Page 1108 - Problem-Based Feline Medicine

1100 PART 13 CAT WITH SKIN PROBLEMS

In dogs and people it is associated with glucagon- recovery diet containing high-quality protein and
secreting tumors and a variety of other diseases not increased levels of amino acids.
associated with a hyperglucogonemia, especially ● A slow IV infusion of an amino acid formulation
hepatic disease. The role of glucagon is not understood, designed for parenteral administration has been
but it is postulated to affect catabolism of amino acids to used successfully in some patients.
glucose.
Supplementation with zinc and essential fatty acids
In cats it has been reported with pancreatic carcinoma, may help some patients.
chronic hepatopathy and thymic amyloidiosis.
Anti-malassezial shampoos (miconazole containing)
may help control the skin lesions.
Clinical signs
Surgical resection of glucogonoma is indicated if present.
Alopecia, erythema, crusts, erosions and ulceration
of the skin most frequently seen at mucocutaneous
Prognosis
junctions and frictional areas of the skin. The skin can
be thickened and may become fissured. Prognosis is poor for long-term survival.
● The skin lesions are often secondarily infected
with bacteria or yeast.
CUTANEOUS ASTHENIA
Footpads show marked hyperkeratosis and fissuring.
Classical signs
Diagnosis ● Fragile, hyperextensible skin which tears
easily.
Diagnosis is based on histopathological examination
● Focal necrosis and paperaceous scars.
of the skin lesions and demonstration of diffuse parak-
● Patchy alopecia.
eratosis, which includes follicles, epidermal pallor,
basal cell hyperplasia (red, white and blue effect).
Pathogenesis
Measurement of plasma glucagon concentration is
indicated to rule out a glucagonoma. Cutaneous asthenia results from a congenital defect of
collagen I synthesis.
Diagnosis of the hepatic or pancreatic disease requires
serum biochemistry analysis to demonstrate
increased liver enzymes, and ultrasound to demon- Clinical signs
strate liver or pancreas pathology.
Cutaneous asthenia appears as hyperextensible skin
Hepatic or pancreatic biopsy via ultrasound guidance and/or “spontaneous” tearing of the skin.
or exploratory laparotomy is usually needed for defini-
Focal necrosis of the skin (necrotic eschars), particu-
tive diagnosis of the underlying condition.
larly involving the dorsal neck, may occur.
Numerous paperaceous scars and patchy alopecia
Differential diagnosis
may be evident.
Differential diagnoses include bacterial and fungal
Hematomas may occur.
infections, neoplasia and pemphigus foliaceous.
Occasionally joint laxity and/or ophthalmic opacities
are seen.
Treatment
Treatment should be directed at controlling the underly- Diagnosis
ing disease and nutritional support.
Diagnosis is based on clinical appearance and
Amino acid supplements can be given by feeding a increased extensibility index of the skin. An extensi-
cooked egg yolk daily, and/or feeding a commercial bility index of greater than 19% is considered abnormal.