A Pre-Neoplastic Lesion: A Case Study

1. Abstract Theaim of this paperis to report a case of Actinic Dermatosis in an 8-year-old female adult dog with erythematous skin. In the clinical evaluation, the animal presented normal parameters for the species, but, duetothelesion sobserved, cytological and parasitological skin tests were requested, which showed the presence of bacteria(cocci), degeneratedneutrophils, and dermatophytefungi, and demodicidosis. Treatment consisted of the use of numerous drugs such as itraconazole, amoxicillin with potassium clavulonate, predinisolone, Sarolaner, and immunomodulators. In addition, the animal has a topical treatment with ketoconazole shampooandcream.Generally,deeppyodermathatreachthefollicleof dogsandformulceratedwounds,causeachronicinflammationof theskin,duetothesun’sultravioletrays,orfamilialpredisposition or microbial hypersensitivity, or due to other diseases and, usual- ly, they are recurrent and do not allow healing. However, in this specific case, the treatment allowed the animal to improve nearly 80%.

2. Introduction Actinic Dermatosis is a deep pyoderma that occurs in the follicle (folliculitis – forunculosis – cellulitis), being a pre-neoplastic lesion.Characterizedbynon-healingwounds,intheformofplaques andulcers,andchronicinflammationoftheskin.Thisdermatosis represents 15% of skin neoplasms in cats aged 10 to 12 years and affects dogs aged 6 to 10 years.Activation of virus and prehistoric activation protein in viruses, can still activate protein activation system and bacterial immunity in problems, still virus and pre-problemimmunityproteinininflammatoryfamilyproblems). The disease is locally, but with low metastatic potential, there is an early diagnosis, it has a good prognosis, however, it can occur [8].Incats,theymainlyservetheearsandnasalregion,while in dogs they mainly serve the digits and eyelids. There may be a metastaticignallymphnode,becomingmetastaticindigits;andin cats there may be a primary lung tumor. The region also hair and skin(frontalcephalicandignal),analregion,maybepresentinthe oral region and pharynx. In cats there is the presence of Pasteur- ella multocida, α-hemolytic Staphylococcus, and Staphylococcus pseudointermedius, and in dogs: Staphylococcus pseudointermedius, Pseudomonas, Proteus, E. coli and even in atopic canines there is the presence of Pseudomonas aeroginosa (Burkhoderia cefacea complex). Itisalsoobservedthatthiskindofdermatitisaffectsmainlywhite or mottled coats, usually with short hair and animals that were exposedtothesun[6].DiagnosisofActinicDermatosisisclini- cal with cytology and histopathology at cytology are bacteria and some neutrophils. It is necessary to identifie sporotrichosis, trichoepitheliomaorcarcinomas.PCRtechniquesandMaldi-TOFcan be used to identify bacteria. Inthetreatment,COX-2inhibitors,cryosurgery,5%imiquimodin cream,cyclosporine5-10mgperkg,SID,ketoconazoleoritraconozol, prednisolone, radiotherapy and photodynamic therapy can be used. Chemotherapy can also be performed with carboplatin, mitoxanthone,orbleomycin.Anti-inflammatoriessuchasmeloxicamorpiroxicamcanalsobeusedaslongasthereisconcomitant useofomeprazoleorranitidine.Electrochemotherapy,whenused, canreach81%ofremission.Antibioticssuchascephalexin30mg per kg, and amoxicillin with clavulonate can be used [5, 9]. Top- ical therapy helps prevent new infections and should be done for 45 days for pyoderma.As an adjuvant, potassium permanganate, vitamin E and Omega 3 and 6 can be used.

3. Case Study Pit bull female dog, weight 38 kg, 8 years old, erythematous skin for 2 years, not dewormed, delayed annual vaccines (rabies and viruses), biopsy with absence of cancer cells and diagnosis of furunculosis and questioning the presence of dermatophytosis.This animalhadpreviouslybeenmedicatedwithcephalexin,rifampic- in, and thymomodulin by another veterinary colleague. A hemogram had been performed. Duringtheclinicalexamination,theclinicalsuspicionwasactinic dermatosis,andcollectionwasperformedforcytologyandsuperficialskinscraping.Thecytologyresultshowedwhatwasexpect- ed in the literature inflammatory cells (neutrophils) and bacteria (cocci)aswellasthepresenceoffungi.Whilethesuperficialskin scraping showed the presence of Demodex canis. Thefirsttherapeuticapproachwastoreducetheinflammatoryprocess,suggestingtheuseofitraconazole10mgperkg,BID,for a month of treatment and baths with benzoyl peroxide; pipettesof dermatocalmante (Ibasa) and 100 mg/SID cyclosporine; after2 months, an improvement in skin inflammation and back hair growthwas observed.Amoxicillin with potassium clavulonate was used as antibiotic therapy, and the use of corticosteroids such as prednisolone 40 mg, SID, in addition to the antifungal, ketoconazole 200 mg, SID.After these medications, the animal improved considerably.Subsequently,theuseof10%ureaforskinhydration and Imiquimod, an immunomodulator, was also suggested to the animalIt was prescribed the use of Sarolaner for demodectic diseaseandthymomodulin(forbetterimmunity)andtheuseofashirt with UVprotection for the dog.Twenty days later, the use of potassiumpermanganatewassuggested,andthedogalsounderwent topical therapy with ketoconazole shampoo and cream. Figure 1 shows the evolution of the treatment.

4. Discussion Figure1:(a)animal beforetreatment,(b)animalafter ninemonthsof treatment. competentandimmunocompromiseddogs,andbacterialisolates The histopathology of the female dog with this deep pyodemitisis characterized by perforating suppurative folliculitis and furunculosis, which corroborates the studies by Hillier andcolleagues [5]. The cytological examination showed the presence of structures suggestive of coccoid bacteria in considerable quantity, compatiblewithbacteriaofthegenusStaphylococcus.According to Barbosa [2], the main etiological agents involved in pyogenic dermatitisarecoccoidbacteriaofthegenusStaphylococcus.However, other agents may be involved, such as Pseudomonas aeruginosa, which are gram-negative bacterial [1, 4, 9, 11]. These skin infectionscausedby thisbacterial complexcan occurinimmunocanbehighlyresistanttoantimicrobials,makingclinicalmanagement challenging. In addition, the skin infection can progress to life-threatening sepsis of the animal [3]. MostdogsanalyzedbyPoggianniandcolleagues[10]hadchronic skin diseases such as pyoderma, bacterial folliculitis, and demodicosis. These conditions are accompanied by inflammation of the skin. Still, these same authors observed that the disease is more frequentinfemalesthaninmalesandthatAmericanPitBulldogs arethemostaffected;informationthatcorroboratesthecaseunder study. Cyclosporineisanewdrugusedforthetreatmentofimmune-me diated skin diseases and a safe and effective alternative to immunosuppressive therapy with glucocorticoids, however, even in dogs treated with cyclosporine (5 mg/kg, once daily) and metrexate(0.25mg/kgonceaweek)thediseaseinthedogmaybestable for six months, but there may be a recurrence [8]. The tutor did not administer cyclosporine at this time, howevertreatment with prednisoloneatanimmunosuppressivedosehadapositiveeffect, and the use of topical Imiquimod as an immunosuppressant also had an effect. Tham and colleagues [11] describe a dog with lethargy, anorexia, pain, and rapidly progressing skin lesions consistent with hemorrhagic papules, pustules, coalescing ulcers, and crusts, and treatment with oral ciprofloxacin, and topical antimicrobial shampoo, resulted in complete resolution of the symptoms in skin lesions within eight weeks. In this work, the use of antibacterial and antifungal shampoos (benzoyl peroxide-peroxyl and ketoconazole) wasfundamentalinthetreatment,whoseantibacterialandantifungalefficacyisscientificallyproven,reestablishingtheskinbalance [7].As well as the use of the antibiotic amoxicillin with clavulonate, like antibiotic therapy.

5. Conclusion Canine dermatoses are one of the most difficult investigations in daily practice, requiring the identification of the specific disease in the face of so many others that can be different and have similar characteristics. The canine showed considerable improvement in relation to the initial state of the lesions (~80%) exactly nine months after the treatment was instituted. Dog´s hair grow completely in dorsal region and in almost all animal’s lateral region. Treatmentwithlaserlight(phototherapy)forabetterremissionof the lesions was suggested however, it was not carried out. Meanwhile, the therapy with antimicrobials, antifungals, vitamins, moisturizers, and immunomodulators used allowed a significant improvementintheclinicalconditionoftheanimal.Andthetutor was very grateful for that.

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Vivianne Souza. A Pre-Neoplastic Lesion: A Case Study . Annals of Clinical and Medical Case Reports 2023