Plasma Cell Pododermatitis

(sometimes called "PILLOW FOOT")

Plasma cell pododermatitis is a foot pad disease of cast which is fairly classical in its appearance yet its significance is poorly understood. "Plasma Cell Pododermatitis" literally means foot inflammation involving infiltration by "plasma cells." Plasma cells are activated lymphocytes in full maturity, fulminantly producing antibodies usually in response to an infection or at least in response to some kind of inflammatory process.

The fact that a cell of the activated immune system is involved in plasma cell pododermatitis implies some sort of immune stimulation in the genesis of the disease and, in fact, therapy targeting the immune system generally controls the disease. That said, understanding of plasma cell pododermatitis has not progressed far enough to begin to suggest exactly what sort of stimulation this might be. Some studies have found a link between plasma cell pododermatitis and Feline Immunodeficiency Virus infection so it is very important to screen an affected cat for this virus. Exactly what the link is between these two conditions remains unclear.

Plasma Cell Pododermatitis orig

(original graphic by marvistavet.com)

CONFIRMING THE DIAGNOSIS

An affected foot pad develops a classic "mushy" appearance and balloons out as shown in the picture above. The skin of the pad may develop a purplish tint and may even ulcerate. All four feet may or may not be affected but rarely is only one foot affected. Any age, gender or breed of cat can be affected. Most cats are not painful and require no treatment but often the cat is lame on its most severely affected foot.On blood tests, affected cats usually have elevated numbers of circulating lymphocytes and high circulating antibody (globulin) levels so such findings are supportive of making this diagnosis. Further, other foot pad swellings such as tumors, insect bites, or proliferations from Eosinophilic Granuloma Complex usually only affect a single foot. If the physical appearance of the foot is not obvious, a biopsy of the foot pad should confirm the presence of plasma cell pododermatitis thus leaving no question.

TREATMENT

Modification of the underlying immune reaction is the core of therapy for cats in which therapy is deemed necessary. At this time, the treatment of choice is oral doxycycline. While doxycycline is an antibiotic, it also has immunomodulating properties and we believe it is these properties that are working in the treatment of plasma cell pododermatitis. Approximately 50% of affected cats will show a good response after two months of therapy. When the condition is in adequate remission, the doxycycline is continued for several months further before discontinuing and seeing if the condition recurs.

Alternatively, high doses of an oral steroid such as prednisone may be helpful for cats that did not respond to doxycycline. Cyclosporine, another immunomodulator which is available as a liquid, has also received attention for treating this condition. Should medicating a cat daily prove a bit daunting another therapy choice might involve injections of methylprednisolone acetate (depomedrol), a long acting steroid. Large ulcerated masses on the footpads may require surgical removal. In most cases, the condition is manageable and the cat can be made comfortable.

Page last updated: 8/31/2013