Endocrine disorder with unique dermatologic symptoms

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When it comes to dermatological manifestations, the first and sometimes only indicator is systemic disease. The changes of the skin can give veterinary professionals clue to the underlying condition the patient could have and might otherwise go unnoticed. Veterinary professionals should recognize these signs to help ensure their patients are getting an accurate and timely diagnosis, but what signs should they look out for?

During his lecture “Dermatologic Manifestations of Systemic Diseases” presented at the New York Vet show in New York, New York, Andrew Rosenberg, DVM, DACVD, explained the endocrine disorder that can cause feline acquired skin fragility syndrome to the clinic with dermatological manifestations, and how to diagnose and treat.

Feline acquired skin fragility syndrome

According to Rosenberg, one of the most dramatic and distressing manifestations of Cushing’s diseases in feline patients is feline acquired skin fragility syndrome. This condition can be caused by excessive use of progestational compounds, diabetes mellitus, and in some reports, liver disease, phenytoin administration, nephrosis, and idiopathic are also associated with this condition. The condition leads to extreme fragility and thinning of the skin which makes it easy to tear even with minimal trauma and can appear to be bruised and with spontaneous wounds.

“This is another syndrome called feline acquired skin fragility syndrome, and this one can actually be sometimes mixed up with that feline para neoplastic syndrome. And with this disease, this skin just becomes really fragile and really extensible. It's been reported with several diseases,” Rosenberg explained to attendees.

“This is an only cat thing. There's no other species of this is founded, and these are really sad cases,” he continued.

Rosenberg informed attendees that this syndrome typically effects middle aged to older cats with no sex predilection. The syndrome can cause the skin to become so thin that it can be translucent, and partial alopecia can occur. To diagnose the syndrome is based primarily on history and clinical signs, especially if the patient is suspected or known to have Cushing’s disease. Veterinary teams can perform bloodwork to rule out hypercortisolism and diabetes mellitus prior to considering other possibilities. Teams can perform a skin biopsy, but Rosenberg stated that it may show non-specific changes like dermal atrophy, but the clinical presentation is normally a clear picture of what is going on.

Treating the syndrome involves addressing the underlying hypercortisolism, but patients with this syndrome are at an advanced stage of the diseases. This means that the prognosis for the patient is usually poor. The patient’s wound management is an important part of treating, but it is a challenge because the fragility of the patients skin makes suturing successfully. Rosenberg said most of these patients are unfortunately euthanized. Because there is a variety of diseases that can cause this, it is important to know and understand its origins.

“Cushing's disease, although it's rare in cats, this is one of the things that it that it can do. Iatrogenic Cushing’s can cause this as well. Steroids can cause epidermal atrophy. Diabetes Mellitus can cause this as a complication, and then we don't really see this much anymore, but progestational compounds like escrow acetate, that used to be used commonly in cats with allergies, used to cause this as a side effect,” said Rosenberg.

Pathogenesis of this is unknown but appears to be multifactorial and probably related to the effect of glucocorticoids or other steroid hormones effect on collagen production in the skin…. So a variety of diseases that all lead to the this really strange and just very, very depressing changes on the skin,” he concluded.

Rosenberg also explained that this is different than cutaneous asthenia, or Ehlers-Danlos syndrome. He explained that this syndrome is a hyper extension of the skin and is seen from time to time in canine patients, but it is present at birth. It is caused by a collagen lacking diseases and can also be seen in humans as well.²

Conclusion

Dermatological manifestations can teach veterinary professionals what to look for when it comes to an underlying condition, or understand what is being presented to them like in the case of feline acquired skin fragility syndrome. Rosenberg explained that to address concerns, a thorough diagnostic approach is needed to identify the changes, figure out a treatment plan, and explain to clients their options.

As the veterinary industry continues to understand the relationships between internal diseases and skin reactions, better diagnostic strategies and therapeutic options can continue to grow.

Reference

1. Rosenberg A. Dermatologic Manifestations of Systemic Diseases. Presented at: New York Vet Show; November 7-8, 2024; New York, New York.
2. Moriello K. Defects of Structural Integrity in Animals - Integumentary System. Merck Veterinary Manual. Published January 2020. Accessed November 8, 2024. https://www.merckvetmanual.com/integumentary-system/congenital-and-inherited-anomalies-of-the-integumentary-system/defects-of-structural-integrity-in-animals