Dermal arteritis of the nasal philtrum: surgery as an alternative to long-term medical therapy in two dogs

Clinical and histopathological features of rostrolateral nasal alar arteriopathy of German shepherd dogs

BACKGROUND

Dermal arteritis of the nasal philtrum (DANP) has been described in large-breed dogs.

OBJECTIVES

To characterise clinically distinct, discrete fissures of the dorsolateral nasal alae associated with severe bleeding in German shepherd dogs (GSDs).

ANIMALS

Fourteen privately owned GSDs with linear rostrolateral nasal alar fissures and a histopathological diagnosis of nasal vasculopathy.

MATERIALS AND METHODS

Retrospective analysis of medical records and histological slides.

RESULTS

Mean age of onset was 6 years. Before biopsy, episodic arteriolar bleeding was noted in 11 of the 14 (79%) dogs. Slide analysis revealed enlarged nasal arterioles with expanded vascular tunics and luminal stenosis beneath ulcers. Histopathological lesions consistent with mucocutaneous pyoderma and/or facial discoid lupus erythematosus were present in 5 of the 14 (36%) dogs. Enlarged arterioles stained blue with Alcian blue and Masson's trichrome stains, consistent with deposition of mucin and collagen, respectively. Immunohistochemical stains (neutrophil myeloperoxidase, IBA1, CD3) were performed. CD3 was negative for all dogs, whilst neutrophil myeloperoxidase and IBA1 occasionally demonstrated intramural neutrophils (3 of the 14 dogs, 21%) or histiocytes (1 of the 14 dogs, 7%) in altered vessels, respectively. All dogs underwent medical management and/or surgical excision. Treatments included tacrolimus, prednisone, ciclosporin-modified, pentoxifylline, antimicrobials and doxycycline/niacinamide. No dogs were treated with antimicrobials alone. For seven dogs with long-term follow-up, treatment response was complete in five (71%) and partial in two (29%), with six of the seven (86%) receiving immunomodulatory treatments to maintain remission.

CONCLUSION AND CLINICAL RELEVANCE

Nasal alar arteriopathy of GSDs shares histopathological changes with DANP. It has characteristic clinical and histopathological features and appears amenable to immunomodulation.

Dermal arteritis of the nasal philtrum: a retrospective study of 23 dogs

BACKGROUND

Dermal arteritis of the nasal philtrum (DANP) is a cutaneous vascular condition that selectively targets large vessels of the nasal philtrum of dogs; little information is published about this disease.

OBJECTIVE

The aim of this study was to report the signalment, clinical signs, treatment options and outcome of dogs with DANP, and to propose a rationale for the clinical diagnosis.

ANIMALS

Twenty-three dogs from four referral veterinary clinics from January 2002 to July 2018.

METHODS AND MATERIALS

Retrospective analysis of medical records of dogs with diagnosis of DANP.

RESULTS

The mean age at disease onset was 5.3 years. Nineteen dogs were pure-bred (11 different breeds) and four were mixed breed. Twenty-three dogs had a clinical diagnosis of DANP and three of these had histopathological confirmation. Eight dogs had episodes of profuse arterial bleeding from the lesion, nine had minor bleeding and six no bleeding. Twenty dogs were managed medically with monotherapy or combined therapy of topical tacrolimus, prednisolone, doxycycline and niacinamide, and/or pentoxifylline. Long-term tacrolimus was prescribed for 15 cases, eight of those cases as sole therapy. Treatment was declined for three dogs and four dogs were lost to follow-up. The lesion was satisfactorily controlled in 12 dogs and well-controlled in four dogs.

CONCLUSIONS AND CLINICAL IMPORTANCE

The distinctive presentation of DANP substantiates the clinical diagnosis. Medical treatment seems to be effective in controlling DANP and tacrolimus used as sole or adjunctive therapy appears to manage the disease satisfactorily.

Tacrolimus therapy for dermal arteritis of the nasal philtrum refractory to surgery and anti-inflammatory therapy (doxycycline/niacinamide and topical fluocinolone) in a dog

BACKGROUND

Dermal arteritis of the nasal philtrum is a rarely reported condition commonly affecting large breed dogs.

OBJECTIVE

To describe the effective treatment of nasal philtrum arteritis with topical tacrolimus in one dog.

ANIMAL

A 9-year-old, intact male German shorthair pointer dog was presented with well-demarcated deep erythematous ulcers targeting exclusively the skin of the nasal philtrum, accompanied by frequent series of haemorrhage.

METHODS

Complete blood count, serum chemistry profile, urinalysis, histopathological examination and immunohistochemistry of skin biopsies.

RESULTS

The presence of a V-shaped ulcer with subendothelial spindle cell proliferation resulting in stenosis of dermal arteries and arterioles on histological evaluation, together with a well-demarcated deep nasal philtrum ulcer was consistent with arteritis of the nasal philtrum. Treatment was initiated with twice daily oral doxycycline and niacinamide in conjunction with topical fluocinolone cream. Over the course of two years, the lesions progressed with frequent bleeding episodes. A novel surgical approach provided deep resection of all grossly affected tissue; four months later a recurrence of fissures and occasional mild bleeding from the original site was noted and there was no improvement after another two months of oral doxycycline/niacinamide and topical fluocinolone treatment. Topical application of 0.1% tacrolimus twice daily resulted in complete healing of the ulceration and normalization of the epidermis. Over the subsequent 15 months, the dog's lesions remained in remission with topical tacrolimus application twice daily.

CONCLUSIONS AND CLINICAL IMPORTANCE

Topical tacrolimus ointment appeared effective at inducing and maintaining lesion remission in this dog with nasal philtrum arteritis.

Successful medical and surgical treatment of dermal arteritis of the nasal philtrum in a Saint Bernard dog

A four-year-old neutered male Saint Bernard dog presented with a 2 year history of nasal philtrum ulceration and recent recurrent arterial hemorrhage from this region. Dermal arteritis of the nasal philtrum was diagnosed and the patient was started on immunosuppressive medications. Clinical signs continued to recur until surgical resection of the lesions was performed. Dermal arteritis of the nasal philtrum is a rare phenomenon but should be considered in certain breeds. Surgical removal of affected tissue should be considered when medical treatment fails. Long-term management with cyclosporine was initiated which has not been previously described in the literature.

Cutaneous vasculitis in small animals

Cutaneous vasculitis is an inflammatory process targeting blood vessels. Underlying factors include drugs, infectious diseases, adverse reactions to food, malignancies, and immune-mediated diseases. Vasculitis is a reaction pattern warranting a workup to identify triggers. Presenting symptoms include purpura, pitting edema, and skin ulcerations. Constitutional signs include fever, depression, and anorexia and seem to be present in the majority of patients. Once a diagnosis is confirmed, treatment and follow-up must be tailored to the individual. High-dose immunosuppressive medications are only recommended once infectious diseases capable of producing a similar constellation of clinical signs have been ruled out.