3.

5 Scales 169

Fig. 3.144  Scaly dermatitis in a West Highland white terrier with generalised demodicosis

transparent tape test (Fig. 3.144) (Mueller 2004; Mueller et al. 2012; Gross et al.
2005; Miller et al. 2013). Unlike dogs, the long and short variants of feline Demodex,
named D. cati and D. gatoi respectively, have been recently demonstrated to indi-
cate two different types of mites (Ferreira et al. 2015). In cats affected by exfoliative
demodicosis, D. gatoi is frequently observed, especially in patients with an immune-­
suppressive disorder or following corticosteroid therapy. In these cases, it is very
common to collect mites on the surface of the skin, as the stratum corneum seems
to be the habitat of these mites (Fig. 3.145).
Cytological Findings
Although normal sized D. canis mites live in the follicles and sebaceous glands,
they mate on the skin surface, after which the females go into the follicular lumen
in which they lay eggs; for this reason, in many cases of generalised demodicosis, it
is also possible to collect them with a piece of transparent tape (Figs. 3.146 and
3.147). In the case of secondary bacterial infection, karyolytic neutrophils with
phagocytosed cocci can also be observed (Fig. 3.148).
In the rare cases of canine crusty or Norwegian scabies, unlike classic scabies
infections, the number of mites is very high and they can easily be collected via the
acetate tape test (Fig. 3.149). This evidence is normal in cats affected by notoedric
mange, in which the chance of collecting mites via the scotch test is very high,
because Notoedres mites are always numerous on the skin (Fig. 3.150).
170 3  Cytology of Canine and Feline Non-neoplastic Skin Diseases

Fig. 3.145  Skin atrophy and scaly dermatitis due to iatrogenic administration of steroids with
secondary Demodex gatoi infestation

Fig. 3.146  Histology of demodicosis: many Demodex canis in the stratum corneum (arrows,
inset)
3.5 Scales 171

Fig. 3.147  Cytology of demodicosis: two adult Demodex canis short body and one egg (arrow)

Fig. 3.148  Cytology of demodicosis: an adult Demodex canis immersed in a neutrophilic inflam-
matory background
172 3  Cytology of Canine and Feline Non-neoplastic Skin Diseases

Fig. 3.149  Histology of scabies: many Sarcoptes scabiei var. canis on the skin surface

Fig. 3.150  Cytology: an adult Notoedres cati sampled via the acetate tape technique
3.6 Erosions 173

3.6  Erosions

3.6.1  Erosive Diseases in Dogs

Epidermal collarettes are the most frequent erosive lesions observed in canine der-
matology and are also more valuable for cytological examination. Collarettes are
round secondary lesions with an erythematous or hyperpigmented central area,
peripherally bordered by scales or crusts, which originate following the breakage of
a pustule. Only in very rare cases is this secondary to the rupture of an intra-­
epidermal vesicle (Ihrke 1996; Gross et al. 2005; Miller et al. 2013). As mentioned
in Chap. 2, as vesiculo-bullous lesions are extremely rare in dogs and cats and are
mostly located at the dermal–epidermal junctions, in the case of vesiculo-bullous
diseases, their rupture is the cause of the development of an ulcer. Accordingly, the
possibility of detecting intra-epidermal vesicles from which collarettes may origi-
nate is extremely rare and limited to pemphigus vulgaris. For this reason, it is pos-
sible to assert that collarettes are almost always secondary to pustules, and therefore,
cytology can often provide very useful results (Fig. 3.151).
Usually, in canine superficial pyoderma, collarettes are present in association
with papules and intact pustules, but sometimes they are the only lesions present.
Large and confluent lesions that resemble collarettes can be observed in spreading
pyoderma, an exfoliative variant of superficial staphylococcal pyoderma (Fig. 3.152).

Fig. 3.151  Epidermal collarettes in a dog with superficial pyoderma

174 3  Cytology of Canine and Feline Non-neoplastic Skin Diseases

Fig. 3.152  Multiple and coalescent erosive and scaly lesions similar to collarettes in a dog with
superficial spreading pyoderma

Although pyoderma is the most frequent cause of collarette formation, they can
develop in all cases of pustular dermatosis. In dogs affected by pemphigus folia-
ceus, during the rest phase of pustular eruption, skin lesions may only be repre-
sented by yellowish crusts and epidermal collarettes and the clinical lesions may
mimic those observed in superficial and spreading pyoderma (Figs. 3.153 and
3.154). In this case, cytology from collarettes can provide important indications for
the diagnosis of autoimmune disease when many acantholytic cells are observed.
Cytological Findings
Cytology obtained from collarettes in dogs with pyoderma shows the same cytology
as that observed in specimens from intact pustules.
Specimens are less cellular and composed of more corneocytes or nucleated
keratinocytes, the latter from the spinous and granular layers, together with many
entire or broken karyolytic neutrophils (nuclear streaks) and cocci, both phagocy-
tosed and free on the slide’s background (Fig. 3.155).
As mentioned, collarettes can be detected in all pustular diseases, regardless of
the cause.
In pemphigus foliaceus, the cytological evidentiation of segmented neutrophils
and acantholytic keratinocytes can orientate the clinicians to perform a histopatho­
logical examination.
3.6 Erosions 175

Fig. 3.153  Multiple and diffuse epidermal collarettes in an English bulldog with PF

Fig. 3.154  Very large and coalescent epidermal collarettes in a dog with PF
176 3  Cytology of Canine and Feline Non-neoplastic Skin Diseases

Fig. 3.155  Cytology collarettes: karyolytic neutrophils with many cocci both intracytoplasmic
and on the bottom of the slide

When sampling erosions, it should be remembered that the visualisation of bac-

teria should be interpreted with more caution, as erosions are exposed to environ-
mental and oral contaminants. The aspect of lesions, and the history orientate the
clinicians towards a correct interpretation of the detected bacteria.

3.6.2  Erosive Diseases in Cats

Epidermal collarettes are extremely rare in cats since pustules are very rare lesions
in this species. In pustular diseases such as PF, rather than collarettes, yellowish
crusts indicative of the dehydration of pustules are more frequently observed. Round
lesions with scaly borders similar to epidermal collarettes are often observed in cats
affected by dermatophytosis, but are not secondary to pustules.

3.7  Ulcer

As mentioned in the chapter regarding the diagnostic techniques, samples from

ulcers are usually of poor quality and highly haemocontaminated; for this reason,
ulcerative diseases rarely supply useful specimens. Nevertheless, there are some
ulcerative diseases for which cytology may provide an immediate diagnosis.
3.7 Ulcer 177

3.7.1  Ulcerative Diseases in Dogs

3.7.1.1  Deep Pyoderma

Ulcers can characterise deep pyoderma in dogs. Ulcer formation can be caused by
self-trauma or following deep lesions such as in cases of bacterial cellulitis or furun-
culosis. Ulcers can be localised as in callus pyoderma or spread all over the body. In
all these cases, ulcerative lesions are secondary and are usually not the direct expres-
sion of bacterial infection (Ihrke 1996; Miller et al. 2013). In dogs, the so-called
mucocutaneous pyoderma is characterised by depigmentation and skin ulceration
located at the mucocutaneous junctions of the lips, eyelids, nares and, less fre-
quently, the anal and genital junctions (Figs. 3.156 and 3.157) (Bassett et al. 2004;
Wiemelt et al. 2004). These particular variants of pyoderma are clinically indistin-
guishable from some autoimmune-mediated diseases such as mucocutaneous lupus
and, in many cases, the histopathological findings are not sufficient for a definitive
diagnosis either (Wiemelt et al. 2004; Olivry et al. 2015). Another form of deep
pyoderma, characterised by ulcerative lesions, is the so-called idiopathic recurrent
pyoderma of the German shepherd dog. The pathogenesis of this form of pyoderma
is unclear and the role of bacteria in the development of the lesions is debated,
because many forms are idiopathic. Furthermore, many dogs recover without the
use of antibacterials, and dramatic improvement with therapies based on immuno-
modulators suggests an immune-mediated pathogenesis (Fig. 3.158) (Wisselink
et al. 1990; Gross et al. 2005; Rosser 2006; Miller et al. 2013). As with erosions,

Fig. 3.156  Ulcerative blepharitis in a German shepherd with mucocutaneous pyoderma

178 3  Cytology of Canine and Feline Non-neoplastic Skin Diseases

Fig. 3.157  Inflammatory depigmentation and ulcer of the mucocutaneous junction of a nostril of
the same dog as in Fig. 3.156

Fig. 3.158  Multiple bleeding ulcers on the trunk of a German shepherd with idiopathic deep
pyoderma