# Cutaneous Reactive Histiocytosis



## CAROLINA MOM (May 12, 2009)

Welcome to the forum, glad you've joined us. 

I'm sorry to hear about Polly's diagnosis. I'm not familiar with this nor have I had any experience so I can't provide you with any information. 

Hope your girl gets the help she needs and will be doing better soon.


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## boomers_dawn (Sep 20, 2009)

What timing, I just had mine to the vet yesterday for a weird lump that freaked me out. Based on her age and appearance, they deemed it a common idiopathic Histiocytosis that resolves itself spontaneously in a few weeks. They offered to biopsy or keep and eye on it and have a recheck. Based on 3 of the same impressions, I decided to go with the recheck.

I'm sorry, I don't have any info on the "cutaneous reactive" sort. I looked online and it seems in human and dogs these disorders are poorly understood and the science is changing as more is discovered. I did find this link that I thought was well written for the "lay person" to understand, but it is still confusing at best. This description is understandable:
"It is a non-cancerous proliferation of mixed reactive cells." 

But it later goes on to use the "c" word ?? My interpretation of the article is that the "-osis" is a disorder and developing into a "sarcoma" is the cancer. I looked up sarcoma, and it is consistent with my interpretation - the "osis" condition is the abnormal proliferation of normal cells and the sarcoma is if the proliferation of normal cells turns over to be cancerous. I hope this makes sense.

Maybe treatment is important, to treat the abnormal proliferation of cells before they can turn over into a sarcoma? this is what my vivid imagination tells me but this is just conjecture on my part, I only have some knowledge of medical terminology and the article and internet to go by, no real knowledge of the disease, so take me with a grain of salt 

Skin - Reactive Histiocytosis | VCA Animal Hospitals 

Best wishes, please let us know what the specialist says.


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## swishywagga (Nov 13, 2012)

Welcome to the forum from another UK member. Unfortunately I too have no experience with this condition, but feel sure others will be able to offer some advice. Polly sounds like such a wonderful golden girl, well done you for adopting her from Battersea, I always follow For The Love Of Dogs with Paul O'Grady!. Hoping things improve and that you have many more happy years together.


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## Karen519 (Aug 21, 2006)

*Aao*



aao said:


> Hi All, I am a first time poster on this forum but wondered whether anybody can help?
> 
> A couple of days ago our beautiful golden daughter Polly was diagnosed with something called Cutaneous Reactive Histiocytosis (although it might still be the slightly more serious form Systemic Reactive Histiocytosis we are waiting for some scans in order to confirm), she has had biopsies on all the lumps they could find and its not thankfully the malignant/cancerous version which seems to have taken so many lives, and it seems from what I can see from the net treatable/manageable with a variety of steroids and immuno suppresents, but there is very little actual information out there about these Illnesses and how best to manage them.
> 
> ...


I am sorry I don't know about cutaneous reactive histiocytosis, but I'm sure someone on here does. Please keep us posted about what the specialist says. I already love her because she had a rough start in life!

I googled and found this University of Pennsylvania study: Most dogs survived the disease...
http://www.researchgate.net/publica...n_dogs_a_retrospective_evaluation_of_32_cases


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## aao (Jan 7, 2015)

Hi All 

Many thanks for the messages they are much appreciated , it seems to be a really odd and rare (although increasingly less so  ) illness on which there is very little real information out there (believe me I have spent hours looking!)

We'll hopefully know more after Wednesdays visit to the specialist and then can go from there, but it does thankfully look like the conditions is treatable/manageable depending on the type she has.

Just in case it happens to one of your goldies the symptoms we saw were very similar to a whole host of other problems and many vets probably wouldn't recognise them for what they are.

At the start of December she had a small (about 1cm) sub cutaneous (under skin) lump on top of her head, you couldn't see it but it felt soft to the touch and seemed attached to the skin. Our vet wasn't very worried about it and gave us a cream to see whether it went away, there was no change but about a week of so later we found another lump on her head and the a few days later we started finding small lumps on various parts of her body (legs, flanks, under arm etc). Some of the lumps felt just under the skin, some felt much deeper. Our vet still wasn't too worried until the lumps spread and she found that Polly's Lymph nodes were larger than normal, at that point we insisted on getting them biopsied.

When she shaved the top of Pollys head she found about larger 4 lumps (1-2cm each) one of which was red and inflamed and about 8 more smaller lumps, about 4 more on her neck, 1 under her ear, 1 under her front shoulder and one on her rear thigh (they look a fair bit like this http://cal.vet.upenn.edu/projects/derm/Home/HISTIOCYT/image/system/syst-2.jpg). The vet decided to remove all of the ones she could fine and send them of to be biopsied (poor Polly looked a bit like Franken Dog after the op!) 
Due to a problem at the clinic it took 3 weeks to get the results! by which time we were beside ourselves with worry, I'd probably read up on every possible illness/cancer that could affect Polly (google is a terrible thing when you are worried and have time on your hands!) and even our vet thought it might be Mast Cell Tumours or Cutaneous Lymphoma. 

Thankfully all of the removed lumps came back as being Cutaneous Histiocytosis, her lymph nodes also came back cancer free but enlarged due to the presence of some form of allergic type reaction, but because the visible lumps are the same for both the Cutaneous form and the Systemic (skin + internal organs) form, she needs a further scan to determine the type. 

I only post this as if your Golden comes back with similar symptoms the good news is that it might not be cancer but If you do end up with multiple small lumps don't lose time before getting them biopsied.


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## boomers_dawn (Sep 20, 2009)

Thanks for the description. I will definitely keep an eye on my little angel and heed your warning. I'll also keep an eye out for your post and send prayers and best wishes for Polly.


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## aao (Jan 7, 2015)

Ok having seen the specialists (and handed over another £1k for xrays, aspirates of the internal organs and the worlds worst haircut!) the good news is that Polly only has the cutaneous version of the disease 

This is as far as it goes very very good news (compared to the alternatives) and means that there is every chance that she can be treated and possibly cured by just using steroids like Predisone.
The slightly worse news is that apparently she has to be on the steroids for the next 6 months! with the first month being on a very high dose (50mg) everyday 

Has anybody had experience of having their goldies on similar doses of Predisone? I have to admit I am a little concerned by the potential side effects especially as she isn't the strongest doggy to begin with....


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## Karen519 (Aug 21, 2006)

*Polly*



aao said:


> Ok having seen the specialists (and handed over another £1k for xrays, aspirates of the internal organs and the worlds worst haircut!) the good news is that Polly only has the cutaneous version of the disease
> 
> This is as far as it goes very very good news (compared to the alternatives) and means that there is every chance that she can be treated and possibly cured by just using steroids like Predisone.
> The slightly worse news is that apparently she has to be on the steroids for the next 6 months! with the first month being on a very high dose (50mg) everyday
> ...


Happy to hear the good news that Polly got. There are lots of people on here whose dogs have been on prednisone, so I will let them chime in. I will pray for Polly and you.


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## boomers_dawn (Sep 20, 2009)

Glad it's only cutaneous and treatable, great news.

My Boomer was on prednisone all his life for hot spots. He was never on 50mg every day for a month though. But nothing really bad ever happened from him being on it long term. He would just drink a lot and pee a lot on it, that's a normal side effect.

Hopefully someone else will chime in about the high doses.


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## ccobena (Nov 4, 2017)

Hi aao,

I would like to know how was with Polly's treatment and what it was ?.
I have a golden Retriever named "Floppy" and is facing exactly same situation you have described. 

It would really help us if you could share your experience after this years.

Many thanks in advance.


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## Ivyacres (Jun 3, 2011)

Thanks for sharing all the info.
Glad Polly's doing better.


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## aao (Jan 7, 2015)

Hi There
Of course I am happy to share our experiences since Polly's first diagnosis. First things first she is doing fine  mostly as happy, hungry and loving as ever, she's now 7 and thankfully none the worse for the RCH (shortened as it is a bit long to type!)

She has had 2 bouts of it, the first was back in 2015 where she had an approximately 6-8 month high dose course of steroids to treat the condition, the first 2 months were on a high dose of 50mg per day with the amount gradually being reduced as the symptoms receded. We saw a very noticeable reduction in the symptoms over the first month and they were completely cleared up at the end of the treatment period at which point the specialist was comfortable taking her off the steroids.
Unfortunately 2-3 months later the RCH had returned again with lumps all over her body, she had to go back onto the high dose steroid treatment program, with a longer 12 month treatment period and a longer period on the high dosage. Again the symptoms were treated by the high dosage, however this time at the end of the defined treatment period we agreed in conjunction with the specialist to continue her on a very low dose of steroids (5mg every 3 days) for the foreseeable future to try and minimise the risk of the condition returning. Touch wood in the time since there hasn't been a re-appearance.

The things we have learned however are that:

1) Don't panic, the condition is relatively benign even though the symptoms probably scared you to death (multiple lumps on Goldens are rarely a good thing  ). There is a risk apparently of it morphing into the less benign version which attacks the internal organs but that is a small risk and the treatment remains the same either way.

2) The high dose of steroids were not the easiest on Polly, she was fairly stiff, more lethargic, considerably more hungry (I know hard to believe) and drank a lot. She also oddly stopped shedding which I suppose is a benefit! All of that said she made it through the treatments fine, her happy loving nature remained the same, she still went on her daily walks and was generally fine. The biggest downside was that she couldn't use anti-inflammatory pain killers like metacam anymore as they don't work with steroids. There are however alternatives like Tramadol if Floppy is on any kind of joint relief treatments.

3) Just because the external symptoms have cleared up does not mean the underlying issue has been resolved, its so tempting to think that once the lumps have disappeared that the RCH has gone and that the treatment can be wound down early. It shouldn't be, in fact our experience at least would suggest that keeping Floppy on a very low dose of steroids going forward after the treatment period is over might well be worth it if there are no other negative side effects. Having the illness re-occur is not enjoyable and the 2nd set of treatments were harder on Polly, also according to the specialist if the illness does re-occur there is always a risk that it becomes resistant to steroids and a more robust (and considerably more expensive) series of treatments are needed. Sadly RCH is a condition which can re-occur at any time, but equally may never come back.

4) Finally a Golden on steroids is a bit of an eating machine (more so then ever) trying to manage their weight becomes even more a challenge!!

Generally though the news is good, its a treatable mostly benign condition which Floppy should recover fine from 

Any questions please don't hesitate to ask.

Alp


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## ccobena (Nov 4, 2017)

Hi Alp,

I really thanks for your comments, definitely give me a lot of encouragement and hope that things will be fine in the future.

As we know this disease is very rare (even more so in my country). Floppy and I were visiting various veterinarians before finding out exactly the root cause of his problem. As this case is very uncommon locally, there are no references on hand of similar cases, and therefore there is not statistic references regarding which specific steroids have worked better in similar cases either.

For now tentatively the first optio is to try using cyclosporine and of course regardless of the steroid used is planned to keep monitoring Floppy's health in order to guarantee there won't be side effects.

Other alternatives we have talked about :
- tetracycline and niacinamide
- prednisone and azathioprine

So Floppy's veterinarian is actually gathering additional information (taking few more days) before starting the treatment (exchanging information with colleagues from other countries). From my part I am trying to get as much information as possible.

It would be very helpful for me if you could comment me , which specific medication is actually used by Polly (principal components). I mean, it's always better to have a success story like yours as reference to start. 

Many thanks in advance.

Christian


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## aao (Jan 7, 2015)

Hi Chrisitian 

Firstly yes if Polly is anything to go by Floppy should do just fine with the proper treatment. RCT is as you've highlighted a rather rare and slightly odd illness so there isn't too much information about it online. Our local vet had no idea about it when we had taken Polly to see her 2 or 3 times about the lumps, and then panicked when she thought it was cancer and tried to remove them all without informing us first (she said she was going to do a punch biopsy on one) and without any benefit or real success. Our poor girl looked like a patchwork quilt! (needless to say we no longer see that vet!). We did however get referred to an excellent specialist vet at NDSR (ndsr.co.uk) in Surrey (UK) called Francesca Fabrizio. She is an oncologist and diagnosed Polly immediately and was very confident in the treatment that was needed for her (she might well be worth contacting directly through NDSR)

The treatment schedule she received as far as we can remember (the treatment periods might be slightly out)

Polly was given an initial 4 week treatment of Prednisolone at 50mg day. 
After that period the lumps had disappeared and the amount of the Prednisolone was reduced, we can't quite remember to how much but I think it was about 30mg for 2 months.
After 2 months the amount was again reduced to about 10-15mg for 2 more months. And then finally dropped to 5mg every 3 days for 2 months.

At the end of the period she seemed cured, but unfortunately the illness repeated after 2-3 months. She went on the same treatment schedule again but this time the initial high dose (50mg) period was increased to 6 weeks, as were the corresponding step down period, at the end of the 7 month treatment period we collectively decided to keep her on 5mg Prednisolone every 3 days and it hasn't repeated in the year or so since then.

She wasn't on any other medication for the illness during that period, and the Prednisolone did work. The specialist did however point out that while in her experience Pred is the first point of call for treatment in terms of both success and cost, there are some cases in which the treatment doesn't work and alternative medications need to be tried. RCT as you can see from our example can re-occur even after treatment, and from our understanding can either be dealt with on a case by case basis or by treating it once and then trying to mitigate the risk of it occurring again by keeping your dog on a life long course of low dose steroids. Each time it re-occurs however the risk that Pred won't work goes up and other treatments may be needed, also having to put your dog through 2 or more consecutive treatments of high dosage steroids does have its own risks and downsides. Ultimately its for you guys and your vet to decide on the best course of action once the initial outbreak has been dealt with.

Polly was 5 when she had her set of treatments and 6 when she had her 2nd. She was around 30kg and generally healthy apart from really bad hips for which she was taking metacam.

She showed very few side effects to the Pred, but there is a mountain of information on the forum and online about how people Goldens have handled Pred.

Overall its very treatable and hopefully Floppy should recover just fine from it, just be prepared for a few months of super hungry goldenness!. Also one thing to look for is that the lumps can appear and disappear very randomly and occur all round the body, our experience of them was that most of them were just under the skin, farily hard and immovable lumps which occurred on the limbs, on the neck, head, and around the body. Some of them even felt deeper in the skin then that. Hopefully by the end of the first month they should have all cleared up, but its worth constantly checking just to make sure that new lumps haven't snuck in. Also bear in mind that if you find a lump that doesn't seem to react much or at all to the treatment it might be something different, Polly acquired a couple of small lumps during that period which resolutely didn't go away, both turned out to be benign cysts, but both again scared the hell out of us when we found them!.


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## ccobena (Nov 4, 2017)

Wow, many thanks for your detailed information.

It will really help us a lot. I will keep in touch sharing my experience with Floppy's treatment and of course adding relevant information that potencially could help in future.

Thanks again Alp.

Christian


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## aao (Jan 7, 2015)

Hi Christian 

Just curious to know how's Floppy doing? And what treatment did you guys go for?

All the best

Alp


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## ccobena (Nov 4, 2017)

Hi Alp,

I tell you Floppy is getting better. We actually decided to go for similar treatment you followed based on prednisolone, starting with 45 mg per day. Now after 20 days seems the treatment is working fine, the lumps have disappeared by 90% until now. 
Only the larger and more aggressive lumps are taking a little longer time in healing, however they almost disappear as well.

Seems no side effects are present right now, indeed his mood is very good. We have started running together again in the mornings and he is very happy . He is eating and drinking a lot (as you said before like an eating machine  ). 

Anyway, next week we have scheduled the appointment for regular monitoring with our vet to confirm this, and decide if we should start reducing the dosage.

All the best,

Christian


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## aao (Jan 7, 2015)

So glad to hear that Floppy is doing better and dealing well with the Pred treatment  

My only advice is don't rush dropping the dosage of the Pred, while the external symptoms do disappear quickly, my experience (and advice from the vet) is that it takes longer for the illness to actually properly go into remission. Polly was on the high dosage for about 6-8 weeks to help ensure that it wouldn't come back and to date it seems to have worked. If like us (the first time) you drop it too soon then there is always the risk the illness could re-occur.


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## ccobena (Nov 4, 2017)

Hi Alp,

Many thanks for your advices. That really help us a lot . 
For real, we will take your advices very serious.

I will be telling you how are the things progressing. 

Christian


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