Alopecia of the flank in a Glen of Imaal Terrier

Alopecia of the flankin a female Glen ofImaal Terrier

Author: Cathy Curtis

Editor: David Lloyd

$C:\Sonya's RVC Work\Derm cases\images\9_Glen of Imaal Terrier_June94\IMG0044_120x80_border.jpg$

$F:\-- Derm cases ESVD\images\new interface\titlebackground2.jpg$

$F:\-- Derm cases ESVD\images\new interface\buttonbackground3.jpg$

Click to reveal the text on this screen

Click the forward arrow to jump to the next screen

History

$F:\-- Derm cases ESVD\images\section images\edited on dk blue\history.jpg$

•3 year old neutered female Glen of Imal Terrier

•Presented with flank alopecia of 3 months duration

•There were no signs of pruritus

•The dog was in good general health

History

$F:\-- Derm cases ESVD\images\new interface\titlebackground2.jpg$

$F:\-- Derm cases ESVD\images\new interface\buttonbackground3.jpg$

General clinicalexamination wasunremarkable

Clinical signs

$F:\-- Derm cases ESVD\images\section images\edited on dk blue\vetExamDogNarrow.jpg$

Signs

$C:\Sonya's RVC Work\Derm cases\images\9_Glen of Imaal Terrier_June94\IMG0044_350W.jpg$

• The flanks showed

•Bilateral, well-demarcated areas of alopecia

•Intense hyperpigmentation of the underlying skin

$F:\-- Derm cases ESVD\images\new interface\titlebackground2.jpg$

$F:\-- Derm cases ESVD\images\new interface\buttonbackground3.jpg$

How would youapproach this case?

Signs

$F:\-- Derm cases ESVD\images\section images\edited on dk blue\vetExamDogNarrow.jpg$

•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 adefinitive diagnosis

$F:\-- Derm cases ESVD\images\new interface\titlebackground2.jpg$

$F:\-- Derm cases ESVD\images\new interface\buttonbackground3.jpg$

Case investigation - 1

$F:\-- Derm cases ESVD\images\section images\edited on dk blue\culture.jpg$

Differentials

•Principle differential diagnoses

•Inflammatory causes of alopecia

•Bacterial - Staphylococcal folliculitis

•Fungal – Dermatophytosis

•Parasitic - Demodex canis

•Non- inflammatory causes of alopecia

•Hormonal

•Dystrophic or dysplastic

•Telogen or anagen effluvium

•Cicatricial

$F:\-- Derm cases ESVD\images\new interface\titlebackground2.jpg$

$F:\-- Derm cases ESVD\images\new interface\buttonbackground3.jpg$

Case investigation - 2

$F:\-- Derm cases ESVD\images\section images\edited on dk blue\culture.jpg$

Tests

•Initial tests

•Skin scrapings, hair plucks and fungal culture

•Haematology and biochemistry profiles

•Urinalysis

$F:\-- Derm cases ESVD\images\new interface\titlebackground2.jpg$

$F:\-- Derm cases ESVD\images\new interface\buttonbackground3.jpg$

Results

•Skin scrapings and fungal culture

•No ectoparasites or dermatophytes demonstrated

•Hair pluckings from the edges of the alopecic areasshowed all hairs to be in telogen

•Haematology and biochemistry profiles

•Routine haematology and biochemistry profiles wereunremarkable

•Urinalysis

•Unremarkable

Tests

$F:\-- Derm cases ESVD\images\section images\edited on dk blue\culture.jpg$

$F:\-- Derm cases ESVD\images\new interface\titlebackground2.jpg$

$F:\-- Derm cases ESVD\images\new interface\buttonbackground3.jpg$

What now?

Tests

$F:\-- Derm cases ESVD\images\section images\edited on dk blue\culture.jpg$

•Which differentials can you now eliminate?

•Are there any other tests you would carry out orsamples you would collect?

•Should you institute therapy at this stage?

$F:\-- Derm cases ESVD\images\new interface\titlebackground2.jpg$

$F:\-- Derm cases ESVD\images\new interface\buttonbackground3.jpg$

Additional procedures

Tests

$F:\-- Derm cases ESVD\images\section images\edited on dk blue\culture.jpg$

•Skin scapings and fungal culture results suggest thatdermatophytosis and demodicosis are unlikely

•Endocrine tests and biopsy examination are nowrequired

•No therapy is indicated at this stage

$F:\-- Derm cases ESVD\images\new interface\titlebackground2.jpg$

$F:\-- Derm cases ESVD\images\new interface\buttonbackground3.jpg$

Additional diagnosticprocedures - 1

Tests

$F:\-- Derm cases ESVD\images\section images\edited on dk blue\culture.jpg$

•Blood tests to investigate possible endocrinopathy

•Total T4 and endogenous TSH levels to assessthyroid function

•ACTH stimulation or low dose dexamethasonesuppression test for adrenocortical function

•ACTH stimulation test for adrenocortical reproductivehormone function (basal reproductive hormoneassays if the above is unavailable)

•Xylazine or clonidine stimulation test for growthhormone status (if available)

•Skin biopsy

$F:\-- Derm cases ESVD\images\new interface\titlebackground2.jpg$

$F:\-- Derm cases ESVD\images\new interface\buttonbackground3.jpg$

Results of additional tests

Tests

$F:\-- Derm cases ESVD\images\section images\edited on dk blue\culture.jpg$

•Thyroid testing

•Endogenous TSH – within normal range

•Total T4 – within normal range

$F:\-- Derm cases ESVD\images\new interface\titlebackground2.jpg$

$F:\-- Derm cases ESVD\images\new interface\buttonbackground3.jpg$

Results of ACTH stimulationtest

Tests

$F:\-- Derm cases ESVD\images\section images\edited on dk blue\culture.jpg$

$F:\-- Derm cases ESVD\images\new interface\titlebackground2.jpg$

$F:\-- Derm cases ESVD\images\new interface\buttonbackground3.jpg$

Additional diagnosticprocedures - 2

Tests

$F:\-- Derm cases ESVD\images\section images\edited on dk blue\culture.jpg$

•Histopathology report (Joan Rest)

•There is hyperpigmentation of the non-thickenedepidermis with markedly dilated follicular ostea filledwith keratin

•Most follicles seen are in telogen

•Sebaceous glands are not atrophic

•A few melanophages are present adjacent to thebases of the follicles

•No current inflammation or micro-organisms wereobserved

$F:\-- Derm cases ESVD\images\new interface\titlebackground2.jpg$

$F:\-- Derm cases ESVD\images\new interface\buttonbackground3.jpg$

Additional diagnosticprocedures - 3

Tests

$F:\-- Derm cases ESVD\images\section images\edited on dk blue\culture.jpg$

•Morphological diagnosis

•Atrophic dermatosis

$F:\-- Derm cases ESVD\images\new interface\titlebackground2.jpg$

$F:\-- Derm cases ESVD\images\new interface\buttonbackground3.jpg$

What is yourdiagnosis?

•Do the investigations permit a definitive diagnosis?

•Are there any additional investigations which you thinkmay need to be done?

Tests

$F:\-- Derm cases ESVD\images\section images\edited on dk blue\culture.jpg$

$F:\-- Derm cases ESVD\images\new interface\titlebackground2.jpg$

$F:\-- Derm cases ESVD\images\new interface\buttonbackground3.jpg$

Diagnosis

•Canine idiopathic flank alopecia

Tests

$F:\-- Derm cases ESVD\images\section images\edited on dk blue\culture.jpg$

$F:\-- Derm cases ESVD\images\new interface\titlebackground2.jpg$

$F:\-- Derm cases ESVD\images\new interface\buttonbackground3.jpg$

How would you dealwith this case?

$F:\-- Derm cases ESVD\images\section images\edited on dk blue\pred.jpg$

•What is your prognosis?

•How will you advise the owner?

•What treatment would you consider?

Therapy

$F:\-- Derm cases ESVD\images\new interface\titlebackground2.jpg$

$F:\-- Derm cases ESVD\images\new interface\buttonbackground3.jpg$

Prognosis

$F:\-- Derm cases ESVD\images\section images\edited on dk blue\pred.jpg$

•In many dogs with idiopathic flank alopecia, hairloss is temporary and regrowth may occurspontaneously

•In some cases, there is a cyclical pattern to thedisease and it may be possible to predict the time ofhair loss and hair regrowth

•Affected dogs remain healthy so the prognosis isgood

Therapy

$F:\-- Derm cases ESVD\images\new interface\titlebackground2.jpg$

$F:\-- Derm cases ESVD\images\new interface\buttonbackground3.jpg$

Action

$F:\-- Derm cases ESVD\images\section images\edited on dk blue\pred.jpg$

Therapy

•Client education and conservative treatment

$F:\-- Derm cases ESVD\images\new interface\titlebackground2.jpg$

$F:\-- Derm cases ESVD\images\new interface\buttonbackground3.jpg$

Comment

$F:\-- Derm cases ESVD\images\section images\edited on dk blue\pred.jpg$

•The dog was followed for the next 18 months

•She regrew her hair 2 months after the referralappointment but again developed flank alopecia atthe same time the following year

•Predictably, the hair regrew 5 months later

•No treatment has been administered and the dogremains in good general health

Therapy

$F:\-- Derm cases ESVD\images\new interface\titlebackground2.jpg$

$F:\-- Derm cases ESVD\images\new interface\buttonbackground3.jpg$

Final diagnosis

$F:\-- Derm cases ESVD\images\section images\edited on dk blue\pred.jpg$

•Canine idiopathic cyclic flank alopecia

Therapy

$F:\-- Derm cases ESVD\images\new interface\titlebackground2.jpg$

$F:\-- Derm cases ESVD\images\new interface\buttonbackground3.jpg$

Review

$F:\-- Derm cases ESVD\images\section images\edited on dk blue\evaluating.jpg$

Notes

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