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Tham HL, Davis JL. Pharmacology of drugs used in autoimmune dermatopathies in cats and dogs: A narrative review. Vet Dermatol 2024. [PMID: 38708551 DOI: 10.1111/vde.13253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 02/15/2024] [Accepted: 04/12/2024] [Indexed: 05/07/2024]
Abstract
Immunosuppressive drugs are the mainstay of treatment for many feline and canine autoimmune skin diseases, either as monotherapy or in combination with other drugs. Treatment with these drugs is often lifelong and may have long-term consequences on the affected animal's overall quality-of-life. Clinicians need to understand the pharmacology of immunosuppressants in planning and executing the treatment regimen for the best possible clinical outcome, as well as reducing the risk of adverse effects. This review paper will focus on the mechanism of action, pharmacokinetics and pharmacodynamics, clinical uses and adverse effects of immunosuppressive drugs used to treat autoimmune dermatoses in cats and dogs. These include glucocorticoids, ciclosporin A, azathioprine, chlorambucil, mycophenolate mofetil, oclacitinib and Bruton's tyrosine kinase inhibitors.
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Affiliation(s)
- Heng L Tham
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, Virginia, USA
| | - Jennifer L Davis
- Biomedical Sciences and Pathobiology, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, Virginia, USA
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Tham HL, Elnady FA, Byrnes MK. A Novel Canine Otoscopy Teaching Model for Veterinary Students. J Vet Med Educ 2022; 50:e20220015. [PMID: 35857867 DOI: 10.3138/jvme-2022-0015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Otoscopic evaluation using an otoscope is an important tool among the diagnostic modalities for otitis externa and is considered a core component of a canine patient's complete physical examination. Traditionally, otoscopic training in veterinary school involves using live dogs (i.e., laboratory dogs or dogs that are patients of the veterinary teaching hospital). While this approach has its advantages, performing otoscopic examination on live dogs presents several challenges: it requires adequate patient restraint, can cause stress to the dog, and can potentially cause trauma and/or injury to the dog's ear canal when performed by an inexperienced individual. Using an alternative teaching tool for otoscopic evaluation could overcome these challenges and improve veterinary students' learning experience. In this study, we investigated student perceptions of a novel canine teaching model for otoscopic evaluation in first-year veterinary students. The Elnady preservation technique was employed to create a realistic, durable, and flexible model for otoscopic training in a dermatology laboratory session in a first-year veterinary course. Student feedback was assessed on a Likert scale, and overall feedback indicated that students felt that the model was beneficial for skill building and removed many of the stressors incurred with using live animals when training in clinical skills. Most students stated that they would like to have additional similar models incorporated into training and would recommend these models to other students.
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Tham HL, Lanz OI, Linder KE. Localised erythema multiforme-like reaction confined to a region of clipper burn in a dog. Vet Dermatol 2022; 33:240-242. [PMID: 35048432 DOI: 10.1111/vde.13058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 11/09/2021] [Accepted: 12/06/2021] [Indexed: 11/29/2022]
Abstract
Localised erythema multiforme (LEM) is only reported to occur in humans and not in domestic species. This case report describes the clinical and histopathological features of LEM-like reaction in a dog, confined to a region of clipper burn.
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Affiliation(s)
- Heng L Tham
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, VA, USA
| | - Otto I Lanz
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, VA, USA
| | - Keith E Linder
- Department of Population Health and Pathobiology, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA
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Tham HL, Olivry T. Determination of the efficacy rate and time-to-efficacy of subcutaneous immunotherapy in dogs with atopic dermatitis. Vet Dermatol 2021; 33:155-e44. [PMID: 34883529 DOI: 10.1111/vde.13048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 08/24/2021] [Accepted: 09/14/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Allergen-specific immunotherapy (ASIT) is reported to have a success rate of 50-70% when given for up to 12 months to dogs with atopic dermatitis (AD). How soon ASIT is clinically effective is unclear. OBJECTIVES To compare the efficacy rate (ER) and time-to-efficacy (TTE) of various types of subcutaneous immunotherapy (SCIT) administered using conventional dosing regimens using the methodology of a critically appraised topic. METHODS AND MATERIALS Three databases were searched to extract information on the ER and TTE of SCIT in dogs with AD. Herein, "efficacy" was defined as a ≥50% reduction in pruritus and/or skin lesions, and the TTE as the time needed to achieve such a reduction. RESULTS We selected 12 publications including 194 dogs. The ER was significantly higher with the polymerised allergoids coupled with nonoxidized mannan than for the "classic" aqueous and alum-precipitated SCIT types. A TTE of three months or shorter was seen in a significantly higher proportion of dogs receiving mannan-couple allergoids, pullulan-conjugated Der f 2 or tyrosine-adjuvanted than aqueous or alum-precipitated SCIT; with the latter two formulations, the TTE might be nine months or longer in ≤20% of atopic dogs. CONCLUSIONS AND CLINICAL RELEVANCE In spite of the low number of articles available for review and small number of enrolled dogs, novel SCIT regimens appear to have a faster - and possibly higher - efficacy than the currently available aqueous or alum-precipitated formulations. A standardisation of outcome measures for ASIT clearly is needed to allow a more meaningful comparison between SCIT types.
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Affiliation(s)
- Heng L Tham
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, VA, USA
| | - Thierry Olivry
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA
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Tham HL, Linder KE, Olivry T. Deep pemphigus (pemphigus vulgaris, pemphigus vegetans and paraneoplastic pemphigus) in dogs, cats and horses: a comprehensive review. BMC Vet Res 2020; 16:457. [PMID: 33228633 PMCID: PMC7686683 DOI: 10.1186/s12917-020-02677-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 11/13/2020] [Indexed: 12/28/2022] Open
Abstract
Pemphigus is the term used to describe a group of rare mucocutaneous autoimmune bullous diseases characterized by flaccid blisters and erosions of the mucous membranes and/or skin. When the autoantibodies target desmosomes in the deep layers of the epidermis, deep pemphigus variants such as pemphigus vulgaris, pemphigus vegetans and paraneoplastic pemphigus develop. In this article, we will review the signalment, clinical signs, histopathology and treatment outcome of pemphigus vulgaris, pemphigus vegetans and paraneoplastic pemphigus in dogs, cats and horses; where pertinent, we compare the animal diseases to their human homologue. Canine, feline and equine pemphigus vulgaris, pemphigus vegetans and paraneoplastic pemphigus have many features similar to the human counterpart. These chronic and often relapsing autoimmune dermatoses require aggressive immunosuppressive therapy. In animals, the partial-to-complete remission of pemphigus vulgaris and pemphigus vegetans has been achieved with high dose glucocorticoid therapy, with or without adjunct immunosuppressants; the prognosis is grave for paraneoplastic pemphigus.
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Affiliation(s)
- Heng L. Tham
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, VA USA
| | - Keith E. Linder
- Comparative Medicine Institute, College of Veterinary Medicine, North Carolina State University, Raleigh, NC USA
- Department of Population Health and Pathobiology, College of Veterinary Medicine, North Carolina State University, Raleigh, NC USA
| | - Thierry Olivry
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC USA
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Tham HL, Linder KE, Olivry T. Autoimmune diseases affecting skin melanocytes in dogs, cats and horses: vitiligo and the uveodermatological syndrome: a comprehensive review. BMC Vet Res 2019; 15:251. [PMID: 31324191 PMCID: PMC6639964 DOI: 10.1186/s12917-019-2003-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 07/12/2019] [Indexed: 02/07/2023] Open
Abstract
Autoimmune dermatoses targeting melanocytes have gained attention in human medicine due to their progressive nature and the social impact suffered by affected individuals. In veterinary medicine, vitiligo and the uveodermatological syndrome are the two autoimmune diseases that are known to affect skin melanocytes.In the first part of this article, we will review the signalment, clinical signs, histopathology and the treatment outcome of vitiligo in dogs, cats and horses; where pertinent, we compare the animal diseases to their human homologue. In a similar fashion, the information on the uveodermatological syndrome in dogs is reviewed and, where relevant, it is compared to the Vogt-Koyanagi-Harada (VKH) syndrome in humans.Canine, feline and equine vitiligo have many features that mirror their human counterparts. The most effective treatment and outcome of vitiligo in animals remain unclear. The canine uveodermatological syndrome resembles the incomplete VKH variant in humans; for affected individuals, an immediate diagnosis and aggressive treatment are crucial to prevent the development of blindness.
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Affiliation(s)
- Heng L. Tham
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, VA USA
| | - Keith E. Linder
- Comparative Medicine Institute, College of Veterinary Medicine, North Carolina State University, Raleigh, NC USA
- Department of Population Health and Pathobiology, College of Veterinary Medicine, North Carolina State University, Raleigh, NC USA
| | - Thierry Olivry
- Comparative Medicine Institute, College of Veterinary Medicine, North Carolina State University, Raleigh, NC USA
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC USA
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Tham HL, Jacob ME, Bizikova P. Molecular confirmation of shampoo as the putative source of Pseudomonas aeruginosa-induced postgrooming furunculosis in a dog. Vet Dermatol 2016; 27:320-e80. [PMID: 27237982 DOI: 10.1111/vde.12332] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND An acute onset furunculosis due to Pseudomonas aeruginosa following grooming is a well recognized entity. Although contaminated shampoos have been suspected to be the source of the infection, a molecular confirmation of this association has been missing. OBJECTIVE This case report describes a dog with postgrooming furunculosis in which Pseudomonas aeruginosa with an identical genetic fingerprint was isolated from the skin lesions as well as from the shampoo used prior to the disease onset. RESULTS The dog presented for lethargy, anorexia, pain and rapidly progressing skin lesions consistent with haemorrhagic papules, pustules, coalescing ulcers and crusts localized to the dorsal and lateral aspects of the thorax and gluteal region, which developed within 24 h after a bath. Cytology demonstrated suppurative inflammation with occasional intracellular rod-shaped bacteria. Bacterial culture from skin lesions and the shampoo bottle yielded Pseudomonas aeruginosa with an identical pulsed-field gel electrophoresis pattern. Treatment with oral ciprofloxacin and topical antimicrobial shampoo resulted in a complete resolution of skin lesions within eight weeks. CONCLUSION AND CLINICAL IMPORTANCE Our clinical investigation suggests a link between Pseudomonas-contaminated shampoo and development of postgrooming furunculosis, and underscores the need for hygienic management of shampoos to help limit this disease.
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Affiliation(s)
- Heng L Tham
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, 1060 William Moore Drive, Raleigh, NC, 27607, USA
| | - Megan E Jacob
- Department of Population Health and Pathobiology, College of Veterinary Medicine, North Carolina State University, 1060 William Moore Drive, Raleigh, NC, 27607, USA
| | - Petra Bizikova
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, 1060 William Moore Drive, Raleigh, NC, 27607, USA.,Comparative Medicine Institute, North Carolina State University, 1060 William Moore Drive, Raleigh, NC, 27607, USA
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Tham HL, Olivry T, Linder KE, Bizikova P. Mucous membrane pemphigoid in dogs: a retrospective study of 16 new cases. Vet Dermatol 2016; 27:376-e94. [DOI: 10.1111/vde.12344] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2016] [Indexed: 01/10/2023]
Affiliation(s)
- Heng L. Tham
- Department of Clinical Sciences College of Veterinary Medicine North Carolina State University 1060 William Moore Drive Raleigh NC 27607 USA
| | - Thierry Olivry
- Department of Clinical Sciences College of Veterinary Medicine North Carolina State University 1060 William Moore Drive Raleigh NC 27607 USA
- Comparative Medicine Institute North Carolina State University 1060 William Moore Drive Raleigh NC 27607 USA
| | - Keith E. Linder
- Comparative Medicine Institute North Carolina State University 1060 William Moore Drive Raleigh NC 27607 USA
- Department of Population Health and Pathobiology College of Veterinary Medicine North Carolina State University 1060 William Moore Drive Raleigh NC 27607 USA
| | - Petra Bizikova
- Department of Clinical Sciences College of Veterinary Medicine North Carolina State University 1060 William Moore Drive Raleigh NC 27607 USA
- Comparative Medicine Institute North Carolina State University 1060 William Moore Drive Raleigh NC 27607 USA
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Tham HL, Linder KE, Tucker A, Maggi R, Bizikova P. Protozoal nodular dermatitis and panniculitis in a Rottweiler puppy caused by Caryospora bigenetica. Vet Dermatol 2015; 27:44-e12. [PMID: 26567903 DOI: 10.1111/vde.12271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Caryospora bigenetica is an intracellular protozoan parasite in snakes and raptors (primary hosts) and rodents (secondary host). Experimental infection has been documented in mice, pigs and goats; natural infection in dogs is rare. OBJECTIVES To describe the clinical presentation, histological features, treatment and outcome of a case of protozoal nodular dermatitis and panniculitis in a Rottweiler puppy caused by C. bigenetica. RESULTS The puppy presented with generalized subcutaneous nodules measuring up to 2 cm in diameter. Histopathology revealed marked suppurative to pyogranulomatous dermatitis and panniculitis with intralesional protozoal organism. PCR and DNA sequencing confirmed infection with C. bigenetica. Treatment with a combination of oral trimethoprim-sulfamethoxazole (TMS), pyrimethamine and high-dose clindamycin (20 mg/kg twice daily) resulted in resolution of lesions in 6 weeks. Discontinuation of the treatment 2 weeks later was followed by a rapid relapse of skin lesions. Clindamycin and TMS were restarted and all lesions resolved within 2 weeks; TMS was discontinued 4 weeks later due to adverse effects. The lesions remained in remission for 2 months while the puppy received clindamycin monotherapy before a second relapse of skin lesions occurred. CONCLUSION AND CLINICAL IMPORTANCE To the best of the authors' knowledge, this is the first documentation of the treatment and outcome of C. bigenetica cutaneous infection in a dog. Although remission of clinical signs can be achieved with combination therapy of clindamycin and TMS, long-term management is challenging and relapses should be anticipated.
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Affiliation(s)
- Heng L Tham
- Department of Clinical Sciences, North Carolina State University College of Veterinary Medicine, 1052 William Moore Drive, Raleigh, NC, 27607, USA
| | - Keith E Linder
- Department of Population Health and Pathobiology, North Carolina State University College of Veterinary Medicine, 1052 William Moore Drive, Raleigh, NC, 27607, USA.,Center for Comparative Medicine and Translational Research, North Carolina State University College of Veterinary Medicine, 1060 William Moore Drive, Raleigh, NC, 27607, USA
| | - Alison Tucker
- Rollins Animal Disease Diagnostic Laboratory, 2101 Blue Ridge Rd., Raleigh, NC, 27607, USA
| | - Ricardo Maggi
- Department of Clinical Sciences, North Carolina State University College of Veterinary Medicine, 1052 William Moore Drive, Raleigh, NC, 27607, USA
| | - Petra Bizikova
- Department of Clinical Sciences, North Carolina State University College of Veterinary Medicine, 1052 William Moore Drive, Raleigh, NC, 27607, USA.,Center for Comparative Medicine and Translational Research, North Carolina State University College of Veterinary Medicine, 1060 William Moore Drive, Raleigh, NC, 27607, USA
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