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Case Report
First Report of Psoriatic-Like Dermatitis and Arthritis in
a 4-Year-Old Female Spayed Pug Mix
Stephanie A. Regan,1Rosanna Marsella,1,2 and Ibrahim Ozmen3
1Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida,
2015 SW 16th Avenue, Gainesville, FL 32610, USA
2Department of Dermatology, Springhill UF Health, 4037 NW 86th Terrace, College of Medicine, University of Florida,
Gainesville, FL 32606, USA
3Department of Dermatology, Corlu Military Hospital, Corlu, 59850 Tekirdag, Turkey
Correspondence should be addressed to Rosanna Marsella; marsella@u.edu
Received July ; Accepted September
Academic Editor: Carlos Gutierrez
Copyright © Stephanie A. Regan et al. is is an open access article distributed under the Creative Commons Attribution
License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly
cited.
Psoriasis manifests as chronic dermatitis and arthritis (PsA) in people. Psoriasis with concurrent PsA is characterized by
erythematous, silvery, scaly plaques, especially on the extremities, and concurrent arthritis with enthesitis, tenosynovitis, and
dactylitis. To date, no such disease has spontaneously occurred in domestic animals. is case report aims to describe the clinical,
radiographic, and histologic appearance of a psoriasis-like dermatitis and psoriatic-like arthritis in a dog. A -year-old female
spayed pug mix presented for the evaluation of chronic history of hyperkeratotic footpads and deforming arthritis. Aer ruling out
other dierential diagnoses and based on the similarity of clinical, radiographic, and histologic ndings to human psoriasis and PsA,
a tentative diagnosis of psoriasis-like disease was made. Treatment was begun to control pain (tramadol, gabapentin, and carprofen)
and psoriatic dermatitis (clobetasol propionate .%, calcipotriene .%, and urea % ointment twice daily). Dramatic positive
response to treatment was achieved conrming the tentative diagnosis. is case may provide preliminary evidence for the existence
of a psoriasis-like condition in dogs and may elucidate treatment options in otherwise refractory cases of chronic dermatitis and
polyarthropathy in dogs.
1. Introduction
Psoriasis is a very common and frustrating disease in people
that can have both cutaneous and bone manifestations. Inter-
estingly there has been no report, so far, of spontaneously
occurring psoriasis-like disease in domestic animals. e
reasons for this dierence are not known. In this report we
describe the rst case of a psoriasis-like disease in a dog
that presented with both cutaneous and bone signs. e
dog of this case report had not responded to treatments
prescribed for the various conditions known in veterinary
medicine attempting to make her t in what is known in
animals. us she had been unsuccessfully managed for a
long time as it did not t in any previously described diseases
of dogs. To the dog’s benet, a human dermatologist happens
to be available for assessment and a diagnosis of psoriasis-like
disease was made as the changes found in this dog appeared to
be classic for how the disease presents in people. e purpose
of this report is to make practitioners aware that although
this psoriasis-like condition may be very rare in dogs, it
candevelopanditseemstorespondtothesametreatments
reported in human medicine.
2. Case Presentation
A -year-old female spayed pug mix weighing . kg pre-
sented for a two-year history of chronic, hyperplastic, crust-
ing, parakeratotic pododermatitis, intermittent episodes of
lethargy and minimal weight bearing on all four limbs. e
dog had ability to ambulate but was reluctant to do so
especially on hard surfaces. ere was so tissue swelling
associated with multiple digits of every foot. e dog had
Hindawi Publishing Corporation
Case Reports in Veterinary Medicine
Volume 2015, Article ID 912509, 4 pages
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Case Reports in Veterinary Medicine
been adopted at age with the above symptoms already
present; thus the exact age of onset of clinical signs was not
known.
When presented to the referring veterinarian (rDVM)
at years old, the original diagnosis was interdigital podo-
dermatitis and cellulitis on all four limbs with almost all
digits involved. Clinical dierentials by rDVM included
necrolytic migratory erythema (NME), pemphigus foliaceus,
and chronic footpad hyperkeratosis, but the joint changes and
so tissue swelling did not t any of these dierentials. Radio-
graphs conrmed so tissue swelling and revealed periosteal
proliferations suggesting chronic periosteitis. Blood work
did not reveal any abnormalities. Oral enrooxacin and
cephalexin were begun as well as debridement, ush, topical
antibiotic ointment, and bandaging of the footpads. Pain
was controlled with metacam liquid. At the one-month
recheck, there was no response to treatment and worsening
in condition had occurred despite oral antibiotics. erapy
was changed to tetracycline, prednisone, and niacinamide as
well as cold laser therapy. Skin biopsy was performed and
showed severe hyperplastic parakeratotic hyperkeratosis with
inltration of lymphocytes and plasma cells and a smaller
population of neutrophils, mast cells, and macrophages.
e dog was then referred to a local dermatologist
who performed a toe amputation for additional biopsy and
culture and sensitivity. Biopsy showed marked acanthosis
with formation of papillae, parakeratosis, and multiple pus-
tules and parakeratotic microabscesses and crust formation.
e crust was composed by necrotic cellular debris and
neutrophils. No acantholysis and no primary etiologic agents
were detected. In the biopsy a moderate amount of chronic
active neutrophilic, supercial perivascular pododermatitis
was present. Bacterial culture showed scant growth of Staphy-
lococcus pseudintermedius sensitive to cephalosporins. While
some of these features were consistent with metabolic epi-
dermal necrosis (e.g., severe parakeratotic hyperkeratosis),
there was no inter- or intracellular edema. Blood work was
repeated (CBC, chemistry panel, and TT) and was within
normal limit. Diagnosis was again presumptive NME or
zinc responsive dermatitis although many of the features
of this disease were not found in the patient. is dog
had no evidence of other liver or pancreatic diseases and
was fed a well-balanced commercial diet. Other dierential
diagnoses included idiopathic chronic hyperkeratosis of foot-
pads but no explanation was provided for the combination
of dermatitis and deforming arthritis and bone changes.
Medications and therapy were modied to a one-month
course of Cefpodoxime proxetil (Simplicef), amino blend
dietary supplement, zinc methionine, omega fatty acids,
egg yolk supplement, and a high protein diet to address
any dermatitis linked to amino acid or zinc deciency and
carprofen (Rimadyl) and tramadol for pain management.
is therapy did not lead to any clinical improvement aer
one month; thus the dog was then referred to UF.
On presentation to UF Dermatology at the veterinary
school, the patient was quiet, alert, and responsive but
reluctant to ambulate. Her cardiothoracic auscultation and
physical exam parameters were within normal limits. Der-
matologic examination revealed severe hyperkeratosis on
F : Photograph before treatment of worst aected digit, fea-
turing so tissue swelling, proliferative arthritis, and hyperkeratosis.
F : Radiographs of forelimbs before treatment, showing
proliferative joint disease in the interphalangeal joint, ankylosis,
dactylitis, and enthesitis.
footpads (Figure ) on all four limbs. All four feet palpated
with a positive pain response. e rDVM provided radio-
graphs which showed proliferative joint disease in the inter-
phalangeal joints of forelimbs (Figure ). Major dierentials
basedonhistoryandpreviousdiagnosticswereagainNME,
possibly due to liver disease, glucagonoma, and GI malab-
sorption. However, these dierentials still failed to explain
the arthritis component, intermittent lethargy, solely digital
distribution of lesions, and the early onset of symptoms (age
or potentially earlier) and were not consistent with any
previous blood work which had all been within normal limits.
NME is frequently linked to liver changes; thus, in
the attempt to further pursue NME, ultrasound was per-
formed but ndings were unremarkable. Pancreatic Lipase
Immunoreactivity (PLI) and Trypsin-Like Immunoreactivity
(TLI) were discussed as diagnostic options to further investi-
gate other possible cases of NME but not pursued at rst visit
in light of the complete absence of clinical signs to support
this dierential diagnosis.
Upon further examination of the conuence of clinical
signs, biopsy results, and radiographic changes noted and in
consultation with a human dermatologist, it was determined
that plaque psoriasis with psoriatic arthritis, although neither
was ever previously documented in canines, could actually
provide a comprehensive explanation for the condition of
this dog. us, a tentative diagnosis of psoriatic-like disease
Case Reports in Veterinary Medicine
F : Occlusion therapy with Pawz dog boots.
was made and it was decided to attempt rst line of defense
therapy for psoriasis as it would be done in human medicine.
Treatment was begun based on a presumptive diag-
nosis of psoriatic-like arthritis and consisted of tramadol
( mg q-hr PRN for pain), gabapentin ( mg qhr
for pain), and carprofen ( mg qhr for pain, arthritis,
and inammation). To control the dermatologic symptoms
clobetasol propionate .% ointment (topical steroid), cal-
cipotriene .% ointment (topical Vitamin D), and urea
% ointment (topical keratolytic) were prescribed to be
used twice daily, with one of the daily administrations to be
performed under occlusion. To properly perform occlusion
therapy, Pawz dog boots (Figure ) were given to provide
a so, water-vapor impermeable membrane that would be
easily applicable to the paws. Topical therapy was prescribed
until reexamination with the possibility of adding systemic
therapy with oral steroids (prednisone) or oral disease mod-
ifying antirheumatic drugs (methotrexate, also classied as
an antimetabolite immunosuppressant) later on, if needed.
Follow-up care was performed at the rDVM with consulta-
tion by UF Dermatology. rDVM noted on follow-up com-
munication that the patient responded beautifully to topical
treatment; crusting of footpads was reduced and the patient’s
comfort and activity level had dramatically increased. While
shewasreluctanttoambulateatallpreviously,shewas
now comfortable and even observed to initiate play several
times. At two-month follow-up some muscle wasting was
noticed, and topical treatment was reduced in frequency.
Muscle wasting resolved following these changes. Owners
were very satised with improvement in quality of life, and
no systemic treatments were needed. One year later she is
currently being maintained with carprofen and tramadol
if needed, capsule of Omega Tri-V PO qhr, clobetasol
propionate .% ointment, calcipotriene .% ointment,
and urea % ointment two times per week, alternating and
without occlusion.
3. Discussion
Psoriasisisachronicinammatoryskinandjointdisease
aecting -% of humans [–]..While psoriasis-like con-
ditions have been described in mice [], this disease has
not been described as spontaneously occurring in domestic
animals. In humans, the most frequent clinical presentation
of psoriasis includes erythematous, silvery, scaly plaques
especially on the extremities and scalp []. Patients may
also suer from itch, pain, nail-related disease, and arthritis
[–]. Up to –% of psoriasis patients will also have
psoriatic arthritis (PsA), with joint disease typically occurring
several years aer the original onset of skin conditions [].
PsA has several patterns, including distal interphalangeal,
asymmetric oligoarthritis, symmetric polyarthritis, arthritis
mutilans, and spondyloarthritis. Clinically, PsA may also
involve enthesitis, tenosynovitis, and dactylitis []. Both
psoriasis and PsA may have varying degrees of severity, and in
humans they have been associated with comorbidities such as
cardiovascular disease, stroke, inammatory bowel disease,
depression, and potentially cancer [, ].
is case report aims to describe the clinical, radio-
graphic, and histologic appearance of a psoriasis-like der-
matitis and corresponding psoriatic-like arthritis in a dog.
Dermatologic manifestations of psoriasis in humans can
usually be diagnosed by visible appearance of the patient
[–]. e most frequent type of psoriasis is chronic plaque
psoriasis, or psoriasis vulgaris, and this is characterized by
distinct, erythematous, scaly plaques, usually on the scalp
or extremities [, ]. Psoriatic arthritis, however, can be a
more dicult diagnosis. Diagnosis can be made using several
factors including corresponding plaque psoriasis diagnosis,
familial history, asymmetric arthritis of distal interphalangeal
joints, dactylitis, enthesitis, axial involvement, extra-articular
manifestations (i.e., uveitis), and laboratory tests (radiology,
rheumatoid factor, ultrasonography, and MRI) [, , ].
Following the above criteria for clinical diagnosis of
human psoriatic patients, this case report describes a dog
with similar presentation to psoriasis vulgaris with PsA. Der-
matologically, she had distinct, erythematous, scaly plaques
located on her footpads or distal extremities. Concurrent with
the psoriasis-like dermatitis, she also exhibited asymmetric
arthritis of distal interphalangeal joints, dactylitis, and enthe-
sitis and had radiographic evidence of so tissue swelling,
proliferative arthritis, and ankylosis. Her histological appear-
ance was also similar to psoriatic patients. In human
patients, histologic samples show hyperkeratosis, parakerato-
sis, Munro microabscesses (neutrophilic inltrate), dilation
of capillaries engorged with erythrocytes and leukocytes,
tortuous blood vessels, and perivascular polymorphonuclear
leukocytic inltrate []. In this case study, the patient
exhibited severe parakeratotic hyperkeratosis with moderate
amount of chronic active neutrophilic, lymphocytic, and
plasma cellular supercial perivascular pododermatitis. It is
common in human patients for individual lesions to have
variants in histologic ndings and to have some indicators
absent; therefore lack of certain histological features in the
dog’s samples does not preclude her from the diagnosis [].
In fact, lesions oen change in histologic appearance even
throughout their own progression []. e dog in this case
report did not have other signs of concurrent disease.
Treatment of psoriasis in human dermatology consists
of topical agents, occlusion therapy, phototherapy, oral sys-
temic agents, injectable biological therapies, and oen a
varying combination of treatment options. Topical agents are
Case Reports in Veterinary Medicine
considered rst line treatment, and the addition of escalated
treatments depends on the added benets of mitigating the
disease process weighed against the increasing side eects
or invasiveness. Topical agents include Vitamin D analogues,
corticosteroids, keratolytics, and retinoids; the combination
of Vitamin D analogues and corticosteroids show the greatest
ecacy in terms of multiple topical therapies []. Mild cases
are commonly treated with topical therapies only, and it is
sometimes dicult for the general practitioner to discern
when patients require secondary care, especially when PsA
may be concurrently involved [].
In this case study, treatment with combined topical ther-
apy of Vitamin D analogue, corticosteroid, and keratolytic
was both therapeutic and diagnostic. Psoriasis had not been
previously described in dogs, but based on the similarities of
clinical appearance and radiographic and histologic ndings,
rst line psoriatic treatment was attempted. erapy under
occlusion was recommended as it has been shown to greatly
increase the response in psoriatic patients [].
Response to treatment further supported the psoriatic-
like dermatitis diagnosis as this dog had failed to respond
to any other previous therapy. Future therapy with immune-
modulating antimetabolites, such as methotrexate, was con-
sidered to address the joint disease but the owner elected to
notpursueitasthequalityoflifeofthisdogwassuciently
controlled with the initial plan. Although this condition
is extremely rare in dogs, it is important to consider the
possibility for cases in which both joint and skin involvement
isreported.Inthiscasetheconsultationwithahuman
dermatologist was crucial to provide proper treatment plan
for this case which had not found relief with previous
therapies that had attempted to treat diseases known in
veterinary medicine.
Conflict of Interests
e authors declared no potential conict of interests with
respect to the research, authorship, and/or publication of this
paper.
Acknowledgment
e authors would like to thank Dr. Suero for his contribution
with this clinical case.
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