Dorsal alopecia in a male crossbred dog

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

CLOSECLOSE History | Signs | Approach | Tests | Treatment | NotesHistory | Signs | Approach | Tests | Treatment | Notes

• Dorsal alopecia in a male crossbred dog

• Weight 25 kg

• Dorsal alopecia and mild pruritus of 9 months duration

• Mild papular rash on dorsum and ventrum. Comedones on dorsum and ventrum. Ventral coat thin but skin “normal”

History and presentingclinical signs - 1

HistoryHistory

• Dorsal alopecia in a male crossbred dog

• Weight 25 kg

• Dorsal alopecia and mild pruritus of 9 months duration

• Mild papular rash on dorsum and ventrum. Comedones on dorsum and ventrum. Ventral coat thin but skin “normal”

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• 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 and presentingclinical signs - 2

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


Initial therapy - 1

• Ectoparasite control• Dog and both cats sprayed fortnightly with

dichlorvos + fenitrothion• Home environment treated every 2 to 3 months

with permethrin + methoprene spray• No improvement

• Ectoparasite control• Dog and both cats sprayed fortnightly with

dichlorvos + fenitrothion• Home environment treated every 2 to 3 months

with permethrin + methoprene spray• No improvement

HistoryHistory


Initial therapy - 2

• 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

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


The ventral abdominal skin

Clinical findings on referral - 1

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

SignsSigns

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


Alopecia & hyperpigmentation in dorsal lumbar region

Clinical findings on referral - 2

• No visual evidence of ectoparasitism

• Pendulous abdomen & ventral liver lobes palpably enlarged

• Testes normal on palpation

SignsSigns

• No visual evidence of ectoparasitism

• Pendulous abdomen & ventral liver lobes palpably enlarged

• Testes normal on palpation


How would you approach this case?

• 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


• Make a list of your principle differential diagnoses

• List any samples you would collect


ApproachApproach


Caseinvestigation

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

including iatrogenic Cushings syndrome, ectoparasitic infestation, dermatophytosis

• Secondary pyoderma, Malassezia dermatitis

• Samples• Coat brushings, deep and superficial skin scrapings,

tape strippings, and hair plucks - search for flea dirt, ectoparasites, dermatophytes, yeasts

• Biochemistry and haematology panels, urinalysis

ApproachApproach

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

including iatrogenic Cushings syndrome, ectoparasitic infestation, dermatophytosis

• Secondary pyoderma, Malassezia dermatitis

• Samples• Coat brushings, deep and superficial skin scrapings,

tape strippings, and hair plucks - search for flea dirt, ectoparasites, dermatophytes, yeasts

• Biochemistry and haematology panels, urinalysis


Preliminary results

• 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

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?


• What are now your principle differential diagnoses?

• Are there any other samples you would collect?


TestsTests


• What are now your principle differential diagnoses?

• Are there any other samples you would collect?



Further tests

• 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

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

ACTH response test

0

100

200

300

400

500

Basal 60 min.

Time

Cortisolnmol/l

What is the significance of this test?

TestsTests

What is the significance of this test?


Results - 2

Low dose dexamethasone suppression test

0

50

100

150

200

250

Basal 3 hours 8 hours

Time

Cortisolnmol/l

TestsTests


Results - 3

High dose dexamethasone suppression test

0

50100

150

200250

300

Basal 3 hour 8 hour

Time

Cortisolnmol/l

What do these tests tell us?

TestsTests

What do these tests tell us?


Further tests

• Radiography• Mass suspected in the left adrenal region

• Ultrasonography• Hypoechoic foci in the liver suggestive of

metastases

TestsTests

• Radiography• Mass suspected in the left adrenal region

• Ultrasonography• Hypoechoic foci in the liver suggestive of

metastases


What is yourdiagnosis?

• What is your principle diagnosis?

• List any additional problems which you think may need treatment

• Are there any other possibilities which should be considered at this stage?

• What is your principle diagnosis?

• List any additional problems which you think may need treatment

• Are there any other possibilities which should be considered at this stage?

TestsTests


Diagnosis

• Hyperadrenocorticism resulting from adrenal neoplasia

• Likely metastasis

TestsTests

• Hyperadrenocorticism resulting from adrenal neoplasia

• Likely metastasis


How would you deal with this case?

• What is your prognosis?

• How will you advise the owner?

• What treatment would you consider?

TreatmentTreatment

• What is your prognosis?

• How will you advise the owner?

• What treatment would you consider?


Prognosis

• Prognosis is guarded• Surgery is not indicated in view of likely metastasis• Medical management with Lysodren

recommended but results not predictable

TreatmentTreatment

• Prognosis is guarded• Surgery is not indicated in view of likely metastasis• Medical management with Lysodren

recommended but results not predictable


Conclusion

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 sde

TreatmentTreatment

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


Review

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NotesNotes

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Health & Medicine

Dorsal alopecia in a male crossbred dog