterial, fungal and mycobacterial cultures of deep tissues

- standard treatment employs immunosuppression with glucocorticoids PO

- with or without adjunctive treatments such as the following:

- oral ciclosporin

and/or

- combination of tetracycline antibiotic with niacinamide

Study design

- study population: dogs seen at Davis from 90-12

- 39 dogs with inclusion criteria that included a histopathological diagnosis

- with negative special stains for infectious organisms

- procedure: records retrospectively reviewed

- breed distributions compared to all other dogs seen at that hospital

(during study period)

- 131,281 dogs admitted to Davis between 1990 and 2012

- correlations between the following assessed

- histological pattern of panniculitis

- histological presence of dermatitis

- clinical presentation of lesions

- dog breed

- therapeutic outcomes

Results

- significantly overrepresented breeds included the following:

- Australian shepherd dog

- Brittany spaniel

- dalmatian

- pomeranian

- chihuahua

- no correlations between inflammatory patterns of panniculitis and the following:

- histological factors

- clinical factors

- 32 of the 39 dogs had no identified concurrent systemic disease

- 4 dogs had concurrent polyarthritis (diagnosed via arthrocentesis)

- signs of polyarthritis developed within days of skin lesions

- history & signalment

- mean age at presentation: 6.5 years of age with a range of 1-13 years

- mean duration of lesions before presentation: 3 months with a range of ¼-12

- clinical signs

- multiple lesions in 33 dogs and a solitary lesion in 6 of the 39 dogs

- dermal or subcutaneous nodules, 35 of the 39 dogs

- draining at initial presentation, 13 dogs

- ulcerated nodules, 2

- ulcers, 1

- hemorrhagic bullae, 1

- crusts and alopecia, 1

- plaque, 1

- affected body regions included the following:

- trunk, 30

- neck, 9

- face/head, 7

- shoulder, 6

- limb, 4

- hip, 2

- fever, 8 dogs (mean: 40°C with a range of 39.6-45°C

- all were normal at subsequent visits

- anorexia, 6

- lethargy reported by owners, 4

- CBC, available for 28 dogs

- nonregenerative, normocytic, normochromic anemia, 12

- median Hct: 31% with reference at 40-55%

- leukocytosis with a mature neutrophilia, 9

- monocytosis, 5

- lymphopenia, 3

- serum biochemistry available for 25 dogs

- increased alkaline phosphatase, 13

- increased aspartate transaminase, 6

- increased alanine aminotransferase, 2

- urinalysis available for 28 dogs, none had significant protein levels

- treatment (1 dog’s lesions resolved without treatment)

- steroids ± other immunomodulatory or immunosuppressant drugs, 32 dogs

- prednisone or prednisolone, 0.8-2.5 mg/kg sid or 0.5-1.3 mg/bid

- prednisone in 21 cases; prednisolone in 7 cases

- tetracycline antibiotic (usually doxycycline) and niacinamide, 14 dogs

- ciclosporin, 9 dogs

- azathioprine, 6 dogs

- chlorambucil, 1

- all 6 dogs with Staphylococcus isolated ultimately got a immunosuppressive

- outcome in 29 dogs with available followup (mean followup: 251 days)

- complete remission of skin lesions, 21 of the 29

- only 4 of 20 dogs achieved remission with corticosteroids alone

- mean time to remission: 2.9 months

- regression of lesions noted before being lost to followup, 7 of 8 cases

“Thirteen dogs initially managed with corticosteroids alone needed at least one of the nonsteroidal immunomodulatory or immunosuppressive medications mentioned above added to control the SNP.”

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