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Multiple Collagenous Nevi In A Dog

by cturner - June 5, 2019 View Case Report

Cora is a 11 year old FS lab with 8 year history of multiple nevi formations on all four feet -- tops and bottoms, ear bases, pinna, muzzle. There are typically 6-10 x 1 -2 cm raised, round, soft, sometimes hairless nodules with the largest more distal on each foot and smaller lesions extending up each limb. A few reside under the foot and interfere with pads, causing intermittent pain and infection. The nodules at her ear bases are so large and more firm they impinge on the canal. Research on this rare condition indicates they can be genetic or not and are considered cutaneous pseudo-neoplasms. The appearance is rather dramatic -- She is a petite lab and she appears like a puppy with these giant feet.

Here is a dropbox link to some images: https://www.dropbox.com/sh/pjgrjybvul3n0kl/AACVo3M6soi_NWngmthqiSSwa?dl=0

The lesions are not hot or damp individually but are prone to infection due to the crowding of tissue and pads on the feet and some self trauma. The pain is due to walking on those on the underside of the feet, but the lesions themselves don't seem painful unless traumatized.

Pulse is weak and tongue is pale and dry. She does not cool or warm seek, eats a kibble/canned diet. She has no GI issues, no current infection or other health problems. She walks with booties to protect her feet and only has mild lameness on a front leg, but otherwise is a typical happy Fire lab.

I was expecting a damp heat sort of pattern here but I'd say she is more Qi and Blood deficient so I was thinking more along the lines of Chu Shi Wei Ling Tang and modified XFZYT vs. things more damp draining. But I wonder your thoughts considering the severity, chronicity and progressive nature of this situation seems more like neoplasia. Was also considering adding coriolus and vit A/D.

Thank you!
Carrie

by naturevet

June 6, 2019

Hi Carrie,

I like your thinking. I would probably pair Xiao Chai Hu Tang with Modified Xue Fu Zhu Yu Tang and try that first. It has been helpful for us as a combination in other severely lumpy dogs. In particular, the lesions as the base of the ears suggest we should be adding XCHT to the protocol.

I'm not sure if you do acupuncture, but if you do, you can confirm the appropriateness of the above by testing the response of the pulse to needling (sedation) of GB and TH points like TH 5, GB 20 and 21, GB 34, and the like. Blood moving points to try include BL 17 and ST 37. If these points moderated the pulse, then you are in business.

Failing that, though, I would still give the two herbs a try. They support increased peripheral circulation, allowing for the active resolution of inflammation. Chronic collagen deposition suggests chronic inflammation as an inciting cause, particularly when the extremities and ears are involved (where blood supply is naturally more meager).

There is nothing wrong with CSWLT either, but if there is an immune-mediated angle to the inflammation, rather than just an unresolved infection, pairing Modified XFZYT with XCHT is a better choice. If you get somewhere, then the next step is to evaluate the diet. We can discuss that later, pending your outcome

Hope that helps!

Steve

by cturner

June 6, 2019

Steve,
Thank you. This is super helpful! Yes, I do acupuncture so I will check those points next time I see her. Will keep you posted!

Carrie Turner

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