Dorsal alopecia in a male crossbred dog Author: Ewan FergusonEditor: David Lloyd © European Society of Veterinary Dermatology

Dorsal alopecia in a male crossbred dog

Author: Ewan FergusonAuthor: Ewan Ferguson Editor: David LloydEditor: David Lloyd

© European Society of Veterinary Dermatology © European Society of Veterinary Dermatology

History | Signs | Differentials | Tests | Therapy | NotesHistory | Signs | Differentials | Tests | Therapy | Notes

Click to reveal the text on this screen

Click the forward arrow to jump to the next screen

History - 1

HistoryHistory

• Dorsal alopecia and mild pruritus of 9 months duration in a male crossbred dog

• Weight 25 kg


History - 2

HistoryHistory

• Mild papular rash on dorsum and ventrum.

• Comedones on dorsum and ventrum.

• Ventral coat thin but skin “normal”


History - 3

HistoryHistory

• Coat has become longer and finer in texture in recent months

• Polyuria and polydipsia (3 litres per day) reported

• Good appetite. Poor exercise tolerance

• No previous history of dermatological disease

• 2 cats in the house, both healthy

• Diagnosed by the referring veterinarian as flea allergy dermatitis


History - 4

HistoryHistory

• Ectoparasite control• Dog and both cats treated with fipronil (Frontline Spot-

On, Merial) monthly• Home environment treated annually with pyroxyfen

and permethrin spray (Indorex, Virbac)• No improvement


History - 5

HistoryHistory

• Pruritus now reported to be controlled with 10 mg prednisolone orally once daily, over the last 4 months

• No hair re-growth seen

• All therapy stopped 2 weeks before referral appointment


Clinical signs - 1

SignsSigns

The ventral abdominal skin

A few scattered papules, epidermal collarettes & crusts on dorsum & ventrum


Clinical signs - 2

SignsSigns

Alopecia & hyperpigmentation in dorsal lumbar region

• No visual evidence of ectoparasitism

• Pendulous abdomen & ventral liver lobes palpably enlarged

• Testes normal on palpation


How would youapproach this case?

SignsSigns

• What are the next steps you would take?

• Make a list of your principle differential diagnoses

• List any samples you would collect

• List any tests you would perform to assist in making a definitive diagnosis


Differential diagnoses

DifferentialsDifferentials

• Principle differential diagnoses• Allergy (fleas, atopy, ?food), Hormonal imbalance

including iatrogenic Cushings syndrome, ectoparasitic infestation, dermatophytosis

• Secondary pyoderma, Malassezia dermatitis


Tests - 1

TestsTests

• Skin scrapings, tape strips, hair plucks and coat brushings - no evidence of ectoparasites or fungi

• Fasted blood sample• Biochemistry: Alkaline phosphatase - 1850 iu/l;

Alanine aminotransferase - 170 iu/l; Glucose - 8.4 mmol/l; Cholesterol - 9.1 mmol/l

• Haematology: Mild mature neutrophilia & eosinopenia

• Urianalysis: Specific gravity - 1.005; No glycosuria


What now?

TestsTests

• What are the next steps you would take?

• What are now your principle differential diagnoses?

• Are there any other samples you would collect?

• List any tests you would perform to assist in making a definitive diagnosis


Tests - 2

TestsTests

• Principal differential diagnosis• Hormonal imbalance particularly natural and

iatrogenic Cushings syndrome• Secondary folliculitis

• Tests• ACTH response test to provide evidence of

possible Cushings syndrome and to identify iatrogenic disease


Results - 1

TestsTests

ACTH response test

0

100

200

300

400

500

Basal 60 min.

Time

Cortisolnmol/l

What is the significance of this test?


Results - 2

TestsTests

Low dose dexamethasone suppression test

0

50

100

150

200

250

Basal 3 hours 8 hours

Time

Cortisolnmol/l


Results - 3

TestsTests

High dose dexamethasone suppression test

0

50100

150

200250

300

Basal 3 hour 8 hour

Time

Cortisolnmol/l

What do these tests tell us?


What is yourdiagnosis?

TestsTests

• Do the investigations permit a definitive diagnosis?

• List any additional investigations which you think may need to be done


Tests - 3

TestsTests

• Radiography• Mass suspected in the left adrenal region

• Ultrasonography• Hypoechoic foci in the liver suggestive of

metastases


How would you deal with this case?

TherapyTherapy

• What is your prognosis?

• How will you advise the owner?

• What treatment would you consider?


Diagnosis

TherapyTherapy

• Hyperadrenocorticism resulting from adrenal neoplasia

• Likely metastasis


Prognosis

NotesNotes

• Prognosis is guarded• Surgery is not indicated in view of likely metastasis• Medical management with trilstane (Vetoryl,

Arnolds) recommended


Conclusion

NotesNotes

The owner requested euthanasia. At post mortem examination an adrenal neoplasm and multifocal metastases were demonstrated.

The adrenal tumour can be seen in the centre of the photograph, the kidney is on the left side


Review

NotesNotes

• If you would like to review this case, please use the navigation buttons below

Documents

Dorsal alopecia in a male crossbred dog Author: Ewan FergusonEditor: David Lloyd © European Society of Veterinary Dermatology