Plasma Cell Pododermatitis

Cat paws being held by human hands

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Plasma cell pododermatitis in cats is much less comfortable than its nickname, “pillow paws”, would suggest. In this episode of Your Vet Wants You to Know, Dr. Brittany Lancellotti talks about Hermoine, a cat with plasma cell pododermatitis, including the symptoms, underlying causes (viral infections, food allergies, etc), diagnostic tests, potential triggers, and treatments. Our closing segment, ‘Scratching the Itch,’ highlights the ‘Calm and Cozy Cat Wrap’, a tool designed to alleviate the stress of administering oral medications to cats.

Table of Contents

A Cat with Painful Pillow Paws

[00:01:04] Welcome, everyone, to today’s episode of Your Vet Wants You To Know. Today, I’m going to be talking about a disease known as plasma cell pododermatitis, which has the adorable nickname of “pillow paws.” Unfortunately, the disease itself is not as adorable as its nickname, and the animals that I see suffering from it can be very uncomfortable. One patient, in particular, that comes to mind when I think of plasma cell pododermatitis is a very cute cat named Hermione. When I first saw her, she was three years old. She’s an orange domestic short hair. For over a year prior, her paws had been swollen, painful, and had wounds that would come and go. She was otherwise healthy, but the discomfort in her paws was affecting her quality of life and her relationship with her owners, as well as the other cats in the household. If you want to see pictures of how Hermione’s paws looked when I first saw her, you can go to the episode page on yourvetwantsyoutoknow.com.

[00:02:01] Hermione’s paws had the classic look of plasma cell pododermatitis, which is a rare disease in cats that causes one or more of the cat’s paw pads and toe beans to get very swollen, cracked, and turn dark pink to purple. They can get so swollen that they look like angry pillow paws. The paws can become very painful to walk on, which can be tough to see at first because of how well cats like to hide their diseases. But as this problem gets worse, they’ll have a harder and harder time getting around comfortably.

image of swollen, crusted, purple cat paws

Diagnosing Plasma Cell Pododermatitis

[00:02:34] This disease usually affects more than one paw, but if only one paw is affected, your veterinarian may recommend a biopsy (taking a small surgical sample of the paw pad while your pet is sedated or under anesthesia, with good pain control), followed by a few little stitches, so they can make sure that they have a really good diagnosis of what is going on with those paw pads.

Another diagnostic test that can be done is called a fine needle aspirate (inserting a needle into the paw pad) to take a sample of some of the cells that are living in there, and put that on a slide to look at under the microscope. Sometimes, that’s done right there in the clinic, in the hospital where you take your pet. Other times, that fine needle aspirate can be sent out to a lab for a clinical pathologist to evaluate. This is especially important if it is in just one paw, to make sure that it’s not another disease process, such as a fungal infection or a certain type of cancer.

Chest x-rays can also be helpful, if this is just one paw, because of a syndrome called lung digit syndrome, where a cat can potentially have a lung nodule or type of cancer growing in the lung, and that shows up as inflammation or swelling in the paw.

Possible Causes of Plasma Cell Pododermatitis

[00:03:58] We’re not exactly sure what causes plasma cell pododermatitis to develop. There are some triggers that can sometimes play a role, including viral infections with feline immunodeficiency virus (FIV) or feline leukemia virus (FELV). It is highly recommended to do blood work on cats with these problems to see if there is a viral infection present, because those viral infections can cause many more problems within the body and not just the paws.

[00:04:27] Blood tests can also measure something called globulins. These are the antibodies (little messengers of the immune system) that are often increased with this disease. This is because the plasma cells in the paws are pumping out totally unnecessarily high levels of antibodies that cause the inflammation or swelling in the pads. Those antibodies will sometimes travel through the bloodstream and get stuck in the kidneys, and that directs the immune system to attack the kidneys, where the antibodies are trapped. Blood work will help us to look at kidney values and make sure that the antibodies are not causing kidney disease because of the damage there. Elevated kidney values and elevated globulin levels, unfortunately, can mean that the disease is more severe than just the paws.

A cat getting a blood test

[00:05:17] We can also have inflammation from allergies to proteins in the food trigger this disease to occur. If we’re concerned that the disease is coming from food allergies, unfortunately, there is no blood test that is accurate for the diagnosis of food allergies in cats. The most accurate way to diagnose this disease is to perform an eight week diagnostic elimination diet trial, using a prescription hydrolyzed protein or a novel protein food, directly under the supervision of a veterinarian who feels comfortable guiding you through this eight week diagnostic test that you are performing at home. If you’d like more information on how to do a really good elimination diet trial, Dr. Megan Painter (another board certified dermatologist) and I did an episode (17) on diet trials, and it is one of my favorite episodes. It takes you through how to do this test and get a really good answer, so that you never have to wonder if food is playing a role again.

[00:06:20] In many of these cases though, we don’t find the underlying trigger. These are termed idiopathic. Idiopathic just means that we haven’t been able to figure out why this condition occurred.

a cat eating from a food dish

Treatment Options for Plasma Cell Pododermatitis

No matter what that underlying trigger is, the big problem with this disease is an overactive immune system causing too much swelling or inflammation. Treatment involves looking for the trigger, but also using anti inflammatory medications to calm down those plasma cells. Some vets may recommend steroids like prednisolone. Others may recommend an antibiotic with anti inflammatory action called doxycycline. It’s important to discuss the benefits and the risks of each medication, and your pet’s specific healthcare concerns with a trusted veterinarian who’s familiar with your pet, as well as this disease. If you want to find a dermatologist who specializes in plasma cell pododermatitis and other skin and ear diseases, you can go to the resources page for a link to find a specialist in your area.

[00:07:25] Getting back to Hermione, I talked to her owner about plasma cell pododermatitis and we came up with a plan for her. She had just recently done blood work with her family vet and her globulins were slightly high, but her kidney values were normal and she was negative for the viral infections, FIV and FELV. I took some cytology and a fine needle aspirate (you can learn more about cytology and what this test is doing in episode 46) and I found a lot of cells commonly seen with inflammation, including those plasma cells, as well as secondary infection. Her body’s normal bacteria had been given the opportunity to pass through a normally protective barrier on the surface of the paw pad because that paw pad was so damaged.

[00:08:11] I did not do a biopsy with Hermione, but biopsy can definitely be helpful to make sure that you have the right diagnosis, especially if a pet is not responding to empiric treatments or treatments that are most commonly effective in this particular disease. Our treatment for Hermione included doxycycline, an antibiotic, to both treat the secondary infection that she had developed on the wounds and use its anti inflammatory action to help bring down the paw swelling. I also recommended some antimicrobial wipes to help keep her paws clean, and some pain medication to help her feel better.

Can Food Allergies Cause Plasma Cell Pododermatitis?

[00:08:49] The owner and I also discussed an elimination diet trial, to investigate if food allergies were playing a role in her disease. And like many cat owners, Hermione’s owners left the first visit with a plan. Unfortunately, like many cat owners, Hermione’s owners struggled with being able to give her oral medications. It was as if she had used all of her magic power to avoid getting the medicine into her mouth. However, Hermione responded incredibly well to a prescription hydrolyzed protein diet, and after a very long time struggling with this disease, her paws were almost completely normal, once we found a food that she wasn’t allergic to and got rid of all of the other foods that could potentially be triggering reactions. The spell had been lifted.

Episodes 2 and 17 of the podcast go through food allergies, as well as elimination diet trials and how to successfully determine if your pet has a food allergy, while working with a veterinarian using a prescription food. 

The Values of Recheck Exams and Specialists

Recheck exams are really important to make sure that your animal is progressing in the right direction and that your veterinarian does not need to adjust the plan. Oftentimes, once they’re doing better, we can taper back on some of the medications that we’re using for treatment of plasma cell pododermatitis.

[00:10:13] Plasma cell pododermatitis is an uncommon disease. Your family veterinarian may be comfortable managing this condition, but if you’d like to find a specialist in your area, you can find one through the American College of Veterinary Dermatologists. If there’s not a veterinary dermatologist in your area, your family veterinarian may be able to consult with specialists through VetHive.

'Scratching the Itch': Highlighting the Calm and Cozy Cat Wrap

calm and cozy cat wrap logo
This section contains affiliate links.

[00:10:44] I like to end each episode with a segment that I call ‘Scratching the Itch.’ This segment is designed to highlight something; an organization, a product, a website, or human interest story that’s designed to provide relief or just make you feel good. Hence, scratching the itch. In honor of how challenging Hermione was for taking her medications from her owner, the ‘scratching the itch’ that I’d like to highlight is the Calm and Cozy Cat Wrap. For anyone who has ever struggled to give medications to their cat, or for those listening who might be veterinary professionals (we’ve got a lot of technicians and vets in the audience), if you’d like to make your exams and treatments less stressful, the Calm and Cozy Cat Wrap provides a comfortable, safe way to perform cat care. This veterinarian designed tool has multiple Velcro flaps, zippers, and wings to easily trim toenails, give subcutaneous fluids, take rectal temperatures, and most importantly, give oral medications. Not only does this tool help to decrease the cat’s anxiety level and improve confidence when handling cats, this is a wholly woman-owned company, whose product is made in the USA with minimal packaging, using recycled and sustainable materials.

As a special bonus for listeners of Your Vet Wants You to Know, you can receive a discount on your purchase of a calm and cozy cat wrap using the code ‘YourVet.’ Thank you all for listening. I look forward to your next visit with Your Vet Wants You To Know.

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