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The synthetic retinoids, isotretinoin (Accutane) and etretinate (Tegison) are vitamin A analogs. They affect epithelial differentiation and thus have potential for therapy for disorders of epithelial maturation such as keratinization defects of cutaneous neoplasia. The pharmacology, indications for use, clinical experience, potential toxicities, and recommended monitoring of these drugs are discussed.

A Quarter horse filly bred from two horses affected with HERDA (hereditary equine regional dermal asthenia) was observed clinically and its skin histologically for the 1.5 years of its life. Severe signs of the disease did not manifest until 1.5 years of age, and were not temporally related to saddling. Histological comparison to an age-, breed- and sex-matched control did not show any consistent diagnostic features. Monitoring of the proband substantiated previous reports of (i) the autosomal recessive nature of the disease, (ii) mares affected with HERDA being able to foal without damage to the skin or reproductive tract, (iii) HERDA foals appearing phenotypically normal throughout the first year of life, and (iv) demonstrated that histological interpretation of skin specimens from grossly normal skin may be insufficient to differentiate HERDA-affected horses from controls.

Four dogs developed cutaneous lesions following the administration of various antibiotics. Histopathology of the lesions was compatible with pemphigus foliaceus, although apoptotic cells suggestive of erythema multiforme were seen in two cases. In two dogs the lesions resolved after 7.5-8.5 months of immune-suppressive treatment. No recurrence was seen during the follow-up period (3 and 4.5 years). The lesions in the other two dogs resolved within 3 weeks to 3 months following discontinuation of the antibiotic. No recurrence of clinical signs occurred during the follow-up period (1 and 4 years, respectively).

Antihistamines were prescribed for 178 of 271 dogs with a diagnosis of atopic dermatitis at the Veterinary Medical Teaching Hospital of the University of California, Davis from 1992 to 1998. Fifty-four percent of 166 dogs given antihistamines responded favorably to these treatments, with 27% of the responses rated as good and 27% rated as moderate. Diphenhydramine and hydroxyzine were the most commonly used antihistamines and were the most frequently effective. Chlorpheniramine and clemastine were administered less frequently and had much lower positive response rates. Responses to antihistamines as a group were significantly better in dogs having onset of clinical signs at younger ages (odds ratios for 1-year increase in age = 0.72, 95% confidence interval = 0.57 to 0.91, P =.005).

One hundred and sixty-nine dogs were diagnosed with atopic dermatitis, and treated with hyposensitization for at least 1 year based on the results of either intradermal skin tests (IDST) or enzyme-linked immunosorbant serum assays (ELISA). Excellent (i.e. hyposensitization alone controlled clinical signs), good (> 50% improvement), moderate (< 50% improvement) and no (clinical signs were unchanged) responses were seen in 19.5, 32.5, 20.1 and 27.8%, respectively. Age of onset, age when treatment was initiated or the duration of clinical signs had no influence on response to hyposensitization. Dogs having concurrent flea allergy dermatitis were statistically more likely to respond better than dogs with concurrent food allergies. Although not statistically significant, there were trends for Golden Retriever and male dogs to respond better than other breeds and female dogs, respectively. Dogs having more than 21 positive reactions in allergy tests and treated with more than 21 allergens had lower response scores, and a longer time course before achieving beneficial response. Lower response scores were seen in dogs having positive reactions to cultivated plants, grasses, trees or insects. There was no difference in response to hyposensitization whether based on IDST or ELISA results.

The medical records of 266 dogs diagnosed as having atopic dermatitis were reviewed. Statistical data were evaluated referable to breed predilections, clinical signs and positive reactions to allergens. Positive reactions were most common to house dust mites (more common with clinical signs in the fall) followed by moulds (more common with clinical signs in the fall and spring). Dogs with positive reactions to moulds, trees or cultivated plants were more likely to have skin and ear yeast infections. Dogs with positive reactions to cultivated plants were more likely to have otitis externa and pedal lesions. Positive reactions to house dust were more common in dogs with early onset of signs and in those tested early in the disease. Dogs had more positive reactions to weeds when allergy tests were performed in the summer and fall. Positive reactions to flea antigen were highly correlated with the clinical diagnosis of flea allergy dermatitis.

Immunostaining with polyclonal anti-Mycobacterium bovis (BCG) was evaluated as a single screen-ing method for the histological identification of micro-organisms in skin biopsy specimens from various veterinary species. Confirmed archival cases infected with Mycobacteria, Nocardia, Actinobacillus, Actinomyces, Streptococcus/Staphylococcus, Dermatophilus, spirochetes, Blastomyces, Coccidioides, Crypto-coccus, Histoplasma, dermatophytes, Malassezia, Sporothrix, Leishmania, Pythium, phaeohyphomycetes and Prototheca organisms were selected. A total of 70 skin biopsy specimens from the dog, cat, horse, ox and llama were evaluated. The anti-BCG immunostain labelled bacteria and fungi with high sensitivity and minimal background staining but did not label spirochetes and protozoa (Leishmania). Differences were not noted between veterinary species. The results indicate that immunostaining with polyclonal anti-BCG is a suitable screening technique for the rapid identification of most common bacterial and fungal organisms in paraffin-embedded specimens. Also, mycobacterial and nocardial organisms were identified more readily with the anti-BCG immunostain in comparison to the histochemical stains.

Human bullous pemphigoid (BP) is an immune-mediated blistering disease characterized by autoantibodies against BP antigens (230/180 kd), which are constitutive glycoproteins of hemidesmosomes found in basal keratinocytes. Blistering diseases similar to human BP have been reported in dogs. IgG deposits at the basement membrane zone (BMZ) are a common feature of canine BP. Although circulating anti-BMZ IgG autoantibodies have been demonstrated in some cases of canine BP, the specific skin protein targeted by these autoantibodies has not been identified. In this study, we characterized the antigenic target of the autoantibodies in the serum from a 3-year-old castrated male Pit Bull Terrier with BP. Direct immunofluorescence of the patient's skin demonstrated IgG deposits at the dermal-epidermal junction. Indirect immunofluorescence demonstrated autoantibodies in the patient's serum that stained the epidermal roof of salt-split canine skin and left the dermal floor unstained. These serum autoantibodies did not stain normal intact dog skin but labeled intact bovine tongue. Direct immunoelectron microscopy of the dog's skin revealed IgG deposits within the hemidesmosomes of the basal keratinocytes. Western immunoblotting experiments showed that canine keratinocytes express both the 230-kd and 180-kd bullous pemphigoid antigens, and the autoantibodies from the patient's serum recognized the 180-kd bullous pemphigoid antigen in proteins extracted from canine and human keratinocytes. Canine BP has many parallel features with human BP including similar immune deposition of IgG within hemidesmosomes and a hemidesmosome-associated 180-kd glycoprotein target for circulating autoantibodies.

Eosinophilic plaque and mosquito-bite dermatitis are recognized hypersensitivity reactions. The pathogenesis of eosinophilic granuloma and indolent ulcer are not as clearly understood. Each of these syndromes is distinctive from a clinical and histopathologic view point. Accurate diagnosis depends on history, physical findings, and histopathologic evaluation. Understanding of feline dermatology will be furthered by including these syndromes in a broader grouping that encompasses all the feline eosinophilic dermatoses.

The past two decades have been a time of extraordinary progress in the discipline of veterinary dermatology. Practitioner interest groups have grown in size and influence worldwide. During this time, veterinary dermatology has become recognized as an independent specialty, separate from internal medicine. Residency training programs have proliferated in North America, Europe, and the United Kingdom. Specialty colleges certifying diplomates through the process of examination have been active in the United States since 1974, and more recently in Australia; similar colleges are in the process of being organized in Europe.

A previous study described cutaneous lymphocytosis (CL) in 23 cats. The process resembles cutaneous pseudolymphoma in humans, a heterogeneous group of benign reactive proliferations of well-differentiated lymphocytes in the skin of humans. Morphological and immunophenotypic characteristics do not offer reliable criteria to accurately predict the clinical outcome of feline CL or pseudolymphoma in humans. Presence of clonal cell populations is more consistent with a neoplastic process. In a previous study, feline CL lesions (20 cats) were evaluated for clonality using PCR, and only two cats had monoclonal T-cell populations. Because false-negative results may occur, the purpose of this study was to repeat the PCR using a revised primer set based on analysis of additional feline T-cell receptor γ (TCRγ) sequences. DNA was isolated from 29 skin lesions and six internal organs of 20 cats. DNA integrity was assessed by glyceraldehyde-3-phosphate dehydrogenase PCR. Polymerase chain reaction clonality was performed using the revised primer set specific for feline TCRγ, and duplicate samples were evaluated. The PCR products were assessed by heteroduplex analysis. Clonal rearrangement of TCRγ was detected in 14 cats (24 of 35 tissues: 21 of 29 skin lesions and three of six internal organs); eight of these cats are still alive and six were euthanized. Monoclonal populations were seen in three of five cats that had involvement of internal organs. These findings indicate that feline CL is best considered as a slowly progressive process which may be reactive, but often evolves into a low-grade indolent lymphoma. Funding: George H. Muller Fund for Research in Dermatology.

Summary A special buffered ammonium sulfate fixative (Michel's fixative) designed for use as a liquid media capable of preserving in vivo tissue fixed immunoglobulins and complement was evaluated. The preservative ability of this fixative was studied by using skin biopsies from a confirmed case of spontaneously occurring equine pemphigus foliaceus. Once obtained, 16 skin biopsies were placed in Michel's fixative. Eight samples were stored at ambient temperature (21°C) and 8 samples were stored in a conventional refrigerator at 4°C. Over an 8 month time period, direct immunofluorescence was performed on these skin biopsies looking for the abnormal presence of IgG, IgM (when done) and C 3 deposition within the intercellular spaces of the epidermis. The results of this study indicated that Michel's fixative was capable of preserving in vivo tissue fixed immunoglobulin and complement for 8 months. This was demonstrated by positive direct immunofluoresence spaces of the epidermis in all of the skin biopsies examined. In addition, it was shown that refrigerated and non-refrigerated skin biopsies in Michel's fixative both yielded a diagnostic quality of direct immunofluorescence. This will allow the mailing of skin biopsies without requiring refrigeration and specimens mailed in the winter should demonstrate reliable results on fluorescent antibody testing when performed.

Two dogs were found to have clinical, histopathological and immunofluorescent findings compatible with a diagnosis of canine discoid lupus erythematosus. The primary lesions included erythema and depigmentation of the nasal planum. Both dogs responded favorably to systemic corticosteroid therapy.

Skin biopsy specimens from 7 dogs with immune-mediated skin diseases diagnosed by routine histology and 5 dogs with other skin diseases were placed in Michel's transport medium for 4 to 9 years. Direct immunofluorescence yielded positive results in tissue samples from 3 dogs with pemphigus foliaceus and 2 dogs with discoid lupus erythematosus. Direct immunofluorescence was not seen in tissue samples from 1 dog with pemphigus foliaceus and 5 dogs with non immune-mediated skin diseases. Direct immunofluorescence was seen in skin biopsy specimens maintained in Michel's medium for 4 to 8 years.